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Objectives. To examine trends and characteristics of proposed and enacted state legislation that would directly affect states' immunization exemption laws.
Methods. We performed content analysis of proposed bills in state legislatures from 2011 to 2017. We classified bills as provaccination or antivaccination.
Results. State legislators proposed 175 bills, with the volume increasing over time: 92 (53%) bills expanded access to exemptions, and 83 (47%) limited the ability to exempt. Of the 13 bills signed into law, 12 (92%) limited the ability to exempt. Bills that expanded access to exemptions were more likely to come from Republican legislators and Northeastern and Southern states.
Conclusions. Although most proposed legislation would have expanded access to exemptions, bills that limited exemptions were more likely to be enacted into law. Legal barriers to exempt one's children from vaccination persist despite vaccine hesitancy, which is encouraging for public health.
Public Health Implications. Most vaccine exemption laws introduced in state legislatures would pose threats to the public's health. There is a need for constituents to engage their elected legislators and advocate provaccination policies. (Am J Public Health. 2019;109: 102-107. doi:10.2105/AJPH.2018.304765)
A primary goal of vaccination policy is to obtain and sustain a sufficient level of vaccinated individuals to establish community immunity against vaccine-preventable diseases. All states require vaccination of children enrolling in public schools and state-funded day care and often private schools as well.1 Although all states allow medical exemptions to this vaccination requirement (e.g., for immunocompromised individuals), all but 3-West Virginia, Mississippi, and, most recently, California-allow exempting for religious and, possibly, ideological reasons. The use of nonmedical exemptions increased nationwide by 19% between 2009 and 2013, from 1.6% to 1.9% among children in kindergarten, with substantial state by state variation.2 Private schools tend to have higher exemption rates than do public schools, although the exact reasons are unclear and likely multifactorial.3 Because some diseases require a very high threshold of immunized individuals for herd protection (e.g., > 90% vaccination coverage for pertussis4), vaccination exemptions may jeopardize community health if nonimmune individuals cluster together, even in states with overall high vaccination rates.5
Laws related to the procedures required to exempt one's children vary by state, and state law pertaining to childhood vaccination exemptions is dynamic and evolving. Many changes have occurred...