A Brief History: Mandated Vaccinations (and Exemptions) in US States, Public Schools, and the Military

Updated April 27, 2022; Originally published October 11, 2021 | Click to download as a PDF | Vaccine Media

  • Jan. 6, 1777: Gen. George Washington
    mandates smallpox inoculation for troops
  • 1796: first vaccine developed
  • 1810: Massachusetts mandates smallpox vaccination 
  • 1812: US Army mandates  smallpox vaccination
  • 1905: first Supreme Court of the United States (SCOTUS) ruling upholding a vaccination mandate
  • 1922: SCOTUS ruling upholds school vaccination  requirements
  • By 1980: all 50 states + DC mandate public school vaccinations with exemptions
  • Sep. 9, 2021: Biden announces COVID-19 vaccine mandates
  • Sep. 17, 2021: CDC says unvaccinated account for over 90% of COVID-19 hospitalizations and deaths
  • Oct. 29 and Dec. 13, 2021: SCOTUS declines 6-3 to block COVID-19 vaccine mandates in Maine and New York
  • Jan. 13, 2022: SCOTUS blocks vaccine mandate for large employers 6-3, upholds for health care facilities 5-4
  • Feb. 22, 2022: SCOTUS rejects a challenge to Maine’s health care worker COVID-19 vaccine mandate (vote count unknown)
  • March and April 2022: SCOTUS allows military to reassign or discipline unvaccinated service members by 6-3 vote

Table of Contents

I. Executive Summary
II. A Brief Timeline of Vaccine Mandates
III. Historical and Current Opposition to Vaccine Mandates
IV. Summary
APPENDIX: The 50 States’ Mandated Vaccines (and Exemptions) for K-12 Public Schools

I. Executive Summary

This report is a brief history of some of the vaccine mandates and exemptions in US states, public schools, and the military from the nation’s founding to the present and some related information.

A mandate is defined as “any mandatory order or requirement under statute, regulation, or by a public agency.”[1]The Free Dictionary, “Mandate,” legal-dictionary.thefreedictionary.com (accessed October 8, 2021) A vaccine mandate does not mean that a person will be forced to get a vaccine, but rather that they can be penalized or excluded from certain places for not complying, unless exempted.

Some people qualify under law for medical exemptions, and those who oppose vaccines can sometimes secure religious or personal belief exemptions. Opposition to vaccine mandates has existed as long as the mandates themselves.

Inoculation against diseases in the United States traces back to the founding of the United States: on January 6, 1777, General George Washington ordered the inoculation of troops against smallpox during the Revolutionary War, almost 20 years before the first vaccine was developed in 1796.[2]The word vaccine was coined by the founder of the first vaccine, Edward Jenner, who based it off the Latin word for cow, “vacca,” because cow pox is widely credited as the source of the vaccine. Inoculation is a broader term than vaccination, but the two words are now often used interchangeably.

Massachusetts was the first state to pass a vaccine mandate for smallpox for the general population in 1810. In 1812, the US Army implemented its first vaccine mandate. In the following years, vaccinations were required for certain diseases for all service members depending on their status within the military, with some exemptions considered. In 1855, Massachusetts became the first state to mandate the smallpox vaccine for school children.

In 1905, the US Supreme Court (SCOTUS) upheld the authority of states to enact and enforce vaccination mandates, and in 1922 SCOTUS decided that states have the authority to enforce vaccine mandates for public school enrollment.

All 50 states have had vaccine mandates for K-12 public school students for diseases such as polio, diphtheria, tetanus & pertussis, and measles and rubella since at least 1980, and all 50 states allow for medical exemptions while some also offer religious or personal belief exemptions.

The COVID-19 pandemic has taken nearly one million lives in the United States.

The FDA granted emergency-use authorization to the first COVID-19 vaccine on December 11, 2020. On August 23, 2021, Pfizer’s Comirnaty became the first COVID-19 vaccine to receive full FDA approval. In an effort to slow the spread of coronavirus the US government then began to issue COVID-19 vaccine mandates for service members, federal workers, federal contractors, health care workers, and private sector companies with more than 100 employees. Some US states and cities have also enacted vaccine mandates.

A CDC report dated September 17, 2021, found that 92% of COVID-19 hospitalizations and 91% of COVID-19 deaths in the US occurred among people who were not fully vaccinated.

As with past vaccine mandates, there has been opposition to the vaccine mandates instituted to fight COVID-19. People cite fears about the safety of the vaccines, religious objections to the cell lines used to develop them, and concerns about infringement on personal freedom.

In November 2021, 10 state attorneys general filed a lawsuit against the Biden administration over the vaccine mandate for staff members at health care facilities that participate in the Medicare and Medicaid programs. Other groups have also filed lawsuits seeking to stop mandates, including more than 60 service members requesting religious exemption from the military’s vaccine requirement.

On January 13, 2022, SCOTUS upheld President Biden’s vaccine requirement for health care facilities that take federal funding by a 5-4 vote, but blocked the vaccine-or-testing mandate for companies with at least 100 employees by a 6-3 vote. Thousands of people gathered in Washington, DC, on January 23, 2022, to protest vaccine mandates.

On January 31, 2022, the FDA approved a second COVID-19 vaccine, Moderna’s Spikevax.

As of February 17, 2022, the US military had granted 15 religious exemptions out of 16,000 requests and federal cases on the matter were pending. In March and April 2022 rulings, SCOTUS allowed the military to reassign Navy SEALs and discipline an Air Force officer, all of whom were unvaccinated against COVID-19 for religious reasons.

On April 7, 2022, the 5th Circuit Court of Appeals reinstated Biden’s vaccine mandate impacting an estimated 3.5 million federal employees.

II. A Brief Timeline of Vaccine Mandates

1700s

1. January 6, 1777 – General George Washington’s inoculation mandate

General George Washington, who went on to become the first President of the United States, led the Continental Army during the American Revolutionary War. At the time, diseases such as smallpox were the leading cause of death for his soldiers. [3]Janet A. Aker, “Gen. George Washington Ordered Smallpox Inoculations for All Troops,” health.mil, August 16, 2021 According to research published by the Library of Congress, General Washington “wrote to Dr. William Shippen Jr., ordering him to inoculate all of the forces that came through Philadelphia. [4]The first inoculation order was technically not the first vaccination mandate because the first vaccine was not created until 1796, when Edward Jenner used the “less dangerous” cow pox disease to … Continue reading He explained that: ‘Necessity not only authorizes but seems to require the measure, for should the disorder infect the Army…we should have more to dread from it, than from the Sword of the Enemy.’” [5]Amy Lynn Filsinger and Raymond Dwek, “George Washington and the First Mass Military Inoculation,” loc.gov, accessed September 12, 2021; Text of letter, “George Washington Papers, Series 3, … Continue reading

2. 1796  – Edward Jenner develops the first successful vaccine

English doctor Edward Jenner developed a vaccine that prevented a boy from contracting smallpox in 1796. [6]BBC, “Edward Jenner (1749-1823),” bbc.co.uk (accessed December 14, 2021) The smallpox vaccine was reportedly made from cow pox, [7]The spelling for cow pox varies by publication. although some researchers speculate that horsepox may have been the original source for the vaccine. [8]Kai Kupferschmidt, “Why the word ‘vaccine’ is probably all wrong,” science.org, October 11, 2017 Jenner coined the term “vaccine” when his findings were published in 1798, allegedly deriving from the Latin word for cow, “vacca.” [9]Stefan Riedel, MD, PhD, “Edward Jenner and the history of smallpox and vaccination,” ncbi.nlm.nih.gov, January 2005

Note: Vaccination refers to the act of putting a vaccine into the body, and immunization is the process of the body becoming protected against a disease. [10]CDC, “Immunization: The Basics,” cdc.gov, September 1, 2021 Inoculation, which introduces a disease into the body to stimulate disease resistance, is a broader term than vaccination and pre-dated the invention of vaccines. In modern times, the terms vaccination, immunization, and inoculation are often used interchangeably. [11]Dictionary.com, “‘Vaccinate’ vs. ‘Inoculate’ vs. ‘Immunize’: What Are The Differences?,” dictionary.com, February 22, 2021

1800s

3. March 6, 1810 – Massachusetts, sixth of the original 13 states to join the union, passes the first state vaccination mandate [12]Samuel Shipley, “List of U.S. states’ dates of admission to the union,” britannica.com, accessed October 9, 2021

Massachusetts passed the first vaccine mandate in the US, granting local health boards the power to require smallpox vaccination for the general population. [13]Philip J. Smith, PhD, David Wood, MD, MPH, and Paul M. Darden, MD, “Highlights of Historical Events Leading to National Surveillance of Vaccination Coverage in the United States,” … Continue reading [14]Jess McHugh, “First U.S. vaccine mandate in 1809 launched 200 years of court battles,” washingtonpost.com, December 12, 2021 On March 6, 1810, the Massachusetts Senate and House of Representatives passed a law titled, “An act to diffuse the benefits of inoculation for the Cow Pox.”[15]Publisher, Boston: Secretary of the Commonwealth, “1809 Chap. 0117. An Act To Diffuse The Benefits Of Inoculation For The Cow Pox.,” Chap. CXVI, books.google.com, Page 204 [16]Although the Act passed on March 6, 1810, the State Library of Massachusetts archive lists the law under the year 1809, and some sources cite 1809 as the year of the first mandate. The reason for … Continue reading

On January 25, 1810, Governor Christopher Gore made a speech to the legislature in favor of vaccinating against smallpox by saying “of the duties which the Representatives of a free people have to perform, none can be more pleasant than that of preserving the lives and health of their fellow- citizens. Experience in the United States…seems to have established a fact, that the Kine Pock [another term for cow pox used for the smallpox vaccine] is a safe, mild, and complete preventive of that loathsome disease, the Small Pox.” [17]Statutes and Stories, “An Act to Encourage Vaccination (1813),” statutesandstories.com, February 17, 2020 [18]Online book, “Resolves of the General Court of the Commonwealth of Massachusetts,” babel.hathitrust.org, accessed October 10, 2021

4. 1812 – First vaccine mandate for the US Army

The first vaccination mandate for US soldiers has been traced back to May of 1812, when the US Army ordered the smallpox vaccination, the first vaccine, “for all of its soldiers.” [19]Editors Lance P. Steahly, MD, and David W. Cannon, Sr., “The Evolution of Forward Surgery in the US Army,” usgovcloudapi.net, accessed September 23, 2021, Page 17; “The Army Medical Department … Continue reading

Note: The military has pursued research, testing and mandatory vaccinations of diseases affecting soldiers from Washington’s smallpox inoculation order up to the COVID-19 pandemic. [20]Todd South, “Humans now testing the Army’s catch-all COVID vaccine,” armytimes.com, June 22, 2021 Since the FDA was not founded until June 30, 1906, and not responsible for vaccine regulation until 1972, the military administered some vaccines that were not FDA approved. [21]FDA, “Milestones in U.S. Food and Drug Law,” fda.gov, accessed October 7, 2021

