A national review of vaccine trends compiled by Bader Law shows that the United States is entering a period of widening public health disparities driven by inconsistent vaccination behavior, rising exemption rates, and shifting attitudes toward vaccine safety. The findings reveal that vaccine decisions are no longer uniform across the country. Instead, they vary sharply by region, political identity, and demographic group. These differences are now shaping disease outbreaks, adverse event reporting patterns, and the overall stability of community immunity.
The study highlights how these fragmented behaviors are influencing both preventable disease resurgence and the public’s perception of vaccine risk.
Myocarditis and COVID 19 Vaccine Risk Patterns
The report begins with an analysis of myocarditis, a rare heart inflammation associated with both COVID 19 infection and mRNA vaccination. Federal data shows that COVID 19 has killed more than 2,000 children and teenagers, including 700 infants. At the same time, an FDA official has linked ten child deaths to COVID 19 vaccination, identifying myocarditis as a contributing factor.
Key findings include:
- Young males ages 12 to 30 experience the highest myocarditis risk after vaccination.
- 81 percent of myocarditis patients recovered within three months.
- COVID 19 infection increases myocarditis risk more than sevenfold compared with vaccination.
- 61 percent of myocarditis cases occurred in men.
- Only 1.07 percent of cases required hospitalization.
- Fatal myocarditis cases were extremely rare at 0.015 percent.
- Moderna’s vaccine showed the highest myocarditis rate among the vaccines studied.
- Studies from the United States and Mexico reported myocarditis rates nearly three times higher than those in Europe.
These findings illustrate the challenge of communicating risk. While the overall likelihood of myocarditis after vaccination remains low, the presence of any measurable risk has influenced public perception, particularly in communities already skeptical of COVID 19 vaccines.
Confidence in Vaccines Shows a Clear Divide
The study cites a KFF poll showing that Americans continue to trust long established vaccines at high levels, but confidence in the COVID 19 vaccine remains significantly lower.
Confidence levels:
- Measles vaccine: 83 percent
- Pneumonia vaccine: 82 percent
- Shingles and flu vaccines: 74 percent
- COVID 19 vaccine: 56 percent
Political identity plays a major role in these attitudes:
- 87 percent of Democrats express confidence in COVID 19 vaccines
- 55 percent of independents
- 30 percent of Republicans
This divide has contributed to uneven vaccination uptake and rising nonmedical exemptions in certain regions.
Nonmedical Exemptions Reach Their Highest Levels in Years
One of the clearest indicators of shifting vaccine behavior is the rise in nonmedical exemptions among kindergarteners. During the 2024 to 2025 school year, 3.6 percent of kindergarteners received exemptions, compared with 2.2 percent a decade earlier. Medical exemptions remain below 1 percent nationwide, meaning most exemptions stem from personal or religious beliefs.
Top States for Nonmedical Exemptions (2024 to 2025)
| State | Percent of Exempt Kindergarteners |
| Idaho | 15.1% |
| Utah | 10% |
| Oregon | 9.7% |
| Alaska | 9% |
| Arizona | 9% |
| Nevada | 6.7% |
| North Dakota | 6.7% |
| South Dakota | 6.7% |
| Michigan | 6.5% |
| Wisconsin | 6.3% |
ABC News reports that rural states often face limited access to medical providers, and lingering concerns about COVID 19 vaccines have influenced attitudes toward other vaccines as well.
Falling Vaccination Rates and the Return of Measles
The consequences of rising exemptions are already visible. During the 2024 to 2025 school year, national kindergarten vaccination coverage fell to:
- 92.1 percent for DTaP
- 92.5 percent for MMR
- 92.5 percent for polio
Additional findings:
- 286,000 kindergarteners lacked documentation of completed MMR vaccination.
- Exemptions increased in 36 states and the District of Columbia.
- 138,000 kindergarteners were exempt from one or more vaccines.
By December 16, 2025, the United States recorded 1,958 measles cases, the highest total in several years.
Measles Case Breakdown (2025)
Age distribution:
- Under 5 years: 512 cases
- Ages 5 to 19: 808 cases
- Over 20: 625 cases
- Unknown: 13 cases
Vaccination status:
- Unvaccinated or unknown: 93 percent
- One MMR dose: 3 percent
- Two MMR doses: 4 percent
- Total hospitalized: 222 people
- Under 5 years: 20 percent
- Ages 5 to 19: 6 percent
- Over 20: 11 percent
Hospitalizations:
Measles Trends Over Time
| Year | Cases |
| 2025 | 1,958 |
| 2024 | 285 |
| 2023 | 59 |
| 2022 | 121 |
| 2021 | 49 |
States With the Most Measles Cases (2025)
| State | Cases |
| Texas | 803 |
| Arizona | 182 |
| South Carolina | 142 |
| Utah | 122 |
| New Mexico | 100 |
The Texas outbreak began in a Mennonite community and spread to other under vaccinated areas, demonstrating how quickly measles can move through communities with low immunity.
States With the Fewest Cases (2025)
- Zero cases: Delaware, District of Columbia, Maine, Massachusetts, Mississippi, New Hampshire, North Carolina, West Virginia
- One case: Alabama, Connecticut
Political Identity and Adverse Event Reporting Patterns
The study also examines how political identity influences the reporting of vaccine side effects. A cross sectional analysis of 620,456 adverse event reports found that:
- A 10 percent increase in Republican voting correlated with a 5 percent increase in reported COVID 19 vaccine adverse events.
- Severe adverse event reporting increased 25 percent under the same conditions.
These findings suggest that political identity affects not only vaccine uptake but also the likelihood of reporting adverse reactions.
Gender Differences in Adverse Events and Fatalities
Among 45,843 adverse events after one vaccine dose:
- 31,018 were female
- 14,688 were male
- 137 unconfirmed
Fatalities from 2020 to 2025 totaled 7,259, including:
- 4,348 male deaths
- 2,847 female deaths
Top States for Male Deaths
| State | Deaths |
| Kentucky | 418 |
| Texas | 294 |
| Michigan | 216 |
| Florida | 191 |
| California | 190 |
Top States for Female Deaths
| State | Deaths |
| Kentucky | 339 |
| Texas | 209 |
| California | 130 |
| Florida | 101 |
| Michigan | 97 |
Kentucky stands out with 757 total deaths, three times higher than expected based on population.
Adverse Event Reporting by State
Highest Number of Adverse Reports (First COVID 19 Dose)
| State | Reports |
| California | 4,726 |
| Texas | 2,894 |
| Florida | 2,581 |
| Michigan | 2,540 |
| New York | 2,349 |
Lowest Number of Reports
| State | Reports |
| Wyoming | 82 |
| Vermont | 119 |
| District of Columbia | 134 |
| North Dakota | 135 |
| Delaware | 137 |
A Growing Divide in Public Health Stability
The study shows that the United States is experiencing a widening gap in vaccine behavior. Some states maintain strong vaccination coverage and low disease incidence, while others face rising exemptions, higher adverse event reporting, and increased vulnerability to outbreaks. These differences are shaping a public health environment where risk is unevenly distributed and where preventable diseases can return quickly in under vaccinated communities.
The findings suggest that until vaccine confidence becomes more consistent across regions, these disparities will continue to influence national health outcomes.
