In this Feb. 2023 OPB file photo, Clive James-May, 6, is comforted by his mother Madison James, as they attend a vaccination clinic at McDaniel High School in Northeast Portland. The clinic was in conjunction with Portland Public Schools and Multnomah County’s Education Service District, aimed to provide childhood vaccines for youth 5-19, before the immunization deadline in the schools.
Kristyna Wentz-Graff / OPB
Oregon kindergarteners are opting out of vaccinations at increasingly higher rates over the last four years. And public health officials are growing increasingly concerned. Oregon is one of just 15 states that allow parents to opt out of childhood vaccinations for nonreligious, nonmedical reasons. The current opt-out rate of 9.7% is the highest recorded in state history. Health officials say the measles and pertussis outbreaks in the state are an indication more work is needed to boost vaccination rates more broadly.
We get more details from Stacy de Assis Matthews, the immunization coordinator at Oregon Health Authority, and Dr. Paul Cieslak, medical director for the Acute and Communicable Disease Prevention Section and the Oregon Immunization Program at OHA.
Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. Oregon families are opting their kindergartners out of required vaccinations in record numbers. The current rate of non-medical exemptions for kindergartners is 9.7%, meaning about one in 10 of them did not receive at least one required vaccine for the current school year. Oregon health officials say that the recent measles and pertussis outbreaks are an indication that more work is needed to boost vaccination rates.
Stacy de Assis Matthews is the school immunization coordinator at the Oregon Health Authority [OHA]. Dr. Paul Cieslak is medical director for communicable diseases at OHA. They both join us now. It’s great to have both of you on Think Out Loud.
Stacy de Assis Matthews: Thank you.
Dr. Paul Cieslak: Thanks very much, good afternoon. Thank you.
Miller: Good afternoon. Paul Cieslak, first – Oregon has long had pretty high exemption rates for these non-medical exemptions, but now they’re higher than ever. Why?
Dr. Cieslak: I think there’s a variety of reasons. It never comes down to exactly one factor. To some degree, Oregonians exhibit an independent streak, where they don’t always go the way that the rest of the country goes, but I think more to the point is that there’s a lot of news or things that people can see on the internet and not all of it is accurate. They tend to follow it or listen to stories that they’ve heard. And it’s natural that people have concerns when there’s so much of this stuff floating around out there. I think some of them just get nervous and decide, “I think I’ll hold off on this decision to vaccinate my child.”
That’s my best explanation for it, but it’s important to remember that over 90% of parents are still getting their kids fully vaccinated. So it’s not like everybody agrees with this. It’s, I guess, an increasing minority.
Miller: Stacy, can you remind us what it takes now in Oregon for a family to opt their kids out of the required vaccinations?
Matthews: Sure. Oregon has had laws in place for over four decades now, requiring kids to have immunizations to go to school. Every kid’s immunization record is checked annually and a child who is behind has the opportunity to either be brought up on vaccines or to claim an exemption. And if a parent wants a non-medical exemption, then the current process that’s been in place since 2015 is that they need to turn in a vaccine education certificate showing that they’ve received education about vaccines – either from a healthcare practitioner or from an online vaccine education video from the Oregon Health Authority. And we see about 95% of parents who are claiming a non-medical exemption are watching that video.
Miller: Because it’s easier, I imagine, than going to a pediatrician?
Matthews: Many people have access to the internet right in their homes or on their phones, so they can take care of it there. But we also hear from health care providers who are counseling parents about vaccines and really strongly recommending these important public health measures that protect kids and our communities. They want parents to watch that video to reinforce that message.
Miller: I want to play just part of that video module, so listeners have a sense for what it entails. Let’s have a listen:
Oregon Health Authority Education Video [recording]: [Narrator speaking] In the U.S., vaccines must be licensed by the Food and Drug Administration. The FDA reviews data on each vaccine’s safety and how well it can be expected to prevent the disease. The FDA may determine that there aren’t enough data to license a vaccine and demand that more trials be done before licensure can be considered.
Once the FDA licenses a vaccine, the national Advisory Committee on Immunization Practices, or ACIP, a group of medical professionals and scientists from across the country, recommends whether children should get the vaccine and at what age. ACIP considers whether it can be given at a regular well-child visit and whether it can safely be given at the same time as other vaccines.
Getting a child vaccinated on schedule increases the likelihood that he or she will be fully protected.
