Vaccine State Mandates

How School Vaccine Mandates Came About


In 1809, the first state law mandating vaccination was enacted in Massachusetts. By 1855, Massachusetts became the first state to enact a school vaccination requirement for Smallpox. By the twentieth century, roughly half of the states had enacted vaccine mandates for children before they could enter school; however, they were not strictly enforced. The Diphtheria vaccine was introduced in the 1920’s, but only a few states made the Diphtheria vaccine compulsory for two decades. By the early 1950’s, with the licensure of the Diphtheria and Tetanus vaccines, state and local health departments began more aggressive vaccination programs. When the Salk Polio vaccine was licensed in 1955, only a few states passed laws that mandated it for school entry. The polio vaccine also led to federal funding of state and local vaccine programs. In 1962, the Vaccination Assistance Act established a federally coordinated program that would supply funds for the purchase and administration of childhood vaccines.  By 1963, several vaccines were mandated, but there was no enforcement by all states. The New York City health commissioner opposed making the Polio vaccine mandatory in 1965.


Compulsory vaccination made some radical changes by the late 1960’s and 1970’s. In 1970 a nationwide rubella vaccine campaign was launched. It was recommended by the Department of Health for all 11-13 year old girls. Then the CDC moved on and began leading a nationwide effort to eradicate Measles. In 1968, only a half the states required one or more vaccines for school entry. By the early 1970’s, the Measles Initiative program was started. By 1976-77, health officials strictly enforced the vaccine mandate for Measles under the Childhood immunization Initiative. Its purpose was to raise vaccination coverage in children to 90% by 1979.  The largest component of this initiative was to enact and enforce school vaccination mandates.

By 1981, all fifty states mandated Measles vaccine along with all others for school entry. Nearly all states had school vaccination mandates covering Kindergarten through 12th grade levels, and mandates for licensed preschools.  State mandated vaccine laws specified which vaccines would be required and the number of doses. Some states authorized the public health boards to designate which vaccines and doses would be required. States were not uniform in what vaccines they require, or how many doses. This still holds true today. In 1980, the state of Wisconsin passed the No-immunization-No School law and was enforced by March 1981. Other states soon followed.

In 1998–1999, all but four states (Louisiana, Michigan, South Carolina, and West Virginia) enacted mandates which covered Kindergarten through 12th grade. In 48 states, with the exception of Iowa and West Virginia, daycare mandates and Head Start program mandates were enacted. Thirty states mandated some requirements for college entrance. School vaccine mandates included:

All 50 states required: Diphtheria toxoid, Polio, Measles and Rubella vaccines

49 states required: Tetanus toxoid

46 states required: Mumps

44 states required: Pertussis

28 states required: Hepatitis B


During the late 1980’s and early 1990’s, state vaccine laws were tightened to make religious and philosophical exemptions harder to obtain. By the end of the 1990’s, the trend was reversed. Religious and Philosophical exemptions were made less restrictive through rewriting exemption clauses.


The Task Force on Community Preventive Services is an independent body carrying out evidence-based reviews of the literature to assess the claims that preventive interventions directed to populations are effective. One of the 17 interventions reviewed for vaccine-preventable diseases was mandatory vaccination requirements. The Task Force found that sufficient evidence existed to demonstrate the effectiveness of these requirements in increasing vaccine coverage, thereby reducing disease incidence, and so recommended their use.

U.S. Congress passed the National Childhood Vaccine Injury Act in 1986 and the Vaccine Compensation Amendments in 1987 and 1995. The NCVIA establishes a compensation system for people who may be injured by routine vaccinations. The National Childhood Vaccine Injury Act of 1986, Public Law 99-660, was signed by President Reagan in November 1986, however, it did not contain a funding mechanism to enable the compensation system to operate.  In 1987, Congress passed amendments to the law and developed a plan to fund the system, which comes from a surcharge on each mandatory vaccine.  The main purpose of the law was to create safety provisions for the administration of vaccines to help prevent future vaccine injuries, to promote the improvement of existing vaccines and develop safer vaccines.  Another element was to create a no-fault compensation system alternative to suing vaccine manufacturers and physicians on behalf of injured or deceased people from reactions to mandated vaccines.  Children and/or adults injured or killed from these vaccines are divided into two categories; those who were damaged or killed before October 1, 1988 and those who were damaged or killed after that date. In 1990, the FDA and the CDC developed the Vaccine Adverse Event Reporting System (VAERS), which allows public and private physicians to use one standard reporting form to report reactions. 


Next, we’ll take a look at some of the court cases that further fueled the school vaccine mandates.