Social Identities and Vaccine Exemptions in the United States: The Role of Religiosity, Partisanship, and Vaccine Hesitancy

Nonmedical vaccine exemptions are increasingly common in the United States and threaten population immunity levels in children. While vaccine hesitancy and pediatric vaccination coverage in the United States have been extensively researched, work focused on vaccine exemptions remains relatively limited. The objectives of this study are to examine associations between parental religious, partisan, and vaccine-hesitant social identities and vaccine exemptions. A national, cross-sectional survey was conducted from August 20 through September 9, 2025. Parents and legal guardians of children five years of age or younger were recruited from an online panel and asked if their child had ever missed a vaccination due to a medical or nonmedical vaccine exemption. A total of 1,042 respondents were included in the data analysis, 72 of whom reported that their child did not receive a vaccine due to a nonmedical exemption. The prevalence of nonmedical vaccine exemptions differed significantly according to respondent race, partisanship, religiosity, and vaccine-hesitant identity. Multiple logistic regression modeling produced significant associations between nonmedical exemptions and race, education, religiosity, and vaccine-hesitant identity. These findings reinforce previously identified predictors of vaccine hesitancy in the United States but also extend the evidence base by explicitly examining predictors of vaccine exemptions.