Covering vaccine mandates and policy in a polarized community

By Tara Haelle

Public health laws that require vaccinations have been an integral part of reducing the burden of infectious disease in the U.S. The elimination of measles in 2000, for example, would not have been possible without state laws that require measles vaccination for public school attendance. But misconceptions about vaccine mandates have also led to confusion among media audiences. This tip sheet aims to provide a background on vaccine mandates in the U.S. and how to report on them accurately, responsibly and thoughtfully for your audiences. 

Overview of vaccine mandates 

A vaccine mandate, a type of public health mandate, is any requirement by a public or private entity for people to receive certain vaccines either to receive public or private services or employment. The right of the state to mandate vaccines was first tested and upheld by the Supreme Court in the 1905 case Jacobson v. Massachusetts. 

Vaccine mandates can be required by local, state, or federal law, or they can be a policy implemented by a private business, such as a hospital requiring health care workers to receive the influenza vaccine to continue employment at that hospital. 

There are no laws requiring anyone to receive a vaccine simply as a condition for residing in the U.S. 

Mandates may be implemented at various public and private levels and continue to exist today as a patchwork of regulations.

Local government, including individual public school districts, can implement vaccine mandates, but this is rare in the U.S. today, with most government vaccine requirements being set at a statewide level. Dorit Reiss, a professor of law at UC Law San Francisco who specializes in vaccines, noted, “The strongest examples recently are in New York City,” where the city implemented a daycare influenza mandate that was challenged in court but ultimately won at the state’s court of appeals.

Since then, there was “experimentation during the pandemic,” but they remain uncommon, and “not all states would allow the local government that kind of autonomy,” Reiss said.

State government mandates are the most common ones today. All states have vaccination requirements for public school attendance, and many have them for college attendance and/or childcare attendance.   

Federal mandates today typically apply only to employees of the federal government. The military has long required certain vaccines, some for all members and some only for those with certain jobs or duty station locations. The policy dates back to 1777 when George Washington required troops to receive inoculation against smallpox.

Additional federal mandates for vaccination were put in place during the COVID-19 pandemic. President Biden issued an executive order in September 2021 requiring COVID-19 vaccination for federal employees. Biden revoked that order with another in May 2023, and in August 2025 Trump ordered all federal employers to scrub records of employees’ vaccination status. 

Vaccines can also be required for some international travelers to the United States, such as requirements for COVID vaccination during the pandemic. Applicants for immigrant visas must provide proof that they have received a long list of vaccines.

Private employers can and have implemented vaccine mandates, a practice which historically has occurred primarily in health care facilities. For workplace mandates, the Civil Rights Act of 1964 requires employers to accommodate employees with sincere religious objections, discussed in depth in this article. The American with Disabilities Act also requires accommodations for people with disabilities, including those with medical contraindications to vaccination. This article further discusses the complex legalities of different types of mandates based on circumstances, purpose, and scope. 

History and politicization of vaccine mandates

The public health rationale for vaccine mandates rests on vaccines’ ability to protect both the individual and the community, the latter through herd immunity. When enough of a population is immune to a pathogen, that disease cannot spread widely through the community. Herd immunity prevents outbreaks, disease spread to neighboring communities, and protects the vulnerable people who either cannot be vaccinated, such as young infants, or those in whom vaccines aren’t effective, such as immune-compromised individuals. 

The threshold for herd immunity varies based on the disease; the most effective vaccines with the highest herd immunity thresholds may have the strongest ethical justification for being mandated to prevent spread of that disease in the community. However, vaccine mandates involve multiple other ethical considerations, addressed in this article.  

Vaccine mandates have been politically controversial almost since their inception. The first state-level U.S. mandate was an 1809 Massachusetts law requiring smallpox vaccination, which immediately led to organized opposition. Massachusetts later became the first state to pass a school vaccination requirement in 1855. Despite opposition, mandates became increasingly common because of their effectiveness. By the 1970s, former first lady of Arkansas Betty Bumpers and former first lady Rosalynn Carter had begun a campaign to strengthen state laws requiring vaccination for public school attendance, resulting in laws in all 50 states by the 1980-81 school year.

