6 tips for covering school vaccination requirements

As kids in the U.S. head back to class this fall, school officials have been checking student shot records to make sure everyone meets school vaccination requirements. The task has taken on a greater sense of urgency as the number of measles cases rises nationwide and many states allow more students to start school unvaccinated or missing doses of vaccines that protect against dangerous, highly contagious diseases.

We created this tip sheet to help journalists cover school vaccination requirements as well as the consequences of tightening or loosening them. It’s a complement to our companion piece on research-based strategies for boosting student vaccination rates.

1. Know the difference between “anti-vax” beliefs and vaccine hesitancy.

News stories often lump people who are nervous about vaccines together with ardent opponents and label them all “anti-vaxxers.” Not only is such coverage misleading, it also can be dangerous, says Sarah Michels, an epidemiologist at the University of Montana’s Center for Population Health Research.

Researchers and public health professionals tend to use the term “vaccine hesitant” to describe this highly heterogeneous group of people who are unsure about the safety, effectiveness or necessity of one or more vaccines. When journalists don’t convey this spectrum of views, their stories make it seem as though opposition to vaccines is more common than it is, Michels says.

Even misconceptions about the prevalence of vaccine hesitancy can influence social norms — what people consider normal and acceptable — and discourage vaccination, researchers from the University of Colorado School of Medicine note in an essay published in The New England Journal of Medicine earlier this year.

A study published in 2022 estimates that 7% of U.S. adults hold “anti-vax” views and that 23% are vaccine hesitant. When a group of researchers surveyed a nationally representative sample of U.S. parents about vaccination, they learned 6.1% were vaccine hesitant when it came to routine childhood immunizations. They were vaccine hesitant largely because of vaccine safety concerns, the researchers write in a 2020 study in Pediatrics.

2. Make clear that the overwhelming majority of U.S. children have received state-required vaccines, including many children in vaccine hesitant families.

U.S. states and the District of Columbia require kids to be immunized against certain diseases before they can attend school. While vaccination policies vary, they generally apply to both public and private schools. Some states require homeschool children also to be vaccinated.

Children nationwide must complete these four immunization series before kindergarten: 
 

• 2 doses of MMR, which protects against measles, mumps and rubella.
• 5 doses of DTaP, which protects against diphtheria, tetanus and acellular pertussis.
• 2 doses of VAR, which provides immunity against varicella, also known as chickenpox.
• 4 doses of Polio, which helps prevent poliomyelitis, commonly referred to as polio.

Michels says school vaccination requirements ensure the vast majority of the U.S. children get immunized. About 93% of the approximately 4 million kids who started kindergarten in 2022-23 had received all doses of these four vaccines, according to a report the U.S. Centers for Disease Control and Prevention released in late 2023.

Another 2.5% of kindergarteners in 28 states were allowed to enroll while catching up on doses their families had accidentally or intentionally skipped.

3. Familiarize yourself with the range of reasons some people delay or refuse to vaccinate their kids.

Although vaccine safety experts agree that the MMR vaccine does not cause autism, fear of autism is the leading reason parents and caregivers give for wanting to skip it, according to a review of 115 academic papers written on the issue from 2000 to 2022.

The MMR vaccine has been widely studied because of its importance — the U.S. continues to have measles outbreaks — and because some parents still have reservations about it. In 2010, The Lancet medical journal retracted a paper that implied a link between the MMR and autism. Since then, numerous studies have confirmed there is no link between receiving vaccines and developing autism.

“This concern appeared repeatedly throughout the literature regardless of the type of study — suggesting how powerful and lasting false information can persist in parents’ minds despite MMR’s established safety and efficacy,” write the authors of the 2023 research review.  

There are lots of other reasons some families have expressed concerns about vaccines. A 2017 study in the academic journal PLOS One identified 72 factors associated with vaccine hesitancy, including people’s past experiences with health care, how much they trust mainstream medicine and how strongly they are influenced by their social networks.

Psychology scholar Dolores Albarracín urges journalists to examine the factors that drive undervaccination, or beginning a required vaccine series but not finishing it. She notes that families — lower-income families in particular — often skip or put off doses simply because it’s tough to get their children to their pediatrician’s office or a vaccination clinic.

Parents and other caregivers might have trouble taking time off work, paying for transportation, juggling the schedules of multiple children or finding a health care professional who offers immunizations for children at convenient hours, says Albarracín, director of the Communication Science Division at the Annenberg Public Policy Center at the University of Pennsylvania.

