Declining childhood vaccination rates have left U.S. children vulnerable to preventable diseases like measles and whooping cough. State-level policies can facilitate or hinder a child’s access to vaccines, and so strengthening state policy commitment for vaccination is critical to protect public health.
Yet in the past five years, an increasing number of anti-science bills proposed at the state level would weaken childhood immunization programs, such as by weakening school vaccination requirements. The 2026 lawmaking season promises to be especially threatening to state-level public health protections. The International Vaccine Access Center (IVAC) at the Johns Hopkins Bloomberg School of Public Health explored these state-level policies and their impact in a recent webinar.
Following a significant increase in vaccine-related bills during the COVID-19 pandemic, state legislative interest in vaccines appeared to slow in 2024. However, the 2025 legislative season saw renewed attention to vaccine policy, a trend that is expected to continue when states reconvene in the coming months.
State Vaccine Policy Trends
The Association of Immunization Managers (AIM) tracked and categorized nearly 550 vaccine-related bills between August 2024 and June 2025. The most common themes that emerged were bills relating to vaccine requirements or exemptions, most of which proposed removing vaccine requirements or making it simpler to obtain an immunization exemption, as well as bills prohibiting discrimination in health care facilities, employment, or in public spaces due to an individual’s vaccination status. Also common were bills seeking to expand access to vaccination by removing cost barriers or giving health professionals like pharmacists and pharmacy technicians the authority to administer vaccines.
Though most bills did not pass, nearly 20% of bills that were introduced passed their chamber of origin, and more than half of those passed the second chamber. “While the vast majority of bills still are not reaching enactment, we’re seeing more vaccine-related legislation get closer and closer to the finish line each year,” said Jack McClure, State Policy and Research Associate Director for AIM.
These policies can have far-reaching impacts on vaccination access and uptake, with state-level coverage of key childhood vaccines like measles, mumps, and rubella (MMR) vaccine ranging considerably. State-specific policies on non-medical exemptions (NMEs) to immunization requirements also vary, with differing mechanisms that make it more or less convenient to obtain an NME. “The majority of the states by far have either highly convenient or moderately convenient exemption policies,” said Rose Weeks, a Senior Research Associate at IVAC. She explained that although we typically think of convenience as a good thing, in this case, adding some friction to the NME process can help to strengthen public health protections and control the spread of disease.
Voices From the Frontlines
The webinar also featured immunization advocates from three different states, who spoke about how their groups are working to strengthen vaccination in the face of policymakers seeking to reverse long-standing commitment to immunization programs. For example, the Louisiana Department of Health has shifted its messaging away from overt vaccination recommendations to instead suggesting that individuals should speak to their doctors and engage in shared decision-making. To combat these kinds of policies, advocates in Louisiana are tailoring their communication to better resonate with local values. "Louisiana is a very underserved region, we have a lot of natural disasters, and so there is this mentality that Louisianans take care of their neighbors,” said Crystal Rommen, Director of Louisiana Families for Vaccines. Framing vaccination as a way to keep your neighbors safe may therefore be an effective way to appeal to local communities.
Similarly, advocates in South Dakota shifted their messaging to reach business owners by emphasizing the economic benefits of immunization, said Carmen Toft, the Director of South Dakota Families for Vaccines. They are also careful in the language they choose, such as by referring to certain NMEs as “philosophical” exemptions rather than “conscientious” objections, since vaccines should not be a moral issue.
Beyond impacting vaccine uptake, state-level policies can also influence vaccine access. Oregon’s current financing model allows providers and clinics to access vaccines with no upfront costs, then reimburse the state once they have been paid by insurers. However, the current structure of this model is unsustainable, with new providers unable to enroll in the program and existing providers facing disenrollment due to funding shortages. Stakeholders are discussing the possibility of a more sustainable universal purchasing model that could greatly increase access to vaccines, particularly in rural areas in the state, said Meg Olson, State Director of Oregon Families for Vaccines. Other states can also expect to see new legislation introduced in the coming months that could impact the cost of vaccines.
