At Nervana Medical in Sandy, Utah, our commitment has always been to provide patients with trustworthy and evidence-based care. In today’s world, conversations around vaccines and COVID-19 are often influenced by politics, personal beliefs, or conflicting information online. Our mission is to remove the confusion and focus on what matters most: accurate, legitimate medical knowledge grounded in science.
We are proud to serve the communities of Sandy, Draper, Salt Lake City, and the surrounding Utah areas with reliable COVID-19 immunization guidance. Nervana Medical now provides prescriptions for the COVID-19 vaccine, available conveniently through telehealth or in-clinic visits for $35. To encourage proactive health, we are also offering a free intramuscular vitamin shot to any patient who brings in their updated vaccine record after receiving the immunization.
Our goal is simple: empower our patients with clear education, modern (traditional and functional) medical options, and supportive care that helps individuals, families, and communities stay healthier, safer and ultimately living their best lives! Over the next few weeks, we will be publishing a series of the top “debatable” questions and concerns and provide you with the most reliable studies and education backing these answers; and encourage ANY additional questions and concerns or desire for additional conversation to help facilitate any lingering thoughts that are left unanswered!
The top three recent government policy changes regarding vaccinations that may be considered counterintuitive for achieving herd immunity are:
- Expansion of nonmedical (religious or philosophical) exemptions for school-entry vaccination requirements. Several states have recently enacted or proposed laws that broaden access to nonmedical exemptions, making it easier for parents to opt out of vaccinating their children for personal or religious reasons. This policy change is counterintuitive because higher exemption rates are strongly associated with lower community vaccination coverage and increased risk of outbreaks, undermining herd immunity.[1][2][3][4]
- Legislation restricting vaccine mandates in employment, education, and public settings. Some states have passed laws that prohibit businesses, schools, or government entities from requiring proof of vaccination for employment, admission, or service. For example, Idaho’s Medical Freedom Act bans such requirements, even though these mandates have historically contributed to high immunization rates and community protection.[3]
- Judicial and legislative expansion of religious exemptions, including in states that previously did not allow them. Recent court decisions and legislative actions have forced states like Mississippi to introduce religious exemptions to school vaccine mandates, reversing decades of policy that contributed to high vaccination rates. This shift creates new opportunities for underimmunized clusters, increasing the risk of outbreaks and threatening herd immunity.[3][4]
These policy changes are considered counterintuitive because they facilitate lower vaccination coverage and increase the risk of vaccine-preventable disease outbreaks, contrary to the public health goal of achieving and maintaining herd immunity.[2][3][4]
References
- Trends and Characteristics of Proposed and Enacted State Legislation on Childhood Vaccination Exemption, 2011-2017. Goldstein ND, Suder JS, Purtle J. American Journal of Public Health. 2019;109(1):102-107. doi:10.2105/AJPH.2018.304765.
- Current Landscape of Nonmedical Vaccination Exemptions in the United States: Impact of Policy Changes. Bednarczyk RA, King AR, Lahijani A, Omer SB. Expert Review of Vaccines. 2019;18(2):175-190. doi:10.1080/14760584.2019.1562344.
- Threats to Vaccinations in the US. Gostin LO, Reiss D. JAMA Health Forum. 2025;6(6):e253290. doi:10.1001/jamahealthforum.2025.3290.
- Medical vs Nonmedical Immunization Exemptions for Child Care and School Attendance: Policy Statement. Hackell JM, Brothers K, Bode S, et al. Pediatrics. 2025;156(2):e2025072714. doi:10.1542/peds.2025-072714.
What are the ripple effects of recent policy changes (yet still very early in the aftermath of these decisions)?
Recent epidemiological data and outbreak reports consistently demonstrate that expansion of nonmedical exemptions, restrictions on vaccine mandates, and the introduction of new religious exemptions are associated with decreased vaccination rates and increased incidence of vaccine-preventable diseases.
National data from the 2023–24 school year show that kindergarten vaccination coverage for MMR, DTaP, polio, and varicella all fell below 93%, with exemptions rising to 3.3%—the highest ever recorded. Fourteen jurisdictions reported that more than 5% of kindergartners had an exemption from one or more vaccine, and coverage declined in the majority of states compared to the previous year. These declines are temporally associated with policy changes that have made it easier to obtain nonmedical exemptions or have restricted enforcement of vaccine mandates.[1]
The American Academy of Pediatrics states that states with less stringent restrictions on nonmedical exemptions, or that have introduced or broadened religious exemptions, have significantly higher exemption rates and lower immunization rates. This clustering of unvaccinated children within communities leads to local coverage insufficient for herd immunity, increasing the risk and size of outbreaks, particularly for measles, varicella, and pertussis.[2]
Empirical policy analysis of California’s 2016 elimination of nonmedical exemptions demonstrated a 3.3% increase in MMR coverage and a 2.4% decrease in nonmedical exemptions, with the largest improvements in counties with the lowest pre-policy coverage. Conversely, states that have expanded exemptions have seen the opposite trend, with increased clustering of unvaccinated children and higher outbreak potential.[3][4]
Outbreak investigations, such as the 2014–2015 Disneyland measles outbreak, have repeatedly shown that outbreaks originate in communities with high exemption rates and then spread to the broader population, confirming the real-world impact of these policy changes on both vaccination rates and disease incidence.[5][6]
References
- Coverage With Selected Vaccines and Exemption Rates Among Children in Kindergarten – United States, 2023-24 School Year. Seither R, Yusuf OB, Dramann D, et al. MMWR. Morbidity and Mortality Weekly Report. 2024;73(41):925-932. doi:10.15585/mmwr.mm7341a3.
