{"id":8774,"date":"2021-10-08T12:00:43","date_gmt":"2021-10-08T17:00:43","guid":{"rendered":"https:\/\/alpha.pewresearch.org\/pewresearch-org\/short-reads\/%year%\/%monthnum%\/%day%\/states-have-mandated-vaccinations-since-long-before-covid-19\/"},"modified":"2025-04-23T23:56:32","modified_gmt":"2025-04-24T03:56:32","slug":"states-have-mandated-vaccinations-since-long-before-covid-19","status":"publish","type":"short-read","link":"https:\/\/alpha.pewresearch.org\/pewresearch-org\/short-reads\/2021\/10\/08\/states-have-mandated-vaccinations-since-long-before-covid-19\/","title":{"rendered":"States have mandated vaccinations since long before COVID-19"},"content":{"rendered":"\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-640-wide\"><img decoding=\"async\" sizes=\"(max-width: 640px) 100vw, 640px\" src=\"https:\/\/alpha.pewresearch.org\/pewresearch-org\/wp-content\/uploads\/2021\/10\/FT_21.09.30_StateImmunizations_feature.jpg?w=640\" alt=\"Students at Huntington Park High School in California wait in line to submit proof of immunization.\" class=\"wp-image-401454\" \/><figcaption>Students at Huntington Park High School in California wait in line to submit proof of immunization. (Irfan Khan\/Los Angeles Times via Getty Images)\n<\/figcaption><\/figure><\/div>\n\n\n\n<p class=\"wp-block-paragraph\">Many Republican governors <a href=\"https:\/\/www.washingtonpost.com\/business\/2021\/10\/05\/osha-vaccine-requirement-republicans\/\">reacted furiously<\/a> after President Joe Biden said he would <a href=\"https:\/\/www.washingtonpost.com\/politics\/vaccine-mandate-federal-employees\/2021\/09\/09\/1c1ce9dc-116b-11ec-882f-2dd15a067dc4_story.html\">require employees<\/a> at large businesses to either get vaccinated against COVID-19 or submit to weekly testing. But Republican- and Democratic-led states alike already require hundreds of thousands of their citizens \u2013 infants, toddlers and schoolchildren, mostly \u2013 to be vaccinated against a panoply of diseases. In fact, mandatory childhood immunizations have been a feature of American society since the 19th century.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Currently, the Centers for Disease Control and Prevention\u2019s Advisory Committee on Immunization Practices recommends routine vaccination against 16 diseases from birth through age 18. The CDC recommendations, in turn, inform individual states\u2019 vaccine mandates: Typically, children who haven\u2019t received the required shots for their age can\u2019t attend school (public, private or parochial) or enroll in child care programs, though there are exemptions\u00a0<a href=\"https:\/\/alpha.pewresearch.org\/pewresearch-org\/short-reads\/2019\/06\/28\/nearly-all-states-allow-religious-exemptions-for-vaccinations\/\">for religious, medical or other reasons<\/a>.<\/p>\n\n\n<div style=\"border-width:1px;padding-bottom:var(--wp--preset--spacing--20);padding-left:var(--wp--preset--spacing--30);padding-right:var(--wp--preset--spacing--30);padding-top:var(--wp--preset--spacing--20);--block-gap: inherit\" class=\"is-style-alternate wp-block-prc-block-collapsible has-background has-ui-beige-very-light-background-color has-border-color has-ui-beige-dark-border-color\" id=\"how-we-did-this\" data-wp-interactive=\"{&quot;namespace&quot;:&quot;prc-block\\\/collapsible&quot;}\" data-wp-context=\"{&quot;collapsibleId&quot;:&quot;how-we-did-this&quot;,&quot;isOpen&quot;:false}\" data-wp-class--is-open=\"context.isOpen\" data-wp-init--scroll-into-view=\"callbacks.onInitScrollIntoView\"><div class=\"wp-block-prc-block-collapsible__title\" data-wp-on--click=\"actions.onClick\"><div>How we did this<\/div><button class=\"wp-block-prc-block-collapsible__icon\"><span data-wp-bind--hidden=\"context.isOpen\"><i class=\"icon icon-library__light icon__circle-plus\"><svg style=\"width: 1em; height: 1em;\"><use xlink:href=\"https:\/\/alpha.pewresearch.org\/pewresearch-org\/wp-content\/plugins\/prc-icon-library\/build\/icons\/sprites\/light.svg#circle-plus\"><\/use><\/svg><\/i><\/span><span