Internet Explorer 11 is not supported

For optimal browsing, we recommend Chrome, Firefox or Safari browsers.

Vaccine Bills Make a Comeback Amid Measles Outbreak

As once-eradicated diseases return, more and more states are debating legislation that would make it harder, or easier, for parents to not vaccinate their kids.

Anti-vaccine protesters hold signs in front of a government building.
Robert Kennedy Jr., left, stands with protesters rallying against a Washington state bill that would remove personal (but not religious) exemptions for the measles, mumps and rubella vaccines.
(AP/Ted S. Warren)


  • The CDC has confirmed 228 cases of measles, a preventable and once-eradicated disease, across 12 states.
  • Legislators have so far filed more than 130 vaccine-related bills in over 30 states this year -- a number so high that the current record of 184 could be broken.
  • The bills include pro-vaccine legislation that would make it harder to get exemptions from vaccine requirements and anti-vaccine legislation that would make it easier.
With measles outbreaks spreading across the country, 2019 is on track to be the busiest year yet for vaccine legislation in the states.

The Centers for Disease Control and Prevention (CDC) has confirmed 228 measles cases across 12 states this month. Clark County, Wash., has had 71 cases alone -- more than half of them children under the age of 10.

State lawmakers historically shy away from legislating immunizations, but with the return of once-eradicated diseases, bills making it harder, and easier, for parents to not vaccinate their kids have made a comeback of their own.

According to the pro-exemption National Vaccine Information Center, legislators have filed more than 130 vaccine-related bills in over 30 states this year -- a number so high that the current record of 184 could be broken in the coming months, the group told Politico.

From 2011 to 2017, the number of bills to change vaccine exemptions steadily rose, according to the American Journal of Public Health. In 2011, only 15 vaccine exemption bills were introduced -- that number jumped to 40 in 2017. A little more than half -- 53 percent -- were anti-vaccination bills proposing to expand access to exemptions.

Only three states -- California, Mississippi and West Virginia -- don’t allow any vaccine exemptions. Eighteen states allow people to be exempt from immunization requirements for both personal and religious reasons. The rest only allow one of those reasons.

Neal Goldstein, assistant research professor at Drexel University and co-author of the American Journal of Public Health study, attributes the uptick in legislation to the increase in outbreaks. As a result, he says, "constituents are becoming more aware that it’s something that is legislated."

Furthermore, anti-vaccine lobbying groups are "very aggressive and very well-funded," says Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine. They include Texans for Vaccine Choice, Colorado Health Choice Alliance and Informed Choice Washington.

But despite their lobbying, no state has passed a bill loosening exemptions since 2003. Experts say it's too soon to know whether that could change this year.

There is no debate in the scientific community about the efficacy of vaccines and their vital role in disease prevention. So why are anti-vaccination bills still getting introduced?

“The overwhelming majority of Americans get vaccinated and support vaccinations. But those that choose not to are more vocal and tend to catch the ear of their legislators,” says Goldstein.


Anti-Vaccine Bills

The majority of anti-vaccine bills filed in statehouses are to make exemptions easier to obtain. This year, seven states are currently weighing such legislation -- up from four states in 2018, according to information provided to Governing by the Association of State and Territorial Health Officials.

Nine states are considering "informed consent" bills that would require doctors to disclose the possible risks of vaccines -- up from six in 2018. The CDC insists that vaccines are overwhelmingly safe. Potential side effects are minor, last only a few days and range from fever to joint stiffness. 

Arizona has been a hotbed of anti-vaccination legislation this year.

The state currently has a personal belief exemption but is considering bills that would add a religious exemption. Also on the table is an informed consent proposal and legislation that would require doctors to offer an "antibody titer" test to show parents whether their child is already immune from a disease. Those tests, however, are not always accurate, according to the American Academy of Family Physicians.

Arizona Republican Gov. Doug Ducey, however, said he would veto any anti-vaccine legislation.

This comes on the heels of last year when the state cancelled a voluntary educational program on vaccines after outcry from the anti-vaccination community. The program offered parents who submitted a nonmedical exemption an online tutorial on the scientific benefits of vaccines. 

Nearby Texas is currently weighing a bill, H.B. 1490, that would remove the state's authority to track the number of vaccine exemptions. Goldstein says this is a fairly new tactic being pushed by anti-vaccine groups and lawmakers.



Expand nonmedical exemptions  
Require doctors to disclose risks  
Both types of legislation

SOURCE: Association of State and Territorial Health Officials, current as of March 2019

Pro-Vaccine Bills

Though anti-vaccination groups are vocal, there is also a flurry of activity in states to tighten vaccine requirements.

Six states are weighing bills to remove nonmedical exemptions. In Vermont, lawmakers could make theirs the fourth state with no exemptions. They're considering a bill that would remove the religious exemption after the state outlawed personal belief exemptions several years ago.

Washington state is poised to pass a bill that would remove personal (but not religious) exemptions for the measles, mumps and rubella vaccines. It was introduced by the lawmaker who represents Clark County -- the epicenter of the measles outbreak. It passed the House and is on its way to the Senate. John Wiesman, the state's health secretary is “cautiously optimistic” it will get sent to Democratic Gov. Jay Inslee's desk, and the governor -- a 2020 candidate for president -- has voiced support for the policy.

In New York, lawmakers are considering bills to remove nonmedical exemptions and to let teenagers who are 14 years or older get vaccinated without their parents' permission. The impetus for the latter bill was likely the Congressional testimony from 18-year-old Ethan Lindenberger, an Ohio teen who made headlines across the country when he talked about getting vaccinated against the wishes of his mother, who believed false information she read on the internet about vaccines.

Washington Health Secretary Wiesman testified alongside Lindenberger, calling for a national campaign to debunk anti-vaccine rhetoric on social media. In the meantime, he says he hopes state and local health officials can pick up the slack on misinformation in their community.

“There are a small number of people who will always refuse vaccines, and we have to counter their information," he told Governing. "There’s also a generation of kids who grew up with the idea that vaccines could cause autism who haven’t been vaccinated, like Ethan. There are a lot of Ethans out there; how can we reach them? We haven’t done a great job about that, and that’s on us.”

This appears in the Health newsletter. Subscribe for free.

Mattie covers all things health for Governing.

Special Projects