Miller: Stacy, what do you think about that? And I should say that this is part of the introduction. It followed a broad explainer about the idea behind vaccines and it precedes a part that has more detail about some of the other federal safety frameworks that undergird vaccines.
But how do you think about what we just heard, in opposition to, say, YouTube streams or videos that are saying, in much more incendiary ways, maybe, or also more personal ways, the exact opposite – that vaccines are dangerous. I’m just curious what you think about the two streams of information against each other?
Matthews: This video is really meant to provide information for parents who are considering a non-medical exemption. This information is presented in a manner that you just heard: first, generally about vaccines and then about each individual vaccine. And it is really an informational video and not intended to be a persuasive video.
Miller: So the state does not have an interest in persuading people to get vaccinated? I’m curious about the distinction you’re making here. I understand not wanting to be seen as heavy-handed or pushing people to do something they don’t want to do, but isn’t it your job to convince people to do what’s best in terms of their health and public health?
Dr. Cieslak: Well, I’ll jump in here and say that part of our thinking when we created the video was that the best way to do that is really to give straight, even-handed information and not to sound like we were selling something. So, there is information about the diseases that the vaccines prevent, including potential consequences of those diseases, as well as the vaccine’s effectiveness and safety record. But we thought when they’re going to a government website, that they need to get it straight, if you will.
Miller: Right, and maybe … I’m just curious, what if getting it straight does lead towards more people should get vaccinated? I guess … how do you thread that needle?
Dr. Cieslak: Well, we think it does. I mean, obviously, we continue to endorse vaccinations strongly. So we do think that laying out the facts, if people are willing to consider the evidence, we think it makes a strong case for vaccination.
You know, what we can’t do is hype things and exaggerate either the incidence of the disease or completely negate the possibility of side effects. So we take seriously our responsibility to give all the facts.
Miller: Stacy, do you know the context in which people are watching this module, in general? I guess what I’m wondering is if people are watching these videos with open minds, taking in information that could lead them to actually get their kids vaccinated, or if many of them are just doing this as a kind of formality that’s on in the background so they can go forward with their plan to not get their kids vaccinated?
Matthews: As Dr. Cieslak mentioned, we have a couple of contributing factors for why people are claiming exemptions. Some people may be using the video as a formality because they have already made up their mind, but we do have people who have questions about immunizations and are considering vaccination.
And then we also have a challenge with some people who aren’t able to access immunizations in a timely manner here in Oregon. And Oregonians who want vaccines for their children may not always have access to them, resulting in some missed opportunities and lower vaccination rates, and driving them to the online module. For example, some people may not have a health care provider for their child. Maybe they recently moved here or changed insurance, and it can be difficult to get into a new provider. And since the pandemic, we’ve seen people who have a provider can’t always get in in a reasonable amount of time.
We actually, just through an administrative rule change that’ll take effect for next school year, are giving parents an extra week after the official notice goes out about the deadline in February, by which time they have to have their immunization documentation updated. They’ll get one extra week, so three weeks instead of two weeks to get those immunizations, for people who are looking for providers to talk to about getting immunizations but haven’t been able to do it in that narrow window, and potentially it was driving them to a non-medical exemption in the past.
Miller: Stacy, the OHA gives all of us a way to look school-by-school at immunization rates or opt-out rates, and there’s gigantic variations. Some school level opt-out rates are below 1%, others are above 60%. Most of those at the very high end are at online, or charter, or religious schools. When you see numbers that high, is there any effort to reach out proactively to entire school communities?
Matthews: That type of outreach really happens at the local level and we want to make sure that people who want to get vaccinated can get vaccinated. We work with schools, medical providers and local health departments, especially, and in addition, community-based organizations, with resources to reach out to those communities that they have those close connections with.
Miller: Paul Cieslak, what difference do you think the public backlash to COVID-era mask mandates, or social distancing guidelines, or vaccine mandates has had in what we’re talking about right now in 2025?
Dr. Cieslak: I do think it’s responsible for at least part of the increase that we’re seeing in exemptions, because in the minds of many of the public – and this is definitely encouraged by prominent voices across the internet, podcasting, and in the news and politicians – public health can’t be trusted. So in general, people’s trust in what we tell them has been knocked down a bit, such that there are a significant number of people anymore, I think, who just aren’t going to listen to anything that we say. So, we see a big part of our job is to counsel the doubtful.