5. May 19, 1855 – Massachusetts enacts “An Act to secure General Vaccination” and includes children and students

Massachusetts became the first state to mandate vaccination for the prevention of smallpox transmission in schools when the Massachusetts governor approved “An Act to secure General Vaccination” on May 19, 1855: [22]State Library of Massachusetts, “1855 Chap. 0414. An Act To Secure General Vaccination.,” archives.lib.state.ma.us (accessed December 7, 2021)

“Sect. 1. Parents and guardians of youth shall cause the children under their care to be vaccinated before they attain the age of two years. Sect. 2. The school committee of the several towns and cities shall not allow any child to be admitted to or connected with the public schools who has not been duly vaccinated…. and every parent or guardian of youth who shall not cause his or her child or ward to be vaccinated (the said child or ward being more than two years of age) shall be liable to a fine of five dollars for each and every year’s neglect.” [23]1855 Senate Bill 0155. An Act To Secure General Vaccination, “An Act To secure General Vaccination,” Senate No. 155. 1855, archives.lib.state.ma.us (accessed October 30, 2021)

1900s

6. February 20, 1905 – US Supreme Court decides 7-2 in Jacobson v. Massachusetts that states have the authority to pass and enforce vaccine mandates

In 1902, Henning Jacobson was a pastor who claimed he had a bad reaction to a smallpox vaccination as a child in his birth country of Sweden and would not comply with a Board of Health of the city of Cambridge order to get revaccinated during an epidemic or pay a $5 fine ($156 in 2021 dollars). [24]Justice Harlan, Opinion of the Court, “Jacobson v. Massachusetts, 197 U.S. 11 (1905),” justia.com, accessed September 18, 2021 [25]Calculator from officialdata.org, accessed October 14, 2021

He refused to get vaccinated, was brought to court, convicted, and refused to pay the $5 fine. Jacobson took his case up to SCOTUS, where it was argued on December 6, 1904; he lost and eventually paid the fine. [26]New England Historical Society, “Henning Jacobson Loses His Fight with the Board of Public Health Over Vaccination,” newenglandhistoricalsociety.com, updated 2021

Oyez.org wrote of the 7–2 decision:[27]Nicholas Mosvick, “On this day, the Supreme Court rules on vaccines and public health,” constitutioncenter.org, February 20, 2021 “The Court held that the law was a legitimate exercise of the state’s police power to protect the public health and safety of its citizens. Local boards of health determined when mandatory vaccinations were needed, thus making the requirement neither unreasonable nor arbitrarily imposed.” [28]Oyez.org, Jacobson v. Massachusetts, oyez.org, accessed October 6, 2021

7. June 1911 – War Department mandates the typhoid vaccine for “all troops entering federal service

The vaccine for typhoid fever was mandated next for US soldiers about a dozen years after the vaccine was introduced. When typhoid fever became problematic in the armed forces during the Spanish-American War, “Major Frederick Russell of the US Army Medical School adapted British and German production methods to produce the inactivated, whole-cell, typhoid vaccine supply used by the entire United States,” and voluntary testing among US soldiers began in 1909. [29]Either Richard Pfeiffer or Almroth Edward Wright, a British pathologist, is credited for creating the typhoid vaccine in 1897, depending on the source. Source: John D. Williamson, Keith G. Gould and … Continue reading [30]John D. Grabenstein, Phillip R. Pittman, John T. Greenwood, and Renata J. M. Engler, “Immunization to Protect the US Armed Forces: Heritage, Current Practice, and Prospects,” silverchair.com, … Continue reading The first typhoid vaccine mandate for “all troops entering federal service” was ordered in June of 1911 by the War Department. [31]“Vaccination: A More Effective Way to Prevent Typhoid Fever,” virginia.edu, accessed October 7, 2021; Dr Jari Vainio and Dr Felicity Cutts, “Yellow fever,” who.int, 1998

8. November 13, 1922 – US Supreme Court decides 8-0 in Zucht v. King that state and local authorities can enforce vaccine requirements for entry into public school

In 1922, the SCOTUS case Zucht v. King upheld vaccination mandates for entry into public schools. A Congressional Research Service report stated that “in Zucht v. King, parents of a child [in Texas] who was excluded from school due to her unvaccinated status challenged the local ordinance requiring vaccination for schoolchildren, arguing that the ordinance violated the Fourteenth Amendment’s Equal Protection and Due Process Clauses.” [32]Wen W. Shen, “State and Federal Authority to Mandate COVID-19 Vaccination,” crsreports.congress.gov, April 2, 2021 The case went to the US Supreme Court. [33]The Writ of Certiorari was notarized on April 21, 1921. Justice Brandeis delivered the 8-0 Opinion of the Court: [34]Edited by Keith Wailoo, Julie Livingston, Steven Epstein, and Robert Aronowitz, “Three Shots at Prevention,” books.google.com, Page 9, accessed September 18, 2021; Reference Staff, Tarlton Law … Continue reading

“Ordinances of the City of San Antonio, Texas, provide that no child or other person shall attend a public school or other place of education without having first presented a certificate of vaccination. Purporting to act under these ordinances, public officials excluded Rosalyn Zucht from a public school because she did not have the required certificate and refused to submit to vaccination…. Long before this suit was instituted, Jacobson v. Massachusetts, 197 U.S. 11, had settled that it is within the police power of a State to provide for compulsory vaccination. That case and others had also settled that a State may, consistently with the Federal Constitution, delegate to a municipality authority to determine under what conditions health regulations shall become operative.” [35]Library of Congress PDF, Zucht, By Her Next Friend, etc. v. King et al., loc.gov, October term, 1922, accessed September 13, 2021

9. January 31, 1944 – US Supreme Court decides 5-4 in Prince v. Massachusetts that the government may restrict parental control over their children

While this case involved a challenge to a Massachusetts child labor law by a Jehovah’s Witness who brought a nine-year-old girl to hand out literature while accepting monetary contributions, it has been cited in vaccine mandate cases. [36]Ross D. Silverman and Thomas May, “Private Choice Versus Public Health: Religion, Morality, and Childhood Vaccination Law,” digitalcommons.law.umaryland.edu, 2001 The ruling pointed to laws regarding compulsory vaccination as an example that the rights of parents and children to exercise religion were not absolute. [37]John R. Vile, “Prince v. Massachusetts (1944),” The First Amendment Encyclopedia, 2009

The ruling stated, in part, that a parent “cannot claim freedom from compulsory vaccination for the child more than for himself on religious grounds. The right to practice religion freedly does not include liberty to expose the community or the child to communicable disease or the latter to ill health or death.” [38]Jethro K. Lieberman, A Practical Companion to the Constitution: How the Supreme Court Has Ruled on Issues from Abortion to Zoning, 1999 [39]Wiley Rutledge, “Prince v. Commonwealth of Massachusetts,” law.cornell.edu, January 31, 1944

10. 1980 – All 50 states have vaccine mandates for K-12 public schools

Following the first mandatory vaccination requirement of public school students in 1855, many states implemented vaccine requirements for students in the early 1900s. [40]Minami Funakoshi, “U.S. state vaccine mandates in schools,” reuters.com, September 15, 2021 In 1977, the federal government started a Childhood Immunization Initiative with the goal of getting more children vaccinated against diseases such as diphtheria, measles, and pertussis. [41]Ashley Welch, “Vaccine Mandates in Schools Aren’t New. They’ve Been Used Since 1850,” healthline.com, August 8, 2021 By 1980, all 50 states required vaccinations for K-12 public schools. [42]Maggie Astor, “Vaccination Mandates Are an American Tradition. So Is the Backlash.” nytimes.com, September 9, 2021

In addition, all 50 US states allow medical exemptions from vaccine requirements, and may have other exemptions for religious or personal beliefs or immunity exemptions, and 36 states have an additional clause that an unvaccinated student may be excluded from attending school in the event of a disease outbreak or epidemic, with some states specifying exclusion for the unvaccinated during a vaccine-preventable disease outbreak.

2000s

11. June 30, 2015 – California eliminates personal belief exemptions from K-12 public school vaccine requirements

Following a rise in measles outbreaks in California, including at Disneyland, state lawmakers passed a bill removing the ability for parents to claim a personal belief exemption to avoid vaccinating their kids attending public schools. Governor Jerry Brown signed the bill on June 30, 2015, leaving only medical exemptions from vaccine requirements. [43]Phil Wilson and Melanie Mason, “California Gov. Jerry Brown signs new vaccination law, one of nation’s toughest,” lattices.com, June 30, 2015

12. July 28, 2021 – Google becomes the first major tech company to announce vaccine mandates

On July 28, 2021, Google announced that employees returning to its work on-site when its offices reopened would be required to have the COVID-19 vaccine. Facebook and Lyft quickly followed suit. [44]Ben Popken and April Glaser, “Google and Facebook mandate vaccines for all employees returning to offices,” nbcnews.com, July 28, 2021

13. August 20, 2021 – San Francisco becomes first city to enforce vaccine mandates for access to restaurants and other indoor establishments

San Francisco becomes first city to require “proof of full vaccination for indoor activities like dining at restaurants, drinking at bars and working out at gyms” starting on August 20, 2021. [45]Nicholas Reimann, “Vax Up Or Stay Home: These Cities Are Mandating Covid Vaccination To Dine In At Restaurants And Other Indoor Fun,” forbes.com, August 12, 2021; City and County of San … Continue reading

14. August 23, 2021 – FDA approves the first COVID-19 vaccine

The FDA had granted emergency-use authorization to the Pfizer-BioNTech COVID-19 vaccine on December 11, 2020. [46]US Food and Drug Administration, “FDA Takes Key Action in Fight Against COVID-19 By Issuing Emergency Use Authorization for First COVID-19 Vaccine,” fda.gov, December 11, 2020 On August 23, 2021, the FDA gave full approval to the vaccine for ages 16 and older. The vaccine was marketed as Comirnaty (koe-mir’-na-tee). According to the FDA, “The result of a person receiving this vaccine is that their immune system will ultimately react defensively to the virus that causes COVID-19. The mRNA in Comirnaty is only present in the body for a short time and is not incorporated into – nor does it alter – an individual’s genetic material.”  [47]FDA, “FDA Approves First COVID-19 Vaccine,” fda.gov, August 23, 2021.

