Texas Vaccine Exemption Requests Climb Ahead of School Year as Experts Warn of Falling Immunity

Texas schools are returning from summer break with more parents requesting vaccine exemption forms, and a new state law will soon make those forms easier to get. Together with cuts to public vaccination programs, public health experts warn the state could see some of its lowest school vaccination rates in decades if exemptions keep rising.

Since 2018, annual requests to the Texas Department of State Health Services for an exemption form have roughly doubled, from 45,900 to more than 93,000 in 2024. In July alone, ahead of the new school year, the state received 17,197 requests, 36% more than in July 2023. Because one requestor can obtain forms for up to eight people, the number of children covered grew from 23,231 in July 2023 to 30,596 in July 2025.

Starting Sept. 1, the exemption form will be downloadable rather than mailed to families. Terri Burke, executive director of The Immunization Partnership, said she believes the problem is "worse than we have known about previously." She said pediatricians and public health officials have told her vaccine skepticism has intensified, to the point that some cannot even raise the subject with parents. Rebecca Hardy, president of Texans for Vaccine Choice, which lobbied for the change, called the fears overblown. She said she has not seen increased interest in the forms and that her group supports "all parents, regardless of how they vaccinate."

Public health officials aim for 95% of school-aged children to be vaccinated, the level needed to protect those who cannot be immunized. Texas kindergarten rates hover around 93%, but some districts fall far lower. In the Austin district, 79.6% of kindergartners were up to date on the MMR vaccine in 2024-25, down from 96% in 2020. In Gaines County, where the West Texas measles outbreak began in January, the figure was 77%. Federal data released last month show Texas has more than 25,000 kindergartners not fully vaccinated against measles, the most in the nation, and its 93.24% rate is the lowest since at least 2011.

Not everyone expects a surge. Lana Scully, a school nurse in Waco, where more than 98% of kindergartners are vaccinated, said she expects her rate to stay low. She said the notarization requirement, which will remain, is a bigger deterrent than the mailing process, along with the need to pick up the form and the fact that exemptions last only two years.

School nurses also describe heavy strain. Funding cuts have left fewer nurses and aides to handle emergencies, medications and chronic illnesses, on top of chasing vaccine records. Chanthini Thomas retired abruptly from Bellaire High School in the Houston school district after 25 years, calling the past year "the worst year I've ever had in school nursing." Students without records or exemptions can legally be sent home, but some districts discourage that because absences cost schools funding. The Houston district said it is not excluding students based on vaccine status. In 2024-25, 2.7% of kindergartners lacked both required measles doses and an exemption.

Public clinics are also seeing changes. Dr. Phil Huang, director of Dallas County Health and Human Services, said summer clinics that once had packed lobbies were quieter this year, and he and his staff believe fears of immigration enforcement are keeping undocumented children and parents away. An estimated 111,000 undocumented children attend Texas schools and do not qualify for state Medicaid.

The end of pandemic-era federal funding has shrunk capacity. Chris Crookham of Austin Public Health said an immunization team of 20 to 25 is now down to seven, with clinics capped at 20 clients. In June, local departments braced for up to $28 million in further federal cuts; ultimately $1.7 million was cut from Texas, which the state health department absorbed through its own budget measures. Crookham said the uncertainty still prompted staff to seek other jobs, including Austin's primary immunization nurse, who leaves at the end of the month. "The damage was done," he said.