Before the pandemic helped fuel the growth of vaccine politicization across the country, less than 1% of Austin school district’s kindergarteners in the fall of 2019 failed to comply with the state’s vaccine reporting requirements.

Five years later, the Austin Independent School District had some of the state’s highest number of kindergarteners who neglected those state requirements — about 1 in 5 kindergarteners had not proven they were fully vaccinated against measles and did not file an exemption.

A Texas Tribune analysis has found that this explosion of vaccine non-compliance has played out across many school districts in the state in recent years, helping to push Texas’ measles vaccine coverage to the lowest it’s been since at least 2011.

“We definitely were on a better trajectory (before the pandemic),” said Alana Bejarano, executive director of health services and nursing for the Austin school district, which reported a 23% delinquency rate for the measles vaccines among their kindergarteners.

“I don’t know that I can pinpoint the concrete answer, except (preschool and kindergarteners) were born at a time where everything kind of went off track and getting them back into that, you know, that’s been difficult.”

The Tribune examined kindergarten measles vaccination compliance because it’s the earliest the state documents school vaccination rates and measles can be especially deadly for young children. The state’s two measles deaths this year were girls ages 6 and 8. Under Texas vaccine requirements, most kindergarteners must show they are fully vaccinated against measles or file an exemption to enroll in school; most who are not fully vaccinated have an exemption.

During the pandemic, the statewide measles vaccine delinquency rate — a term the Texas Department of State Health Services uses to track students not compliant with those requirements — more than doubled.

The Tribune estimated the number of vaccine-delinquent kindergarteners in each district by comparing delinquency rates and enrollment totals.

In school districts with the most delinquent kindergarteners in the 2024-25 school year, the latest data available from the state, as much as 44% of their kindergarteners were delinquent in the measles vaccines, and their delinquencies also outnumbered exemptions, which was not the case at the state level. Those school districts had vaccine delinquency rates as small as a fraction of a percent just five years prior.

The five other vaccinations required for kindergarten followed similar increases in delinquency rates during the same time period.

The pandemic is the driving force behind the increase in vaccine delinquency, school district officials say. Many children are entering school after falling behind on their immunizations during the pandemic, making it an untenable task for resource-strapped school districts to chase after parents to vaccinate their children or submit an exemption.

Meanwhile, access to vaccines, especially free and low-cost doses, have also dwindled over the last several years amid funding cuts and the politicization of vaccines.

State laws and rules don’t dictate who has to enforce vaccine compliance, although the Texas Department of State Health Services administers the law and school districts have traditionally been among the first line of enforcement.

While school districts acknowledge they are enrolling students not compliant with state vaccine requirements, district officials say they are caught in a no-win situation. Pushing vaccines too hard could lead to retaliation from groups and politicians opposed to vaccine mandates, and district officials don’t want to disenroll students — public schools have a responsibility to educate all children and so much of their funding is tied to attendance, too.

“We encourage our school nurses to advocate strongly to promote and protect public health at their campus,” Becca Harkleroad, executive director of the Texas School Nurse Organization. “But ultimately it’s up to the superintendent and the principal to decide how strictly they are going to enforce it or if they are going to enforce it.”

Statewide, the percentage of kindergarteners who were delinquent in getting the measles vaccine more than doubled to 2.68% between 2019-20 and 2024-25, the latest data available. The delinquency rate jumped to 3.1% in 2021-22, surpassing the number of students who had an exemption. Those rates have not returned to pre-pandemic levels, although the exemption rate has returned to exceeding the delinquency rate.

The federal Centers for Disease Control and Prevention estimates that a year ago 25,000 Texas kindergarteners were not fully vaccinated against measles. Of those, more than 16,000 had an exemption, and about 9,000 did not have an exemption and under the state’s definition, were vaccine delinquent.

The overall vaccine delinquency rates may be small, but anything that causes vaccination levels to fall means more children are vulnerable. Ideally, schools try to keep their vaccination levels at 95% to help protect those children with compromised immune systems or medical conditions that keep them from being vaccinated.

In addition to vaccine delinquency, the state also tracks the percentage of students who are vaccinated, formally exempt from vaccinations, and provisionally enrolled because of vaccination status.

Most unvaccinated students in Texas are permitted to enroll because they have an exemption form or a note from a doctor. They can also provisionally enroll without proving vaccination status if they are homeless, military dependents or in foster care and their records cannot be obtained by the start of the school year.

The Texas measles kindergarten vaccination rate of 93% is the lowest it’s been since at least 2011, ranking the state 18th nationally.