15. August 24, 2021 – Mandatory vaccination of military service members against COVID-19

On August 24, 2021, the Secretary of Defense directed the mandatory vaccination of service members against COVID-19. [48]Department of Defense, “Mandatory Coronavirus Disease 2019 Vaccination of DoD Civilian Employees,” defense.gov, October 4, 2021. Mandatory vaccinations required for all servicemembers upon … Continue reading Pentagon spokesman John Kirby said some service members will be exempt due to medical concerns and “some can apply for a religious accommodation.” [49]Patricia Kime, “US Troops Go to Court Seeking Vaccine Exemption for Those Who’ve Had COVID-19,” military.com, September 29, 2021

16. September 9, 2021 – Biden issues “Executive Order on Requiring Coronavirus Disease 2019 Vaccination for Federal Employees”

On September 9, 2021, Biden issued the “Executive Order on Requiring Coronavirus Disease 2019 Vaccination for Federal Employees” requiring mandatory COVID-19 vaccinations for federal employees as defined in the order. [50]The White House website, “Executive Order on Requiring Coronavirus Disease 2019 Vaccination for Federal Employees,” whitehouse.gov, September 9, 2021

17. September 9, 2021 – Biden gives a speech on his plan to have businesses with 100-plus employees require proof of vaccination or regular testing

In an effort to have more Americans vaccinated, President Joe Biden, in a speech on September 9, 2021, announced a COVID-19 action plan with six points, including working with the Labor Department’s Occupational Safety and Health Administration (OSHA) on requiring businesses with 100-plus employees to ensure the workforce is vaccinated or having regular testing. [51]Although we use the term vaccination throughout this paper, others use the term immunization and some use vaccination and immunization interchangeably. [52]The White House website, “Path out of the Pandemic,” whitehouse.gov, accessed September 12, 2021

18. September 17, 2021 – CDC says unvaccinated account for over 90% of COVID-19 hospitalizations and deaths 

A CDC report released September 17, 2021, found that 92% of COVID-19 hospitalizations and 91% of COVID-19 deaths in the US occurred among people who were not fully vaccinated. [53]Heather M. Scobie, et al., “Monitoring Incidence of COVID-19 Cases, Hospitalizations, and Deaths, by Vaccination Status — 13 U.S. Jurisdictions, April 4–July 17, 2021,” cdc.gov, September 17, … Continue reading Dr. Rochelle Walensky, Director of the CDC, said the data gathered during the Delta variant showed that unvaccinated people were “about four and a half times more likely to get COVID-19, over 10 times more likely to be hospitalized, and 11 times more likely to die from the disease.” [54]Rochelle Walensky, “Press Briefing by White House COVID-⁠19 Response Team and Public Health Officials,” whitehouse.gov, September 10, 2021

19. October 1, 2021 – California becomes the first state to mandate the COVID-19 vaccine for schools

In a press release on October 1, 2021, Governor Gavin Newsom “announced plans to add the COVID- 19 vaccine to the list of vaccinations required to attend school in-person when the vaccine receives full approval from the Food and Drug Administration (FDA) for middle and high school grades, making California the first state in the nation to announce such a measure. Following the other first-in-the-nation school masking and staff vaccination measures, Governor Newsom announced the COVID-19 vaccine will be required for in-person school attendance—just like vaccines for measles, mumps, rubella and more.” [55]Office of Governor Gavin Newsom, “California Becomes First State in Nation to Announce COVID-19 Vaccine Requirements for Schools,” ca.gov, October 1, 2021

20. October 29, 2021 – US Supreme Court declines 6-3 in John Does 1–3, et al. v. Janet T. Mills, Governor of Maine, et al. to block Maine’s vaccine mandate for health care workers 

SCOTUS denied an emergency request to block Maine’s COVID-19 vaccine mandate for health care workers who wanted to claim religious exemptions. [56]Shawna Chen, Supreme Court declines to block enforcement of Maine’s vaccine mandate for health workers,” axios.com, October 29, 2021

The state had previously allowed some religious exemptions from vaccine requirements, but in 2019 did away with all non-medical exemptions. [57]Pete Williams, “Supreme Court declines to block vaccine mandate for health workers in Maine,” nbcnews.com, October 29, 2021

21. November 4, 2021 – Biden Administration issues emergency regulation requiring that staff at health care facilities participating in the Medicare and Medicaid programs get the COVID-19 vaccine

The Centers for Medicare & Medicaid Services announced that staff at health care facilities that receive Medicare and Medicaid funds must be fully vaccinated against coronavirus by January 4, 2022, a requirement that could apply to more than 17 million health care workers across the United States. [58]Centers for Medicare & Medicaid Services, “Biden-Harris Administration Issues Emergency Regulation Requiring COVID-19 Vaccination for Health Care Workers,” cms.gov, November 4, 2021

22. December 6, 2021 – New York City becomes the first city to announce private sector vaccine mandates and expands indoor vaccine mandate program to include children aged 5-11

New York City’s “Key to NYC” Covid-19 vaccine mandate for indoor dining, gyms, and entertainment venues took effect on September 13, 2021, requiring proof of at least one vaccine dose for everyone age 12 and older. On December 14, 2021, the order expanded to cover kids between 5 and 11 years old. Mayor Bill de Blasio also announced on December 6, 2021, that two vaccine doses will be required for everyone 12 and older starting December 27, 2021. [59]The Official Website of the City of New York, “Mayor de Blasio Announces Vaccine Mandate for Private Sector Workers, and Major Expansions to Nation-Leading ‘Key to NYC’ Program,” … Continue reading [60]Bill de Blasio, “Emergency Executive Order No. 226,” www1.nyc.gov, August 20, 2021

Also announced to begin on December 27, 2021 is a “first-in-the-nation” vaccine mandate for all private sector workers in the city. [61]The Official Website of the City of New York, “Mayor de Blasio Announces Vaccine Mandate for Private Sector Workers, and Major Expansions to Nation-Leading ‘Key to NYC’ Program,” … Continue reading

23. December 13, 2021 – US Supreme Court declines 6-3 in Dr. A, et al., Applicants v. Kathy Hochul, Governor of New York, et al. to block New York’s COVID-19 vaccine mandate for health care workers [62]Rachel Scharf, “High Court Won’t Block NY Health Care Worker Vax Mandate,” law360.com,” December 13, 2021 

SCOTUS refused to block New York state’s vaccine mandate for health care workers who claim religious objections. Justice Gorsuch wrote a dissent in support of the vaccine mandate challengers “because their religion teaches them to oppose abortion in any form, and because each of the currently available vaccines has depended upon abortion-derived fetal cell lines in its production or testing.” [63]Adam Liptak, “Supreme Court Allows Vaccine Mandate for New York Health Care Workers,” nytimes.com, December 13, 2021

New York Attorney General Letitia James stated that there are no aborted fetal cells in the vaccines, and that the fetal cell lines used for vaccine testing were grown in a lab and “are thousands of generations removed from cells collected from a fetus in 1973.” [64]Ariane de Vogue, “Supreme Court declines to block New York vaccine mandate,” cnn.com, December 13, 2021

SCOTUS previously denied requests for emergency relief without referral to the full court for cases involving vaccine mandates for students at Indiana University (August 2021), for employees in New York City public schools (October 2021), and for hospital workers in Massachusetts (November 2021). [65]Adam Liptak, “Supreme Court Allows Vaccine Mandate for New York Health Care Workers,” nytimes.com, December 13, 2021

24. January 7, 2022 – US Supreme Court holds a special hearing on vaccine mandates

On January 7, 2022, SCOTUS began to hear oral arguments related to two of Biden’s vaccine mandates: a requirement for workers at companies with more than 100 employees to be fully vaccinated or get tested weekly, and a requirement for health care workers at facilities receiving federal funding to be vaccinated against coronavirus.[66]Adam Liptak, “Supreme Court to Hold Special Hearing on Biden Vaccine Mandates,” nytimes.com, December 22, 2021

25. January 13, 2022 – US Supreme Court blocks vaccine mandate for large companies but upholds mandate for health care facilities

On January 13, 2022, SCOTUS issued two rulings on vaccine mandates. In the case National Federation of Independent Business v. Department of Labor, SCOTUS voted 6-3 to block the Biden administration’s requirement that workers at companies with 100 or more employees be vaccinated or tested weekly. The mandate would have applied to over 80 million US workers. In the case Biden v. Missouri, SCOTUS voted 5-4 to allow the vaccine mandate for employees of health care facilities that receive federal funding to take effect. The mandate applies to an estimated 10.3 million health care workers.[67]Lawrence Hurley and Andrew Chung, “U.S. Supreme Court blocks Biden vaccine-or-test policy for large businesses,” reuters.com, January 13, 2022

26. January  31, 2022 – FDA approves a second COVID-19 vaccine for people age 18 and older

On January 31, 2022, the FDA approved a second COVID-19 vaccine, manufactured by Moderna, which began marketing under the name Spikevax. As with the approval Pfizer’s Comirnaty, the FDA stated that it conducted a “rigorous evaluation” of the potential for side effects of myocarditis and pericarditis, noting an increased risk seven days following the second dose for men ages 18-24. Most people’s symptoms resolved, but some required intensive care. The FDA “determined that the benefits of the vaccine outweigh the risk of myocarditis and pericarditis in individuals 18 years of age and older.” [68]US Food and Drug Administration, “Coronavirus (COVID-19) Update: FDA Takes Key Action by Approving Second COVID-19 Vaccine,” fda.gov, January 31, 2022

27. February 2, 2022 – Army announces plans to discharge service members who have not gotten the COVID-19 vaccine

On February 2, 2022, the US Army said that soldiers who refuse to be vaccinated against COVID-19 and have not received a waiver will be discharged from service. At that point, an estimated 96% of active troops had gotten vaccinated; among the rest, 5,900 had temporary exemptions and 3,350 soldiers refused to be vaccinated.[69]Avie Schneider, “U.S. Army begins to discharge soldiers who refuse COVID-19 vaccination,” February 2, 2022

Federal judges in various cases about religious exemptions soon issued rulings to stop some firings while lawsuits were in progress.[70]Steve West, “Challenges to military vaccine mandates mount,” wng.org, February 22, 2022

28. February 17, 2022 – Fifteen religious exemptions have been granted across all branches of the military

Six Marines and nine members of the Air Force had been granted exemptions from the COVID-19 vaccine mandate, while the Army and Navy had not granted any religious exemptions, out of an estimated 16,000 religious waiver requests. [71]Rachel S. Cohen, “Air Force approves first religious exemptions to COVID-19 vaccine for 9 troops,” airforcetimes.com, February 8, 2022 [72]Oren Liebermann and Ellie Kaufman, “US military has approved religious exemptions to vaccine mandate for 15 service members out of 16,000 requests,” cnn.com, February 17, 2022

The Air Force reported 1,500 medical exemptions and an estimated 2,300 administrative exemptions for service members who are leaving the military soon. The Navy granted 252 temporary and 11 permanent medical exemptions, and 500 administrative exemptions. The Marine Corps granted an estimated 400 administrative exemptions and 250 medical exemptions. [73]Meghan Myers, “Could Florida case strike down the military’s vaccination mandate?,” tampabay.com, February 18, 2022

29. February 22, 2022 – SCOTUS rejects a challenge to Maine’s health care worker COVID-19 vaccine mandate

On February 22, 2022, SCOTUS denied a petition to review lower court rulings that upheld Maine’s health care worker COVID-19 vaccine mandate that only allows for medical exemptions (vote count unknown). The court rejected an emergency request from the same plaintiffs, a group of Maine health care workers who want the state to include religious exemptions, in November 2021 by a 6-3 vote. [74]Greg Store, “U.S. Supreme Court Spurns Bid for Religious Opt-Out From Vaccine Rule,” bloomberg.com, February 22, 2022

