Minding the “gap”: low vaccination rates in some local schools could spell trouble

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Massachusetts is one of the most vaccinated states in the country, but vaccination rates are not uniform across the Commonwealth. 

With measles, a notoriously infectious viral disease, back in the United States after being declared “eradicated” 25 years ago public health officials and school administrators in some parts of western Mass are steeling for potential outbreaks. 

Measles and other diseases have been held at bay in Massachusetts for decades because the vast majority of residents are vaccinated against them, conferring “herd immunity” upon the population that prevents the disease from spreading. Today, while Massachusetts schools generally trend at or above herd immunity, some have historically fallen well below that threshold. 

“It’s hard to believe that we’re having a conversation about measles, but we are,” Robert Dorit, a professor of biological sciences at Smith College with a research background in public health and epidemiology, told The Shoestring in early April. 

Recently, childhood immunization rates have been on a decline across the country, and Dorit is concerned for classrooms in western Massachusetts. Typically, there is a margin of tolerance for those who either cannot get vaccinated or choose not to, as 100% of a population does not necessarily need to vaccinate in order to contain a disease. According to a risk assessment made in February by Johns Hopkins Bloomberg School for Public Health, the standard rate for herd immunity against measles is 95%, leaving a “buffer” of 5%.

“Usually, that little margin gave people who really had religious reasons the ability to be accommodated,” Dorit said. “It was a margin for people who might be immunocompromised, for whom the challenge of the vaccine might not be as beneficial, and the side effects more dramatic. It was a margin for people who are just out to lunch and don’t remember to get vaccinated. Because this has become a political issue … we’re beginning to fall below these vaccination thresholds that give populations immunity.”

Among the four counties of western Massachusetts, several elementary schools have fallen as many as 30 percentage points short of the herd immunity rate for the measles, mumps, and rubella vaccine in the past two school years. That’s according to The Shoestring’s analysis of state data from the 2023-2024 school year — the most recent period with complete data — as well as partial data from the current school year.

The state measures MMR-vaccine rates when students enter kindergarten, then again in the seventh, 11th, and 12th grades. Among some of the local schools that have fallen the furthest from the herd immunity threshold for kindergarteners in recent years include:

• Newton School in Greenfield, which has historically been too small of a school to require reporting immunization rates. It reported a 71% MMR-vaccine rate for the 2024-2025 school year — the lowest so far in the state this year, with just under 58% of schools having reported data by press time.
• Two schools in Holyoke that fell below the threshold in 2023-2024: Lt. Clayre P. Sullivan School (64%) and Maurice A. Donahue Elementary School (71%). In the current school year, every Holyoke elementary school reached herd immunity except William G. Morgan School Elementary school, which had an MMR-vaccine rate of 91%.
• Three schools in Westfield during the 2024-2025: Abner Gibbs Elementary School (78%), Munger Hill Elementary School (84%), and Franklin Avenue Elementary School (87%). Munger Hill was also among the region’s least-vaccinated schools the previous school year, with an 85% MMR-vaccine rate.
• Agawam’s James Clark Elementary School (84%) and William P. Sapelli Elementary School (88%) during the 2024-2025 school year. James Clark School also had an 85% MMR-vaccine rate in the previous school year.
• The Berkshire Waldorf School in Great Barrington, which had a kindergarten MMR-vaccine rate of 34% in the 2023-2024 school year and did not report data for the current school year. That followed a 2023 article in The Boston Globe focusing on the school’s large vaccination gap.
• A handful of schools in Pittsfield in the current school year, including Williams Elementary School (80%), Egremont Elementary School (84%), Crosby Elementary School (86%), and Stearns Elementary School (88%). Crosby Elementary also had a low MMR-vaccine rate last school year, at 85%. 

The Shoestring reached out to each of those school districts, as well as leadership for Berkshire Waldorf, for comments on their MMR-vaccine rates. Only Holyoke responded, but the district said they were not able to compile relevant information by press time.

A number of the schools falling below MMR-vaccine rate thresholds also fall well below the threshold for polio vaccination. While just one recent polio case has been identified in the United States — in New York in 2022 — the virus has been detected in wastewater, indicating community transmission.

Map: Data from the state’s Department of Public Health show measles, mumps, and rubella vaccine rates for the 2023-2024 school year.

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If a child does not meet state requirements for vaccination without an exemption, they are at risk of losing their ability to remain enrolled in school. Massachusetts only offers two kinds of vaccine exemptions: religious and medical, the latter requiring a physician’s sign-off. 

According to the Centers for Disease Control and Prevention, some medical exemptions may include allergies, autoimmune diseases, or chemotherapy treatments, which weaken the immune system’s ability to fight against the side effects of a vaccine.

