VaxImpactMap Projects State-Level Burden of Declining Childhood Vaccination

Data released this year shows the continued trend of declining immunization rates of kindergarten-aged children in the US. As an example of this consequence, the country is in the midst of its worst measles outbreak in decades, with over 4,000 cases, hundreds of hospitalizations, and 6 measles-related deaths.

Researchers at Emory University’s Rollins School of Public Health recently released an expanded version of VaxImpactMap, an interactive tool that shows how declining childhood vaccination coverage could affect children, families, and health systems at the state level. VaxImpactMap estimates annual disease burden from sustained coverage reductions rather than predicting specific outbreaks or one-time events.¹ Public health departments, researchers, journalists, and advocacy organizations can explore the projections and state profiles.²

“We’re not predicting specific outbreaks, and we’re also not making predictions here,” said Benjamin Lopman, PhD, professor of epidemiology and global health at Emory University’s Rollins School of Public Health. “We’re saying what if.”

Lopman noted the projections do not account for individual behavioral changes during outbreaks or intensive public health responses, such as those seen with measles cases. The models also assume pathogens remain stable and do not project the emergence of new strains.

Nationally, a 10% decline in varicella vaccine coverage sustained over five years could result in approximately 337,000 additional cases, 3,100 hospitalizations, 35 deaths, and $737 million in additional annual health care and productivity costs. Each scenario assumes a sustained reduction, with burden accumulating over the selected period.¹

For pediatric respiratory syncytial virus (RSV), a 10% decline in immunization coverage is projected to produce 79,000 additional cases, 4,800 hospitalizations, and 11 deaths annually.¹ For rotavirus, the same decline corresponds to 385,000 additional cases, 5,500 hospitalizations, and 3 deaths annually.¹ Rotavirus illness alone could generate approximately $572 million in health care and productivity costs.¹

The tool also includes projections for pertussis, pneumococcal disease, and Haemophilus influenzae type b (Hib).¹ Users can select a disease, model coverage declines from 0% to 20%, and view projected cases, hospitalizations, deaths, missed workdays, productivity costs, and hospitalization costs.² The models are calibrated to current state-level coverage, birth rates, and disease surveillance data.¹

State-level Variation in Projected Disease Burden

Projected consequences differ substantially by state, reflecting differences in population size, birth rates, baseline coverage, and disease burden. At a 10% decline in coverage, Florida is projected to experience 380 additional rotavirus hospitalizations, compared with 37 in New Mexico.¹

Florida offers a case study in policy-driven risk. A proposed rule change in the state would end requirements for varicella, Hib, pneumococcal, and hepatitis B vaccines for school or daycare entry. Under a 10% decline in varicella vaccination over five years, Florida could see 25,000 additional cases, 222 hospitalizations, 2 deaths, and more than $50 million in associated costs.¹

Burden also varies by pathogen, not only by geography. For varicella, Florida and Texas face substantially higher projected burden than California, a gap driven by lower baseline coverage rather than population size alone.¹ The state profiles allow health departments and policymakers to compare local coverage against national benchmarks and review exemption policies and pending legislation.¹

States with lower baseline coverage “don’t have as much of a cushion,” Lopman said because further declines push them further below herd immunity thresholds. “These states with lower coverage have more to lose and more to gain by either declining or increasing coverage,” he said.

REFERENCES

1.Emory team expands VaxImpactMap to show consequences of declining childhood vaccination at the state level. News release. Emory University Rollins School of Public Health. September 15, 2026. Accessed October 14, 2026. [URL]

2.VaxImpactMap. Emory University Rollins School of Public Health. Accessed October 14, 2026. https://vaximpactmap.org