data-wp-bind--hidden=\"!context.isOpen\" hidden><i class=\"icon icon-library__light icon__circle-minus\"><svg style=\"width: 1em; height: 1em;\"><use xlink:href=\"https:\/\/alpha.pewresearch.org\/pewresearch-org\/wp-content\/plugins\/prc-icon-library\/build\/icons\/sprites\/light.svg#circle-minus\"><\/use><\/svg><\/i><\/span><\/button><\/div><div class=\"wp-block-prc-block-collapsible__content\">\n\n<p class=\"wp-block-paragraph\">President Biden\u2019s new COVID-19 vaccine mandate ignited a political controversy. At the time, several news accounts pointed out that vaccine mandates <a href=\"https:\/\/www.nytimes.com\/2021\/09\/12\/us\/politics\/vaccine-mandates-republicans.html\">were common<\/a> at the state level, including in Republican-governed states. We wanted to know just how common such mandates were and how they differed from state to state.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">To find out, we searched state statutes and rules governing immunizations required for entry to schools and child care centers, by far the most widespread state vaccine mandates. We also consulted the websites of each state\u2019s health department and, when details were still unclear, news reports and other non-official sources.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Our information about recommended vaccines for infants, children and teens came directly from the <a href=\"https:\/\/www.cdc.gov\/vaccines\/schedules\/hcp\/imz\/child-adolescent.html\">Centers for Disease Control and Prevention.<\/a> For the history of vaccine development, approval and recommendations, we consulted the CDC and the <a href=\"https:\/\/www.fda.gov\/vaccines-blood-biologics\/vaccines\/vaccines-licensed-use-united-states\">Food and Drug Administration<\/a>, as well as histories maintained by <a href=\"https:\/\/www.historyofvaccines.org\/timeline#EVT_100832\">The College of Physicians of Philadelphia<\/a> and the <a href=\"https:\/\/www.chop.edu\/centers-programs\/vaccine-education-center\/vaccine-history\/developments-by-year\">Children\u2019s Hospital of Philadelphia<\/a>.<\/p>\n\n<\/div><\/div>\n\n\n<p class=\"wp-block-paragraph\">Under Biden\u2019s plan, all companies with more than 100 workers will have to either require their employees be immunized or undergo weekly testing. Biden also acted to mandate shots for <a href=\"https:\/\/www.nytimes.com\/2021\/09\/09\/us\/politics\/federal-employee-vaccine-mandate.html\">federal contractors and most federal workers<\/a>, and expanded a previously announced vaccine mandate for nursing-home workers to cover virtually <a href=\"https:\/\/www.usatoday.com\/story\/news\/health\/2021\/09\/10\/covid-biden-cms-requires-all-health-care-workers-get-vaccinated\/8272026002\/\">all health care workers<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Some states already mandate certain vaccinations for specific categories of adults. <a href=\"https:\/\/www.health.ny.gov\/prevention\/immunization\/laws_regs.htm#Facilities\">New York<\/a>, for example, requires that all workers in hospitals, nursing homes and other health care facilities be immunized against measles and rubella. Rhode Island requires <a href=\"https:\/\/health.ri.gov\/immunization\/for\/schools\/\">child care workers<\/a> to not only be immunized against several common childhood diseases, but to get an annual flu shot, too. Several states have specific vaccination mandates for college students.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">But in the main, most vaccine mandates apply to children and teens. We studied state laws, regulations and information from state health departments to assess how widely mandated the CDC\u2019s vaccine recommendations are.