Vaccinations are vital to maintaining the overall health of our kids and our communities. Unfortunately, Colorado lags behind other states in vaccination rates for child care- and school-aged-children, leaving tens of thousands of kids vulnerable to severe illness from vaccine-preventable diseases. In fact, Colorado ranked 44th in the nation for vaccination rates for kindergartners in 2020. The rate of MMR vaccination in Colorado for kindergartners recorded during the 2019-2020 school year hovers around 91%, lower than the Healthy People 2030 goal of 95%, and low enough to put many of our schools at risk for a potential outbreak–which can prove deadly even to otherwise healthy children. Routine vaccinations have slipped even further since the start of the COVID-19 pandemic, leaving children even more vulnerable to vaccine-preventable illnesses. And though vaccination rates have recovered slightly from an initial substantial drop, the number of doses administered from mid-March 2021 through late October of this year was 7.1% lower than that same period in 2019. There’s still work to do to improve and maintain our state’s immunization rates, and vaccine requirements are one tool we have to accomplish that goal.

Recent focus on COVID-19 vaccine requirements has raised questions about the broader place of vaccine requirements in our society. In Colorado, vaccine requirements for school and child care entry have been in place since 1978. Colorado also has flu vaccination requirements for health care providers to help prevent the spread of flu in health settings, and recently adopted moderate COVID-19 vaccine requirements to help curb the spread of COVID-19. These vaccine requirements have helped support vaccination and generally helped to keep deadly diseases like measles and polio out of our schools and communities. For instance, since 2014, Colorado has reported only five cases of measles. One of the major factors affecting childhood vaccination rates in Colorado is the lenient process by which parents can exempt their child from school vaccine requirements.

In Colorado, children are required to be vaccinated before they enter school or child care. However, state regulations allowing parents to exempt their children from these vaccination requirements are incredibly lax when compared with other states. In addition to a Medical Exemption (which all U.S. states allow), Colorado is one of only 15 states to also offer a personal belief exemption, called a Non-Medical Exemption (NME). Previously it required very little effort to claim a personal belief exemption (including a religious exemption) from school immunization requirements. Parents could simply write on a piece of paper—even a post-it note or a napkin—that they wished to exempt their child and their school had to accept it. There was also no way statewide to tell if parents were simply not in compliance (they simply hadn’t submitted their child’s vaccine record to the school) or were taking a personal belief exemption for their child since there was little to no standardization of the exemption process.

In 2020, Senate Bill 20-163 was passed to create an “equal-effort” system, whereby parents seeking an NME are required to submit the same kind of documentation as a parent seeking a Medical Exemption or a parent submitting their child’s immunization records to their school. Parents can no longer submit exemptions via napkin. The legislation created a Certificate of Non-Medical Exemption, which was created and is maintained by the state health department, that needs to be submitted to the school. The Certificate must obtained either from an immunizing provider who signs the form or through completion of an online educational module about vaccination. This Certificate can be completed once for child care, and must be completed again before kindergarten and every subsequent year that the parent still wishes to claim an NME for their child.

Despite this new process, we are still one of the states with the easiest ability to obtain an NME. The ease of obtaining an NME creates an environment where vaccine rates in schools can remain at dangerously low rates, allowing the spread of severe, preventable diseases that parents may not fear as much as they used to—thanks to widespread vaccination and near-elimination of these diseases which historically caused many cases of severe illness and even death. The difficulty we face lies in overcoming vaccine hesitancy or inaction on the part of parents to raise the immunization rates of child care- and school-aged-children.

The fact is, vaccines are safe and they save lives. They prevent diseases, hospitalization and death, and they save the U.S. billions of dollars in direct medical costs. Longstanding, bipartisan vaccine requirements in our state and across the nation have led to historic successes in keeping debilitating and deadly diseases out of our schools and communities.

Immunize Colorado has created a fact sheet to dispel myths about Medical and Non-Medical Exemptions, clarify what is currently required for children to enter child care or school, and explain the enormous benefits to vaccinating children before they start gathering in schools or child care environments where diseases can easily spread. This resource aims to help parents stay up to date on the latest required vaccines in Colorado, while emphasizing the importance of getting children vaccinated and the continued positive impact that vaccine requirements have on our state’s students and communities.