# Engaging school communities to prevent exemptions to kindergarten vaccination mandates

> **NIH ALLCDC U48** · UNIV OF NORTH CAROLINA CHAPEL HILL · 2024 · $350,000

## Abstract

ABSTRACT
Vaccine hesitancy, or the state of being conflicted about or opposed to getting vaccinated, is a “top 10” threat
to public health, according to the World Health Organization. In the United States, vaccine hesitancy among
parents has recently emerged as a particular concern because exemptions to kindergarten vaccination
mandates have increased almost 50% since the onset of the Covid-19 pandemic. At the same time, national
vaccination coverage among kindergarten-age children has fallen. For example, the proportion of
kindergarteners vaccinated against measles has dropped below the 95% needed to prevent community-level
transmission to 93%, with even lower coverage found in states such as Georgia (88%), Wisconsin (87%), and
Idaho (81%). Despite the public health importance of vaccination mandates, surprisingly little is known about
why parents are filing exemptions more often or what communities can do to support parents in ways that
prevent exemptions. School-based interventions are a promising way to address this research gap because
they can influence vaccine hesitancy and behavior by addressing vaccine-related perceptions, social norms,
and practical issues like vaccine accessibility. Thus, we propose to partner with school communities in
Georgia, Wisconsin, and Idaho to develop an intervention to prevent vaccine exemptions. In Aim 1, we will
characterize multilevel drivers of exemptions to kindergarten vaccination mandates. Working with 9
school communities with high exemption rates, we will use ethnographic methods, including observations and
in-depth interviews, to understand the reasons for rising exemptions. In Aim 2, we will develop a multilevel
intervention to reduce vaccine exemptions, in partnership with school communities. Using the
participatory method of group concept mapping, we will collaborate with parent partners and our school health
advisory board to prioritize targets for our intervention. Together, we will develop intervention components
drawing from evidence-based strategies for increasing vaccine uptake. In Aim 3, we will pilot the vaccine
exemption intervention in partnership with school communities. We will iteratively deliver and adapt our
intervention in our 9 study schools over two years. Our multimethod evaluation will examine pre/post-
intervention changes in intermediate outcomes related to vaccine perceptions, social norms, and practical
issues. To guide future implementation efforts, we will also evaluate implementation outcomes such as
acceptability, reach, and delivery cost. Exploratory analyses will assess changes in exemption rates and
vaccination coverage. The proposed study is designed to further the ARISe network’s goal of advancing the
science of immunization services by providing actionable data and scalable solutions to the growing problem of
exemptions to kindergarten vaccination mandates. If successful, this research will lay the groundwork for a
future cluster randomized effectiveness-implemen...

## Key facts

- **NIH application ID:** 11047214
- **Project number:** 1U48DP006839-01
- **Recipient organization:** UNIV OF NORTH CAROLINA CHAPEL HILL
- **Principal Investigator:** ALICE S AMMERMAN
- **Activity code:** U48 (R01, R21, SBIR, etc.)
- **Funding institute:** ALLCDC
- **Fiscal year:** 2024
- **Award amount:** $350,000
- **Award type:** 1
- **Project period:** 2024-09-30 → 2029-09-29

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/11047214

## Citation

> US National Institutes of Health, RePORTER application 11047214, Engaging school communities to prevent exemptions to kindergarten vaccination mandates (1U48DP006839-01). Retrieved via MORVS 2026-10-27 from https://api.morvs.ai/grant/nih/11047214. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*