‘I question it myself’: South Dakota vaccination rates fall amid mistrust and misinformation
Grant Vander Vorst is at the epicenter of vaccine hesitancy in South Dakota: Just 56% of incoming kindergartners in Faulk County, where he lives, were up to date on their measles, mumps and rubella vaccination during the 2023-24 school year, which was the lowest rate of any county in the state with available data.
Vander Vorst is the superintendent of Faulkton Area Schools. He said some parents are skeptical about the safety of administering multiple childhood vaccinations in a short window of time, “and justifiably so.” “I question it myself, and a lot of others do as well,” he said.
Vander Vorst said his views are influenced by U.S. Health and Human Services Secretary Robert F. Kennedy Jr., a longtime vaccine skeptic whose statements about vaccines have been called false and misleading by medical professionals.“I haven’t looked into the research, but he obviously has,” Vander Vorst said.
Tobin said a growing number of parents are trusting web posts and social media influencers over local health care professionals. “It used to be that I could start a discussion with a patient with the words ‘the CDC recommends,’” Tobin said, referencing the U.S. Centers for Disease Control and Prevention, “and now I’m cautious to use that because people don’t trust the CDC.”
During the 2018-19 school year, before the COVID-19 pandemic, 96% of kindergarteners in South Dakota received all their required vaccinations. That number fell to 91% during the 2023-24 school year, the most recent year of available statewide data.
Public health advocates are sounding the alarm about declining vaccination rates as the United States experiences its most severe measles outbreak since 2000, with over 1,000 confirmed cases across 31 states, including 12 confirmed cases in North Dakota. South Dakota has not had a confirmed case of measles so far this year, but last July, it reported its first measles case in nine years.
According to the CDC, a measles vaccination rate of 95% is needed to achieve herd immunity and prevent outbreaks, given the highly contagious nature of the virus.
Ten years ago, only six South Dakota counties had MMR rates below 95%, with the lowest being 80%. Now, more than 40 counties in the state are below 95%, with 12 below 80% and five below 70%. The rates could be even lower than the numbers indicate, because kindergarten-age students being homeschooled or attending other forms of alternative instruction are not required to report their vaccination status. There were 431 alternative-instruction kindergarten students statewide last fall.
The MMR vaccine is a key indicator for public health, said Dr. Amy Winter, an epidemiologist at the University of Georgia College of Public Health. When MMR vaccination rates fall, it signals broader vulnerabilities.
“Where there is measles, there could be other outbreaks, other infectious diseases, depending on the dearth of vaccination that may be happening,” Winter said.
Mark Sternhagen, a retiree who formerly taught at South Dakota State University, knows those risks well. He was born soon after the polio vaccine came out in 1955. He contracted polio before his parents were able to get him vaccinated, and has used a wheelchair ever since.
“There is absolutely no doubt in my mind that if I got the vaccine, I would not have gotten polio,” he said. “I look at these declining rates and it just makes me sick.”
Sternhagen said his mother carried guilt, but he doesn’t blame her. He said vaccinations in South Dakota were less accessible, and parents were less informed, but modern parents who do have access to vaccines and valid information don’t have those excuses.
“You’re putting your children and others’ children at risk, and there is no question about that,” he said.
Requirements and religion
The first laws requiring immunization appeared in the 1800s, coinciding with the development and spread of a smallpox vaccine.
In 1922, the U.S. Supreme Court upheld a local government’s vaccination mandate as a prerequisite to attending public school, leading states to implement similar requirements. States began allowing religious exemptions in the mid-20th century following advocacy from religious minorities, like the Christian Scientists.
Adherents generally rely on prayer over medical care, and often decline to vaccinate children, according to the Harvard Divinity School. South Dakota’s immunization law requires children entering school or early childhood programs to be immunized against poliomyelitis, diphtheria, pertussis, rubeola, rubella, mumps, tetanus, meningitis and varicella.
There are two exemptions in South Dakota’s law. One is a medical exemption for children with certification from a licensed physician that immunization would threaten their life or health. Those exemptions have remained steady over the past decade at 0.2% of kindergartners or less.
There’s also a religious exemption, requiring a written statement from a parent or guardian that the child is an adherent of a religious doctrine whose teachings are opposed to immunization.
Religious exemptions are growing in South Dakota, where 5.4% of kindergarteners had them last school year, compared to 1.5% a decade ago. In raw numbers, that’s a change from 181 kindergarteners to 636.
Tobin, the nurse practitioner and former legislator, said the claiming of a religious exemption is probably not religiously motivated in many cases.
“I do think they’re using that as this all-encompassing exemption, and so it’s probably something they just don’t believe in, but not necessarily something that is against the religion,” she said.
One factor contributing to South Dakota’s declining vaccination trend is falling rates among Hutterite people, members of a communal branch of the Anabaptist faith who have dozens of agricultural-based colonies in the state.
During the 2019-20 school year, six of the approximately 50 Hutterite colony elementary schools in the state reported vaccination rates of 0%.
Thirty-two of them did so during the 2023-24 school year. There are questions about the validity of the data. A state Department of Health dashboard shows some Hutterite colony schools with 0% of their kindergarten students vaccinated, but also shows some of those same schools with less than 100% of the students claiming a religious or medical exemption. South Dakota Searchlight asked the Department of Health and the Department of Education to explain the discrepancy but did not receive a full explanation from either department.
Searchlight followed-up by asking the departments what the state is doing to address the discrepancies.
