Kindergarten vaccination rates in Hawaii continue to lag behind the national average, according to the latest data from the U.S. Centers for Disease Control and Prevention.
While there was a slight improvement over the year, the rates of routine childhood vaccinations for measles, mumps, whooping cough and chickenpox, among others, remain below the national average and failed to meet most rates required to reach so-called herd immunity.
“Hawaii being below herd immunity for most of our childhood illnesses is a concern,” said State Epidemiologist Dr. Sarah Kemble. “I’m encouraged that the numbers are going up. That’s good; they’re going in the right direction. But we’re not seeing as much gain toward that herd immunity level as we would like to see in order to provide true protection to our population, to our community here in Hawaii.”
Herd immunity, also known as population immunity, is the point at which enough people are immune to a disease that it’s difficult for it to spread from one person to another. This helps protect those who are not immunized, notably for measles and other highly contagious viruses.
For measles, herd immunity is achieved when the vaccination rate is at 95% or greater. Hawaii is below this, with a current measles vaccination rate of 89.9%.
For the 2024-25 school year, Hawaii’s vaccine coverage rate for kindergartners was at 91.5% for DTaP, or diphtheria, tetanus and pertussis; 92.6% for hepatitis B; 92.3% for polio; and 89.5% for varicella, or chickenpox.
The religious exemption rate in Hawaii, meanwhile, increased slightly, from 5.3% for the 2023-2024 school year to 5.4% for the 2024-2025 school year, and from 3.1% to 3.4% nationally.
According to CDC, Hawaii is one of 17 states in the U.S. where exemptions exceed 5.0%.
Hawaii’s declining trends are in line with the rest of the U.S., where routine vaccination rates for kindergartners continue to drop as exemptions continue to increase, according to KFF, a nonpartisan health policy organization.
KFF said these rates are due to growing public skepticism of the safety and effectiveness of vaccines, likely fueled by vaccine misinformation, along with eroding trust in health authorities in general, and a growing partisan divide.
These U.S. trends began during the COVID-19 pandemic and have continued over time. The COVID-19 shots, however, are not a required childhood vaccine in any states.
U.S. Health Secretary Robert F. Kennedy Jr., a longtime vaccine skeptic, is leading efforts to re-examine the federal childhood vaccine schedule. He has gutted and replaced members of the CDC’s Advisory Committee on Immunization Practices with his own picks as part of an effort to regain trust, he said.
States set their own vaccine requirements for schoolchildren but many follow the ACIP’s recommendations.
The Hawaii Department of Health says religious exemptions and other factors make it difficult to reached the desired 95% coverage target for herd immunity.
But determining what is behind these local trends is complex.
The religious exemption rates in Hawaii were increasing before the changes to the ACIP, according to DOH. Declining vaccination rates also occurred before the COVID-19 pandemic, according to Kemble, with the biggest dip before 2020.
She believes concerns about vaccines have been rising for over the past decade, and attributes it, in part, to the spread of misinformation over social media, along with the politicization of vaccines.
Measles concerns
Hawaii health officials are particularly concerned about a potential measles outbreak in the state, given the isles’ low vaccination coverage.
A measles outbreak centered in Texas earlier this year resulted in three deaths, including two unvaccinated, school-aged children.
“When you look at the outbreak that happened in Texas this past year, the kindergarten coverage rate for MMR before that outbreak was over 93% in Texas for the 2024-25 school year,” Kemble said. “That’s actually pretty close to that 95%, and yet they still have a major outbreak.
“In Hawaii, we’re still hovering just below 90%, and keep in mind that statewide we have pockets where it’s actually much lower than that. A lot of those pockets are in rural areas or at neighbor islands. So, yes, to answer your question. I’m concerned that we could see an outbreak like that in Hawaii.”
In April, DOH reported two cases of travel-related measles in a child under age 5 and a related household member on Oahu, with no further spread.
Four months later, a positive wastewater sample of measles virus was detected on Hawaii island but has so far not been followed by a confirmed case.
The threat of measles is still out there, with new outbreaks tracked in the past two weeks in Arizona, Minnesota and Utah, according to the U.S. Measles Tracker recently launched by the John Hopkins Bloomberg School of Public Health.
The number of measles cases in the U.S. this year has surpassed 1,500, the highest number since 2000, when the virus was declared eliminated.
Additionally, cases of pertussis, or whooping cough, have been on the rise this year, with more than 200 cases confirmed in Hawaii as of this summer compared to 84 for all of last year.
Pertussis is a highly contagious disease spread through the air via the coughs or sneezes of an infected person. The most effective way of preventing pertussis is through the DTaP vaccine, and DOH believes the low vaccination rate is a likely contributor to the surge in cases.
DOH also confirmed a recent mumps case on Hawaii island that was not travel-related, indicating it could be spreading in the community there.
Many not up to date
Hawaii state law requiresall students from preschool to high school to be immunized before attending public or private school. Exemptions are allowed for either religious or medical reasons.
According to DOH, 20.7% of students statewide — representing nearly 40,000 children — were not up-to-date with Hawaii’s school-required immunizations. This includes students with exemptions, missing records or incomplete vaccinations.
“Too many of our students remain unprotected against serious diseases like measles and pertussis,” Kemble said. “With outbreaks increasing both here and worldwide, we urge families to review their children’s records and work with their health care providers to ensure they are up to date on all required immunizations.”
The gap is most pronounced among seventh graders, where more than half — 51.6% — were not up to date, compared to 15.6% of kindergartners, due in part to additional requirements implemented in 2020.
Based on data from nearly 400 schools, the highest religious exemption rates are in Kauai County, at 9.5%, followed by Hawaii County at 9.1%, Maui County at 6.8%, and Honolulu City &County at 3.3%.
Kemble said DOH wants to be a trusted resource and is reaching out to schools to provide science-based information on vaccines.
Hawaii recently joined the West Coast Health Alliance, which includes California, Washington and Oregon, that issued its own recommendations for COVID-19, flu and RSV vaccines informed by trusted scientists and respected national medical organizations.
The alliance last month said the ACIP’s decision to no longer recommend a combined measles-mumps-rubella-varicella shot for children under 4 was not based on standard scientific methods or new data.
That change is not expected to have much impact on varicella vaccination rates in Hawaii, according to Kemble.
“We understand that some people have questions about vaccines, and we are here to answer them,” she said. “We’re very open to working with schools to provide more information, education and a safe space where people can ask whatever questions they may have.”
DOH’s Healthy Hawaii Partners Program will host more than 350 clinics at schools this year to provide flu and COVID-19 shots and school-required immunizations, along with tuberculosis screenings, physical exams and wellness checks.
Last year, 47 of these clinics were rolled out at schools, which are for students, school staff and the community.
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Student Vaccination Rates
Vaccine Hawaii percentage* National average*
DTaP 89.4% to 91.5% 92.1%
Hepatitis B 91.1% to 92.6% 94.0%
MMR 89.8% to 89.9% 92.5%
Polio 90.2% to 92.3% 92.5%
Varicella 89.1% to 89.5% 92.3%
Source: U.S. Centers for Disease Control and Prevention; state Department of Health
* From 2023-24 to 2024-25; national averages are for 2024-25 and reflect rates at the start of the school year in 2024.
Measles, Mumps, Rubella coverage in Hawaii
>> 2024-25: 89.9%
>> 2023-24: 89.8%
>> 2022-23: 86.4%
>> 2021-22: 94.3%
>> 2020-21: 90.7%
>> 2019-20: 89.7%
>> 2018-19: 91.5%
>> 2017-18: 95.6%
>> 2016-17: 93.5%
Source: State Department of Health
Source: The Garden Island