- Medical vs Nonmedical Immunization Exemptions for Child Care and School Attendance: Policy Statement. Hackell JM, Brothers K, Bode S, et al. Pediatrics. 2025;156(2):e2025072714. doi:10.1542/peds.2025-072714.
- The 2016 California Policy to Eliminate Nonmedical Vaccine Exemptions and Changes in Vaccine Coverage: An Empirical Policy Analysis. Nyathi S, Karpel HC, Sainani KL, et al. PLoS Medicine. 2019;16(12):e1002994. doi:10.1371/journal.pmed.1002994.
- Spatial Clustering of Vaccine Exemptions on the Risk of a Measles Outbreak. Gromis A, Liu KY. Pediatrics. 2022;149(1):e2021050971. doi:10.1542/peds.2021-050971.
- Association Between Vaccine Refusal and Vaccine-Preventable Diseases in the United States: A Review of Measles and Pertussis. Phadke VK, Bednarczyk RA, Salmon DA, Omer SB. JAMA. 2016;315(11):1149-58. doi:10.1001/jama.2016.1353.
- Health Consequences of Religious and Philosophical Exemptions From Immunization Laws: Individual and Societal Risk of Measles. Salmon DA, Haber M, Gangarosa EJ, et al. JAMA. 1999;282(1):47-53. doi:10.1001/jama.282.1.47.
Recent Government Restrictions and the Effect of Access to Vaccines:
Recent government restrictions placed on certain vaccines have resulted in reduced access to vaccines. When recommendations for routine use are rescinded or coverage is restricted, insurers may no longer be required to cover the cost of those vaccines, creating financial barriers for lower-income populations. For example, the removal of COVID-19 vaccines for children and pregnant women from routine recommendations means that insurers and programs such as the Vaccines for Children program may not cover these vaccines, directly limiting access for millions of eligible individuals.[1]
Additionally, government-imposed mandates or restrictions can have unintended consequences. States that implemented vaccine mandates or restrictions saw lower uptake of COVID-19 boosters and influenza vaccines, particularly in populations already less likely to vaccinate, indicating that such policies can indirectly reduce voluntary vaccine adoption beyond the targeted vaccine.[2] During the COVID-19 pandemic, stay-at-home orders and guidance to postpone routine vaccinations led to sharp declines in vaccine administration rates for both children and adults, with rates remaining below pre-pandemic levels even after restrictions were lifted, further exacerbating access issues.[3][4][5][6][7]
In summary, government restrictions on certain vaccines decrease access by limiting insurance coverage, reducing public program eligibility, and creating indirect barriers to vaccine uptake and completion.[1][2][3][4][5][6][7]
References
- Changed Recommendations for COVID-19 Vaccines for Children and Pregnant Women. Gostin LO, Reiss D, Offit PA. JAMA. 2025;:2835581. doi:10.1001/jama.2025.10658.
- US State Vaccine Mandates Did Not Influence COVID-19 Vaccination Rates but Reduced Uptake of COVID-19 Boosters and Flu Vaccines Compared to Bans on Vaccine Restrictions. Rains SA, Richards AS. Proceedings of the National Academy of Sciences of the United States of America. 2024;121(8):e2313610121. doi:10.1073/pnas.2313610121.
- Impact of the COVID-19 Pandemic on Administration of Selected Routine Childhood and Adolescent Vaccinations – 10 U.S. Jurisdictions, March-September 2020. Patel Murthy B, Zell E, Kirtland K, et al. MMWR. Morbidity and Mortality Weekly Report. 2021;70(23):840-845. doi:10.15585/mmwr.mm7023a2.
- Decline in Receipt of Vaccines by Medicare Beneficiaries During the COVID-19 Pandemic – United States, 2020. Hong K, Zhou F, Tsai Y, et al. MMWR. Morbidity and Mortality Weekly Report. 2021;70(7):245-249. doi:10.15585/mmwr.mm7007a4.
- Childhood Immunization During the COVID-19 Pandemic in Texas. Nuzhath T, Ajayi KV, Fan Q, et al. Vaccine. 2021;39(25):3333-3337. doi:10.1016/j.vaccine.2021.04.050.
- Association of the COVID-19 Pandemic With Routine Childhood Vaccination Rates and Proportion Up to Date With Vaccinations Across 8 US Health Systems in the Vaccine Safety Datalink. DeSilva MB, Haapala J, Vazquez-Benitez G, et al. JAMA Pediatrics. 2022;176(1):68-77. doi:10.1001/jamapediatrics.2021.4251.
- Changes in Vaccine Administration Trends Across the Life-Course During the COVID-19 Pandemic in the United States: A Claims Database Study. Eiden AL, DiFranzo A, Bhatti A, et al. Expert Review of Vaccines. 2023 Jan-Dec;22(1):481-494. doi:10.1080/14760584.2023.2217257.
Public health is shaped by science, policy, and the people working behind the scenes. In our next update, we’ll share who is responsible for vaccine safety and why there have been disagreements at the CDC, FDA, HHS, and government level. Follow along as we continue to break down the facts and keep our community informed with clear, unbiased medical education.