30. February 23, 2022 – Google lifts COVID-19 vaccine mandate for employees

On February 23, 2022, Google, which had been among the first companies to announce a vaccine mandate for its workers, reversed the policy as it prepared to reopen offices. Workers who are not vaccinated will be required to wear masks and submit negative COVID-19 tests regularly in order to return to the office. [75]Dade Hayes, “Google Lifts Covid Vaccine Mandate, Restores Perks For Workers Returning To Office,” deadline.com, February 24, 2022

31. March 25, 2022 – SCOTUS Grants Partial Stay Allowing Pentagon to Consider Vaccination Status in Operational Decisions

On March 25, 2022, SCOTUS issued a temporary block of a federal trial court order in Austin v. US Navy SEALs. The 6-3 ruling allowed the military to factor in the COVID-19 vaccination status of Navy SEALs when making deployment decisions, including reassigning unvaccinated SEALs. Justice Alito and Justice Gorsuch dissented, and Justice Thomas, who was in the hospital until the day of the ruling, noted that he would dissent. The Navy SEALs argued that the military COVID-19 vaccine mandate disregarded their religious beliefs. [76]Amy Howe, “Court Allows Department of Defense to Reassign Unvaccinated Navy SEALs,” scotusblog.com, March 25, 2022

32. April 7, 2022 – 5th Circuit Court of Appeals Reinstates Federal Employee Vaccine Mandate

On April 7, 2022, the 5th Circuit Court of Appeals reinstated Biden’s mandate that federal workers must get the COVID-19 vaccine or seek a religious or medical exemption. A federal judge in a Texas district court issued a nationwide injunction in January preventing the government from enforcing the mandate, which applies to an estimated 3.5 million people. The appeals court vacated the injunction and ordered the lower court to dismiss the case.[77]Eric Katz, “Appeals Court Reinstates Biden’s Vaccine Mandate for Federal Employees,” govexec.com, April 7, 2022 [78]Nick Niedzwiadek, “Biden Administration Makes Case to Save Vaccination Mandate for Federal Employees,” politico.com, March 8, 2022

33. April 18, 2022 – SCOTUS Allows Defense Department to Discipline Unvaccinated Air Force Officer

On April 18, 2022, the US Supreme Court denied an application for an injunction pending appeal by a 6-3 vote. The two-sentence ruling in Dunn v. Austin, et. al. noted that Justice Thomas, Justice Alito, and Justice Gorsuch would have granted the injunction. The case was filed by Jonathan Dunn, an air force lieutenant colonel, chose not to get the COVID-19 vaccine based on religious grounds. Dunn asked the Supreme Court for an injunction against disciplinary action against him while his litigation made its way through the lower courts. [79]Amy Howe, “With Three Conservatives Dissenting, Court Declines to Intervene on Behalf of Air Force Officer Who Won’t Get Vaccinated,” scotusblog.com, April 18, 2022

Dunn had previously gotten other required vaccines. He responded to a denial of his COVID-19 vaccine exemption request by sending a memo to a major general that just read, “NUTS!” (interpreted as “go to hell,” according to a government representative). The Air Force removed Dunn from command, citing Dunn’s memo as justification independent of his vaccine refusal. [80]Lauren Aratani, “Us Supreme Court Rules Against Air Force Officer Who Refused COVID Vaccine,” theguardian.com, April 19, 2022

34. April 21, 2022 – Analysis Estimates That Vaccines Could Have Prevented 234,000 COVID-19 Deaths

A Kaiser Family Foundation analysis released on April 21, 2022, estimated that 234,000 COVID-19 deaths since June 2021 could have been prevented by vaccination. June 2021 is the date by which researchers thought all US adults could have received primary vaccination (two shots of Moderna or Pfizer/one shot of Johnson& Johnson). Since then, 60% of all adult COVID-19 deaths in the United States were vaccine preventable. While the study did not include booster shot data, the authors noted that boosters would have prevented even more deaths of both vaccinated and unvaccinated people. [81]Krutika Amin, Jared Ortaliza, Cynthia Cox, Joshua Michaud, and Jennifer Kates, “COVID-19 Mortality Preventable by Vaccines,” healthsystemtracker.org, April 21, 2022

Challenges to government and private vaccine mandates are ongoing. The information in this report is intended to give a brief overview and may not be updated after the publication date.

III. Historical and Current Opposition to Vaccine Mandates

1. Historical Opposition to Vaccine Mandates

There has been opposition to vaccine mandates since around the time the first mandate was introduced. During the time Gen. Washington made his inoculation mandate, Virginia and other areas either banned or regulated inoculation because improper quarantine procedures could cause an outbreak. [82]Multiple sources accessed October 9, 2021, including: “Disease in the Revolutionary War,” mountvernon.org; “A Deadly Scourge: Smallpox During the Revolutionary War,” armyheritage.org

  • In the 1870s, according to Martin Kaufman in “The American Anti-Vaccinationists and Their Arguments,” when smallpox was a rising concern again, “anti-vaccinationists” stoked fears about the vaccine and were successful in lobbying several states to repeal their “compulsory vaccination” laws. [83]Bulletin of the History of Medicine, Published by: The Johns Hopkins University Press, Vol. 41, No. 5 (September-October 1967), jstor.org, Pages 463-478 The New England Anti-Compulsory Vaccination League was founded in 1882 and others followed, according to the article.
  • Opposition to a 1902 vaccination order issued in Cambridge, Massachusetts, led to the US Supreme Court decision in Jacobson v. Massachusetts on February 20, 1905, upholding the legal authority and enforcement of state and local vaccine mandates and orders.
  • On November 13, 1922, the US Supreme Court decided in Zucht v. King that state and local authorities can enforce vaccine requirements for entry into public school after a case was brought opposing a Texas school vaccine mandate.
  • In the 1965 case United States v. Chadwell brought before the court when two marines declined the smallpox, typhoid, paratyphoid, and influenza vaccines because of their religious beliefs, the Navy Board of Review court (now the Navy-Marine Corps Court of Criminal Appeals) ruled that the “military could order servicemembers to receive vaccinations, even over religious objection.”[84]CRS Report, “Mandatory Vaccinations: Precedent and Current Laws,” everycrsreport.com, January 18, 2005 to May 21, 2014 [85]“In The U.S. Navy-Marine Corps Court Of Criminal Appeals Washington Navy Yard Washington, D.C.,” jag.navy.mil, accessed October 7, 2021
  • On May 18, 1998, US Department of Defense Secretary William S. Cohen mandated the anthrax vaccine for the entire US military after first reviewing the vaccine for safety and other standards for two years. [86]Randall D. Katz, “Friendly Fire: The Mandatory Military Anthrax Vaccination Program,” jstor.org, April 2001 Hundreds of soldiers opposed the vaccine and penalties ranged from loss of rank to loss of their military career. [87]Todd South, “Troops who refused anthrax vaccine paid a high price,” militarytimes.com, June 17, 2021 In 2003 a lawsuit questioning FDA approval halted the mandate, it was started again, then another court stopped the mandate again in 2004. [88]Julie Watson, “Potential military vaccine mandate brings distrust, support,” apnews.com. August 5, 2021According to an article in Army Times, “Federal courts brought a halt to the program in 2004 because the FDA had not licensed the vaccine, failed to follow its own rules in the vaccine’s review and allowed the DoD to use the vaccine for an ‘unapproved use.’ But by 2005, the FDA made the court-directed changes and the program resumed.” [89]Todd South, “The shadow of anthrax: The voluntary COVID-19 vaccination effort owes much to past failures,” armytimes.com, June 17, 2021

2. Current Opposition to the COVID-19 Vaccine Mandates

COVID-19 has killed nearly one million people (991,254) in the US as of April 25, 2022. [90]Kaiser Health News, “KHN Morning Briefing,” khn.org, April 26, 2022 Following the availability of several COVID-19 vaccines, federal, state, and local governments implemented varying requirements that people be vaccinated to work in certain occupations (such as health care and teaching) or to access public spaces (such as indoor dining and gyms).

Opposition to COVID-19 vaccine mandates arose immediately. Some people oppose the mandates because of the COVID-19 vaccine itself, for reasons including a fear that the new vaccines were rushed into use without sufficient research into their long-term impacts and could cause death or serious illness. [91]Jeffrey Kluger, “Too Many Americans Still Mistrust the COVID-19 Vaccines. Here’s Why,” time.com, January 5, 2021 There are also religious and ethical objections to the vaccine having been developed using cell lines with a link to aborted fetal tissue. [92]Matthew K. Wynia, Thomas D. Harter, and Jason T. Eberl, “Why A Universal COVID-19 Vaccine Mandate Is Ethical Today,” healthaffairs.org, November 3, 2021 Other people might trust the vaccine itself, but object to what they see as an attack on their civil liberties and personal freedoms. [93]Alana Wise, “The political fight over vaccine mandates deepens despite their effectiveness,” npr.org, October 17, 2021

Legal challenges and other protests to vaccine mandates included:

  • On September 14, 2021, Arizona Attorney General Mark Brnovich filed the first lawsuit in the country “against the Biden Administration’s radical actions requiring COVID-19 vaccines.” [94]Katie Conner, “First state lawsuit filed against federal vaccine mandate,” azag.gov, September 14, 2021
  • On September 16, 2021, 24 Attorneys General (21 from red states and three from blue states) signed a letter to President Joe Biden: [95]Of those 24 states, 21 are Red (states that went for Trump in the 2020 General Election): Alabama, Alaska, Arkansas, Florida, Indiana, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Montana, … Continue reading

“We, the Attorneys General of 24 states, write in opposition to your attempt to mandate the vaccination of private citizens. On September 9, you announced that you would be ordering the Department of Labor to issue an emergency temporary standard, under the Occupational Safety and Health (OSH) Act, which would mandate that private sector employers require most of their employees to either get a COVID-19 shot, submit to weekly testing, or be fired….We thus urge you to reconsider your unlawful and harmful plan and allow people to make their own decisions. If your Administration does not alter its course, the undersigned state Attorneys General will seek every available legal option to hold you accountable and uphold the rule of law.”

