pharmacist at work

Pharmacists were the most common health provider to receive authority to administer vaccines.

Vaccines: Tracking Legislative Trends in 2021

By Erik Skinner | March 2, 2022 | State Legislatures News | Print

Vaccine policy tops the list of the most popular public health issues in NCSL’s new State Public Health Legislation Database. With more than 800 introduced bills in 2021, state activity spanned routine child vaccination, COVID-19 vaccination and population-wide vaccination policies.

Over half of the 800 bills proposed adding, removing or otherwise addressing vaccine requirements. At least 12 states enacted legislation to provide exemptions from vaccine requirements for public schools, institutions of higher learning or employers, while one state removed an exemption for school vaccine requirements. For example, Utah prohibited institutions of higher learning from requiring COVID-19 vaccination, and Connecticut removed religious exemptions for routine vaccinations for school children in grade 12 or below.

Over half of the 800 bills proposed adding, removing or otherwise addressing vaccine requirements.

Coming in second with nearly 150 bills introduced and 46 bills enacted, many states addressed vaccine insurance coverage and the provider workforce in 2021. Pharmacists were the most common health provider to receive authority to administer vaccines. Arkansas authorized pharmacists to administer recommended vaccines to children 3 and older. The bill also requires that pharmacists who administer vaccines to children 3 to 6 years old participate in the federal Vaccines for Children Program. California granted pharmacists authority to independently initiate and administer any COVID-19 vaccines approved or authorized by the FDA, as well as vaccines on the CDC’s recommended immunization schedules. Other providers granted vaccine authority include optometrists (New Jersey), podiatrists (South Carolina), dentists (Wisconsin) and cardiac/emergency technicians (Georgia).

On the insurance side, Rhode Island and Maine enacted legislation to require coverage for any service related to a COVID-19 vaccine or test and to prohibit cost sharing.

Just behind vaccine insurance and workforce bills were vaccine access measures, with 91 introduced and 11 enacted. For example, Mississippi sought to integrate vaccine programs for children into maternal health settings. The bill requires the state Medicaid program and department of health to coordinate and notify obstetricians and gynecologists that the Vaccines for Children Program is available to providers free of charge.

Finally, 88 introduced bills addressed vaccine registries and reporting. Virginia’s was one of 10 enacted measures. It requires health care providers administering immunizations to participate in the state immunization information system and report patient history and information.

Besides vaccine policy, the new database also tracks public health data collection and reporting, prevention of infectious disease and more.

NCSL would like to acknowledge the Centers for Disease Control and Prevention and the Pew Charitable Trusts for supporting the State Public Health Legislation Database.

Erik Skinner is a policy associate 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 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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