As rising vaccine skepticism undermines a key function of public health, the question isn't whether health departments should act – it's how to act strategically and effectively to protect communities.
The numbers tell a sobering story. For the 2023-2024 school year, new CDC data show fewer than 93% of kindergarteners are up to date on their vaccinations, down from the pre-pandemic level of 95%. Official exemptions increased in 40 states and DC, with 14 states reporting exemptions exceeding 5%. All told, approximately 280,000 children remain unvaccinated and unprotected against measles, including both those with exemptions and others who haven’t received the MMR vaccine.
These aren't just statistics. In early 2025, two unvaccinated school-aged children in Texas died from measles, along with one unvaccinated adult from New Mexico—the first such deaths in the U.S. in a decade. Of the recent measles cases reported nationwide, 96% occurred in people who were unvaccinated or had unknown vaccination status, putting entire communities – including those who cannot be vaccinated – at risk of severe illness, complications, and death.
Understanding the New Landscape
What we're seeing today isn't just another temporary drop in vaccination rates – it's something much bigger. Unlike past situations where vaccine hesitancy was tied to specific worries about a particular vaccine's safety or effectiveness, health departments are now facing skepticism about vaccines in general.
A January 2024 study from Columbia University published in BMJ found that vaccine misinformation is spreading on social media faster than health departments can counter it, driving up hesitancy rates at an unprecedented pace.
As misinformation spreads, recent changes in federal vaccine policies have left many people confused and uncertain about which vaccines are recommended for them and their families. This confusion has shaken their trust in public health agencies and made it harder for people to make informed decisions about vaccination.
For local health departments, this creates a perfect storm: declining trust in government health agencies, proliferation of misinformation through social media, and reduced federal support for vaccine promotion.
While some interventions show promise in changing attitudes, few have proven effective at getting people to roll up their sleeves and get vaccinated. This means local health departments are fighting an uphill battle with tools that may not be working as effectively as needed – all while communities face the very real threat of preventable disease outbreaks returning.
Vaccination figures prominently in public health strategic planning, but some changes can’t wait for the next strategy cycle. Health departments can begin acting now with a three-pronged approach designed to leverage every available tool and relationship in the fight to protect community health.
3 Strategic Approaches for Local Action
Despite the challenges, local health departments do possess significant advantages, including community trust, local knowledge, and the ability to form meaningful partnerships. Here are three evidence-based strategies that build on those advantages:
1) Show Transparency with Data-Driven Community Monitoring
Transform your immunization registry into a community engagement tool. Move beyond basic reporting to create targeted public-facing dashboards that build trust by demonstrating competence and providing actionable information to different community stakeholders. Research shows that as the number of unvaccinated children in a school increase, so does the risk of outbreaks, emphasizing the public health threat posed by declining vaccination coverage.
- Provide regular data analysis: Track vaccination coverage rates by neighborhood, school district, and demographic group.
- Create public transparency dashboards: Create visually compelling reports showing:
- Current vaccination rates by geographic area or by state
- Trending vaccination waiver requests by state and local jurisdiction
- School-specific coverage rates and exemption patterns
- Areas at highest risk for disease outbreaks
- Prepare community-specific reporting: Package data differently for parents (school-specific rates), healthcare providers (patient population gaps), and policymakers (policy impact correlations) using clear visuals and plain language.
- Monitor the policy landscape: With all but five states allowing non-medical exemptions – and many making these easier to obtain – it is important to know how exemption policy changes correlate with vaccination rates. Create quarterly policy impact reports and share findings with providers, schools, and the public.
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2) Build Trust Through Strategic Partner Communications
Move beyond centralized, one-way communication to build authentic partnerships that facilitate meaningful community conversations.
- Start a local immunization coalition including:
- Healthcare providers and health systems
- School administrators and nurses
- Faith leaders and community organizations
- Parent groups and representatives from communities with lower vaccination rates
- Provide regular partner support:
- Monthly briefings or newsletters on emerging misinformation trends
- Evidence-based messaging tools and talking points
- Training to address common vaccine concerns
- Conduct community listening: Use focus groups to understand specific hesitancy drivers – rural families, immigrant communities, and young parents each have different concerns.
- Focus on authenticity: People trust neighbors, faith leaders, and teachers more than government officials. Empower these trusted messengers with accurate information to counter misinformation where it spreads – in everyday community conversations.
3) Maximize Impact Through Resource Sharing
Pool resources, expertise, and infrastructure to deliver comprehensive vaccination programs that expand reach while reducing costs for all partners. Strategic resource sharing creates sustainable interventions that no single organization could implement long term on its own.
- Coordinate joint vaccination events:
- Partner with healthcare systems, FQHCs, and pharmacies regularly
- Share costs for staffing, supplies, and promotion at kindergarten registration, back-to-school events, community baby showers and health fairs
- Implement collaborative interventions: Partner with schools and clinics on reminder/recall strategies combined with dialogue opportunities.
- Exchange specialized expertise:
- Develop agreements to provide, share, or coordinate epidemiology and health education staff with smaller healthcare providers and neighboring health departments
- Develop agreements to provide, share, or coordinate outbreak investigation based on staff skills, capacity, competencies, and expertise
- Partner with local universities or establish academic health department relationships to strengthen existing staff knowledge and capacity through research collaboration and continuing education opportunities
- Share operational resources:
- Create mutual aid agreements for surge capacity during outbreaks or large vaccination campaigns
- Develop long term co-located clinics with specific healthcare partners including hospitals, clinics, pharmacies, and school health programs to share costs
- Pool funding for shared public information officers to coordinate messaging and outreach efforts across multiple organizations including pediatricians, health departments, school nurses, and community partners
- Engage media partners to amplify impact through coordinated, unified, and regular messaging
Turning Challenge into Opportunity
The current vaccine hesitancy trend, while daunting, presents an opportunity for health departments to redefine their role as essential community health leaders. Rather than viewing declining vaccination rates as an insurmountable problem, forward-thinking health departments can use this moment to build stronger, more resilient public health infrastructure that will serve communities for years to come.
Resource constraints are forcing innovation. With reduced federal funding, loss of key programs, and staff reductions at all levels, every action must maximize efficiency while maintaining impact. This reality demands strategic focus on high-impact, locally driven solutions that leverage existing community assets rather than relying on external support that may no longer be available.
Each of the three strategic approaches – data transparency, community partnerships, and resource sharing – serves a dual purpose: immediately addressing vaccination coverage gaps while strengthening the foundational relationships and systems that protect community health. These strategies also align with PHAB accreditation standards, helping health departments demonstrate excellence across multiple domains.
The Path Forward
With vaccination rates at 15-year lows and diminishing support at every level, local action is essential. The communities that will thrive are those where dedicated local staff, working with fewer resources but deeper commitment, take ownership of protecting their neighbors' health through strategic, resource-efficient approaches.
More than just tinkering at the margins, success requires a fundamental shift in mindset:
- From one-way communication to genuine community dialogue
- From population-wide messaging to targeted, culturally responsive interventions
- From standalone programs to integrated partnership networks
- From dependence on external resources to local innovation and collaboration
Turn resource constraints into competitive advantages. When you must be efficient, you become more strategic. When external support disappears, local partnerships become stronger. When staffing is lean, community relationships become more valuable. Health departments that embrace this reality will emerge as more resilient, more trusted, and more effective than those waiting for outside resources to return.