  • As of September 17, 2021, governors in a dozen states had enacted bans on various COVID-19 vaccine mandates. [96]Hannah Mitchell, “12 states banning COVID-19 vaccine mandates & how they affect healthcare workers,” beckershospitalreview.com, September 17, 2021; National Academy for State Health Policy, … Continue reading
  • On September 23, 2021, Air Force officers, a Secret Service agent and others filed a lawsuit in the US District Court in Washington to halt federal and military COVID-19 vaccine mandates. [97]Paul Duggan and Alex Horton, “Lawsuit seeks to halt Biden’s vaccination mandates for federal workforce,” washingtonpost.com, September 30, 2021
  • On November 10, 2021, attorneys general in 10 states filed a lawsuit against the Biden administration over the vaccine mandate for staff members at health care facilities that participate in the Medicare and Medicaid programs. [98]Mark Hagland, “Republican State Attorneys General Sue Administration Over CMS Vaccine Mandate,” hcinnovationgroup.com, November 11, 2021
  • On January 23, 2022, thousands of people gathered in Washington, DC, to protest vaccine mandates. Speakers such as Robert F. Kennedy, Jr., compared vaccine mandates to life in Nazi Germany. [99]Katie Mettler, Lizzie Johnson, Justin Wm. Moyer, Jessica Contrera, Emily Davies, Ellie Silverman, Peter Hermann, and Peter Jamison, “Anti-vaccine activists march in D.C. — a city that mandates … Continue reading
  • On February 4, 2022, 16 states challenged the federal health care worker vaccine mandate in a Louisiana court, arguing that the mandate is unconstitutional and unnecessary due to lowered vaccine effectiveness against the new COVID-19 variant. [100]David A. Lieb and Geoff Mulvihill, “EXPLAINER: Who must follow Biden’s vaccine mandates?,” abcnews.go.com, February 24, 2022
  • As of February 18, 2022, more than 60 service members had joined lawsuits challenging the military’s process for dealing with COVID-19 vaccine religious exemption requests. [101]Meghan Myers, “Could Florida case strike down the military’s vaccination mandate?,” tampabay.com, February 18, 2022
  • On February 23, 2022, ten states filed a renewed lawsuit in a Missouri federal court arguing against the federal vaccine mandate. [102]David A. Lieb and Geoff Mulvihill, “EXPLAINER: Who must follow Biden’s vaccine mandates?,” abcnews.go.com, February 24, 2022

IV. Summary

The above shows that vaccine mandates, opposition to vaccine mandates, and concerns about the vaccines themselves are not new issues in the United States.

Vaccine mandates have been imposed by state and local governments since the 1800s, and mandates to inoculate against disease started at the founding of the country before vaccines were introduced.

Even though vaccine mandates do not require a person to get a vaccination, they do penalize those who choose not to get vaccinated. There may be exemptions for medical, religious, or personal reasons.

Opposition to vaccine mandates has come from states and private citizens since around the time vaccines were first mandated.

On three separate occasions, in 1905, 1922, and 2022, the US Supreme Court upheld the authority of state and local governments to enforce vaccine mandates. In 2022, SCOTUS also blocked a government vaccine mandate.

In late February 2022, many cities began relaxing vaccine verification requirements for indoor venues such as restaurants as COVID-19 case numbers started to decrease. [103]Katie Teague and Peter Butler, “Big Cities Drop Vaccine Requirements as COVID Cases Fall,” cnet.com, February 20, 2022

We hope the information above adds a bit of history to the current news about vaccine mandates in general and COVID-19 specifically.

APPENDIX: The 50 States’ Mandated Vaccines (and Exemptions) for K-12 Public Schools

By 1980, all 50 states required some vaccinations for K-12 public schools, and still do as of December 14, 2021. [104]Maggie Astor, “Vaccination Mandates Are an American Tradition. So Is the Backlash.” nytimes.com, September 9, 2021 Proof of vaccination is mandated for polio, diphtheria, tetanus & pertussis, and measles and rubella (mumps is mandated in every state except Iowa). [105]The District of Columbia, not included in the chart, mandates polio, diphtheria, tetanus, pertussis, measles, rubella. Source: “DC Health: School Immunization Requirements Guide,” … Continue reading

All 50 US states allow for medical exemptions from vaccine requirements, and may have other exemptions for religious beliefs, personal beliefs, or existing immunity. [106]A personal belief exemption is used for any non-medical exemption that is not religious, such as philosophical reasons. The immunity category covers exceptions for people who do not have to get a … Continue reading Receiving an exemption generally means that the unvaccinated student will be allowed to attend school, but 36 states have an additional clause that an unvaccinated student may be excluded from attending school in the event of a disease outbreak or epidemic, with some states specifying exclusion for the unvaccinated during a vaccine-preventable disease outbreak.

This information is for research purposes only and not a legal guide or for people looking for information regarding enrollment rules or a guide for K-12 enrollment. Table is current as of 9/27/2021.

Table: Mandated Vaccines (Columns B, C, D) and Exemptions (Column E)

 A. State
(Most recent date / school year for vaccine requirements information)
B. PolioC. Diphtheria,
Tetanus,
Pertussis,
Dtap, Tdap,
DTP, Td
D.
Measles, Rubella
E.
(M) Medical, (R) Religious, (PB) Personal Belief, (I) Immunity
1Alabama [107]Birmingham City Schools, “What Are The Vaccination Requirements?” bhamcityschools.org, accessed September 27, 2021; National Conference of State Legislatures, “States With Religious and … Continue reading
(2021-2022)
M, R, I
2Alaska [108]State of Alaska, “Child Care & School Immunization Requirements Packet: 21-22 SY,” PDF, dhss.alaska.gov, accessed September 27, 2021
(2021-2022)
M, R, I
Proof of immunity (doctor note, lab results, other) accepted in place of vaccine for polio, diphtheria, tetanus, measles, rubella
3Arizona [109]Arizona Department of Health Services, “School and Child Care Immunization Requirements,” azdhs.gov, updated June 2021
(2021-2022)
M, R, PB, I
Proof of immunity (doctor note, lab results, other) accepted in place of vaccine for polio, diphtheria, tetanus, pertussis, measles, rubella
4Arkansas [110]Arkansas State Board Of Health, “Rules And Regulations Pertaining To Immunization Requirements,” effective September 1, 2014, healthy.arkansas.gov, accessed September 14, 2021; Arkansas … Continue reading
(Effective date September 1, 2014; website accessed September 27, 2021)
M, R, PB, I
Proof of immunity (doctor note, lab results, other) accepted in place of vaccine measles, rubella
5California [111]Natomas Unified School District, “Immunization Requirements for 2021-2022 School Year,” natomasunified.org, July 6, 2021; Shots for Schools, “Medical Exemptions,” shotsforschool.org, accessed … Continue reading
(2021-2022)
M
6Colorado [112]State of Colorado, Department of Public Health & Environment, “School-required vaccines,” cdphe.colorado.gov, accessed September 27, 2021; Colorado Department of Public Health & … Continue reading
(May 2021)
M, R, PB, I
Proof of immunity (doctor note, lab results, other) accepted in place of vaccine for DTaP, Td, measles, rubella
7Connecticut [113]State of Connecticut, Department of Public Health, “Immunization Requirements For Enrolled Students In Connecticut Schools 2021-2022 School Year,” ncps-k12.org, revised January 21, 2021; State of … Continue reading
(2021-2022)
M, R, I
Proof of immunity (doctor note, lab results, other) accepted in place of vaccine for measles, rubella
8Delaware [114]Delaware Department of Education, “Delaware Immunization Requirements,” doe.k12.de.us, accessed September 14, 2021; State of Delaware, “804 Immunizations,” delaware.gov, accessed September … Continue reading
(Website accessed September 27, 2021)
M, R, I
Proof of immunity (doctor note, lab results, other) accepted in place of vaccine for measles, rubella
9Florida [115]Florida Health, “School Immunization Requirements,” floridahealth.gov, last reviewed date March 8, 2021; Florida Health, “Exemption from Required Immunizations,” floridahealth.gov, last … Continue reading
(March 8, 2021)
M, R, I
10Georgia [116]Georgia Department of Public Health, “School Vaccines and Updates,” dph.georgia.gov, last updated June 11, 2021; Georgia Department of Education, “Immunization Information,” PDF, gadoe.org, … Continue reading
(June 11, 2021)
M, R
11Hawaii [117]Hawaii State Dept. of Health, “Immunization Requirements Summary,” health.hawaii.gov, May 29, 2020; State of Hawaii, Department of Health, Disease Outbreak Control Division, “Immunization … Continue reading
(May 29, 2020)
M, R, I
Proof of immunity (doctor note, lab results, other) accepted in place of vaccine for diphtheria, tetanus, measles, rubella
12Idaho [118]Idaho Division of Public Health, “2020-21 Guide To Idaho School Immunization Requirements For Parents of Children in or Entering Preschool & Grades K-12,” publicdocuments.dhw.idaho.gov, … Continue reading
(2020-2021)
M, R, PB
13Illinois [119]Illinois Department of Public Health, “Minimum Immunization Requirements Entering a Child Care Facility or School in Illinois, Fall 2021,” PDF, dph.illinois.gov, accessed September 14, 2021; … Continue reading
(Fall 2021)
M, R, I
Proof of immunity (doctor note, lab results, other) accepted in place of vaccine for rubella
14Indiana [120]Indiana State Department of Health, Immunization Division, “Indiana 2021-2022 Required and Recommended School Immunizations,” PDF, in.gov, August 2020; Indiana Department of Health, “2021-2022 … Continue reading
(2021-2022)
M, R, I
Proof of immunity (doctor note, lab results, other) accepted in place of vaccine for polio, measles, rubella
15Iowa [121]Iowa does not include the mumps vaccine like the other 49 states. Iowa Department of Public Health, “Immunization Requirements,” PDF, idph.iowa.gov, January 2017; Iowa Department of Public … Continue reading
(Website directs to PDF dated January 2017)
M, R, I
16Kansas [122]Kansas Department of Health and Environment, “Kansas School Kindergarten Through Grade 12 Immunization Requirements For 2021-2022 School Year,” kdheks.gov, February 16, 2021; State of Kansas, … Continue reading
(2021-2022)
M, R, I
17Kentucky [123]Kentucky School Boards Association, “Immunizations in Kentucky: A shot at better health,” ksba.org, accessed September 14, 2021; Commonwealth of Kentucky, “Parent or Guardian’s Declination on … Continue reading
(Website accessed September 27, 2021)

M, R, I

18Louisiana [124]Louisiana Department of Health, “Required vaccinations to attend Louisiana schools,” ldh.la.gov, accessed September 21, 2021; Louisiana Department of Health, “Louisiana School Immunization … Continue reading
(October 2019)

M, R, PB

19Maine [125]Maine Department of Education, “Maine School Immunization Requirements,” maine.gov, June 2021; State of Maine, “Immunization Requirements For School Children,” maine.gov, last updated May 10, … Continue reading
(June 2021)

M, I

20Maryland [126]Maryland Department of Health, “Vaccine Requirements For Children Enrolled in Preschool Programs and in Schools…Maryland School Year 2021–2022 (Valid 9/1/21 – 8/31/22),” ccboe.com, … Continue reading
(2021-2022)
M, R, I
Proof of immunity (doctor note, lab results, other) accepted in place of vaccine for polio, measles, rubella
21Massachusetts [127]Commonwealth of Massachusetts, “School Immunizations,” (Link to Word Document, “Massachusetts School Immunization Requirements 2021-2022§”) mass.gov, accessed September 26, 2021
(May 26, 2021)
M, R, I
Proof of immunity (doctor note, lab results, other) accepted in place of vaccine for measles, rubella
22

Michigan [128]Michigan Department of Health and Human Services, “Vaccines Required for School Entry in Michigan,” PDF, michigan.gov, December 11, 2019; Michigan Department of Health and Human Services, “2021 … Continue reading
(December 11, 2019)

M, R, PB, I
Proof of immunity (doctor note, lab results, other) accepted in place of vaccine for measles, rubella
23