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><a rel=\"attachment wp-att-13402\" href=\"https:\/\/alpha.pewresearch.org\/pewresearch-org\/short-reads\/2021\/10\/08\/states-have-mandated-vaccinations-since-long-before-covid-19\/ft_21-09-30_stateimmunizations_2-png\/\"><img data-dominant-color=\"f0ede5\" data-has-transparency=\"false\" style=\"--dominant-color: #f0ede5;\" loading=\"lazy\" decoding=\"async\" sizes=\"auto, (max-width: 640px) 100vw, 640px\" height=\"1024\" width=\"999\" src=\"https:\/\/alpha.pewresearch.org\/pewresearch-org\/wp-content\/uploads\/sites\/20\/2021\/10\/FT_21.09.30_StateImmunizations_2.png?w=999\" alt=\"A map showing which states mandate which vaccines for K-12 enrollment\" class=\"wp-image-13402 not-transparent\" srcset=\"https:\/\/alpha.pewresearch.org\/pewresearch-org\/wp-content\/uploads\/sites\/20\/2021\/10\/FT_21.09.30_StateImmunizations_2.png 1280w, https:\/\/alpha.pewresearch.org\/pewresearch-org\/wp-content\/uploads\/sites\/20\/2021\/10\/FT_21.09.30_StateImmunizations_2.png?resize=293,300 293w, https:\/\/alpha.pewresearch.org\/pewresearch-org\/wp-content\/uploads\/sites\/20\/2021\/10\/FT_21.09.30_StateImmunizations_2.png?resize=768,787 768w, https:\/\/alpha.pewresearch.org\/pewresearch-org\/wp-content\/uploads\/sites\/20\/2021\/10\/FT_21.09.30_StateImmunizations_2.png?resize=999,1024 999w, https:\/\/alpha.pewresearch.org\/pewresearch-org\/wp-content\/uploads\/sites\/20\/2021\/10\/FT_21.09.30_StateImmunizations_2.png?resize=395,405 395w, https:\/\/alpha.pewresearch.org\/pewresearch-org\/wp-content\/uploads\/sites\/20\/2021\/10\/FT_21.09.30_StateImmunizations_2.png?resize=200,205 200w, https:\/\/alpha.pewresearch.org\/pewresearch-org\/wp-content\/uploads\/sites\/20\/2021\/10\/FT_21.09.30_StateImmunizations_2.png?resize=260,267 260w, https:\/\/alpha.pewresearch.org\/pewresearch-org\/wp-content\/uploads\/sites\/20\/2021\/10\/FT_21.09.30_StateImmunizations_2.png?resize=310,318 310w, https:\/\/alpha.pewresearch.org\/pewresearch-org\/wp-content\/uploads\/sites\/20\/2021\/10\/FT_21.09.30_StateImmunizations_2.png?resize=420,431 420w, https:\/\/alpha.pewresearch.org\/pewresearch-org\/wp-content\/uploads\/sites\/20\/2021\/10\/FT_21.09.30_StateImmunizations_2.png?resize=640,656 640w, https:\/\/alpha.pewresearch.org\/pewresearch-org\/wp-content\/uploads\/sites\/20\/2021\/10\/FT_21.09.30_StateImmunizations_2.png?resize=740,759 740w, https:\/\/alpha.pewresearch.org\/pewresearch-org\/wp-content\/uploads\/sites\/20\/2021\/10\/FT_21.09.30_StateImmunizations_2.png?resize=160,164 160w, https:\/\/alpha.pewresearch.org\/pewresearch-org\/wp-content\/uploads\/sites\/20\/2021\/10\/FT_21.09.30_StateImmunizations_2.png?resize=320,328 320w\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Of the 16 immunizations the CDC recommends for children and teens, all 50 states (plus the District of Columbia) mandate diphtheria, tetanus, pertussis (whooping cough), polio, measles, rubella and chickenpox. In addition, every state except Iowa mandates immunization against mumps. (The diphtheria, tetanus and pertussis vaccines usually are given as a single combined shot, as are the measles, mumps and rubella vaccines.) Except for the chickenpox vaccine, which became available in the United States in 1995, all those vaccines have been around for 50 years or more.<\/p>\n\n\n\n<figure class=\"wp-block-image size-640-wide\"><a rel=\"attachment wp-att-13406\" href=\"https:\/\/alpha.pewresearch.org\/pewresearch-org\/short-reads\/2021\/10\/08\/states-have-mandated-vaccinations-since-long-before-covid-19\/ft_21-09-30_stateimmunizations_3-png\/\"><img data-dominant-color=\"f6f5f3\" data-has-transparency=\"false\" style=\"--dominant-color: #f6f5f3;\" loading=\"lazy\" decoding=\"async\" sizes=\"auto, (max-width: 640px) 100vw, 640px\" height=\"648\" width=\"640\" src=\"https:\/\/alpha.pewresearch.org\/pewresearch-org\/wp-content\/uploads\/sites\/20\/2021\/10\/FT_21.09.30_StateImmunizations_3.png?w=640\" alt=\"A timeline showing currently recommended routine immunizations\" class=\"wp-image-13406 not-transparent\" srcset=\"https:\/\/alpha.pewresearch.org\/pewresearch-org\/wp-content\/uploads\/sites\/20\/2021\/10\/FT_21.09.30_StateImmunizations_3.png 1280w, https:\/\/alpha.pewresearch.org\/pewresearch-org\/wp-content\/uploads\/sites\/20\/2021\/10\/FT_21.09.30_StateImmunizations_3.png?resize=296,300 