Religious exemptions allow vaccination decline, measles outbreaks, in schools

Record increases in measles cases across the country have coincided with large drops in students getting vaccinated, even though vaccinations are required in order to attend school.

The latest outbreak is concentrated in South Carolina's Spartanburg County, where public health officials have identified a dozen cases of the highly contagious viral disease as of Oct. 15. Officials expect more cases in the fast-growing upstate region, where an outbreak was first confirmed in early October. And new cases have been identified among students who were previously quarantining because they weren't vaccinated.

Measles has already had a record year this century in the United States, according to Centers for Disease Control and Prevention data. In 2025, the country has seen nearly 1,600 cases and three deaths, representing the most cases in over 30 years and the first deaths in a decade.

Some of South Carolina's largest school districts are concentrated in upstate, and officials say large drops in vaccination are contributing to the growing local health threat. Melissa Nolan, director of the Institute for Infectious Disease Translational Research at the University of South Carolina, said the outbreak is concentrated in one of the state's more conservative areas, where vaccine uptake has declined.

“Unfortunately, we're not surprised to see these outbreaks in those particular communities,” Nolan told USA TODAY. 

Two Spartanburg County schools have had nearly 140 students in quarantine because they weren’t vaccinated. One of the schools has less than a fifth of students who have their required immunizations, far below the 95% threshold needed to prevent outbreaks. The measles, mumps and rubella (MMR) vaccine is highly effective at preventing disease, offering 97% protection with the full vaccine regimen.

But how can students attend school without being vaccinated if it's legally required? The primary answer is religious exemptions.

Religious exemptions drive falling vaccination rates

All states require certain vaccines, including the MMR, for children to attend school, according to the National Conference of State Legislatures. However, parents can opt their children out under certain exceptions.

In South Carolina, parents can obtain medical or religious exemptions to opt their children out of school-mandated vaccines, said Nolan, also an associate professor at the University of South Carolina's Arnold School of Public Health. More than a dozen other states offer personal, or philosophical, exemptions, though South Carolina does not.

South Carolina public health data show exemptions on religious grounds at both affected schools.

At Global Academy of South Carolina, a K-5th grade charter school, 82% of all 605 students in the 2024-25 school year had religious exemptions, compared with just 17% who had their required immunizations.

Mark Robertson, Global Academy's principal, said in an Oct. 16 email that the school identified a single measles case.

"The school has taken immediate action by individually contacting all families whose children were identified as being in close contact with the confirmed case, ensuring a controlled and compliant response," Robertson said.

Robertson didn't respond to emailed questions about what's driving the high number of religious exemptions at the school.

At Fairforest Elementary School, a public school which has had students quarantine, 85% of the 764 students had required immunizations last school year. An additional 13% had religious exemptions and 1% had other exemptions. Just 1% were on catch-up vaccine schedules.

Fairforest didn't immediately respond to a request for comment.

In an Oct. 15 news briefing, Dr. Linda Bell, South Carolina’s state epidemiologist, said the outbreak didn't appear to be connected to a specific social group. Prior large outbreaks have been connected to undervaccinated religious communities, such as Mennonite communities in Texas, or Orthodox Jewish communities in New York.

Instead, in affected South Carolina communities, parents "from a variety of different individuals" made the choice not to vaccinate their children, Bell told reporters.

The upstate region had South Carolina's highest religious exemption rate, at 5.3%, according to state Department of Public Health data. About 3.3% of students across the state had religious exemptions. The national nonmedical exemption rate among kindergartners was 3.4%, according to CDC data.

The statewide immunization rate has also declined, with 93.5% of students who received required vaccines last year, compared with 95.9% in the 2020-21 school year. In upstate South Carolina, the rate is 92.8%, state health data showed.

The nationwide average of students who have received the MMR vaccine has also continued to decline. About 92.5% of kindergarten students received the MMR vaccine last school year, compared with 94.7% in the 2010-2011 school year, CDC data show.

Meanwhile, exemptions overall have increased across the country, to 3.6% in the 2024-25 school year, and are driven largely by nonmedical reasons, according to CDC data. Nationally, the percentage of kindergarten students with a nonmedical exemption was 3.4%, compared with 1.4% in 2010-11. Medical exemptions, which are issued by health providers, have held steady nationally.

Growing measles outbreaks linked to vaccination decline

In 2000, the United States declared measles eliminated. Elimination meant that there was no spread within the country and the few new cases only came from abroad.

Vaccine hesitancy and resistance has been an increasing trend for the past several years in upstate South Carolina, Bell, the state epidemiologist, said. This is also reflected nationally with increasing outbreaks.

“That puts us at risk, not just for measles," she said. "We continue to see outbreaks of other vaccine-preventable diseases in that area of the state as well."