By Terri Langford, Data reporting by Dan Keemahill, The Texas Tribune.

Texas school districts are coming back from summer with a rising number of parents asking for vaccine exemption forms and a new law that will make those documents even easier to obtain.

Combined with funding cuts to public vaccination programs, chilling effects of immigration policies on health care, and the wearying battle by school nurses to balance parental consent and overall student body health, Texas schools are on track to have the lowest vaccination rates in decades if exemption rates continue to climb.

“I do think that there is a problem — period — that is worse than we have known about previously,” said Terri Burke, executive director of The Immunization Partnership, which advocates for public policies that support increased access to vaccines.

Since 2018, the requests to the Texas Department of State Health Services for a vaccine exemption form have doubled from 45,900 to more than 93,000 in 2024.

In July, ahead of the new school year, the state received 17,197 requests for a vaccine exemption form, 36% higher than the number reported in July 2023. Because each requestor can have forms for up to eight individuals, the number of children those forms covered also soared — 23,231 in July 2023 compared to 30,596 in July 2025.

Now, as some public health departments indicate there are drops in the number of poorer children coming to them to get vaccinated during the summer months, and a new Sept. 1 law that will make the vaccination exemption form downloadable instead of it being mailed, vaccine experts fear herd immunity will be tougher to achieve.

Rebecca Hardy, president of Texans for Vaccine Choice, which successfully lobbied for the easier exemption process, suggests the fears are overblown. She said she hasn’t seen an increase in interest in exemption forms and insists that her organization exists to “support all parents, regardless of how they vaccinate.”

Vaccination picture for Texas 

Vaccination effectiveness relies on having enough people immunized so that those with compromised immune systems and cannot vaccinate are protected. The gold standard used by public health officials and schools is to have 95% of school-aged children vaccinated. A clear statistical picture of this school year’s vaccination rates will likely not be available for months.

While vaccination rates for Texas kindergarteners hover around 93%, pockets of 80% or lower exist with some school districts reporting a high exemption rate .

For example, in the Austin school district during the 2024-25 school year, 79.6% of kindergarteners were up to date on the vaccine for measles, mumps and rubella, or MMR, a drop from 2020 when 96% were vaccinated. And in Gaines County , where the West Texas measles outbreak began in January, 77% of kindergartners were vaccinated the same year.

Texas leads the nation with the most kindergartners — more than 25,000 — who were not fully vaccinated against measles, followed by Florida and California, according to U.S. Centers for Disease Control and Prevention data released last month . The Texas measles kindergarten vaccination rate of 93.24% is the lowest it's been since at least 2011, ranking the state 18th nationally.

Vaccine supporters, such as Burke, told lawmakers earlier this year that legislation to make the vaccine exemption form easier to obtain would inevitably drive down vaccination rates for school-age children.

In recent weeks, Burke said her organization has had disheartening conversations with pediatricians and public health officials who say vaccine skepticism has worsened. “Their frustration is that they can’t even bring up the subject with parents.”

In the Waco district, more than 98% of kindergartners were vaccinated and less than 1% of students filed exemptions. Lana Scully, a school nurse in Waco, said even with the new downloadable option going into effect in September, she anticipates her rate staying low.

The main nuisance for parents wasn’t that exemption forms had to be mailed to them by the Texas Department of State Health Services, she said. Parents didn’t want to have to take the extra step of getting it notarized. That requirement will not change when the new downloadable form is made available next month.

“You know there’s two inconveniences of it, well, actually three” Scully explained. “One is you have to go to the health department, pick it up. One is you have to get it notarized. And the last one is they’re only good for two years. So that kind of weeds out who's got the strong feelings versus who doesn't want to get to the doctor.”

Scully said she has no issue with parents wanting fewer vaccinations for their child.

“If somebody really has a strong conviction, great,” Scully said. “That's your strong conviction, and you're doing what's best for you and your family … But if it's just, I don't feel like taking my kid to the doctor 'cause I'm sitting on the couch watching Wheel of Fortune, it's a lot easier to go get the shots.”

School challenges driving up vaccine delinquencies

Funding cuts for schools have meant fewer school nurses and health aides and a crushing workload for those who remain. There’s the constant managing of emergency health equipment , maintaining students’ daily medication regimens and caring for more kids with chronic illnesses.

Finally, there’s the year-round chase of parents for their child’s vaccination records — or vaccine exemption forms.

“It was a snap decision, but it was oncoming,” said Chanthini Thomas, a school nurse who abruptly retired from Bellaire High School in the Houston school district after 25 years in the profession. “This past year was the worst year I've ever had in school nursing.”

Historically, Texas public schools have been a stopgap to compel vaccinations. S tudents are required to be vaccinated to attend school unless they have a notarized exemption form or face being sent home until they have either.

As larger urban districts combat suburban ones for students, Texas school nurses are hearing often from districts, including Houston, not to let vaccination requirements prevent students from attending school. If every student without the required paperwork were denied entry to class, schools would lose out on its basic allotment funds for each student enrolled.

“There are some superintendents that will say, ‘All kids come to school. I don't care if they've got their vaccines or not,’” said Karen Schwind, a past president of the Texas Association of School Nurses.

In the 2024-25 school year, 2.7% of kindergarteners did not have records of the required doses of the measles vaccine and lacked an exemption.

“I have kids, been hounding them for two years,” Thomas recalled. “All I can do is send letters and call parents and beg.”

The Houston school district confirmed to The Texas Tribune in April that “at this time, we are not excluding students from learning based on vaccine status.” District officials more recently said their policy has not changed.

Hardy, with Texans for Vaccine Choice, said her group “applauds any school that recognizes that being militant about vaccine paperwork simply makes no sense.”

“Whether families submit shot records, vaccine exemptions, or a mix of both, it’s still just paperwork,” she said. All of those things are not a “measure of a student’s health and certainly irrelevant to the core mission of schools: to educate, not operate as ad hoc health clinics.”

Public health departments report some vaccination dips

Each year, many of the state’s school age children who have no health insurance or who are covered by Medicaid turn to public health departments for their vaccinations. Dallas and Austin public health officials have reported some decreases in visits to summer vaccination clinics.

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

Huang and his staff believe threats of ICE arrests and deportations have pushed more undocumented children and their parents to stay away from vaccination. In Texas, there are an estimated 111,000 undocumented children , all of whom do not qualify for state Medicaid health insurance coverage, attending school.

Funding cuts have also contributed to the reduction of vaccinations, particularly among the uninsured and Medicaid health insured populations.

During the pandemic, local health departments received a surge in federal funding. That boost allowed local health departments to “right size” their lean immunization programs for the first time in years.

“We had 20, 25 team members, so we were able to see well more than 20 people [daily] or even conduct multiple clinics at a time,” said Chris Crookham, program manager of the immunization unit at Austin Public Health.

Today, public health officials are now scaling back after the f ederal government put an early end to such funding. “Now the team is down to just seven people, and so we're capping our clinics at 20 clients only,” Crookham said.

In June, Austin Public Health and other local health departments braced for even more cuts, up to $28 million more in federal immunization cuts. Eventually, $1.7 million was cut from Texas and that entire amount was absorbed by DSHS through the agency’s own reduction in vaccine marketing materials and other budget-tightening measures.

Still, that potential pause forced local health departments to start scaling back and their employees to consider other career options.

That happened at Austin Public Health, where its primary staff immunization nurse will be leaving for another job at the end of this month.

“The damage was done,” Crookham said. “We started to go through looking at a RIF [reduction in force] process, and because of that, people started looking for other jobs.”

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