Since 2021, lawmakers have generated more than 2,500 vaccine-related bills, about 400 of which were introduced during the 2024 legislative sessions, as reflected in NCSL’s State Public Health Legislation Database.
About 46% focused on vaccine requirements—particularly efforts to prohibit certain mandates (most related to COVID-19 vaccines) and to modify vaccine requirements and/or non-medical vaccine exemptions for schools or day care settings. Just over 20% of introduced bills addressed the vaccine workforce or insurance policies, with many aiming to expand pharmacy authority to administer vaccines. Other bills addressed a range of topics including requiring parental consent for vaccinating minors, providing information to parents regarding school vaccine requirements and exemption policies and reporting adverse outcomes or side effects related to vaccination
Enacted Legislation
About 9% of the vaccine-related bills introduced in 2024 were enacted into law. The most common type of enacted legislation related to the vaccine health care workforce and vaccine administration. These bills primarily expanded the scope of practice for pharmacists, pharmacy technicians and interns to administer vaccines. Some also extended authority to other professionals, such as physician assistants and emergency medical personnel.
After vaccine health care workforce bills, the most common type of enacted legislation last year had to do with vaccine requirements, with 12 bills enacted by eight states. For example, Washington, D.C., repealed a COVID-19 school vaccine requirement, and Louisiana prohibited COVID-19 school vaccine requirements. Idaho allowed students who are 18 to request exemption from school vaccine requirements. Utah exempted students enrolled in a home-based microschool from certain immunization requirements.
Vaccine-Related Bills, 2024
| Vaccine bill topic |
Number of bills introduced |
Number of bills enacted |
| Vaccine Access |
25 |
3 |
| Workforce/Insurance |
83 |
16 |
| Registries/Reporting |
38 |
1 |
| Vaccine Requirements |
205 |
12 |
| Other Vaccine Bills |
95 |
4 |
A Glance at 2025 Legislation
In the first three months of 2025, more than 370 vaccine-related bills were introduced across 44 states and Puerto Rico. About 42% of introduced legislation addresses vaccine requirements, including at least 35 bills related to modifying school immunization requirements and/or non-medical exemption polices. At least 15 bills propose prohibiting COVID-19 and/or mRNA vaccine requirements.
About 33% of 2025 bills address other vaccine-related polices. These include at least 22 bills addressing vaccination consent—primarily concerning parental consent for minors—and 10 bills addressing liability protections related to vaccine administration including for states, employers or manufacturers in cases of adverse reactions to vaccines.
As of March 31, four vaccine-related bills were enacted by Alabama, New Jersey, Tennessee and Utah regarding the transfer of immunization records for school enrollment and requirements for reporting vaccinations.
Childhood Vaccination Trends
Kindergarten Vaccination
Most vaccine-related laws apply to children and students. All 50 states and Washington, D.C., require certain vaccines for students to attend K-12 schools.
National kindergarten vaccination rates have decreased during the past five school years (2019-20 to 2023-24) to just below 93%—down from a steady 95% rate maintained during the previous decade, according to the Centers for Disease Control and Prevention.
This decline may impact community immunity (also known as herd immunity), which occurs when a high percentage of individuals are immune to a disease, typically through vaccination, and which reduces the chance of a disease spreading. The level of immunity required varies by disease: For measles, for example, at least 95% of the population needs to be vaccinated to maintain community immunity, according to the U.S. Department of Health and Human Services.
During the 2023-24 school year, national kindergarten vaccine coverage for measles, mumps and rubella (MMR) was 92.7%. This decrease equates to about 280,000 kindergartners attending school without documentation of completing the MMR vaccine series, according to the CDC.
Exemptions From School Vaccine Requirements
All states allow medical exemptions from school vaccine requirements. Additionally, 35 states and Washington, D.C., allow religious and/or personal belief exemptions. Five states do not allow any type of non-medical exemption.
The national exemption rate for kindergartners, including medical and non-medical exemptions, has risen in recent years. For the 2023-24 school year, the exemption rate reached 3.3% (0.2% medical and 3.1% non-medical)—the highest level reported in the U.S., according to the CDC. Exemption rates exceeded 5% in 14 states. The recent increase is primarily attributed to a rise in non-medical exemptions.
Respiratory Virus Vaccination Trends
States also enact laws regarding respiratory virus vaccination such as laws requiring hospitals to offer vaccines to older patients being discharged, for example in Georgia and Illinois. Vaccines are available for three main seasonal respiratory viruses: influenza (flu), COVID-19 and respiratory syncytial virus, or RSV.
Influenza Vaccination
During the current 2024-25 season, about 49.2% of children and 46.7% of adults received a flu vaccine. Adults ages 65 and older were more likely to receive a flu vaccine, with a rate of 71.8%.
Flu vaccination overall has declined by about 10 million-20 million doses over the past three flu seasons. Among pregnant women, flu vaccination has decreased from 57% in the 2019-20 season to 38% in the current season, according to the CDC.
The 2024-25 flu season has been severe across all age groups. As of mid-March 2025, the CDC estimates there have been about 560,000 hospitalizations and 24,000 deaths from flu, including more than 150 pediatric deaths.
COVID-19 Vaccination
Uptake of the updated 2024-25 COVID-19 vaccine has been highest among older adults. About 44% of adults ages 65 and older received the vaccine, compared with 23% of all adults and 13% of children.
The CDC reported deaths per week from COVID-19 ranged between 335-1,037 in 2025, through March 29. Most of these deaths occurred among adults ages 75 years and older.
RSV Vaccination
RSV is a common respiratory virus that can be serious for infants and older adults. RSV vaccines were first approved in 2023. The CDC recommends RSV vaccine for adults ages 75 and older. As of March 22, 2025, about 47% of adults ages 75 and older in the U.S. reported receiving the vaccine.
To protect infants, the CDC recommends either maternal RSV vaccination during pregnancy or administration of an RSV monoclonal antibody called Nirsevimab for infants. Each year two to three out of every 100 infants under 6 months of age are hospitalized with RSV. During the 2023-24 season, the CDC estimated that 56% of infants were protected from RSV through either maternal vaccination or Nirsevimab.
For more information on vaccine-related legislation, see the following NCSL resources:
Shannon Kolman is an NCSL senior policy specialist.