The numbers drop as the kids age. 

When kindergarteners arrived at Richmond Public Schools on the first day of the year, almost 89% were vaccinated — only a little less than the 90.7% of kindergarteners across the state who received their full slate of vaccines.

But from there, the numbers diverge. At the beginning of the 2024-25 school year, only 71.7% of Richmond public school seventh graders were considered adequately immunized, compared to 91.2% statewide. Twelfth graders were even worse: Just 58.2% of Richmond high school seniors had their full slate of required vaccinations, in contrast to an 84.7% rate statewide. 

“Oftentimes families can’t take off the work to go to doctor’s appointments and get these necessary vaccines that are required,” said Candiece Bourne, the coordinator of school health services for Richmond Public Schools. 

Furthermore, she noted, “As children get older, we tend to also see the trend of parents falling off, with, ‘Oh, my kid’s pretty healthy. They don’t need to go to the doctor every year.’”

But for public health experts, low vaccination rates are a cause for alarm, opening the door to outbreaks that can seriously damage people’s health — or even kill them. Between June 2022 and February 2025, a Virginia outbreak of meningococcal disease infected 41 people and left eight dead. In Texas, a measles outbreak has killed one school-aged child and hospitalized 20 others; state officials say they expect cases to rise because of low vaccination rates. 

Vaccines are “recommended for a reason,” said Dr. Elaine Perry, director of the Richmond and Henrico Health Districts. “The diseases that these vaccines help prevent are serious and in some cases can be fatal.” 

With immunization rates for the city’s youth lagging the state, Richmond Public Schools has emerged as a key provider of vaccines for students, particularly as they enter their teen years. Through outreach efforts by school nurses and in-school clinics offered in partnership with the health district, the division makes sure hundreds of students are vaccinated every year. 

“We make phone calls, we send letters,” said Bourne. “If we have a kid that comes in and they are behind, we have nurses that reach out to pediatricians and make appointments for families.” 

While state law requires students to receive certain vaccinations for enrollment in public schools, it also provides some flexibility. Besides religious and medical exemptions, students can be “conditionally” enrolled if they provide proof of having received at least one dose of the required immunizations as well as a schedule for completing them within 90 to 180 days, depending on the type of vaccine. 

Particularly among conditionally enrolled students, the division has made major inroads. Over the past three years, over 1,800 students have been vaccinated. This year, 773 rising 7th and 12th graders got vaccines between the end of September and the end of February, more than halving the pool of students who didn’t meet requirements when schools opened. 

Those numbers are expected to rise even further. School vaccination clinics, which this year run from Feb. 5 to March 26, are currently underway offering free immunizations for tetanus, diphtheria, whooping cough and meningococcal disease to rising 7th and 12th grade students at schools around the city. Parents are still required to sign a consent form allowing their child to be immunized.

“The goal of this effort is to try and bring these vaccines to the students literally where they are,” said Perry.

School nurses are a key part of the push. While Richmond Public Schools partners with the Richmond and Henrico Health Districts for the in-school clinics, vaccines are physically administered by the division’s nurses, who are more familiar to students and have had a chance to build up trust with families. 

“Sometimes families, when they go to the doctor's office, they feel intimidated,” said Bourne. “They feel more comfortable being able to ask the school nurse, well, why does my kid need this vaccine? Can you please break down to me what actually is it for? And we're able to do that.”

That also makes a difference for children wary of the pain a shot may cause. 

“Vaccines often have a negative connotation because it is a needle,” she said. “So we do a lot of hand holding and hugging and tear drying along with that.” 

The division’s efforts have been particularly crucial in the wake of the COVID-19 pandemic, which saw a decline in childhood vaccination rates as families avoided public settings like doctor’s offices during lockdowns, as well as rising hesitancy about vaccines fueled by misinformation spread on social media. The higher trust families have in school nurses have helped combat some of those effects, Bourne indicated.

“In the last three years since we’ve been doing this, we’ve seen a decrease in the distrust of vaccination, because we give parents the opportunity to ask the questions,” she said. 

Perry said while it’s still preferable for all children to have a primary care doctor who they can visit for all health reasons, including vaccination, officials realize that isn’t the case in reality. 

“This is a way to supplement but not at all replace” primary care, she said. “From a public health perspective, every child vaccinated is a success.”