Vaccinations, Mandatory

Law and Policy

Compulsory vaccination requirements in the United States date back some two centuries, with Massachusetts becoming the first state to enact a compulsory smallpox vaccination that gave its state health board the right to require citizens to be vaccinated when the board determined that the best interests of the public health and safety were served. Compulsory vaccinations as a condition for school attendance soon followed, with early legal challenges to these requirements occurring in the late 1800s.

While the 50 states set the requirements for compulsory vaccinations, the federal Center for Disease Control (CDC) currently recommends that children receive the following vaccinations on a recommended schedule between birth and 6 years of age: hepatitis B (HepB); rotavirus (Rota); diphtheria, tetanus, and pertussis (DTaP); Haemophilus influenzae type b (Hib); pneumococcal (PCV); inactivated poliovirus (IPV); influenza; measles, mumps, and rubella (MMR); varicella (VAR) (chicken pox); hepatitis A (HepA); and meningococcal (MPSV4). While compulsory vaccination requirements as a condition for school entry vary from state to state, all jurisdictions require the diphtheria, tetanus, measles, and rubella vaccinations, and nearly all states require the hepatitis B and varicella vaccines.

As compulsory vaccination policies have evolved, so have policies regarding exemptions to these requirements. Currently, all 50 states provide for either temporary and/or permanent medical exemptions, with all requiring a physician's verification that one or more vaccines would pose detrimental risks to a child's health; a few states allow for verification to come from a chiropractor. In addition, 48 states [Page 868]provide for religious exemptions; the requirements for seeking and gaining a religious exemption vary from state to state, with most states providing that students with religious exemptions may be excluded from attending school in times of epidemic. Depending on the source, 17 or 18 states currently provide exemptions based on reasons of philosophy, conscience, moral convictions, and/or personal beliefs, with the first such exemption enacted by Idaho in 1978 and the most recent by Arkansas in 2005. Finally, at least one state, Texas, provides an exemption for students who are currently on active duty in the U.S. armed forces.

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