“If any students are identified as neither vaccinated nor exempted (medical or religious), the accreditation team identifies that as a ‘finding, which requires the school district to resolve the deficit,” Department of Education spokeswoman Nancy Van Der Weide said in written statement. “If the school takes action to correct the situation within the allotted timeframe, the district receives accreditation. If they fail to do so, the school may be placed on probation or ultimately suspended.”
As of Friday, Van Der Weide had not identified which schools, if any, are currently on probation or facing suspension over vaccination exemption issues.
Upland Colony Elementary near Letcher, within the Sanborn Central School District, is one such school where the data does not add up. Laura Licht is an administrative assistant with the district. She said students at the colony have filed exemptions, and the data may not be getting pulled properly by the state.
Vander Vorst said his school district of 36 kindergarteners includes three Hutterite colony schools in its borders, and he said that likely contributes to the county’s low vaccination rate. The numbers show that Faulkton Area School’s kindergarten vaccination rate for required immunizations was 77% last year, while the rates for the three colony schools in the district ranged from zero to 50%.
Josh Oltmanns, CEO and elementary principal of Hanson School District, echoed that. The vaccination rate among kindergarteners at Hanson Elementary last year was 94%. The rates at the district’s colony schools were as low as 50%.“
I’d bet, if you look, a lot of these lower school districts have colonies,” Oltmanns said. “And that’s within those peoples’ rights.” It’s unclear why Hutterite people would be less supportive of vaccinations now than previously.
South Dakota Searchlight made multiple calls to Hutterite colonies and to educators who serve Hutterite students, but most were unwilling to speak about the potential reasons for vaccine hesitancy. An academic who studies the Hutterite faith said he doesn’t know why vaccination rates at colonies would be falling.
At one colony, a member who declined to provide her name said hesitancy is driven by the number of vaccines now being given to children.“They’ve added so many more,” she said. “It’s a risk we don’t want to take.”
Answering concerns
Medical professionals say those fears are unfounded.The CDC says vaccines contain weakened or killed versions of germs that cause a disease.
These elements of vaccines, and other molecules and micro-organisms that stimulate the immune system, are called “antigens.”
Dr. Allie Alvine, founder of South Dakota Families for Vaccines, said children encounter more antigen exposure during “one play session in a sandbox” than during an entire vaccine schedule.
“And the ones we expose a child to via vaccination are proven to be good for them,” Alvine said. “What we expose them to is targeted and saves lives.”
Dr. Ashley Sands, a specialist in pediatric infectious diseases with Sanford Health, said parents are more frequently asking questions about the efficacy of vaccinations. She finds herself debunking some of Kennedy’s claims, like rumored links between vaccines and autism. The claim that the MMR vaccine causes autism originated from a 1998 study by Andrew Wakefield, which was discredited due to serious methodological flaws, undisclosed conflicts of interest, and ethical violations.
Multiple large-scale studies since then have found no credible evidence supporting the claim. Wakefield lost his medical license, and his paper was retracted.
“The medical community can read the research it conducts,” Sands said. “Is it not far more likely Kennedy, who has never done medical research nor formally studied medicine, is misinterpreting or misrepresenting the data?”
Sands emphasized that vaccination recommendations are built on decades of peer-reviewed and replicated research.
“A good doctor is keeping up with the medical journals pertinent to their field and adjusting patient recommendations as our shared science evolves,” Sands said. “Meanwhile, Kennedy is using his position to push conspiracies.”
Sands also hears parents romanticize “natural immunity” over vaccination. She warns that natural infection with diseases like measles can be deadly. Plus, infants and immunocompromised people rely on those around them to be immune, blocking the disease’s spread. If enough people are vaccinated, the disease can’t reach those most at risk.
“A child with cancer should have the freedom to go to school without being exposed to illnesses that are easily preventable,” Sands said.
Vaccinations and Pierre politics
Alvine said vaccine misinformation has taken hold in South Dakota politics. She cited recent failed legislation targeting vaccines, including bills promoting “conscience exemptions” to vaccination mandates and separating blood donations based on COVID-19 vaccination status — all based on misinformation, Alvine said.
“They prey on parents’ fears,” Alvine said. “Once you instill fear, it’s hard to fix that.”
Republican House Majority Leader Scott Odenbach of Spearfish voted for the conscience exemptions bill. He said “the ‘trust the science’ phase of COVID” is why people are more vaccine hesitant.
“I think wisdom is needed to make the distinction between true public health emergencies and those situations, more often, where personal bodily autonomy has to remain inviolate,” Odenbach said.
Alvine said she’s trying to educate people to accept vaccines, not force them against their will.
“Anytime we can save a child’s life, to grow up and live, it’s worth it,” she said. “It’s not, ‘Most kids will get through it and be fine.’ They will be miserable. A portion will get lifelong, deadly diseases stemming from measles, and some will even die.”
Nearly every child in the U.S. caught measles before the vaccine became available in 1963. In 2000, health officials declared measles eliminated in the U.S. thanks to nearly universal vaccination.
The South Dakota Department of Health declined an interview for this story but provided a statement noting the downward trend in childhood vaccinations is concerning. The department highlighted ongoing marketing efforts, refreshed ad campaigns, and 1,700 more total immunizations – combined among children and adults – administered in 2024 than 2023.
“We can have a positive impact on all health outcomes, including childhood vaccination rates, by addressing access to care, social drivers of health care outcomes, and public awareness campaigns,” the department said.
President Donald Trump’s federal spending cuts have included $1.7 million in reduced or eliminated grants to the department, including $83,500 labeled as being for immunizations and vaccines for children.
