elderly woman receives covid-19 vaccine at a health clinic

Many states have adjusted provider scope-of-practice rules to enable more workers to contribute to mass vaccination efforts.

State Legislatures Tackle COVID-19 Vaccination

By Kate Bradford, Noah Cruz and Tahra Johnson | March 23, 2021 | State Legislatures News

One year into the pandemic, we are starting to see a light at the end of the tunnel. Rates of coronavirus cases, hospitalizations and deaths across the country have continued to decrease thanks, in part, to the accelerating pace of COVID-19 vaccinations.

Vaccination is one of the most effective public health interventions to prevent potentially life-threatening diseases and plays a key role in the multifaceted approach of pandemic response. Effective distribution and administration of vaccines protects the public, helps the population reach herd immunity and eventually can end a pandemic.

Policymakers across the country are working with their state health agencies on legislation that will streamline access to and increase public confidence in the available vaccines.

Below we address a few of the frequently asked questions NCSL receives on this issue.

What are we seeing across state legislatures?

The vaccine-related bills introduced in every state and the District of Columbia since last year number more than 300. Of them, 16 have been enacted—primarily to appropriate federal or state funds supporting vaccine efforts, to authorize more providers to administer vaccines or to outline certain components of state plans, including requirements for equitable distribution.

Among the 200-plus bills introduced during 2021 sessions, the majority relate to prohibiting COVID-19 vaccine mandates and facilitating greater access. Many states have adjusted provider scope-of-practice rules to enable more workers to contribute to mass vaccination efforts. Minnesota, for instance, authorized dentists to administer vaccines, and Virginia established a process for qualified health care providers to volunteer to administer vaccines during a state of emergency.

At least 19 states have introduced bills prohibiting employers from requiring the COVID-19 vaccine (for example, Tennessee), and several others have introduced bills limiting vaccine mandates generally (for example, Idaho) or limiting employers from taking action against employees who don’t get vaccinated (for example, Rhode Island). Still other states have introduced legislation limiting employer mandates for immunizations more broadly, not specific to the coronavirus or a state of emergency.

Other bills prioritize certain groups—for example, teachers in California—or building public awareness and combatting vaccine misinformation, as does a pending bill in Florida.  

What else should I know about state distribution and allocation?

So far, two states—Alaska and Mississippi—are offering the vaccine to all people 16 and older. Several states are not far behind. Ohio, North Dakota and Utah announced they will expand eligibility to all adults by the end of this month and at least a dozen more announced they will follow suit in April.

Rural and historically underserved Black and Hispanic populations were disproportionately impacted by the pandemic. State and federal policymakers have made a point of ensuring equitable distribution of and access to vaccines in these communities.

The White House COVID-19 Response Team recently reported that, due to accelerated vaccination efforts, eligibility restrictions may be lifted ahead of schedule. On March 11, the Biden administration directed state, tribal and territorial governments to make all adults eligible to receive a vaccination no later than May 1.

Where can I find more information and guidance on state vaccination efforts?

NCSL resources:

• NCSL is tracking bills related to the COVID-19 vaccine in our State Action on COVID-19 Database (under the topic Health: Vaccine). Since the 2020 legislative session, there have been over 300 bills introduced.

• NCSL’s COVID-19: State Health Actions webpage includes information on the COVID-19 vaccine.

• NCSL has developed several policy snapshots—state policy options, state examples, federal action, key resources, etc.—on priority health topics related to the COVID-19 pandemic. 

Several national organizations are keeping track of a variety of COVID-19 vaccine topics.

The Centers for Disease Control and Prevention provides information on vaccine safety and efficacy, planning and communications resources, and guidance for those who are vaccinated:

Safety of COVID-19 Vaccines

Possible Side Effects After Getting a COVID-19 Vaccine

COVID-19 Vaccine Rollout Recommendations

COVID-19 Vaccination Planning and Partnerships

Communication Resources for COVID-19 Vaccines

Building Confidence in COVID-19 Vaccines

When You’ve Been Fully Vaccinated

The Kaiser Family Foundation offers multiple resources tracking data and policies related to COVID-19 vaccination efforts at the state and federal levels:

COVID-19 Vaccine Monitor

State COVID-19 Data and Policy Actions

Global COVID-19 Vaccine Access: A Snapshot of Inequality

The National Academy for State Health Policy has resources tracking the phases of vaccine distribution across states and the disparities and inequities in access:

State Plans for Vaccinating Their Populations Against COVID-19

States Identify and Address COVID-19 Vaccine Disparities Through Targeted Rollout and Outreach

Kate Bradford and Noah Cruz are research analysts and Tahra Johnson is a program director in NCSL’s Health Program.

This project is supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $300,000 with 100% funded by CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, CDC/HHS, or the U.S. government.

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