A look at recent changes in state vaccine requirements for schoolchildren

Routine vaccination rates for kindergarten children have decreased since the start of the COVVI-19 pandemic, while exemptions from school vaccination requirements, in particular non-medical exemptions, have increased. These trends coincide with changing attitudes towards infantile vaccination, probably partly fueled by disinformation of vaccines. The past few years have seen more skepticism and confusion among the public on the safety and efficiency of vaccines, a decrease in the confidence of health authorities and an increasing partisan fracture. Changes in vaccine attitudes are reflected in recent policy changes at state level, state legislators with more than 2,500 bills related to the vaccine since 2021, with almost half of the vaccine requirements. In addition, Florida officials recently announced its intention to eliminate all school vaccination requirements. Despite these changes, recent KFF surveys have revealed that public confidence in routine vaccine safety like MMR remains high and about eight in ten parents (81%) as well as the vast majorities of parents who identify as democrats, independent and republicans support the current requirements of state vaccines, which should be held to respond to public schools and polio to respond to public schools Some exceptions. This political watch examines recent changes in state policy to the requirements of school vaccines and to what extent they can have an impact on vaccination trends.

States and local jurisdictions, not the federal government, have established a vaccine requirements For daycare and school entrance. The federal government, however, has a system based on long -standing evidence to approve and recommend vaccines for the public, including the vaccination calendar on childhood. The vaccination calendar on childhood is established by the centers for Disease Control and Prevention (CDC) on the basis of the recommendations of the Consultative Committee for Vaccination Practices (ACIP). APIP’s recommendations are used by many states to develop the requirements of school vaccines. The secretary of HHS, Robert F. Kennedy Jr. (RFK Jr.), who has long recommended the immunizations and the dissemination of disinformation of vaccines, led recent efforts to re-examine the federal calendar of childhood vaccines, replace the members of the AIPI and restrict vaccines against 19 COVI-19 and research on HRNM vaccines. In addition, the Trump administration recently published a report that calls for a new vaccine framework which includes the reassessment of the infant vaccine calendar and the fight against vaccine injuries.

All states currently require Children must be vaccinated against certain diseases in order to frequent public schools. School vaccination requirements are an important tool for reducing the spread of diseases and increasing vaccination coverage rates. The vaccinations required in all states and DC include MMR, DTAP, polio and chickenpox; Some states also require hepatitis A vaccines, hepatitis B, meningococcal and / or HPV. Currently, no state needs the COVVI-19 vaccine for school entry. Although it has not yet been promulgated, Florida’s plan to eliminate all school vaccination requirements would make it the first and the only state to do so. However, as the gap between red and blue states on health policy increases, more states may consider moving this direction.

All states authorize the exemptions from school vaccination requirements for medical reasons and almost all states (47 including DC) allow exemptions for religious and / or personal beliefs (Figure 1). This leaves four states (California, Connecticut, Maine and New York) which only allow medical exemptions. Studies have shown that higher exemption rates in school vaccination requirements are associated with lower vaccination coverage and an increased risk of flaming of diseases. During the school year of 2024-2025, the share of children demanding an exemption from the vaccination requirements of one or more vaccinations increased to 3.6%, the highest national exemption rate to date, against 2.5% in 2019-2020. The increases in non -medical exemptions represented recent increases, non -medical exemptions from 2.2% to 3.4% during the period. Vaccination rates and exemption rates vary considerably depending on the state, the share of children demanding an exemption from one or more vaccinations during the 2024-2025 school year ranging from 0.1% in California to 15.4% in Idaho.

Until now, at least 10 states this year have promulgated or issued changes related to routine vaccination requirements for children (Table 1). In the years following the pandemic, states have experienced an increase in policy proposals related to the vaccine. The pandemic stimulated an increase in the legislative activity of the States was initially concentrated on the authority at the level of the State to demand COVVI-19 vaccines. However, over time, when the response to COVID-19 has become more politicized, states have started to limit the mandates of COVVI-19 vaccine and to focus more on routine vaccination requirements (and exemptions to these requirements) in schools. In particular, most of the bills linked to the vaccine presented by legislators since the start of the pandemic have not been adopted, but ten states during the past year have promulgated or issued policy changes linked to the requirements of academic vaccination or childcare.

Almost all states (nine out of 10 states with recent changes) have made changes that could lead to more students to claim a non -medical exemption, which could reduce vaccination rates. Many of the recent changes (described in Table 1) will facilitate families with children in the middle of care or the school to obtain an exemption from non -medical vaccination. In particular, the governor of Virginia-Western signed a decree allowing exemptions from religious and personal beliefs in January 2025, although disputes are underway. Before 2025, West Virigina was one of the five states (now four states) which only authorized medical exemptions and had the highest vaccination rates and the lowest exemption rates in the country during the 2023-2024 school year (the latest data available for the State). In addition, the Idaho, the state with the lowest vaccination rates and the highest exemption rates during the 2024-2025 school year, transferred the control of the vaccines required to the Legislative Assembly and restricted medical mandates (probably weakening the application of the requirements of the school vaccine). These changes, in addition to the broader efforts of the State to develop the awareness and promotion of immunization, the changes to the recommendations of vaccines at the federal level and the reduction of federal government support for the health services of states and premises, could further increase the number of exemptions requested and reduce vaccination rates in children. Florida’s plan to eliminate all school vaccination requirements goes beyond the expansion of exemptions and would mark a major change in state vaccination requirements, although the problem should be addressed by state legislature.

At the same time, a state has brought a change that could maintain or increase children’s routine vaccination rates. Colorado recently adopted a law allowing the consideration of vaccination recommendations of external groups such as the American Academy of Pediatrics (AAP), not only the AIPI, during the development of the requirements of school vaccines. More states can evolve in this sense according to the result of the upcoming meeting of the APIP on the recommendations of vaccines and potential changes in RFK JR. at the Panel ACIP. In addition, the AAP has also recently reaffirmed their support for the elimination of non -medical exemptions in the midst of increasing exemption rates, and certain states, such as Massachusetts and Hawaii, propose to eliminate non -medical exemptions, although these changes have not been promulgated. Although the appointment of RFK JR. at the beginning of 2025 has probably stimulated additional efforts to loosen the requirements of the vaccine in many states this year, other states are working to ensure access to vaccines in the midst of changes in the federal level.