Although mandates have been controversial in the U.S. since the late 1800s, vaccination policy has become increasingly partisan in the last decade. Critics of vaccine mandates came from both the political left and right until a variety of shifts in the mid 2010s, motivated particularly by movements promoting “liberty,” moved the issue more strongly toward the right. Now, affiliation with the Republican party is associated with lower rates of vaccination, though American support for vaccine mandates in K-12 settings remains high. 

Impact of vaccine mandates

Research has shown that vaccine mandates can be effective in increasing vaccination coverage, but not in isolation. Implementation requires a sufficient supply of and access to vaccines, and mandates come with the ethical expectation that governments will ensure the safety of vaccines. That means investment in safety surveillance programs (such as the U.S. Vaccine Adverse Event Reporting System and Vaccine Safety Datalink), ongoing research to improve vaccine safety, and potentially compensation programs for legitimate vaccine injuries, such as the U.S.’s Vaccine Injury Compensation Program. 

Access is key to mandates’ effectiveness. In the U.S., for example, despite school mandates, many children did not receive the measles vaccine because of its cost and lack of stable medical care, explains Adam Ratner, a pediatric infectious disease physician at NYU Langone Health. School mandates in the U.S. only led to widespread high vaccination rates after creation of the Vaccines for Children program, which subsidizes vaccines for families that cannot afford them. 

When people have adequate access to vaccines, a strong evidence base supports vaccine mandates’ effectiveness, particularly in schools and in health care facilities (see more about the efficacy of mandated vaccination here and here). Broader mandates, such as those for COVID-19, have been found “ethical and effective” after exhaustion of other strategies, such as financial incentives. 

Exemptions to vaccine mandates

Risks of vaccine mandates include erosion of public trust in the government, erosion of vaccine confidence and uptake, political polarization, use of state resources for enforcement, and negative impacts on social wellbeing. However, mandates have often had greater public receptiveness when accompanied by exemptions besides ethically mandatory medical exemptions for people who cannot safely receive them. Non-medical exemptions are typically religious or philosophical “personal belief exemptions.” 

Most U.S. states offer some type of non-medical exemption to school vaccine requirements. However, exemptions have become particularly controversial in the U.S. in the past two decades as researchers have documented an increase in their use, accompanied by a decrease in community vaccination coverage and an increase in outbreaks. This includes the 2025 measles outbreak, after warning signs arose nearly a decade earlier due to non-medical exemptions.

As evidence accrued linking vaccine refusal to increased measles outbreaks, a gradual two-decade rise in non-medical exemptions increased the likelihood of disease outbreaks in clusters where exemptions are more common. This geographic clustering was considered partly responsible, for example, for the 2015 “Disneyland” measles outbreak and a subsequent outbreak in Quebec, Canada, imported from Disneyland. Earlier restrictions to California’s exemptions had lowered the exemption rate from 3.1 percent to 2.3 percent in 2015, but problematic clustering remained.

California passed a 2016 law removing non-medical exemptions, which led to an increase in vaccination coverage and improved herd immunity. But it also resulted in an increase in previously stable levels of medical exemptions. After another law to tighten medical exemption requirements and oversight of them, medical exemptions fell by 72 percent and are predicted to remain low.

Responsibly reporting on vaccine mandates

Keep the following tips in mind when reporting on vaccine mandates in your communities:

Avoid false balance

False balance, or false equivalence, sometimes colloquially called “bothsidesism,” is presenting differing viewpoints with equal weight when the evidence or reality does not reflect that. For example, decades of research shows that the U.S. Centers for Disease Control and Prevention’s recommended childhood immunization schedules safely and effectively prevent multiple infectious diseases in children. Some individuals may not believe it’s safe or effective, but those opinions do not reflect the scientific evidence or the consensus of physicians and public health experts. 

A story that includes equal numbers of quotes from those who do and do not believe in the schedule’s safety inappropriately includes false balance. A story that includes one source’s doubts about the schedule’s safety—to help audiences understand that perspective—can be responsibly included when it is contextualized by pointing out it is a minority belief that is contradicted by the scientific evidence. 