Minnesota [129]Minnesota Department of Health, Immunization Program, “Immunization Form,” health.state.mn.us, 2019; Religious exemption covered under non-medical exemption.
(August 2021)

M, R, PB, I
24Mississippi [130]Mississippi State, “Mississippi School Immunization Requirements,” msdh.ms.gov, June 3, 2020; Mississippi State Department of Health, “Medical Exemption Request,” msdh.ms.gov, July 15, 2020
(June 2020)
M, I
Proof of immunity (doctor note, lab results, other) accepted in place of vaccine for measles, rubella
25Missouri [131]Missouri State, “2021-2022 Missouri School Immunization Requirements,” health.mo.gov, revised February 2021
(2021-2022)
M, R, I
26Montana [132]Montana, Public Health in the 406, “Vaccines Required for School Attendance, Preschool -12th Grade,” dphhs.mt.gov, September 2019; Montana Department of Public Health and Human Services, … Continue reading
(September 2019)
M, R
27Nebraska [133]Nebraska Department of Health and Human Services, “School Immunization Reporting,” dhhs.ne.gov, accessed September 21, 2021
(Website accessed September 27, 2021)
M, R, I
28Nevada [134]Clark County School District, “Student Enrollment Information,” ccsd.net, accessed September 21, 2021; Nevada Vaccines for Children Program, “Exemption Rules,” vfcnevada.org, accessed … Continue reading
(2021-2022)
M, R, I
29New Hampshire [135]State Of New Hampshire, Department of Health And Human Services, “New Hampshire School Immunization Requirements 2021-2022,” dhhs.nh.gov, February 2021; New Hampshire Department of Health and … Continue reading
(2021-2022)
M, R, I
Proof of immunity (doctor note, lab results, other) accepted in place of vaccine for measles, rubella
30New Jersey [136]New Jersey Department of Health, “Summary of NJ School Immunization Requirements,” nj.gov, updated September 2020
(September 2020)
M, R, I
31New Mexico [137]New Mexico Department of Health, “New Mexico Childcare/Pre-School/School Entry Immunization Requirements: 2021-22 school year,” nmhealth.org, updated March 3, 2021; New Mexico Department of … Continue reading
(2021-2022)
M, R, I
32New York [138]New York State Department of Health, “2021-22 School Year New York State Immunization Requirements for School Entrance/Attendance,” health.ny.gov, April 2021; New York State Department of Health, … Continue reading
(2021-2022)
M, I
Proof of immunity (doctor note, lab results, other) accepted in place of vaccine for measles, rubella
33North Carolina [139]North Carolina Department of Health and Human Services, “K-12 School Requirements,” immunize.nc.gov, updated July 23, 2020; North Carolina Department of Health and Human Services, “N.C. … Continue reading
(Website updated July 23, 2020)
M, R, I
Proof of immunity (doctor note, lab results, other) accepted in place of vaccine for measles, rubella
34North Dakota [140]North Dakota Health, “2021-2022 School Immunization Requirements,” health.nd.gov, updated January 5, 2021
(2021-2022)
M, R, PB, I
Proof of immunity (doctor note, lab results, other) accepted in place of vaccine for measles, rubella
35Ohio [141]Ohio Department of Health, “Ohio Immunization Summary for School Attendance…Fall 2021 Immunizations For School Attendance,” ohio.gov, September 14, 2021; Ohio Laws and Administrative Rules, … Continue reading
(Fall 2020)
M, R, PB
36Oklahoma [142]Oklahoma State Department of Health, “Guide to Immunization Requirements in Oklahoma: 2021-22 School Year,” oklahoma.gov, revised May 7, 2021; Oklahoma State Department of Health, “Certificate … Continue reading
(2021-2022)
M, R, PB, I
37Oregon [143]Oregon State, “School Year 2021-2022,” oregon.gov, dated January 2021; Oregon Health Authority, “Oregon Certificate of Immunization Status,” oregon.gov, accessed September 24, 2021; Oregon … Continue reading
(2021-2022)
M, R, PB, I
Proof of immunity (doctor note, lab results, other) accepted in place of vaccine for measles, rubella
38Pennsylvania [144]Kimberly Snyder, “Immunizations Required for Attendance During the 2021-2022 School Year,” hempfieldsd.org, July 13, 2021; Commonwealth of Pennsylvania, “§ 23.84. Exemption from … Continue reading
(2021-2022)
M, R, PB, I
Proof of immunity (doctor note, lab results, other) accepted in place of vaccine for measles, rubella
39Rhode Island [145]State of Rhode Island, Department of Health, “Immunization Information for Schools and Child Care Workers,” health.ri.gov, accessed September 21, 2021; Rhode Island Department of Health, … Continue reading
(Website accessed September 27, 2021)
M, R
40South Carolina [146]South Carolina Department of Health and Environmental Control, “5K–12 Immunization Info For Parents,” scdhec.gov, April 2021; South Carolina Department of Health and Environmental Control, … Continue reading
(2021-2022)
M, R, I
41South Dakota [147]South Dakota Department of Health, “Kindergarten Vaccination Requirements,” doh.sd.gov, revised July 16, 2021; South Dakota Department of Health, “Certificate Of Immunization,” doh.sd.gov, … Continue reading
(July 16, 2021)
M, R, I
42Tennessee [148]Tennessee Immunization Program, “Diseases Covered by Tennessee Child Care and School Immunization Requirements,” tn.gov, updated January 2020; Tennessee Department of Health, “Required … Continue reading
(January 2020)
M, R, I
Proof of immunity (doctor note, lab results, other) accepted in place of vaccine for measles, rubella,
43Texas [149]Texas Department of State Health Services, “2021-2022 Texas Minimum State Vaccine Requirements for Students Grades K–12,” dshs.texas.gov, revised January 2021
(2021-2022)
M, R, PB, I
Proof of immunity (doctor note, lab results, other) accepted in place of vaccine for measles, rubella
44Utah [150]Utah Department of Health Immunization Program, “Utah Immunization Guidebook 2021-2022,” immunize.utah.gov, revised April 2021
(2021-2022)
M, R, PB, I
Immunity exception for DTaP/DT with note from doctor of prior infection
45Vermont [151]Vermont Department of Health, “School Year 2021-22 Immunization Entry Requirements,” healthvermont.gov, accessed September 21, 2021; Vermont Department of Health, “Immunization Exemptions,” … Continue reading
(2021-2022)
M, R, I
46Virginia [152]Virginia Department of Health, “School and Day Care Minimum Immunization Requirements,” vdh.virginia.gov, accessed September 27, 2021; Commonwealth of Virginia, “Commonwealth Of Virginia … Continue reading
(Website accessed September 27, 2021)
M, R, I
Proof of immunity (doctor note, lab results, other) accepted in place of vaccine for measles, rubella
47Washington [153]Washington State Department of Health, “Parents– Are Your Kids Ready for School? Required Immunizations for School Year 2021-2022,” doh.wa.gov, October 2020; Washington State Department of … Continue reading
(2021-2022)
M, R, PB, I
48West Virginia [154]West Virginia Department of Health and Human Resources, “West Virginia Immunization Requirements for New School Enterers,” oeps.wv.gov, accessed September 21, 2021; West Virginia Department of … Continue reading
(PDF accessed September 27, 2021)
M, I
49Wisconsin [155]Wisconsin Department of Health Services Division of Public Health Bureau of Communicable Diseases Immunization Program, “Wisconsin School Immunization Requirements 2021-2022,” dhs.wisconsin.gov, … Continue reading
(2021-2022)
M, R, PB, I
Proof of immunity (doctor note, lab results, other) accepted in place of vaccine for measles, rubella
50Wyoming [156]Wyoming Department of Health, “Wyoming Immunization Requirements,” health.wyo.gov, updated June 30, 2021; Wyoming Department of Health, Immunization Unit, “Medical Waiver Request,” … Continue reading
(June 30, 2021)
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References

