In West Virginia, a legal battle over school vaccine mandates reflects national tension

This is Part 2 of The Vaccine Divide, a data investigation into how an escalating movement against immunization is challenging public education, widening health disparities and threatening the health of America’s children.

When Marisa Jackson dropped her son Maxwell off at elementary school in St. Albans, West Virginia, in years past, she had the comfort of knowing that most, if not all, of the kids around him were vaccinated.

West Virginia was one of just five states in the country that allowed only medical exemptions to school vaccine requirements.

Sending Maxwell, age 10, to school this year felt different.

On his first day in office in January, the state’s Republican governor, Patrick Morrisey, issued an executive order allowing families to opt out of school vaccine mandates on religious or philosophical grounds.

That order — backed by Health Secretary Robert F. Kennedy Jr. — has ignited a legal battle involving multiple families and state agencies over what guidance should prevail.

In May, Jackson and a pediatric cancer doctor sued the state health department, which is in charge of granting exemptions, arguing that the exceptions could make Maxwell more vulnerable to getting sick.

Maxwell was diagnosed at age 2 with FOXG1 syndrome, a rare genetic disorder that prevents him from speaking and requires him to use a wheelchair and feeding tube. He’s vaccinated against childhood diseases, but would be at elevated risk of severe illness if an outbreak were to occur in his school.

Then, in June, three other moms in favor of relaxed exemptions sued the West Virginia Board of Education, which had said earlier that month that it would not enforce the governor’s order. A judge required the board to let the mothers’ kids attend schools for now.

The ongoing clash in West Virginia is a microcosm of the growing, nationwide tensions over vaccine mandates that swelled during the pandemic and have yet to subside.

According to an exclusive NBC News and Stanford University analysis, 53% of U.S. counties saw vaccine exemption rates more than double from the first year of available data to the most recent (states provided an average of 10 years of data).

The data investigation also revealed that a stunning 77% of U.S. counties have seen a decline in vaccination rates since 2019.

After Morrisey issued his executive order, West Virginia’s health department granted at least 463 nonmedical exemptions for K-12 students for the 2025-26 school year, a figure NBC News obtained via a Freedom of Information Act request.

In 2023, only 2% of the state’s kindergartners — around 300 children — weren’t up to date on their childhood immunizations. If the governor’s order holds up in court, West Virginia’s vaccine exemption policy could become one of the most permissive in the U.S.

While some states embrace exemptions and decry mandates as infringements on personal freedom, others are fighting to preserve vaccine requirements on the basis that they benefit public health and protect vulnerable people. The result is a fast-developing chasm in vaccine uptake and availability that could alter the country’s public health landscape for years to come.

Florida Surgeon General Joseph Ladapo said earlier this month that the state will work to eliminate all vaccine mandates for adults and children, a first in the U.S.

Meanwhile, states like Colorado, Massachusetts, New Mexico, New York, Pennsylvania and Washington are endeavoring to preserve access to Covid shots after the Food and Drug Administration narrowed its approval to only certain high-risk groups.

Public opinion is also increasingly divided. Most Americans — anywhere from 51% to 79%, depending on the poll — think kids should be vaccinated to attend school. But the belief in the importance of vaccines is lower than it was two decades ago, with a pronounced dip among Republicans since the pandemic.

But in West Virginia, where 70% of voters voted for Trump in the 2024 election, most favor vaccine requirements. In a 2025 poll from West Virginia MetroNews, 71% of respondents said states should require children to be vaccinated against highly contagious diseases before entering school. The lower house of the West Virginia Legislature also voted in March against a bill that would have allowed parents to submit written statements to their school administrator exempting them from vaccine requirements on religious grounds.

Aubrey Sparks, legal director of the American Civil Liberties Union of West Virginia, said the governor’s office is throwing the door wide open for anyone to claim exemptions.

“We’re going from the state that has arguably the narrowest pathway to getting vaccine exemptions to a state with one that is so unworkably broad that you’re just one email away from a kid not needing vaccinations, regardless of the impact that it has on their community,” Sparks, who represents Jackson, said.

Morrisey’s office did not respond to multiple requests for comment.

The competing lawsuit, filed in June, alleges three mothers were barred from enrolling their unvaccinated children in school, despite being granted religious exemptions by the state health department. Last month, a Raleigh County judge consolidated the case with Jackson’s, meaning he will consider them jointly.

The Board of Education plans to defend the school vaccine mandate and appeal the decision that let the kids return to the classroom for now. That appeal will be heard by the state Supreme Court, likely early next year.

Lawsuits against Covid vaccine mandates were abundant during the pandemic, but the legal battles playing out in West Virginia could presage broader attempts to roll back childhood vaccination requirements for dangerous illness such as measles, whooping cough, polio or diphtheria nationwide. A similar challenge in New York was recently appealed to the U.S. Supreme Court after it was struck down by a lower court in March. The plaintiffs, which include three private Amish schools, are pushing back on New York’s 2019 decision to end religious exemptions to its school vaccine mandate.

Last month, the Department of Health and Human Services said West Virginia was obligated to follow its Equal Protection for Religion Act in order to receive funding from the Vaccines for Children Program, putting pressure on the health department to grant exemptions. The program makes some vaccines free to kids who are uninsured or underinsured. HHS subsequently sent out nationwide letters reminding states that they could only get funds from the program if they complied with religious exemption laws.

“We will enforce conscience protections and defend every family’s right to make informed health decisions,” Kennedy said in a post on X.

Should the governor’s order stand, Jackson worries about breakthrough infections — the small number of infections that may occur in vaccinated people, particularly if there’s an outbreak — at Maxwell’s school as more families claim exemptions.

“I think that’s the point where public school would no longer be safe for him,” she said.

Even if Maxwell is immunized against the severe effects of a virus like measles, she said, a simple cough could lead to vomiting and pneumonia because he has difficulty clearing mucus on his own.

Doctors say it’s easy to forget how devastating vaccine-preventable illnesses can be, since vaccines have rendered them far less common and life-threatening. In today’s misinformation climate, they say, unfounded claims about adverse reactions may seem scarier than the known risks of viruses themselves.

“Vaccines are important for all populations. They’re specifically important for us because of our challenges with access to health care,” said Dr. Jeffrey Lancaster, an associate professor of pediatrics at West Virginia University.

West Virginia is one of the poorest states in the country and has some of the worst health outcomes. It’s also mostly rural, so many families have to travel far to see a doctor, making it harder to treat illnesses early.

Aaron Siri, a lawyer representing the plaintiffs seeking religious exemptions, pushed back on the idea that relaxing mandates would lead to health risks by noting there are many pathogens that children aren’t required to be vaccinated against.

“There’s no such thing as a child whose immune state renders them only susceptible to serious harm from the few pathogens for which vaccination is required to attend school in West Virginia,” he wrote via email. He deferred to court filings for questions regarding the case and said he would not allow his clients to speak to the media during active litigation.

According to the lawsuit, all three plaintiffs are Christian and say they object to “altering” their children’s immune systems through vaccination.

One plaintiff, registered nurse Miranda Guzman, “sincerely believes that God designed her child’s immune system with special care and with the well-designed ability to counteract disease,” the lawsuit says.

In her view, the suit adds, “to preemptively alter that immune system would demonstrate a lack of faith in God.”

This article was originally published on NBCNews.com