Routine childhood immunization is one of the crown achievements in public health over the past century. A 2013 New England Journal of Medicine study estimated that childhood vaccination programs have prevented 103.1 million cases of diphtheria, hepatitis A, measles, mumps, pertussis, polio and rubella since 1924. A 2005 Archives of Pediatric and Adolescent Medicine study estimated that for every dollar spent in the US, vaccination programs saved more than $5 in direct costs and approximately $11 in additional costs to society.

However, challenges remain. Outbreaks of measles, pertussis, Hib, and other vaccine preventable diseases are returning. Numerous factors–including the cost of acquiring and administering vaccines, an increasingly complex delivery system, as well as a small but growing number of parents who are forgoing vaccination for their children–put success in jeopardy.

AAP Position

  • The American Academy of Pediatrics (AAP) has long supported preventive care, including immunizations, in the medical home setting as a major component of pediatric health care and disease prevention and believes economic barriers should not restrict access to immunizations or other forms of preventive care for children. The AAP works to educate the public and key decision makers about the importance of routine child immunization and actively counters misinformation about vaccine safety and efficacy.
  • The AAP recommends that state laws permitting nonmedical exemptions to school entry immunization requirements should be eliminated.
  • While the Patient Protection and Affordable Care Act (ACA) mandates insurance coverage of preventive services without copay, including immunizations, gaps in coverage remain. The AAP advocates for appropriate funding for public immunization programs, and works to promote reform of the vaccine delivery and payment system to ensure that children have access to vaccines and that administrative and financial burdens on physician practices are reduced.


  • 70.4% of children between the ages of 19 and 35 months were immunized according to ACIP/AAP/AAFP/ACOG recommendations in 2017.
  • 15,808 cases of whooping cough (pertussis) were reported in the US in 2017. A multistate outbreak of measles linked to an amusement park in California led to 188 cases in 24 states from January 1 to August 21, 2015. Most measles patients were unvaccinated against the disease. These outbreaks prompted state level reforms of nonmedical exemption policies.
  • 2% of children entering kindergarten across the country in the 2017-2018 school year had nonmedical exemptions from immunization requirements. Of states and localities reporting, Oregon has the highest rate at 7.5%, and California, the lowest at 0.1%.


  • 29 states – laws allowing religious exemptions to school entry immunization requirements
  • 16 states – laws allowing religious or personal exemptions to school entry immunization requirements