There is a lot of confusion—even among doctors—about whether certain vaccines are recommended or mandated. So it’s not unfair to question if your child should get every vaccine their pediatrician says they should.
This article takes a closer look at vaccine mandates and why they vary depending on where you live. It includes a few reasons why people choose to opt out of vaccines. It also dispels a few myths that stop people from getting them.
Are Vaccines Required in Schools?
All U.S. states have vaccine requirements, but these differ from state to state. Though the vaccines on the CDC’s recommended schedule are only recommended, some states may opt to mandate them to prevent the spread of vaccine-preventable diseases among school children.
For school-mandated vaccinations, each state makes its own list of vaccines that are required for a certain age or grade. Parents who don’t comply and provide evidence of the vaccination will typically be barred from having their kids attend school.
As straightforward as this might seem, there are challenges and barriers that affect how these mandates are issued and implemented. These include:
Variations by region: Vaccine mandates vary widely throughout the country, and sometimes within individual cities or school districts. For example, students in one city may be required to have at least one dose of the meningococcal vaccine before 8th grade, while students in a neighboring city may not. Variations by governing authorities: The body authorized to issue mandates also varies by state. Some states might pass legislation to mandate vaccinations statewide while others let the state health department decide. Others still may offer city councils or school districts room to effect their own mandates when appropriate. Variations in legislation sessions: The frequency of mandate reviews can also vary depending on how often the state legislature meets and how long it takes for legislation to be passed. In such cases, it may take years to update vaccine requirements after a new CDC recommendation.
Can Vaccines Be Required by Employers?
In some states, employers are prohibited from mandating vaccinations. In others, employers can require vaccinations, with certain limitations.
Employers that have vaccine mandates are expected to give religious and medical exemptions to employees that qualify for them, as long as those exemptions don’t create hardship for the business. This means the employer has to provide “reasonable accommodations” for employees who can not get vaccinated because of a disability or legitimate religious belief.
When and if an employer terminates an employee for not complying with a mandate, they also have to be able to prove they did not discriminate against that person.
Vaccine Mandates for Travel
As of 2022, you don’t need to provide proof of COVID vaccination to fly within the United States. However, travelers flying into the United States from other countries are required to be fully vaccinated.
If you are traveling from the U.S. to another country, it is important to check the travel restrictions for your destination. Some countries still require that you are up-to-date on your COVID-19 vaccination before you can travel there.
Military Vaccine Mandates
As of 2022, military service members on active duty and in selected reserve were also required to be fully vaccinated against COVID-19. Other vaccines may be recommended for military service members who are traveling to areas where certain infectious diseases are present.
Who Sets Vaccine Recommendations?
Every year, the Centers for Disease Control and Prevention (CDC) publish a recommended immunization schedule for the United States. This schedule is put together by a panel of 15 experts known as the Advisory Committee on Immunization Practices (ACIP).
The ACIP panel is comprised of experts in medical and public health fields. Doctors, researchers, infectious disease specialists, and community representatives are all part of the panel.
The schedule’s purpose is to provide people with the maximum protection from vaccine-preventable diseases as safely as possible. The schedule is organized according to the age ranges in which the recommended vaccinations should be given.
This schedule is updated every year to ensure that it is always based on the most up-to-date research. Medical professionals across the country use it to immunize their patients, and state governments follow the recommendations to determine which vaccines should be required (or mandated) for school.
Challenges in Implementation
A number of variables can also influence how policies are enacted, including politics, cultural norms, and practicality. None of these issues should be minimized.
For example, while annual flu vaccination is recommended by the CDC and may be mandated for school children within a state, requiring families to prove compliance every year would not only be burdensome but costly.
Parents and public opinion also play a role. In recent years, states that have mandated the human papillomavirus (HPV) vaccine to prevent the spread of the sexually transmitted disease have been faced with protests from community members who believe that doing so promotes teen sex.
Such an event occurred in New York State in 2019 when state officials mandated the HPV vaccination for students aged 11 to 12.
States can also require vaccines for specific groups, such as college students or nursing home employees, while individual schools or employers may issue mandates as well (such as hepatitis B and COVID-19 vaccinations for hospital workers).
Opting Out
The concept of “forced vaccination” is a concept largely promoted by anti-vaccination (“anti-vaxxing”) activists. It suggests that the government is forcing them or their kids to receive medications they don’t want out of the threat of retribution.
The reality is far less dramatic. Vaccine requirements don’t mean kids are being forced to be vaccinated. The requirements are limited to those attending school, and, even then, parents who don’t want to vaccinate their kids still have options.
In every state, children who shouldn’t receive vaccines for medical reasons—such as organ transplants or severe allergies—can receive medical exemptions.
Opting out for non-medical beliefs may be more difficult. In most U.S. states parents are permitted to opt out of vaccines for non-medical reasons, such as religious objections to vaccination, but five states do not allow opting out for non-medical reasons.
Where non-medical exemptions are allowed, the process for obtaining one may be as simple as signing a form. Other states require parents to undergo an educational module or counseling by a physician on the risks and benefits of vaccination before they can get an exemption.
Are Current Mandates Enough?
While states continue to expand school vaccine requirements, they are not as comprehensive—and therefore not as protective—as the recommended schedule issued by the CDC.
For example, while many states require meningococcal and pertussis (whooping cough) vaccination in schools, only two require the HPV vaccine, and none require the flu vaccine. This is despite the fact that between 2010 and 2020, influenza killed an estimated 12,000to 52,000 people per year. HPV can also be deadly; the CDC estimates that 4,000 women per year die from cervical cancer, and that more than 90% of these cancers are caused by HPV.
This is why the CDC recommends vaccines against all four of these diseases for adolescents 11 to 12. They are each considered equally important in the eyes of the ACIP but are rarely required by schools.
That is not to say that all vaccines are equally important. If a vaccine isn’t necessary for everyone to get, the ACIP has ways of indicating that it is optional.
A Word From Verywell
It is important to note that school-mandated vaccine requirements are minimum standards. Because the ACIP schedule is more comprehensive, those who follow it will have no problem meeting requirements for school or work.
By contrast, getting only what is mandated may leave you vulnerable to preventable—and potentially serious—infections. If in doubt, speak with your healthcare provider to check if your child is getting all of the recommended vaccinations on the ACIP list, not just the mandated ones.
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