It’s concerning enough that the proportion of U.S. kindergartners exempted from school vaccinations has hit its highest level ever, but it’s especially disturbing that Hawaii saw the largest jump.

About 3% of kindergartners nationwide aren’t getting immunized, U.S. health officials said, and in Hawaii, the exemption rate rose to 6.4%, nearly double the year before.

These are safe and routine vaccinations, which used to be automatically done to start school. Pediatricians as well as school and health officials need to launch educational efforts to allay parental concerns, and turn the tide.