Immunization Laws Around the Nation

Many areas of medicine that intersect with law and immunizations are associated with a very specific set of laws across the nation. Three areas are heavily affected by vaccination authority laws: schools, health care facilities, and pharmacies that administer vaccinations.

The Journal of Law, Medicine & Ethics published a brief review article that summarizes vaccination laws across the United States.

All 50 states require children to be vaccinated before they can attend classes, and all states allow medical exemptions. Forty-seven states allow religious exemptions, and 18 allow philosophical exemptions.

The authors reviewed the 2014 California measles outbreak that resulted in 125 cases of active measles. Of these 80% were California residents. Almost half of infected patients were unvaccinated—67% of whom were intentionally unvaccinated—and public health officials were unable to determine vaccination status in an additional 43%. The authors noted that pursuant to this outbreak, many states began discussions about mandatory vaccination requirements. Vermont and California passed legislation that makes it difficult for parents to seek exemptions from mandatory vaccination requirements. However, changes such as these often lead to lawsuits.

Additionally, laws vary among states with regard to health care worker vaccination. Health care facilities may be required to know or ensure that their workers have been vaccinated, offer vaccinations, or direct unvaccinated workers to wear surgical masks in the workplace, as is the case in 3 states. State laws concerning hepatitis B, influenza, measles, mumps, pertussis, pneumonia, rubella and varicella vary significantly. At a minimum, most state laws address influenza vaccination.

The authors also discussed the use of pharmacist immunization to expand vaccine accessibility. Here, the variation in laws among states is significant, with more than 200 distinct legal variables reported across 51 state jurisdictions. The authors indicated that 3 legal provisions have a significant impact on pharmacists’ ability to vaccinate:

• Patient age restrictions affect access, and evidence indicates that in states where age restrictions are less stringent, vaccination coverage rises.
• Specific vaccine restrictions also challenge access. The authors noted that when manufacturers produce and the FDA approves new vaccines, some states have trouble keeping up. States that allow pharmacists to administer any vaccine approved by the Advisory Committee on Immunization Practices have less legal paperwork to complete as new vaccines enter the market.
• Third-party authorization requirements also affect patient access to vaccines and pharmacies. The authors indicated that many states require pharmacists to receive authorization from third-party payers before they administer vaccinations. The authors encouraged states to give pharmacists prescriptive vaccination authority, thus removing barriers to immunization.

Barraza L, Schmit C, Hoss A. The latest in vaccine policies: selected issues in school vaccinations, healthcare worker vaccinations, and pharmacist vaccination authority laws. J Law Med Ethics. 2017;45(1_suppl):16-19. doi: 10.1177/1073110517703307.