References
1 The Free Dictionary, “Mandate,” legal-dictionary.thefreedictionary.com (accessed October 8, 2021)
2 The word vaccine was coined by the founder of the first vaccine, Edward Jenner, who based it off the Latin word for cow, “vacca,” because cow pox is widely credited as the source of the vaccine.
3 Janet A. Aker, “Gen. George Washington Ordered Smallpox Inoculations for All Troops,” health.mil, August 16, 2021
4 The first inoculation order was technically not the first vaccination mandate because the first vaccine was not created until 1796, when Edward Jenner used the “less dangerous” cow pox disease to create a smallpox vaccine. Source: SITNBoston, Special Edition On Infectious Disease, “The Fight Over Inoculation During the 1721 Boston Smallpox Epidemic,” sitn.hms.harvard.edu, December 31, 2014
5 Amy Lynn Filsinger and Raymond Dwek, “George Washington and the First Mass Military Inoculation,” loc.gov, accessed September 12, 2021; Text of letter, “George Washington Papers, Series 3, Subseries 3B, Varick Transcripts, Letterbook 2,” loc.gov, accessed September 24, 2021
6 BBC, “Edward Jenner (1749-1823),” bbc.co.uk (accessed December 14, 2021)
7 The spelling for cow pox varies by publication.
8 Kai Kupferschmidt, “Why the word ‘vaccine’ is probably all wrong,” science.org, October 11, 2017
9 Stefan Riedel, MD, PhD, “Edward Jenner and the history of smallpox and vaccination,” ncbi.nlm.nih.gov, January 2005
10 CDC, “Immunization: The Basics,” cdc.gov, September 1, 2021
11 Dictionary.com, “‘Vaccinate’ vs. ‘Inoculate’ vs. ‘Immunize’: What Are The Differences?,” dictionary.com, February 22, 2021
12 Samuel Shipley, “List of U.S. states’ dates of admission to the union,” britannica.com, accessed October 9, 2021
13 Philip J. Smith, PhD, David Wood, MD, MPH, and Paul M. Darden, MD, “Highlights of Historical Events Leading to National Surveillance of Vaccination Coverage in the United States,” ncbi.nlm.nih.gov, 2011
14 Jess McHugh, “First U.S. vaccine mandate in 1809 launched 200 years of court battles,” washingtonpost.com, December 12, 2021
15 Publisher, Boston: Secretary of the Commonwealth, “1809 Chap. 0117. An Act To Diffuse The Benefits Of Inoculation For The Cow Pox.,” Chap. CXVI, books.google.com, Page 204
16 Although the Act passed on March 6, 1810, the State Library of Massachusetts archive lists the law under the year 1809, and some sources cite 1809 as the year of the first mandate. The reason for this discrepancy in dates is unclear.
17 Statutes and Stories, “An Act to Encourage Vaccination (1813),” statutesandstories.com, February 17, 2020
18 Online book, “Resolves of the General Court of the Commonwealth of Massachusetts,” babel.hathitrust.org, accessed October 10, 2021
19 Editors Lance P. Steahly, MD, and David W. Cannon, Sr., “The Evolution of Forward Surgery in the US Army,” usgovcloudapi.net, accessed September 23, 2021, Page 17; “The Army Medical Department 1775-1818,” Mary C. Gillett, history.army.mil, accessed September 23, 2021
20 Todd South, “Humans now testing the Army’s catch-all COVID vaccine,” armytimes.com, June 22, 2021
21 FDA, “Milestones in U.S. Food and Drug Law,” fda.gov, accessed October 7, 2021
22 State Library of Massachusetts, “1855 Chap. 0414. An Act To Secure General Vaccination.,” archives.lib.state.ma.us (accessed December 7, 2021)
23 1855 Senate Bill 0155. An Act To Secure General Vaccination, “An Act To secure General Vaccination,” Senate No. 155. 1855, archives.lib.state.ma.us (accessed October 30, 2021)
24 Justice Harlan, Opinion of the Court, “Jacobson v. Massachusetts, 197 U.S. 11 (1905),” justia.com, accessed September 18, 2021
25 Calculator from officialdata.org, accessed October 14, 2021
26 New England Historical Society, “Henning Jacobson Loses His Fight with the Board of Public Health Over Vaccination,” newenglandhistoricalsociety.com, updated 2021
27 Nicholas Mosvick, “On this day, the Supreme Court rules on vaccines and public health,” constitutioncenter.org, February 20, 2021
28 Oyez.org, Jacobson v. Massachusetts, oyez.org, accessed October 6, 2021
29 Either Richard Pfeiffer or Almroth Edward Wright, a British pathologist, is credited for creating the typhoid vaccine in 1897, depending on the source. Source: John D. Williamson, Keith G. Gould and Kevin Brown, “Richard Pfeiffer’s typhoid vaccine and Almroth Wright’s claim to priority,” pubmed.ncbi.nlm.nih.gov, April 8, 2021; National Portrait Gallery, “Sir Almroth Edward Wright,” npg.org.uk, accessed October 7, 2021
30 John D. Grabenstein, Phillip R. Pittman, John T. Greenwood, and Renata J. M. Engler, “Immunization to Protect the US Armed Forces: Heritage, Current Practice, and Prospects,” silverchair.com, March 28, 2006
31 “Vaccination: A More Effective Way to Prevent Typhoid Fever,” virginia.edu, accessed October 7, 2021; Dr Jari Vainio and Dr Felicity Cutts, “Yellow fever,” who.int, 1998
32 Wen W. Shen, “State and Federal Authority to Mandate COVID-19 Vaccination,” crsreports.congress.gov, April 2, 2021
33 The Writ of Certiorari was notarized on April 21, 1921.
34 Edited by Keith Wailoo, Julie Livingston, Steven Epstein, and Robert Aronowitz, “Three Shots at Prevention,” books.google.com, Page 9, accessed September 18, 2021; Reference Staff, Tarlton Law Library, email response September 24, 2021
35 Library of Congress PDF, Zucht, By Her Next Friend, etc. v. King et al., loc.gov, October term, 1922, accessed September 13, 2021
36 Ross D. Silverman and Thomas May, “Private Choice Versus Public Health: Religion, Morality, and Childhood Vaccination Law,” digitalcommons.law.umaryland.edu, 2001
37 John R. Vile, “Prince v. Massachusetts (1944),” The First Amendment Encyclopedia, 2009
38 Jethro K. Lieberman, A Practical Companion to the Constitution: How the Supreme Court Has Ruled on Issues from Abortion to Zoning, 1999
39 Wiley Rutledge, “Prince v. Commonwealth of Massachusetts,” law.cornell.edu, January 31, 1944
40 Minami Funakoshi, “U.S. state vaccine mandates in schools,” reuters.com, September 15, 2021
41 Ashley Welch, “Vaccine Mandates in Schools Aren’t New. They’ve Been Used Since 1850,” healthline.com, August 8, 2021
42, 104 Maggie Astor, “Vaccination Mandates Are an American Tradition. So Is the Backlash.” nytimes.com, September 9, 2021
43 Phil Wilson and Melanie Mason, “California Gov. Jerry Brown signs new vaccination law, one of nation’s toughest,” lattices.com, June 30, 2015
44 Ben Popken and April Glaser, “Google and Facebook mandate vaccines for all employees returning to offices,” nbcnews.com, July 28, 2021
45 Nicholas Reimann, “Vax Up Or Stay Home: These Cities Are Mandating Covid Vaccination To Dine In At Restaurants And Other Indoor Fun,” forbes.com, August 12, 2021; City and County of San Francisco, sf.gov, August 20, 2021; “FAQs for COVID-19 Health Order C19-07y,” sfdph.org, accessed October 10, 2021
46 US Food and Drug Administration, “FDA Takes Key Action in Fight Against COVID-19 By Issuing Emergency Use Authorization for First COVID-19 Vaccine,” fda.gov, December 11, 2020
47 FDA, “FDA Approves First COVID-19 Vaccine,” fda.gov, August 23, 2021.
48 Department of Defense, “Mandatory Coronavirus Disease 2019 Vaccination of DoD Civilian Employees,” defense.gov, October 4, 2021. Mandatory vaccinations required for all servicemembers upon entering initial entry or basic training include adenovirus, hepatitis A & B, influenza, measles/mumps/rubella, meningococcal, poliovirus, tetanus-diphtheria, and varicella (chickenpox), as of August 6, 2021. Other vaccines are mandated based on deployment. Source: Bryce H. P. Mendez, Analyst in Defense Health Care Policy, “Defense Health Primer: Military Vaccinations,” fas.org, August 6, 2021.
49 Patricia Kime, “US Troops Go to Court Seeking Vaccine Exemption for Those Who’ve Had COVID-19,” military.com, September 29, 2021
50 The White House website, “Executive Order on Requiring Coronavirus Disease 2019 Vaccination for Federal Employees,” whitehouse.gov, September 9, 2021
51 Although we use the term vaccination throughout this paper, others use the term immunization and some use vaccination and immunization interchangeably.
52 The White House website, “Path out of the Pandemic,” whitehouse.gov, accessed September 12, 2021
53 Heather M. Scobie, et al., “Monitoring Incidence of COVID-19 Cases, Hospitalizations, and Deaths, by Vaccination Status — 13 U.S. Jurisdictions, April 4–July 17, 2021,” cdc.gov, September 17, 2021
54 Rochelle Walensky, “Press Briefing by White House COVID-⁠19 Response Team and Public Health Officials,” whitehouse.gov, September 10, 2021
55 Office of Governor Gavin Newsom, “California Becomes First State in Nation to Announce COVID-19 Vaccine Requirements for Schools,” ca.gov, October 1, 2021
56 Shawna Chen, Supreme Court declines to block enforcement of Maine’s vaccine mandate for health workers,” axios.com, October 29, 2021
57 Pete Williams, “Supreme Court declines to block vaccine mandate for health workers in Maine,” nbcnews.com, October 29, 2021
58 Centers for Medicare & Medicaid Services, “Biden-Harris Administration Issues Emergency Regulation Requiring COVID-19 Vaccination for Health Care Workers,” cms.gov, November 4, 2021
59, 61 The Official Website of the City of New York, “Mayor de Blasio Announces Vaccine Mandate for Private Sector Workers, and Major Expansions to Nation-Leading ‘Key to NYC’ Program,” www1.nyc.gov, December 6, 2021
60 Bill de Blasio, “Emergency Executive Order No. 226,” www1.nyc.gov, August 20, 2021
62 Rachel Scharf, “High Court Won’t Block NY Health Care Worker Vax Mandate,” law360.com,” December 13, 2021
63, 65 Adam Liptak, “Supreme Court Allows Vaccine Mandate for New York Health Care Workers,” nytimes.com, December 13, 2021
64 Ariane de Vogue, “Supreme Court declines to block New York vaccine mandate,” cnn.com, December 13, 2021
66 Adam Liptak, “Supreme Court to Hold Special Hearing on Biden Vaccine Mandates,” nytimes.com, December 22, 2021
67 Lawrence Hurley and Andrew Chung, “U.S. Supreme Court blocks Biden vaccine-or-test policy for large businesses,” reuters.com, January 13, 2022
68 US Food and Drug Administration, “Coronavirus (COVID-19) Update: FDA Takes Key Action by Approving Second COVID-19 Vaccine,” fda.gov, January 31, 2022
69 Avie Schneider, “U.S. Army begins to discharge soldiers who refuse COVID-19 vaccination,” February 2, 2022
70 Steve West, “Challenges to military vaccine mandates mount,” wng.org, February 22, 2022
71 Rachel S. Cohen, “Air Force approves first religious exemptions to COVID-19 vaccine for 9 troops,” airforcetimes.com, February 8, 2022
72 Oren Liebermann and Ellie Kaufman, “US military has approved religious exemptions to vaccine mandate for 15 service members out of 16,000 requests,” cnn.com, February 17, 2022
73, 101 Meghan Myers, “Could Florida case strike down the military’s vaccination mandate?,” tampabay.com, February 18, 2022
74 Greg Store, “U.S. Supreme Court Spurns Bid for Religious Opt-Out From Vaccine Rule,” bloomberg.com, February 22, 2022
75 Dade Hayes, “Google Lifts Covid Vaccine Mandate, Restores Perks For Workers Returning To Office,” deadline.com, February 24, 2022
76 Amy Howe, “Court Allows Department of Defense to Reassign Unvaccinated Navy SEALs,” scotusblog.com, March 25, 2022
77 Eric Katz, “Appeals Court Reinstates Biden’s Vaccine Mandate for Federal Employees,” govexec.com, April 7, 2022
78 Nick Niedzwiadek, “Biden Administration Makes Case to Save Vaccination Mandate for Federal Employees,” politico.com, March 8, 2022
79 Amy Howe, “With Three Conservatives Dissenting, Court Declines to Intervene on Behalf of Air Force Officer Who Won’t Get Vaccinated,” scotusblog.com, April 18, 2022
80 Lauren Aratani, “Us Supreme Court Rules Against Air Force Officer Who Refused COVID Vaccine,” theguardian.com, April 19, 2022