296w, https:\/\/alpha.pewresearch.org\/pewresearch-org\/wp-content\/uploads\/sites\/20\/2021\/10\/FT_21.09.30_StateImmunizations_3.png?resize=768,778 768w, https:\/\/alpha.pewresearch.org\/pewresearch-org\/wp-content\/uploads\/sites\/20\/2021\/10\/FT_21.09.30_StateImmunizations_3.png?resize=1011,1024 1011w, https:\/\/alpha.pewresearch.org\/pewresearch-org\/wp-content\/uploads\/sites\/20\/2021\/10\/FT_21.09.30_StateImmunizations_3.png?resize=400,405 400w, https:\/\/alpha.pewresearch.org\/pewresearch-org\/wp-content\/uploads\/sites\/20\/2021\/10\/FT_21.09.30_StateImmunizations_3.png?resize=200,203 200w, https:\/\/alpha.pewresearch.org\/pewresearch-org\/wp-content\/uploads\/sites\/20\/2021\/10\/FT_21.09.30_StateImmunizations_3.png?resize=260,263 260w, https:\/\/alpha.pewresearch.org\/pewresearch-org\/wp-content\/uploads\/sites\/20\/2021\/10\/FT_21.09.30_StateImmunizations_3.png?resize=310,314 310w, https:\/\/alpha.pewresearch.org\/pewresearch-org\/wp-content\/uploads\/sites\/20\/2021\/10\/FT_21.09.30_StateImmunizations_3.png?resize=420,425 420w, https:\/\/alpha.pewresearch.org\/pewresearch-org\/wp-content\/uploads\/sites\/20\/2021\/10\/FT_21.09.30_StateImmunizations_3.png?resize=640,648 640w, https:\/\/alpha.pewresearch.org\/pewresearch-org\/wp-content\/uploads\/sites\/20\/2021\/10\/FT_21.09.30_StateImmunizations_3.png?resize=740,749 740w, https:\/\/alpha.pewresearch.org\/pewresearch-org\/wp-content\/uploads\/sites\/20\/2021\/10\/FT_21.09.30_StateImmunizations_3.png?resize=75,75 75w, https:\/\/alpha.pewresearch.org\/pewresearch-org\/wp-content\/uploads\/sites\/20\/2021\/10\/FT_21.09.30_StateImmunizations_3.png?resize=160,162 160w, https:\/\/alpha.pewresearch.org\/pewresearch-org\/wp-content\/uploads\/sites\/20\/2021\/10\/FT_21.09.30_StateImmunizations_3.png?resize=320,324 320w\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Among newer childhood vaccines, though, state mandates are something of a mixed bag. Only two states (Alabama and South Dakota) don\u2019t require vaccination against hepatitis B at some point in a child\u2019s life, but about half (24) don\u2019t require it for hepatitis A. Just six states \u2013 five of them in the Northeast \u2013 require annual flu vaccines for child care or preschool enrollment, and none do so for K-12 students.<\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"alignright size-420-wide\"><a rel=\"attachment wp-att-13400\" href=\"https:\/\/alpha.pewresearch.org\/pewresearch-org\/short-reads\/2021\/10\/08\/states-have-mandated-vaccinations-since-long-before-covid-19\/ft_21-09-30_stateimmunizations_1-png\/\"><img data-dominant-color=\"e5e4e2\" data-has-transparency=\"false\" style=\"--dominant-color: #e5e4e2;\" loading=\"lazy\" decoding=\"async\" sizes=\"auto, (max-width: 420px) 100vw, 420px\" height=\"654\" width=\"420\" src=\"https:\/\/alpha.pewresearch.org\/pewresearch-org\/wp-content\/uploads\/sites\/20\/2021\/10\/FT_21.09.30_StateImmunizations_1.png?w=420\" alt=\"A chart showing which states mandate which vaccines for day care, child care or preschool\" class=\"wp-image-13400 not-transparent\" srcset=\"https:\/\/alpha.pewresearch.org\/pewresearch-org\/wp-content\/uploads\/sites\/20\/2021\/10\/FT_21.09.30_StateImmunizations_1.png 840w, https:\/\/alpha.pewresearch.org\/pewresearch-org\/wp-content\/uploads\/sites\/20\/2021\/10\/FT_21.09.30_StateImmunizations_1.png?resize=193,300 193w, https:\/\/alpha.pewresearch.org\/pewresearch-org\/wp-content\/uploads\/sites\/20\/2021\/10\/FT_21.09.30_StateImmunizations_1.png?resize=768,1196 768w, https:\/\/alpha.pewresearch.org\/pewresearch-org\/wp-content\/uploads\/sites\/20\/2021\/10\/FT_21.09.30_StateImmunizations_1.png?resize=658,1024 658w, https:\/\/alpha.pewresearch.org\/pewresearch-org\/wp-content\/uploads\/sites\/20\/2021\/10\/FT_21.09.30_StateImmunizations_1.png?resize=260,405 260w, https:\/\/alpha.pewresearch.org\/pewresearch-org\/wp-content\/uploads\/sites\/20\/2021\/10\/FT_21.09.30_StateImmunizations_1.png?resize=200,311 