Religious waivers for student vaccinations on Kauaʻi soared to 9.5% last school year from 5.7% during the 2018–2019 school year, leaving hundreds of school children at risk, state data shows.

Leading the pack is Hanalei Elementary School, where 42.5% of the public school’s 181 students had a religious waiver. At Alakai O Kauai, a charter school in Kōloa, 36.6% of the school’s 243 students were not vaccinated due to religious reasons.

The climbing rate of students on the Garden Isle with a religious waiver is higher than other counties and nearly double the statewide rate of roughly 4.9%, according to a new Hawaiʻi Department of Health report on public, private and charter school immunization rates. Experts say the trend is tied to eroding trust in health authorities and the influence of politics in family decision-making about medical issues.

Kauaʻi’s student vaccination rate falls below the 95% herd immunity threshold required to prevent disease outbreaks, especially measles. Immunization rates under this target increase the likelihood of an infection spreading from one person to another and put those who lack immunizations at higher risk.

Vaccine coverage has slipped across all counties in recent years. In the 2013-14 school year, roughly 99% of students across the state were fully vaccinated, according to a Civil Beat analysis.

State epidemiologist Dr. Sarah Kemble said in a statement that Hawaiʻi health regulators are concerned that vaccine misinformation may influence some parents and guardians to seek religious exemptions for their children based on faulty advice or misunderstandings. 

“While the decision to vaccinate is an individual one,” she said, “it also has implications for the health and safety of the broader community.”

Religious Waivers Easy To Obtain

In Hawaiʻi, parents can obtain immunization waivers for their children by claiming a medical or religious exemption.

Religious waivers are on the rise. The process to obtain one is simple: A parent or guardian completes and signs a form at their child’s school certifying that their religious beliefs prohibit vaccines.

Children can be exempted for medical reasons only if their doctors certify that vaccination would create undue risk.

While some people seek waivers for reasons that are sincere, Kemble said vaccine skeptics might inappropriately claim a religious exemption at the school their child attends. The state health department does not track the reasons behind such decisions.

The religious exemption rate is 9.1% for Hawaiʻi County, 3.3% for the City and County of Honolulu, 9.5% for Kauaʻi County, and 6.8% for Maui County.

The state health and education departments declined interview requests to discuss the most recent vaccination data.

Local Data Mirrors National Trends

Nationwide, a rise in non-medical vaccine exemptions for children is tied to more frequent outbreaks of measles and other preventable diseases. The double-dose measles vaccine, which is typically given at 12 to 15 months of age with a second dose at 4 to 6 years of age, is considered 97% effective when more people in a community have immunity. The improved measles vaccine used today was developed in 1968.

In the decade before the creation of the original 1963 measles vaccine, an estimated 2 million to 3 million Americans were infected every year, spurring 400 to 500 annual deaths and 48,000 hospitalizations, according to the U.S. Centers for Disease Control and Prevention.

There have been 44 measles outbreaks and 1,563 confirmed cases reported to the CDC so far this year, with 12% of infected patients receiving hospital care. 

Three measles deaths occurred in 2025. Two unvaccinated school-aged children died in Texas and an unvaccinated adult died in New Mexico. Previously, there had not been a measles death in the U.S. since 2015.

In Hawaiʻi, there were two confirmed cases of measles in April, followed by a wastewater sample detection of the measles virus in August.

On Monday, state health regulators reported a confirmed case of mumps on the Big Island. The case is not travel-related, suggesting that mumps may currently be circulating on the island, health officials said.

The Hawaiʻi County Department of Parks and Recreation temporarily closed Harold H. Higashihara Park in Kona to sanitize contact surfaces on Wednesday after the person reportedly infected with mumps attended an event there Sept. 25.

The last significant mumps outbreak in Hawaiʻi took place from March 2017 through October 2018, with 1,009 confirmed cases statewide. Most cases were on Oʻahu, but the Big Island, Kauaʻi and Maui also had confirmed cases.

Low vaccination rates of the combined diphtheria, tetanus and pertussis, or whooping cough, vaccine — a seventh-grade requirement — is likely contributing to the current surge in whooping cough cases in the state, health regulators said.

A fifth of all students, or nearly 40,000 children, were not up to date with Hawaiʻi’s required immunizations last school year. The largest gap is among seventh graders. More than half of seventh-grade students are missing at least some required vaccinations, compared to 15.6% of kindergarteners. 

Of the 399 schools that submitted data to health officials this year, more than three-quarters had more than 5% of their students missing at least some vaccinations. Two dozen schools reported having more than half their students behind on required immunizations. At six schools, more than 75% of students did not have all of their required shots.

Civil Beat’s reporting on Kauaʻi is supported in part by a grant from the G. N. Wilcox Trust.