“If you ran out of cash and you can’t take a bus or there’s no bus and you need to do it this week, a whole year or semester might go by before you find the opportunity,” she adds. “A lot of it is really about access.”

4. Report that school vaccination exemptions tend to reduce vaccination rates.

In all states and the District of Columbia, students who cannot receive vaccines because of a medical condition are exempt from school vaccination requirements, according to the National Conference of State Legislatures. But the number of students who apply for and receive these exemptions is very small — 0.2% of kindergarteners nationwide in 2022-23, CDC data show.

A larger share of students receive exemptions for religious, philosophical or other reasons. In 2022-23, about 3% of kindergarteners obtained exemptions, up slightly from 2.6% the prior year. Exemption rates varied considerably across states, ranging from less than 0.1% in West Virginia to 12.1% in Idaho.

As of August 2024, 30 states and the District of Columbia allow exemptions based on religious objections. Another 13 states allow exemptions for either religious or personal reasons.

Public health officials expect exemption rates to rise in Mississippi, where a federal judge last year ordered the state to grant religious exemptions. Before that, Mississippi was one of a handful of states that only provide medical exemptions.

Journalists need to explain to their audiences that allowing exemptions reduces vaccination rates in local areas, Michels and Albarracín say. They worry declining vaccination rates will put students, their families and their communities at risk. 

So far this year, 219 measles cases and 13 outbreaks were reported in the U.S., up from 59 cases and four outbreaks during all of 2023, according to the CDC.

Academic research shows unvaccinated kids often live in the same areas or attend the same schools, creating population clusters where vaccination rates are not high enough to maintain herd immunity. Studies also show that a new public policy can change social norms around vaccination, Albarracín adds.

A study she coauthored, published in Nature’s Scientific Reports, “provides robust evidence that policies can foster a culture of vaccination by signaling what constituents approve of and do,” she notes in a January 2024 article published by the University of Pennsylvania.

5. Remind audiences that routine childhood vaccines are safe and effective.

Christopher Clarke, director of the Science Communication Graduate Program at George Mason University, recommends journalists remind the public that vaccination is one of the best ways to protect kids against serious infectious diseases.

His research finds that highlighting the scientific consensus on vaccine safety can improve people’s knowledge and attitudes about immunization. In an experiment he and his colleagues conducted, 181 people read versions of a news article about vaccines, some of which contained a statement explaining that scientific studies have found no link between vaccines and autism and that scientists agree no link exists.

Participants who read an article that included such a statement “were less likely to believe that scientific evidence and opinion is unclear on whether vaccines cause autism,” they write in the resulting paper, published in the Journal of Health Communication in 2015. Also, the more certain people were that no links exists after reading the news article, the more positive their attitudes were toward vaccines.

Journalists need to remind their audiences what the research shows, Clarke wrote to The Journalist’s Resource. 

“Childhood vaccines are safe, essential, and effective, and medical doctors and experts have known that for a very long time,” he wrote.

6. Choose vaccination images that are medically accurate.

The American Academy of Pediatrics and SELF Magazine have teamed up to create the  Immunization Image Gallery. The photos, free for anyone to use, portray children’s experiences getting vaccinated more accurately than many photos that appear in news coverage, Casey Gueren, a former executive editor at SELF, writes to explain why the project exists.

“The stock photography commonly used in stories about vaccines are often medically inaccurate in a range of ways, from showing the wrong syringes to showing shots being administered incorrectly,” Gueren writes.

Health and science reporter Tara Haelle created a tip sheet to help news outlets pick photos for vaccine stories. In it, she cautions against images featuring crying babies, worried mothers and oversized needles.

She notes that many — if not most — vaccine stories “may not actually need a photo with a needle in it. A bandage on an arm, a person with a healthcare worker, a vial or similar images are often adequate.” 

“While it’s not a journalist’s job to promote public health per se, we certainly need to avoid undermining it,” explains Haelle, the author of Vaccination Investigation: The History and Science of Vaccines and a health beat leader at the Association of Health Care Journalists.

Some other tip sheets worth checking out:

• 4 tips for covering religious exemptions to vaccine mandates from The Journalist’s Resource.
• Vaccine hesitancy: A roundup of research summaries and survey data sources from the Journalist’s Resource
• Tips for reporting on vaccines, hesitancy and misinformation from the International Center for Journalists.
• 4 tips for covering COVID-19 vaccine boosters from The Journalist’s Resource.
• Tips for professional reporting on COVID-19 vaccinesfrom the World Health Organization.

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