200w, https:\/\/alpha.pewresearch.org\/pewresearch-org\/wp-content\/uploads\/sites\/20\/2021\/10\/FT_21.09.30_StateImmunizations_1.png?resize=310,483 310w, https:\/\/alpha.pewresearch.org\/pewresearch-org\/wp-content\/uploads\/sites\/20\/2021\/10\/FT_21.09.30_StateImmunizations_1.png?resize=420,654 420w, https:\/\/alpha.pewresearch.org\/pewresearch-org\/wp-content\/uploads\/sites\/20\/2021\/10\/FT_21.09.30_StateImmunizations_1.png?resize=640,997 640w, https:\/\/alpha.pewresearch.org\/pewresearch-org\/wp-content\/uploads\/sites\/20\/2021\/10\/FT_21.09.30_StateImmunizations_1.png?resize=740,1152 740w, https:\/\/alpha.pewresearch.org\/pewresearch-org\/wp-content\/uploads\/sites\/20\/2021\/10\/FT_21.09.30_StateImmunizations_1.png?resize=160,249 160w, https:\/\/alpha.pewresearch.org\/pewresearch-org\/wp-content\/uploads\/sites\/20\/2021\/10\/FT_21.09.30_StateImmunizations_1.png?resize=320,498 320w\" \/><\/a><\/figure><\/div>\n\n\n\n<p class=\"wp-block-paragraph\">Three vaccines \u2013 against rotavirus, pneumococcal disease and <em>Haemophilus influenzae<\/em> type b, or Hib \u2013 typically are recommended for children younger than 5 years old. (Hib, despite what its name might imply, doesn\u2019t cause the flu, but it can cause a <a href=\"https:\/\/www.cdc.gov\/hi-disease\/index.html\">range of other ailments<\/a>, from mild ear infections to potentially deadly meningitis and blood infections.) However, while all but four states mandate the Hib vaccine for day care or pre-K, 10 don\u2019t require the pneumococcal shot, and only eight require immunization against rotavirus.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The remaining two vaccines, against <a href=\"https:\/\/www.cdc.gov\/std\/hpv\/stdfact-hpv.htm\">human papillomavirus<\/a> (HPV) and <a href=\"https:\/\/www.cdc.gov\/meningococcal\/index.html\">meningococcal disease<\/a>, are recommended for teens and older children around age 11 or 12. A majority of states (33, as well as D.C.) require the meningococcal vaccine, although Massachusetts is phasing in its requirement and Vermont only requires it for students living on campus. But only D.C., Hawaii, Rhode Island and Virginia <a href=\"https:\/\/www.cdc.gov\/hpv\/parents\/vaccine-for-hpv.html\">require the HPV shot<\/a>, which protects against cervical and other cancers but <a href=\"https:\/\/www.npr.org\/2011\/09\/19\/140543977\/hpv-vaccine-the-science-behind-the-controversy\">has been controversial<\/a> because HPV is transmitted sexually.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Vaccination mandates in the U.S. date back to the 19th century, when many cities and states started requiring children to be immunized against smallpox; the Supreme Court upheld such mandates in a <a href=\"https:\/\/tile.loc.gov\/storage-services\/service\/ll\/usrep\/usrep197\/usrep197011\/usrep197011.pdf\">landmark 1905 decision<\/a>. A combination vaccine against diphtheria, tetanus and pertussis became available in 1948, and it was quickly added as a routinely recommended shot.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In 1977, the World Health Organization\u2019s Expanded Program on Immunization <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/3176515\/\">set a goal<\/a> of giving every child in the world access to immunization against six diseases by 1990: dipththeria, pertussis, tetanus, polio, measles and tuberculosis, or TB. (Infants and small children are commonly\u00a0<a href=\"https:\/\/www.cdc.gov\/tb\/topic\/basics\/vaccines.htm\">vaccinated against TB<\/a>\u00a0in countries where the disease is prevalent. In the U.S., however, only children who are specifically at risk for contracting TB \u2013 or adults in high-exposure settings, such as health care workers \u2013 are offered the shot.)<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Republican- and Democratic-led states alike already require hundreds of thousands of citizens to be vaccinated against various diseases. 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