Governments Reviewing Vaccination Strategies and Public Health Authority
In the United States, the federal government offers policy recommendations for vaccines, but the ultimate power to impose or revoke vaccine requirements and determine exemptions, outside of health emergencies, lies with the states. This decentralised approach to vaccination policy has been a topic of discussion, especially during the COVID-19 pandemic.
One of the strategies recommended by the Association of State and Territorial Health Officials (ASTHO) to prioritise evidence-based public health authority is to strengthen public health expertise in developing vaccination policy. This approach supports agencies in protecting and improving health.
Recent legislative actions in several states have seen a shift in the authority for determining school-based immunization requirements. For example, New Hampshire's HB 357 aims to remove the state health official's ability to add vaccines to the list required for school attendance. Similarly, Maine's LD 727 seeks to remove the health department's authority to determine school vaccine requirements as part of a larger repeal effort.
Moreover, some states have introduced legislation to prohibit the selling of food containing vaccine or vaccine material. In Idaho, H 290 removes the state board of health's authority to determine which immunizations are required for daycare and school enrollment.
The decline in routine vaccinations among U.S. children since the pandemic has raised concerns. Health officials have seen declines in coverage for several other vaccine-preventable diseases like pertussis, mumps, hepatitis, and polio. Vaccine-related myths have significantly contributed to this decline.
Interestingly, several bills introduced in Texas, West Virginia, North Carolina, and other states target shifting authority and/or modifying vaccine requirements for certain school types. Some states, like Iowa, have sought to prohibit 'gene-based vaccines' (i.e., those developed using mRNA or DNA technology).
In 2025, at least seven states introduced legislation to ban or limit the use of mRNA vaccines. However, there are no records indicating that in 2025 any states introduced laws transferring the authority of health agencies to the parliament to determine mandatory vaccinations for school attendees.
The 2025 measles outbreak marked the first measles-associated deaths in more than a decade, underscoring the importance of vaccination. Measles is now under threat of resurgence as vaccine rates fall below the thresholds to uphold herd immunity.
State health agency decisions rely heavily on input from experienced, knowledgeable, and skilled agency staff. State and territorial health agencies are foundational to preventing the spread of infectious diseases through vaccine education and administration.
These developments highlight the ongoing debate and evolving landscape of vaccination policies in the United States. As the pandemic continues, it is crucial to maintain a focus on evidence-based public health strategies to protect and improve the health of Americans.
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