Health Care

Immunization and Vaccination Laws in the US

In 1809, Massachusetts became the first state to pass a law requiring immunization against smallpox. Since then, immunization laws have been a controversial topic, and to this day, it continues to be fought over in state legislatures and the courts.

On one side are those who insist vaccines are safe and needed to protect public health. The other side argues vaccines aren't safe or effective, or that they violate religious or other personal beliefs. No matter which side you're on, it's good to know your options and legal responsibilities when it comes to immunizations and vaccines.

Immunization Laws Affecting Adults

The federal and state governments don't require adult citizens to be vaccinated. However, the National Immunization Program, which is run by the Centers for Disease Control and Prevention (CDC), recommends (PDF) certain vaccinations for adults.

Young Adults & Teens

The CDC also recommends certain vaccinations for teens and college students. In fact, it's not uncommon for colleges and universities to require new students to get certain vaccinations before they enter school. Vaccinations against illnesses like meningitis and hepatitis B are good examples.

Employer-Required Vaccines

While the law may not require adults to get vaccinated, their employers may. For example, the US military requires certain vaccinations. Heath care providers often require or promote vaccination for employees, such as seasonal flu or H1N1 shots. Employees may opt for vaccines to avoid losing time from work - some employers have rules against coming to work when sick.

Vaccines May Be Required for Foreign Nationals

The federal government has vaccination requirements for non-US citizens who want to live here. Foreign citizens who are seeking permanent residency in the US, as well as foreign-born children who are entering the country to be adopted, must be vaccinated against all vaccine-preventable diseases before entry to the US.

Immunization Laws for Children

The government does require children to be vaccinated. Every state has immunization requirements (PDF) for school-aged children. These laws are often based on the recommendations of the CDC and other health care experts.

State laws vary, but most require vaccinations for:

  • Diphtheria
  • Haemophilus influenza type b
  • Hepatitis B
  • Pertussis (whooping cough)
  • Polio
  • Measles
  • Mumps
  • Rubella
  • Tetanus (lockjaw)

Some states also require the varicella (chicken pox) vaccine.

Although many adults may have received the smallpox vaccine when they were young, this vaccine is not required nowadays because the disease is no longer a threat.

Parents Must Prove It, Too

Most states require the parents or guardian of a child entering school to have written proof, by a health care provider, that the required vaccinations were given. Unless there's a valid objection or medical reason, children who haven't gotten the required immunizations won't be allowed to attend school.

Objections to Immunizations

In many states, parents may be able to avoid the legal requirements for vaccinating their children.

Medical Reasons

All states allow for medical exemptions to state immunization requirements. This type of exemption is usually granted to children with compromised immune systems, allergies to vaccine ingredients, and other chronic or severe illnesses.

A letter from your doctor usually is enough to support a request for an exemption based on a medical objection.

Religious & Philosophical Reasons

Every state except West Virginia and Mississippi allow parents with religious objections to immunization to ask for an exemption from the state's immunization requirements.

Less than one-half of the states let parents who don't believe in the safety, need or effectiveness of immunizations to ask for an exemption based upon a philosophical objection.

Check the laws in your state to see if you can ask for an exemption on religious or philosophical grounds.

Backing-up your claim.

You'll need to give the school a written form explaining your religious or philosophical objection to immunizing your child. Sometimes a simple letter will do, other times you may need a special form from the local school district or department of education.

It' possible that the school won't honor your objection. A letter from your lawyer explaining your legal right to object should solve the problem. In extreme situations, parents have fought their local school districts in court to gain or uphold their right to keep their child from being vaccinated.

Information about Risks and Benefits of Vaccines

Federal law requires that parents, guardians or patients be given written information about the risks and benefits of vaccine before it's given. In addition, the National Childhood Vaccine Injury Act requires all US health care providers to give parents copies of a Vaccine Information Statement before administering many vaccines.

Questions for Your Attorney

  • If I claim a religious exemption for my child, can the school district reject my claim or scrutinize my beliefs?
  • Can parents who do immunize their children demand that students who aren't protected be kept separate if there's an outbreak of a disease? Isn't that the idea behind herd immunity?
  • If my employer requires a vaccination I can't take due to health reasons, does it have to reassign me to another work setting where my immunization status isn't an issue?
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