Public Health Authority Legislative Update

December 2023

Public Health Decision Making: School Vaccine Requirements


This marks our sixth Legislative Update and fourth focused on vaccinations. Why? Because while advancements in the public’s health would not—and will not—be possible without vaccines, they remain under attack. Schools have been key public health partners in previous efforts to fight vaccine-preventable diseases, such as the elimination of polio beginning in the 1950s. The vaccination of U.S. children born between 1994 and 2021 is estimated to have prevented 472 million illnesses and more than one million deaths, and saved nearly $2.2 trillion in total societal costs.

 

We add to the good news from past Legislative Updates about increased access to vaccines through expanded scope of practice laws (here and here), and celebrate a 0% passage rate for the bills discussed below, seeking to shift critical public health decision making away from public health experts. 


Bills Limiting Public Health Authority Regarding Vaccine Requirements

 

Let’s look at bills introduced in 2023 that would have limited public health powers to determine which vaccines are required for school entry—bills seeking to revisit who can decide which vaccines are required for students to attend school. These are critical public health decisions often exercised through administrative regulatory processes. Protecting this authority should be a priority for public health advocates, and indeed none of these 2023 bills passed. However, they are signs that we must remain vigilant to protect public health powers that are proven to improve the health and wellbeing of all people in our communities.

 

State laws establish school-entry vaccination requirements, and many states align their requirements with recommendations from the CDC’s Advisory Committee on Immunization Practices. The Advisory Committee is a body of health experts equipped with the knowledge and experience to make evidence-based recommendations about controlling vaccine-preventable diseases in the U.S.


With the heightened politicization of the COVID-19 response and the addition of the COVID-19 vaccine to the 2023 immunization schedule specifically, it became important to clarify who makes what decisions related to school vaccination requirements. Public health advocates must continue to demonstrate why public health expertise matters in public health decision making. We must understand both how current public health decisions are made and how those governance processes could be improved to better serve the public’s health.

 

Of bills seeking to revisit which state-level actors are responsible for determining which vaccines are required for school entry, none were enacted between January 1 and May 22, 2023. 

 

  • In total, 18 limiting bills were introduced in Indiana, Maine, New Hampshire, New York, Oklahoma, South Dakota, Texas (4), Virginia (3), West Virginia (3), and Wisconsin (2). 
  • Despite state legislatures not being designed or equipped to evaluate highly technical information, 15 of the 18 bills (83%) sought to vest state legislatures as the sole decision-making body, either explicitly or implicitly. 
  • The remaining 3 bills would have vested vaccine determination authority with parents (WV HB 2603) or physicians (WV HBs 2046 and 2536 would have shifted the authority for granting medical exemptions—the only exemption allowed in the state—from the health commissioner to individual physicians).

 

Congratulations to the public health advocates who achieved a 0% enactment rate for bills limiting public health powers to determine which vaccines are required for kids to attend school from January to May 2023! We look forward to continuing to support your efforts to improve the conditions for everyone to live healthy lives in the new year and beyond.

 

Explore the data on this topic, and more, on LawAtlas.org, and visit Act for Public Health to find additional resources, trainings, and a network of law and policy peers available to help you explore re-centering public health and health equity.

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