Legal Epidemiology of U.S. Immunization Law

Background

An outright attack is occurring on the tenets of immunization policies and programs in the United States. For better and for worse, there is a shift in vaccine federalism and state immunization policy is rapidly diverging. Some states are expanding pharmacist authority, strengthening coverage requirements and adopting non-federal clinical guidelines, while others are weakening school entry standards, broadening exemptions and shifting authority away from health agencies. Policymakers, advocates, health providers, and other stakeholders are navigating this rapidly changing and legally complex vaccine policy landscape without a comprehensive and current map of state law to guide action.

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Project Overview

This project, funded by an anonymous grant to APHA, will develop a comprehensive legal compendium of statutes, regulations, and related policy instruments governing vaccination in the United States. Using a legal epidemiology approach, the Immunization Law Compendium is intended to describe variations in state-level vaccine policy, identify gaps and emerging risks, and provide policymakers, advocates, and other stakeholders with actionable legal and policy information to support evidence-based decision-making and protect access to vaccination. The compendium will be developed as a user-friendly digital platform with interactive features to facilitate broad dissemination and practical use of the findings.

Research Approach

The project will systematically identify, collect and analyze statutes, regulations, state executive orders and related guidance from all 50 states and the District of Columbia through structured searches of legal research databases, state legislative and regulatory websites, and secondary policy sources. Bill tracking, planned or announced rule-making and litigation tracking will not be included in this analysis. 

A robust team of lawyers with cross-disciplinary experience in health care and vaccine policy are conducting the analysis. The research will identify policies in effect at the time of data collection (July-September 2026), with ongoing tracking to capture new and amended policies through June 2028. Identified laws and policies will be coded using a framework that captures key features across multiple policy areas, including school entry requirements and exemptions, other vaccine requirements, insurance coverage and managed care provisions, scope of practice for vaccinating providers, universal purchase programs, immunization information systems and more.

Deliverable

The project will produce the Immunization Law Compendium, a publicly accessible, user-friendly website featuring information functionality by state and policy domain, plain language policy summaries and direct links to source law.

Timeline

Data collection and website development will begin summer 2026 and proceed concurrently through fall. The website will launch in early Q1 2027 and will be updated quarterly through spring 2028, with continuing updates if further grant funding is obtained.