“The decrease in vaccination rates overall is certainly a concern because it leaves our population vulnerable to different infections,” said Dr. Erin Nicholson, a pediatric infection physician at Texas Children’s Hospital and an assistant professor at Baylor College of Medicine. “And we saw that front and center with the measles outbreak that recently happened.”

Schools: A first line of defense against infectious disease

By the time most children enter kindergarten, they have received two MMR vaccination doses, which will provide lifelong protection against measles, as well as mumps and rubella for most people. The MMR vaccination for kindergarteners is considered one of the most important immunization targets by the U.S. Department of Health and Human Services.

State health officials audit school vaccination records each year for accuracy, by sampling school district records, explains Chris Van Deusen, spokesperson for the Texas Department of State Health Services. But there is nothing in state rules that requires DSHS to enforce the vaccination requirement.

As a result, the de facto enforcement has traditionally fallen to school districts.

Some of the state’s highest kindergarten measles delinquency rates were in larger school districts and charter networks: KIPP Texas Public Schools (44%), Spring ISD (30%), Austin ISD (23%), Dallas ISD (20%), and Houston ISD (7%).

The five public school systems with the highest counts made up more than half of all delinquent kindergartners in the state, despite enrolling less than 10% of the state’s public school kindergarteners.

Some district officials, including Dallas, say they try to follow state requirements by sending home students who do not have completed vaccination requirements or an exemption. But, they enroll those students, contributing to the district’s vaccine delinquency rate.

The Austin school district will also enroll the students who don’t meet vaccine requirements, but they wait to send those students home until their parents have been notified of their vaccine delinquency three times, Bejarano said. They can return once they have proof of vaccination or the exemption form.

State data doesn’t track how many vaccine-delinquent students school districts send home. It also doesn’t reflect changes to vaccine delinquency later in the year because the data is based on surveys school districts submit in the first half of the school year.

While some school districts say they try to send home students who don’t meet vaccine requirements, Houston ISD officials said they are keeping those students in the classroom. They, too, dedicate time and resources to track all students’ vaccination status and try to communicate information with parents about the need for staying up to date on the schedule.

But, they are “not excluding students from learning based on vaccine status,” according to a statement to the Tribune.

Chanthini Thomas, a school nurse who retired from her job at Houston ISD’s Bellaire High School last summer, said the conflicting messages from the district, resource reductions and the yearlong chase to get vaccine paperwork in was frustrating.

“You have little support,” she said. “Why would you say … that’s a requirement to any school for the state of Texas but then you put out a mandate from the district to say, don’t let immunizations prevent enrollment? And the reason is because they need the numbers, because the numbers were dwindling.”

Like many other urban school districts, HISD is battling declining enrollment — and the funding that comes with it — as more families move toward better job opportunities and lower housing costs in the suburbs or choose charter and private schools.

As school nurses have told the Tribune over the summer, school districts choose to enroll unvaccinated children so they can keep “butts in the seats” and the base amount of money they receive from state and local sources to educate each student — about $6,160.

“I see the school as being in a tough spot,” said Melissa Gilkey, a University of North Carolina professor who studies vaccine efforts at schools. “We work so hard to minimize absenteeism … that I do have some sympathy for that idea that it’s hard to exclude them for one health service.”

KIPP Texas Public Schools, a charter network with campuses across the state, declined an interview but insisted it was following the state immunization requirements. Its kindergarten measles vaccine delinquency rate was less than 1% in 2019 compared to 44% last year.

Spring ISD, north of Houston, reported last year that more than 30% of its kindergarteners were measles vaccine delinquent. The district informed the Tribune it also follows state rules closely but said its high MMR delinquency rate was evidence of “enrollment and access issues” and that Spring ISD was “actively working to strengthen this process.”

The Spring district cited family’s frequent moves in the area, limited access to health care and language barriers as reasons there’s a delay in getting student shot records updated in time for school.

“We are committed to improving compliance rates and ensuring our students are protected against preventable diseases,” said Shane Strubhart, the Spring ISD spokesperson.

Access to vaccines has dwindled

The pandemic disrupted preventive health care, becoming most apparent in some of the most recent kindergarten classes, filled with students born around the first COVID-19 outbreak. The COVID-19 pandemic not only interrupted home and school life, experts say, it upended regular health checkups younger children typically receive before they start school and that impact continues to be felt today.

Families “going to see the doctors got off track for everyone during the pandemic,” Austin ISD’s Bejarano said.

