Michigan is loosening the rules parents must follow to exempt their school-age children from vaccinations, moving from a mandatory in-person counseling requirement to a hybrid online process as the state confronts a measles outbreak and record-high opt-out rates, according to Kate Wells of KFF Health News, reporting in partnership with NPR.
The shift comes after more than a decade in which state health officials tried to make it harder for parents to send unvaccinated children to school. In 2015, Michigan began requiring parents seeking nonmedical waivers to attend an in-person vaccine education session at their local health department. That requirement drove a 32% drop in kindergarten waiver rates that year — a significant public health victory at the time, said Norm Hess, executive director of the Michigan Association for Local Public Health. But waiver rates began rebounding after that first year, and the COVID-19 pandemic plunged immunization rates lower still.
By 2026, the in-person sessions had become what local health officials described as counterproductive and dangerous for staff. Dr. Juan Marquez, medical director for Livingston and Washtenaw counties, said nurses were subjected to yelling and hostility. “Our nurses are just trying to do their job,” Marquez told KFF Health News. “And you can imagine, to have somebody yell at you or just say not nice things to your face and sit through that for hours is demoralizing.” He added that the sessions may have changed the minds of only one or two people out of 10,000 waivers issued over the past decade, leading him to question “If we’re not changing folks’ minds, can we do this in a safe way?”
Washtenaw County has had seven measles cases since March and is believed to be the source of an eighth in a neighboring county. As of May 28, the state had recorded 14 cases total this year. The highly contagious virus can cause brain swelling, deafness, and death, state Chief Medical Officer Natasha Bagdasarian noted. At schools where only 30% to 40% of students are now vaccinated, Bagdasarian said it is “simply not possible to keep diseases like measles at bay.” She warned that when measles cases enter low-immunization communities, “the ember really has a chance to expand and become a wildfire.”
State health officials began reconsidering the in-person requirement after Livingston County piloted a hybrid model in which parents took a 20-minute online course about vaccine benefits and the risks of preventable diseases, then made an in-person appointment to get their waivers signed. State immunizations director Ryan Malosh said he initially was skeptical. “We were worried that this could be sort of a sinkhole,” he told KFF Health News. But when waiver rates in Livingston County rose at the same rate as the rest of the state — suggesting the convenience of the online course did not itself drive more waivers — the state asked the University of Michigan to develop a standardized online course that any county could adopt. Under the hybrid model, parents complete the 20- to 30-minute course, answer questions about its content, and then go in person to get waivers signed.
About a third of Michigan’s 83 counties have adopted the hybrid approach, the state said. But St. Clair County, in Michigan’s conservative Thumb region, has gone further, allowing parents to bypass in-person signing entirely. Dr. Remington Nevin, the county’s medical director, told a January board meeting that parents who “felt pressured” into vaccinations “are going to experience a new era of vaccine choice in St. Clair County.” Parents there can apply for school vaccine waivers online and receive them by email days after filling out a brief digital form. State health officials have not challenged the move.
The tensions playing out in Michigan have deep roots in the state’s experience with pandemic restrictions. Michigan had some of the most polarizing COVID-19 lockdowns in the country, and the political backlash reshaped the landscape for public health work. Republican state Rep. Jennifer Wortz said at a vaccine-choice rally that her own waiver session at a health department felt demeaning. “I had a very negative experience there, simply because we made decisions as parents and did the research,” Wortz said.
Those resentments boiled over in St. Clair County last fall in a dispute involving a family whose children attended high school in neighboring Macomb County. The parents, Andrew Eberly and his wife, refused to obtain a state-recognized waiver because they did not want their children’s vaccination status recorded with local health officials. Eberly said at a November public health meeting that the requirement “forces parents like me to register personal health decisions” with a state he said he does not trust. School officials eventually asked the sheriff’s department to intervene. Body-camera footage obtained by KFF Health News through a public records request shows a deputy describing the counseling requirement as a set of “stupid hoops” while warning the Eberlys that continuing to send their children to school without a waiver could result in criminal charges for contributing to truancy.
The clash became a local cause célèbre. At a January health board meeting, Nevin seized on the dispute as evidence that Michiganders who distrust the public health establishment “have sound reasons for doing so.”
Malosh, the state immunizations director, said state officials are emphasizing the importance of parents understanding the risks of vaccine-preventable diseases rather than engaging in conflict with counties that have adopted the loosest waiver procedures. “Local health departments get to decide for themselves in a lot of ways what’s best for their residents,” Malosh said. “I think that what’s best is to be as upfront as possible, to be as truthful as possible, and to try to give the best information that we have available to us to parents so that they can actually make an informed decision.”