False balance in articles does a disservice to readers and can even endanger their health, as Curtis Brainard describes in his Columbia Journalism Review article “Sticking with the Truth.” For more on false balance, see SciLine’s best practices on reporting on vaccines, and for in-depth examples of false balance and tips to avoiding it, see the Voices for Vaccines False Balance Toolkit. 

Accurately and fairly represent major policy viewpoints with context 

It’s important not to conflate scientific evidence with opinions regarding policy decisions about what should be done about that evidence. The scientific evidence may show that the CDC’s immunization schedule is safe and effective, but a state legislature’s decision about whether and how to follow that schedule for its schoolchildren is a policy decision. Journalists should fairly and accurately represent different viewpoints on policy while contextualizing how many people support each of those viewpoints. If a parent group opposes a vaccine mandate, include how large the group is, how large other groups supporting the mandate are, and the arguments each group is using to support their arguments, including how those arguments measure up to the evidence base.

Avoid amplifying misinformation but provide and explain the evidence clearly and accurately.

When inaccurate information infiltrates the public consciousness, journalists should provide accurate information that explains the evidence without restating the misinformation unnecessarily. For example, instead of restating a myth and then debunking it, present the misinformation as a question (“Do vaccines cause autism?”) or without even fully stating the misconception (“Contrary to some people’s beliefs, vaccines do not cause autism.”) See the Debunking Handbook for in-depth best practices in debunking.

Employ prebunking before misinformation becomes rampant. 

Prebunking refers to providing accurate information about a topic or concept before people have a chance to hear and begin believing inaccurate information about it—while also warning them to be on the lookout for false or misleading information. Research has shown prebunking to be an effective way to counter vaccine misinformation. See this EDF guide for quick tips and A Practical Guide to Prebunking Misinformation for in-depth info on prebunking.

Meet audiences where they are while also trusting them with appropriate amounts of clearly explained context and nuance.

It’s vital to understand your audience when communicating information about vaccine mandates, so that you can provide the information they need without assuming they know the evidence or assuming they know nothing. Avoid shaming or condescending tones or terms with judgmental connotations that can turn off audiences, and provide only enough information to explain evidence clearly without glossing over the nuance or overwhelming people with too much data. When discussing risks, provide context with analogies or metaphors to help audiences understand risk without relying on fear-based, inflammatory, or hyperbolic messaging.

Tracking information about vaccine mandates in your state

• Reporters can find out their state’s current vaccine requirements and laws at Immunize.org here. Most state legislatures also have bill tracking notifications with keywords that reporters can sign up to receive.
• Several states have chapters of Families for Vaccines, a pro-vaccine political advocacy organization that tracks legislation in their state and advocates for or against bills related to vaccination. 
• The oldest and largest anti-vaccine advocacy organization in the U.S., the National Vaccine Information Center, regularly tracks state and federal legislation related to vaccines. Their State Vaccine Laws & Exemptions page can be helpful as long as journalists keep in mind they are an anti-vaccine advocacy group that includes inaccurate information about vaccine science on their website.  
• Voices for Vaccines is a pro-vaccine, non-profit, non-political parents’ organization that shares stories and accurate information about vaccine science and policy. A similar group, Vaccinate Your Family is a similar organization that also is a reliable source of information for families making decisions about vaccines., began as Every Child by Two, the initiative that previously advocated for state school vaccine requirements.  
• Physician groups that frequently issue statements on vaccines include the American Academy of Pediatrics (see also here), the American College of Obstetricians and Gynecologists (also see here), and the American Academy of Family Physicians.
• Other resources include the Vaccine Integrity Project, state health departments, your state’s vaccine Immunization Manager, the Association of Immunization Managers, National Network of Immunization Coalitions and your state’s immunization action coalition, Immunize.org, Nurses Who Vaccinate, and Shot@Life. 

Tara Haelle is a freelance science/health journalist based in Dallas. She is author of Vaccine Investigation: The History and Science of Vaccines, and has covered vaccines for 15 years at National Geographic, Scientific American, The New York Times, and over a dozen other publications.