“It’s sort of funny terminology, because we can only think of two religions that actually have an exemption. So, it’s really more of an ideological exemption than a religious exemption,” said Peter Dillon, the superintendent of the Berkshire Hills Regional School District. The one elementary school in his district, Muddy Brook Elementary, reported a 97% vaccination rate against MMR in 2025 and 100% the previous school year.

According to a 2013 study by John Grabenstein for the peer-reviewed medical journal Vaccine, the only legitimate theological objections to vaccines were held by the Dutch Reformed Church and Christian Scientists, though they express respect for those who do vaccinate themselves. The rest is a grey area, according to Grabenstein, although many leaders in large religions have generally encouraged vaccinations. During the COVID-19 pandemic, for example, Pope Francis determined getting vaccinated to be a “moral obligation.” 

Even so, the process of obtaining a religious exemption is not a difficult one.

“It couldn’t be more simple,” said Becki Touponce, who has been a school nurse at Muddy Brook Elementary School for 20 years. “We have a form that has to be filled out yearly, and it just says, ‘Due to my sincere religious belief, my child isn’t vaccinated.’ They sign that, hand it in, and then they have the exemption.”

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The future of religious exemptions has been up in the air for nearly seven years now, explained Katie Blair, the director of Massachusetts Families for Vaccines, a pro-vaccine advocacy group. Blair explained that the group has been focused on supporting bills like H.2554 in the state House of Representatives, which aims to remove the non-medical exemption. 

But the bill faces opposition from some.

Testifying at a hearing in 2023 against a previous version of the bill, one commenter, Kathleen Howarth argued that her ancestors “didn’t cross the ocean and fight for religious freedom in this country, only to be told its sincerely held religious beliefs protected by the oldest constitution in this country do not align with any major world religion.” Her statement was in response to the claim that no major religions clearly oppose vaccines. “They do not have to. That is not what our constitution says.” 

In contrast, State Rep. Andres Vargas, D-Haverhill, the bill’s lead sponsor, pointed out that “the Supreme Court of the United States has already decided and reaffirmed that mandatory vaccination laws are constitutional.”

The Legislature’s Joint Committee on Public Health is hosting a hearing on the bill on June 6, and will accept written testimony until June 9.

“To be honest, the fact that we are still talking about this is embarrassing,” said Janna Koretz, a psychologist and mother to a child with complex medical needs testifying in support of the bill for the fourth year in a row in 2023. “For my family, having someone opt out of vaccines for so-called religious reasons is no different than them choosing to be above the law and drive drunk and kill someone. The effect is the same for us.”

There is little room for schools to dispute religious exemptions, even if there is no way to cite vaccine hesitancy as being attributed to a sincere tenet of an individual’s religion. The implication, then, turns to politics.

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Pediatric physician and hospitalist at Cooley Dickinson Hospital Jana Cable said that personal philosophy may be masquerading as religious exemption, though politics don’t tell the whole story. In Cable’s experience, scientific misunderstanding ultimately plays the largest factor in parents’ vaccine hesitations. 

“When a kid’s parents don’t want to vaccinate, it’s a tricky position for pediatricians to be in,” she said. “Usually, if you show them the scientific evidence and talk about the benefits of being vaccinated, they’ll change their mind, but not everyone is open to discussion.”

She described apps like YouTube, TikTok, and Instagram as being key players in the spread of medical misinformation, especially about vaccines. 

“In the moment, it can seem like you’ve discovered this area that the mainstream media isn’t talking about … So, I can see how families get sucked into it,” she said. “Sometimes I think these sources could be doing even more damage than the current administration is.”

Up until the recent spate of outbreaks across the United States, Secretary of Health and Human Services Robert F. Kennedy Jr. had been loudly against vaccinations. In a video from February, Kennedy said, “You may be killing more [children with the measles ‘vaccine’] over the long run than measles ever did.” 

However, at the beginning of April, his rhetoric appeared to shift following a visit with a family in Texas whose child had died of measles. He wrote on social media that “the most effective way to prevent the spread of measles is the MMR vaccine,” prompting backlash from a subset of the anti-vaccination movement.

“The irony is that public health has been so successful that it’s actually lulled people into thinking that they don’t need public health vigilance,” Dorit, the Smith College professor, said.

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As of 2023, Berkshire, Franklin, and Hampden counties account for some of the highest rates of unvaccinated preschool and kindergarten-aged children in Massachusetts who do not maintain a medical or religious exemption. These students fall into the “gap” of undocumented vaccination information, meaning that even if they have been immunized, their schools have no record of it. In state data, these students are categorized as unvaccinated. Berkshire county maintains the highest gap percentage in the whole state: 8.7%. Massachusetts has a cumulative gap rate of 4.6%. 

