US States Ranked Lowest on 9 Essential Vaccination Indicators
States in the deep South and the West consistently ranked lowest on rates of flu vaccination across age groups, number of teens vaccinated against HPV, and older individuals with shingles vaccination.
Lowest influenza vaccination rate in children (6 mos–17 yrs)
Childhood flu vaccination rates remain uneven, with states like Mississippi, Wyoming, and Montana at the bottom.
In these states, fewer than half of children receive annual flu protection, compared to nearly double that rate in top-ranked Massachusetts. This gap leaves children — and their communities — more vulnerable during flu season.
Lowest HPV vaccination coverage (ages 13–17 yrs)
HPV vaccination is key to preventing cervical and other cancers, yet uptake is strikingly low in states such as Mississippi, Georgia, and Oklahoma.
Coverage in these states is about half the rate seen in Rhode Island, the top performer. These missed opportunities represent preventable cancer risk for thousands of adolescents.
Lowest MenACWY vaccination coverage (ages 13–17 yrs): Mississippi
Protection against meningococcal disease is lagging many states, with the lowest rates seen in Mississippi, Oklahoma, Alaska, Wyoming, and Montana.
Adolescents in these states are about half as likely to be protected compared to peers in high-performing states like Connecticut. Given the rapid, life-threatening nature of meningococcal infections, this coverage gap is concerning.
Lowest adult flu vaccination coverage: Mississippi
Once again, Mississippi was found lowest for the proportion of adults most likely to receive protection against a vaccine-preventable disease that can be deadly for certain populations.
Nevada, Arizona, Wyoming, and Louisiana make up the 5 states ranked at the bottom of 51-state ranking. The gap highlights ongoing challenges in reaching adults in states with lower population density and other barriers to health care access.
Lowest adult tetanus vaccination coverage: Mississippi
Adult tetanus booster coverage is particularly weak in Mississippi, Nevada, and Louisiana. In contrast, adults in Vermont are nearly twice as likely to be up to date.
Low booster uptake leaves adults at risk for a disease that is entirely preventable with routine vaccination.
Lowest shingles (zoster) vaccination coverage (≥60 yrs): Mississippi
Older adults in Mississippi, Kentucky, and Alabama are among the least likely to receive shingles vaccination.
Coverage is about half that of states like Vermont, despite the vaccine’s effectiveness at preventing painful and debilitating zoster infections. The gap is a significant one in protecting seniors’ quality of life.
Lowest 7-vaccine series* completion among children aged 19-35 mos living in poverty: California
Children who live in impoverished environments face additional barriers to completing the full 7-vaccine series, with California, Michigan, and Virginia performing worst.
In these states, fewer than half of children are fully vaccinated, compared with nearly all children in top-ranked Minnesota. This disparity underscores the importance of outreach and equity-focused vaccination programs.
*DTaP vaccine, poliovirus vaccine, Haemophilus influenzae type b, hepatitis B, varicella, pneumococcal conjugate vaccine
Highest uninsured population: Texas
Texas, Oklahoma, and Georgia lead the nation in rates of uninsured residents, with nearly 1 in 5 people lacking health coverage. By comparison, Massachusetts’ insured rate is 7 times better.
High uninsured rates create barriers to routine preventive care, including vaccinations, amplifying health disparities.
Lowest participation among children <6 yrs in immunization information systems: Alabama
Alabama ranks lowest in the nation for participation of children younger than age 6 years enrolled in immunization information systems. By contrast, participation in Washington, DC is nearly double.
An Immunization Information System (IIS) is a state- or city-managed registry that consolidates vaccination data from participating providers. It provides a reliable record of each patient’s immunization history, supports identification of missed or overdue vaccines, and provides official documentation needed for school, travel, or other requirements.
Weak registry participation hampers clinicians’ ability to track, remind, and ensure children stay on schedule with vaccines.
Immunization coverage varies dramatically nationwide, creating significant health disparities between regions. Although certain states maintain consistently robust vaccination programs, others face persistent challenges that expose their populations to heightened risks of vaccine-preventable disease outbreaks. WalletHub's comprehensive 2025 state-by-state evaluation examined vaccination performance across all 50 states plus Washington, DC, analyzing 16 distinct immunization indicators that were grouped into 3 key areas: immunization rates among kids and teenagers; adult and elderly vaccination rates; and uptake disparities and influencing factors. The metrics evaluated range from coverage rates for various diseases to the share of people without insurance.
Key Patterns Revealed
States exhibiting the lowest immunization rates typically struggle with inadequate public health infrastructure, substantial uninsured populations, and cultural or regulatory barriers to vaccination acceptance.
The Southeast emerges as a particular concern, with Mississippi, Alabama, and Georgia appearing among the worst performers nationally.
These WalletHub results underscore the significant obstacles facing public health officials working to protect vulnerable communities in underperforming regions. Suboptimal vaccination coverage elevates outbreak probability, intensifies emergency healthcare utilization, and compounds pressure on already overburdened medical systems.
The analysis further demonstrates how policy frameworks, healthcare accessibility, and community perspectives continue shaping population health outcomes.