There are people who have legitimate questions, and they’re willing to listen and review the data, and that’s what we want to lay in front of them so that they can make informed decisions, which, as I said, I think will end up on the side of vaccinating their children. But there is a group of people nowadays, I think probably larger than pre-COVID, who just aren’t willing to be persuaded by people like ourselves.
Miller: Where does that leave you? I mean, I’m curious if the answer then is to find trusted messengers who are very different from you, who could be allies in this. If, for some people, whatever you say is going to be heard as, at the best, uninformed, and at the worst, evil, part of some conspiratorial plot – what can you do to reach them in other ways?
Dr. Cieslak: I think you put your finger on it. Finding trusted messengers has been something that we’ve been working on. I think maybe Stacy can give you more details about that.
One thing that I know that I’ve done is to reach out to communities that were suffering from the measles outbreak in 2024 and try to find messengers who would be willing to speak to that relatively unvaccinated, close knit group of people.
Miller: Well, Stacy, I’d love to hear your thoughts on this as well. But, Dr. Cieslak, that was something like 31 or so cases in the summer of 2024. Did anything positive come from that outreach? Did you find people who would spread the word about vaccination after dealing with that in their own families?
Dr. Cieslak: I don’t know that we got anybody who, in their family, had a case of measles. We were mostly working with leadership in the community, and we did find people who were willing to endorse a vaccination as a way of stemming the outbreak and as an important public health measure. Whether they got a lot of people vaccinated in the wake of that, I actually couldn’t tell you. But that’s what we were trying to do and we met with some success, at least in engaging them.
Miller: Stacy, what do you think about building some kind of very different network of trusted messengers?
Matthews: The government, us here at the Oregon Health Authority, we’re a long way from people who are directly in the community. And it’s really important to have those trusted messengers in the community. Ways that we can support is by taking the immunization data that you mentioned, that shows each individual school’s immunization rates and making sure that those trusted messengers, people in the community, know about those.
The local health care provider who’s serving that community can take that information and say, “Look, your child attends this school. Its measles immunization rate is only 70%. That means there’s a bigger risk, if a case of measles came into this school, it could spread and turn into an outbreak and impact your individual child.” So we can play a supporting role in making sure people have the tools to have those conversations.
Miller: Paul Cieslak, the premise of my questions about the challenges facing you as a public health official, it didn’t take into account one of the most profound shifts in who is in charge of federal health care right now, which is RFK Jr., one of the most prominent disseminators of vaccine misinformation in our country’s history … I think it’s fair to say.
What difference do you think it means for everything we’re talking about to have someone like RFK Jr. in the role he is in?
Dr. Cieslak: I’m concerned about it. He has definitely made statements regarding vaccination that I think are inaccurate, that I disagree with strongly. And I don’t know the degree to which he’s going to impose those on the agencies that he’s working with.
To date, we’ve still seen CDC, the Centers for Disease Control in Atlanta, endorsing vaccination, particularly in response to the measles outbreak that was centered in Texas but is now involving several states. So the CDC is still endorsing vaccination, but I think it remains to be seen how much those sentiments will be reflected in federal government policy. But yes, I am concerned about it.
Miller: And finally, before we say goodbye, we’ve been talking about measles. I’ve mentioned pertussis at the beginning. What does the summer look like in terms of COVID?
Dr. Cieslak: Oh boy, you’re asking me to predict COVID, which I’ve never been very good at doing. I will say that we’re seeing a little bit of uptick in the percent of tests that are coming in positive lately, so we may be seeing the start of increasing numbers of COVID cases during the summer. I don’t know whether that will be sustained, though, and the positivity and numbers of people in hospitals still remain quite low compared to what we saw at some of the peak periods of the epidemic. So, not a big problem right now, but this may be warning us that it could be coming a bit.
Miller: Paul Cieslak and Stacy de Assis Matthews, thanks very much.
Dr. Cieslak: Thank you for your time.
Matthews: Thank you.
Miller: Paul Cieslak is the medical director for communicable diseases at the Oregon Health Authority. Stacy de Assis Matthews is school immunization coordinator at the Oregon Health Authority. They joined us to talk about the record level of non-medical vaccine exemptions among Oregon kindergartners this school year.
Note: The following transcript was transcribed digitally and validated for accuracy, readability and formatting by an OPB volunteer.
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