For low-income and immigrant families who already found health care access a challenge, more are struggling to find what Bejarano calls their “medical” home, a regular primary care doctor who can either vaccinate their children or answer concerns and perhaps direct them to the state’s exemption process if they feel strong enough to opt out.

“COVID didn’t do vaccination or education and many other things as a whole, any favors,” said Jennifer Finley, executive director of health services for Dallas ISD. The district’s kindergarten measles delinquency rate jumped to 20% last school year compared to 1% during the 2019-20 school year.

Diminished vaccine access is also a factor. Up until the early aughts, public health departments, churches and even lawmakers would hold free or low-cost immunization clinics over the summer for families.

In 2004, the Dallas school district turned away hundreds of students, who walked and drove to nearby clinics for free or low-cost vaccines, according to a Dallas Morning News article.

After the pandemic, those resources are even fewer.

“It really stopped during the pandemic,” Finley said. “Some of the folks lost their funding.”

Schools rely heavily on local public health departments to help them with vaccination clinics. Once the threat of COVID lessened, public health departments used those funds to add more staff and hold more vaccination clinics.

But two things began impacting vaccination efforts by local health departments. First, those leftover funds were clawed back early by the Trump administration this year, prompting some staff to look for other jobs, thereby causing staff shortages in public health vaccination departments. And second, public health officials suspect more immigrant families are shying away from vaccination because of stepped-up immigration efforts and deportations.

In Texas, there are an estimated 111,000 immigrant children, all of whom do not qualify for state Medicaid health insurance coverage, attending school.

“We typically have big lines and the waiting room is packed. Our whole lobby is packed,” Dr. Phil Huang, the director of the Dallas County Health and Human Services Department, told the Tribune in August. “This year it has not been that way.”

Vaccine hesitancy changing school messaging

After the pandemic, many parents watched as debates raged over the safety of the quickly-developed COVID-19 vaccine. As a result, they are asking more questions about all childhood vaccinations.

In many cases, parents are spreading MMR doses out and that, too, could be the reason for more kindergartners showing up with an incomplete vaccination status, Bejarano said.

“The main concern (among parents) is basically, ‘Am I doing the right thing for my child, that is in their best interest and help me understand what the risks are of these infectious diseases that vaccines are trying to prevent,’” Nicholson, the Texas Children’s physician, said.

Before COVID, many doctors adopted an imperial tone — “you should do this because I’m the expert,” she said. That changed after the pandemic. “We are looking at how we talk to these parents, because the last thing that we want to do is come across as condescending.”

School nurses have also worked tirelessly to try to find a winning formula to reach families of vaccine-delinquent kids. At a national school nurse conference in Austin this summer, an entire session was devoted to teaching nurses how to have tension-free conversations with parents who are skeptical of vaccine requirements.

Ultimately, school nurses just want to inform parents of their two options to stay compliant with state rules: either provide proof of vaccination or an exemption, Bejarano said.

“We’ve made these large campaigns and we are really kind when they register, letting them know what is the law, what the exemptions (are),” Bejarano said. “I just think the district in general is understanding we need to do better when it comes to public health and getting these rates up.”

The good news, she says, is that the greater efforts made by school nurses in the fall to try to help parents become vaccine compliant tends to push down the high delinquency rates by the end of the school year. Data provided to the Tribune by Austin ISD proved that out. That 23% delinquency rate for kindergartners recorded in the fall of 2024 fell drastically to 6% by May 2025 possibly due to the fear produced by the measles outbreak in the months prior.

“I do think that everybody came together in the Austin community and really did try to push for that” compliance, Bejarano said. “And I think that’s why it helped the rate last year.”

Finley points to other lesser-known reasons complicating the back-to-school vaccination picture. Among them, an influx of students came to Texas from other states, many already armed with vaccination exemptions or with incomplete vaccination histories who are having to be re-educated about Texas requirements.

Starting Sept. 1, Texas parents can more easily obtain a vaccine exemption form by downloading it off the state’s website, but how that will impact the delinquency gap won’t be seen until data is released next year.

Nicholson, Finley, Bejarano and others say they would like to see more data that clearly explains the rising delinquency rate and how many students who were once marked delinquent end up becoming fully vaccinated or obtaining an exemption by the end of the year.

“Does it mean, you know, people are just struggling with paperwork?” Nicholson said. “Or does it mean that really those vaccinations are falling?”

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This story was originally published by The Texas Tribune and distributed through a partnership with The Associated Press.