The reason for this gap is difficult to pin down. First, experts say reported immunization data usually do not capture an entire school year. Some data is also missing; schools with less than 30 students per class year are not required to report immunization data to the state, which, according to experts, allows for a margin of error. 

“Sometimes, parents are just doing a catch-up schedule,” said Touponce, the Muddy Brook Elementary School nurse. In addition to providing direct care to students, she is responsible for tracking and reporting the school’s vaccination data. While the schools urge parents to follow the medically recommended vaccination schedule, “sometimes they didn’t want to start their kids too early, or they didn’t want them to have too many at one time — that sort of thing. And we work with them on that. I’ll chase them down.”

Unofficial exemptions are granted to families who have recently immigrated to the school district from outside the United States, or to families who are unhoused or unable to list a permanent residence. 

“We can’t keep them out of school for not being up to date on their immunizations, because sometimes it’s difficult for them to get to a doctor,” Touponce said. “There’s a big lack of primary care physicians around here, so people have trouble with that.”

Difficulty getting into a doctor’s office is not a problem limited only to recently immigrated families, either. The Center for Health Information Analyses found in a 2023 survey that 41% of Massachusetts residents had difficulty getting an appointment at doctors offices or clinics, a phenomenon that has been gradually worsening since the COVID-19 pandemic. To Dillon, the Berkshire Hills superintendent, the issue may be geographically specific.

“People talk a lot about food deserts in urban communities, when people don’t have access to fresh food, right? With determinants of health, there’s certainly a similar lack of access — or there are really long waits,” Dillon said. “That could be to see a pediatrician, a counselor, a psychologist, or a social worker, whether it’s for themselves or for their kids.”

However, Cable, the Cooley Dickinson pediatric physician, doubts that medical shortages have directly impacted vaccine rates in western Massachusetts. 

“There’s certainly a primary-care shortage, which is multifactorial, but to my knowledge it hasn’t affected pediatrics as much as it’s affected adult care,” Cable said. “Most practices really try to get kids in for wellness checks and immunizations — it’s a big priority.”

The reason behind this prioritization is the “immunological memory” of human beings, Dorit said. 

“Kids are fairly immunologically naive,” he said. “Your immune system has what seems like a completely unreasonable task, which is to recognize everything that is in your body, circulating in your mucous membranes, that shouldn’t be there.”
Because children have short immunological memories, the number of vaccines that young children need to receive is much higher than older kids, teenagers, and adults. Some are one-and-done, but others need regular booster shots. A measles vaccine is typically a once in a lifetime vaccine, but since the disease’s re-establishment in the United States, Dorit said, “there are wrinkles now.” Certain groups may want to consider receiving a booster shot, according to a recent article from Harvard Health Publishing.

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Ultimately, the ability of physicians and school administrators to protect children from infectious disease is limited by their roles.

“Our goal is to support all kids and families,” Dillon said. Some infectious diseases have longer excusal days than others, given the cycle of the disease. “It’s advantageous if they’re in school, but we’re also cognizant of exposure.”

In the event of an outbreak, any parents with children exempted from the full vaccination circuit — or children who do not meet all requirements — must be contacted by the school. Such was the case at Muddy Brook when one child contracted chicken pox.

“We just called all the families with exemptions and said, ‘You can either keep them home days 10 to 21 after exposure, or you can go to the doctor within the next five days,’ which everyone did,” Touponce said.

A 2024 CDC survey aimed at assessing parents’ attitudes, experiences, and knowledge regarding vaccination requirements and exemptions found that over 30% of parents and guardians surveyed agreed that unvaccinated children should be allowed to attend school or daycare. This finding reflects a broader debate about vaccination requirements and their impact on children’s education. While most parents support enforcing vaccination policies, there is concern about the consequences of excluding children from school or daycare.

A child who contracts measles must be kept out of school for at least 20 days to minimize potential spread. 

“I imagine some number of people that have religious exemptions would at that point entertain getting their child immunized, because 20 days of not going to school is like a month not going to school, and it would be very hard to manage that if you had a little kid and you were working,” Dillon said.

The impact of exclusion periods can vary greatly based on the individual circumstances of each family. For some parents with flexible schedules, the disruption caused by these periods is minimal. Yet for others, these periods simply compound additional financial and logistical challenges. 

While strong vaccine regulations have repeatedly proved to prevent outbreaks and protect public health overall, Cable acknowledged that it is crucial not to forget what lies at the center of these deliberations. 

“At the root of all of this is parents wanting to be good parents,” Cable said. “We have to be okay meeting them where they’re at. Regardless, we’re going to care for their kid even if they don’t follow our recommendations.”

This article was written by Smith College students in a data journalism course taught by Naila Moreira and Ben Baumer, in collaboration with The Shoestring’s editors. 

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