The NCSL Blog


By Noah Cruz, Charlie Severance-Medaris and Erik Skinner 

Public health was thrust into the spotlight in 2020 and states introduced more than 1,000 bills to tackle issues such as vaccines, public health data, prevention of infectious disease and more.

Doctor in hallwayTo track all this state action in 2021 and going into 2022, NCSL launched a new State Public Health Legislation Database.

The database is easy to navigate and serves as a convenient tool for keeping up with how state legislatures are curbing the spread of infectious diseases, governing the administration of vaccines, and building the capacity of public health systems. Bills from the 2022 legislative sessions are being added regularly.

At least 22 states introduced 66 bills related to health information technology and data interoperability as well as public health workforce capacity in 2021. Of these, 24 bills were enacted. For example, Nebraska required the sharing of certain information by health care facilities and health insurance plans and Nevada established a database to better track the state’s health care workforce.

The new resource includes legislation related to the prevention of infectious diseases, including school-based prevention, screening, treatment and syringe service programs. At least 32 states considered 105 bills, with 15 states eventually enacting 22 bills in 2021. Arizona authorized syringe service programs to reduce the incidence of overdose and bloodborne diseases. Several other states, such as Maine, expanded access to HIV prevention medications like pre and post-exposure prophylaxis.

Not surprisingly, vaccine bills account for most of the total legislation, with more than 800 bills introduced in 2021 across topics including vaccine requirements, vaccine insurance, workforce and provider authority, registries and reporting. Over half of the vaccine bills fall under the “requirements” topic that tracks state efforts to add, remove or otherwise address the vaccine requirement process.

At least 14 states, enacted legislation to provide or remove exemptions from vaccine requirements for public schools, institutions of higher learning and/or employers. For example, Utah prohibited institutions of higher learning to institute COVID-19 vaccine requirements and Connecticut removed the religious exemption for vaccine requirement for children in grade 12 or below.

In addition to this new tool, NCSL continues to track related public health legislation in the COVID-19 and Injury Prevention and Opioid Use Prevention legislation databases. NCSL also tracks school immunization requirements and exemptions on the States With Religious and Philosophical Exemptions From School Immunization Requirements webpage.

NCSL would like to acknowledge the Centers for Disease Control and Prevention and Pew for supporting this database.

Noah Cruz is a policy analyst, Charlie Severance-Medaris is a senior policy analyst and Erik Skinner is a policy associate in NCSL's Health Program. 

Email Erik Skinner

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About the NCSL Blog

This blog offers updates on the National Conference of State Legislatures' research and training, the latest on federalism and the state legislative institution, and posts about state legislators and legislative staff. The blog is edited by NCSL staff and written primarily by NCSL's experts on public policy and the state legislative institution.