81 Krutika Amin, Jared Ortaliza, Cynthia Cox, Joshua Michaud, and Jennifer Kates, “COVID-19 Mortality Preventable by Vaccines,” healthsystemtracker.org, April 21, 2022
82 Multiple sources accessed October 9, 2021, including: “Disease in the Revolutionary War,” mountvernon.org; “A Deadly Scourge: Smallpox During the Revolutionary War,” armyheritage.org
83 Bulletin of the History of Medicine, Published by: The Johns Hopkins University Press, Vol. 41, No. 5 (September-October 1967), jstor.org, Pages 463-478
84 CRS Report, “Mandatory Vaccinations: Precedent and Current Laws,” everycrsreport.com, January 18, 2005 to May 21, 2014
85 “In The U.S. Navy-Marine Corps Court Of Criminal Appeals Washington Navy Yard Washington, D.C.,” jag.navy.mil, accessed October 7, 2021
86 Randall D. Katz, “Friendly Fire: The Mandatory Military Anthrax Vaccination Program,” jstor.org, April 2001
87 Todd South, “Troops who refused anthrax vaccine paid a high price,” militarytimes.com, June 17, 2021
88 Julie Watson, “Potential military vaccine mandate brings distrust, support,” apnews.com. August 5, 2021
89 Todd South, “The shadow of anthrax: The voluntary COVID-19 vaccination effort owes much to past failures,” armytimes.com, June 17, 2021
90 Kaiser Health News, “KHN Morning Briefing,” khn.org, April 26, 2022
91 Jeffrey Kluger, “Too Many Americans Still Mistrust the COVID-19 Vaccines. Here’s Why,” time.com, January 5, 2021
92 Matthew K. Wynia, Thomas D. Harter, and Jason T. Eberl, “Why A Universal COVID-19 Vaccine Mandate Is Ethical Today,” healthaffairs.org, November 3, 2021
93 Alana Wise, “The political fight over vaccine mandates deepens despite their effectiveness,” npr.org, October 17, 2021
94 Katie Conner, “First state lawsuit filed against federal vaccine mandate,” azag.gov, September 14, 2021
95 Of those 24 states, 21 are Red (states that went for Trump in the 2020 General Election): Alabama, Alaska, Arkansas, Florida, Indiana, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nebraska, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Texas, Utah, West Virginia, and Wyoming; 3 are Blue (states that went for Biden in the 2020 General Election): Arizona, Georgia, and New Hampshire.
96 Hannah Mitchell, “12 states banning COVID-19 vaccine mandates & how they affect healthcare workers,” beckershospitalreview.com, September 17, 2021; National Academy for State Health Policy, “State Efforts to Ban or Enforce COVID-19 Vaccine Mandates and Passports,” nashp.org, updated October 1, 2021
97 Paul Duggan and Alex Horton, “Lawsuit seeks to halt Biden’s vaccination mandates for federal workforce,” washingtonpost.com, September 30, 2021
98 Mark Hagland, “Republican State Attorneys General Sue Administration Over CMS Vaccine Mandate,” hcinnovationgroup.com, November 11, 2021
99 Katie Mettler, Lizzie Johnson, Justin Wm. Moyer, Jessica Contrera, Emily Davies, Ellie Silverman, Peter Hermann, and Peter Jamison, “Anti-vaccine activists march in D.C. — a city that mandates coronavirus vaccination — to protest mandates,” washingtonpost.com, January 23, 2022
100, 102 David A. Lieb and Geoff Mulvihill, “EXPLAINER: Who must follow Biden’s vaccine mandates?,” abcnews.go.com, February 24, 2022
103 Katie Teague and Peter Butler, “Big Cities Drop Vaccine Requirements as COVID Cases Fall,” cnet.com, February 20, 2022
105 The District of Columbia, not included in the chart, mandates polio, diphtheria, tetanus, pertussis, measles, rubella. Source: “DC Health: School Immunization Requirements Guide,” dchealth.dc.gov, accessed September 13, 2021
106 A personal belief exemption is used for any non-medical exemption that is not religious, such as philosophical reasons. The immunity category covers exceptions for people who do not have to get a vaccine if they can show proof they had the disease or lab results showing other required results.
107 Birmingham City Schools, “What Are The Vaccination Requirements?” bhamcityschools.org, accessed September 27, 2021; National Conference of State Legislatures, “States With Religious and Philosophical Exemptions From School Immunization Requirements,” ncsl.org, April 30, 2021; Alabama Public Health, “Recommended Vaccines,” alabamapublichealth.gov, accessed September 27, 2021; Casetext online, “Ala. Admin. Code r. 420-6-1-.03,” casetext.com, Current through Register Vol. 39, No. 11, August 31, 2021
108 State of Alaska, “Child Care & School Immunization Requirements Packet: 21-22 SY,” PDF, dhss.alaska.gov, accessed September 27, 2021
109 Arizona Department of Health Services, “School and Child Care Immunization Requirements,” azdhs.gov, updated June 2021
110 Arkansas State Board Of Health, “Rules And Regulations Pertaining To Immunization Requirements,” effective September 1, 2014, healthy.arkansas.gov, accessed September 14, 2021; Arkansas Department of Health, “Arkansas 2021-2022 Immunization Exemption Application Packet for Childcare or School Students,” healthyarkansas.com, accessed September 27, 2021
111 Natomas Unified School District, “Immunization Requirements for 2021-2022 School Year,” natomasunified.org, July 6, 2021; Shots for Schools, “Medical Exemptions,” shotsforschool.org, accessed September 21, 2021; California Department of Public Health, “California Immunization Requirements For K – 12th Grade,” eziz.org, January 2021; Irvine Unified School District, “Medical Exemption to Required Immunizations,” iusd.org, accessed September 27, 2021
112 State of Colorado, Department of Public Health & Environment, “School-required vaccines,” cdphe.colorado.gov, accessed September 27, 2021; Colorado Department of Public Health & Environment, “Colorado Certificate Of Immunization,” drive.google.com, last reviewed May 2021; State of Colorado, “Vaccine exemptions…Implementation of SB20-163, School Entry Immunization,” cdphe.colorado.gov, September 24, 2021; CDPHE, “Immunization: Certificate of Nonmedical Exemption,” drive.google.com, last reviewed August 2021
113 State of Connecticut, Department of Public Health, “Immunization Requirements For Enrolled Students In Connecticut Schools 2021-2022 School Year,” ncps-k12.org, revised January 21, 2021; State of Connecticut, State Department Of Education, “CSDE Guidance Regarding Public Act 21-6, ‘An Act Concerning Immunizations,’“ portal.ct.gov, May 25, 2021; Connecticut State, “Connecticut Department of Public Health Medical Exemption Certification Statement,” revised April 2011, portal.ct.gov, accessed September 23, 2021
114 Delaware Department of Education, “Delaware Immunization Requirements,” doe.k12.de.us, accessed September 14, 2021; State of Delaware, “804 Immunizations,” delaware.gov, accessed September 21, 2021
115 Florida Health, “School Immunization Requirements,” floridahealth.gov, last reviewed date March 8, 2021; Florida Health, “Exemption from Required Immunizations,” floridahealth.gov, last reviewed date March 7, 2021 (link to March 2013 “Immunization Guidelines,” floridahealth.gov, accessed September 26, 2021)
116 Georgia Department of Public Health, “School Vaccines and Updates,” dph.georgia.gov, last updated June 11, 2021; Georgia Department of Education, “Immunization Information,” PDF, gadoe.org, accessed September 26, 2021
117 Hawaii State Dept. of Health, “Immunization Requirements Summary,” health.hawaii.gov, May 29, 2020; State of Hawaii, Department of Health, Disease Outbreak Control Division, “Immunization Exemptions,” health.hawaii.gov, accessed September 21, 2021
118 Idaho Division of Public Health, “2020-21 Guide To Idaho School Immunization Requirements For Parents of Children in or Entering Preschool & Grades K-12,” publicdocuments.dhw.idaho.gov, August 2020
119 Illinois Department of Public Health, “Minimum Immunization Requirements Entering a Child Care Facility or School in Illinois, Fall 2021,” PDF, dph.illinois.gov, accessed September 14, 2021; Illinois State, “Illinois Certificate Of Religious Exemption To Required Immunizations And/Or Examinations Form,” illinois.gov, accessed September 21, 2021; Joint Committee on Administrative Rules, Administrative Code, “…Section 665.520 Medical Exemption,” ilga.gov, accessed October 4, 2021
120 Indiana State Department of Health, Immunization Division, “Indiana 2021-2022 Required and Recommended School Immunizations,” PDF, in.gov, August 2020; Indiana Department of Health, “2021-2022 School Immunization Requirements Frequently Asked Questions for School Nurses Indiana Department of Health (IDOH) – Immunization Division,” in.gov, accessed September 23, 2021
121 Iowa does not include the mumps vaccine like the other 49 states. Iowa Department of Public Health, “Immunization Requirements,” PDF, idph.iowa.gov, January 2017; Iowa Department of Public Health, “Immunization Audits – Frequently Asked Questions 2021-2022 School Year,” idph.iowa.gov, August 9, 2021
122 Kansas Department of Health and Environment, “Kansas School Kindergarten Through Grade 12 Immunization Requirements For 2021-2022 School Year,” kdheks.gov, February 16, 2021; State of Kansas, “Kansas Statutes Related To School Immunizations,” kdheks.gov, March 4, 2019; Kansas Department of Health and Environment, “Kansas Certificate Of Immunizations – Form B: Medical Exemption,” kdheks.gov, revised February 16, 2021
123 Kentucky School Boards Association, “Immunizations in Kentucky: A shot at better health,” ksba.org, accessed September 14, 2021; Commonwealth of Kentucky, “Parent or Guardian’s Declination on Religious Grounds to Required Immunizations,” chfs.ky.gov, effective June 2017 
124 Louisiana Department of Health, “Required vaccinations to attend Louisiana schools,” ldh.la.gov, accessed September 21, 2021; Louisiana Department of Health, “Louisiana School Immunization Entry Requirements,” ldh.la.gov, October 2019; Louisiana Department of Education, “Statement Of Exemption From Immunizations,” ldh.la.gov, accessed September 24, 2021
125 Maine Department of Education, “Maine School Immunization Requirements,” maine.gov, June 2021; State of Maine, “Immunization Requirements For School Children,” maine.gov, last updated May 10, 2018
126 Maryland Department of Health, “Vaccine Requirements For Children Enrolled in Preschool Programs and in Schools…Maryland School Year 2021–2022 (Valid 9/1/21 – 8/31/22),” ccboe.com, accessed September 21, 2021; Maryland, Center for Immunization, “Maryland Department Of Health Immunization Certificate,” health.maryland.gov, revised May 2021
127 Commonwealth of Massachusetts, “School Immunizations,” (Link to Word Document, “Massachusetts School Immunization Requirements 2021-2022§”) mass.gov, accessed September 26, 2021
128 Michigan Department of Health and Human Services, “Vaccines Required for School Entry in Michigan,” PDF, michigan.gov, December 11, 2019; Michigan Department of Health and Human Services, “2021 Medical Contraindication Form,” michigan.gov, accessed September 26, 2021; Michigan Department of Health and Human Services, “Nonmedical Waiver Rule for Childhood Immunizations in School and Licensed Childcare Programs: Information for Parents/Guardians,” michigan.gov, May 3, 2021
129 Minnesota Department of Health, Immunization Program, “Immunization Form,” health.state.mn.us, 2019; Religious exemption covered under non-medical exemption.
130 Mississippi State, “Mississippi School Immunization Requirements,” msdh.ms.gov, June 3, 2020; Mississippi State Department of Health, “Medical Exemption Request,” msdh.ms.gov, July 15, 2020
131 Missouri State, “2021-2022 Missouri School Immunization Requirements,” health.mo.gov, revised February 2021
132 Montana, Public Health in the 406, “Vaccines Required for School Attendance, Preschool -12th Grade,” dphhs.mt.gov, September 2019; Montana Department of Public Health and Human Services, “Affidavit Of Exemption On Religious Grounds From Montana School Immunization Law And Rules,” mcpsmt.org, revised June 2015
133 Nebraska Department of Health and Human Services, “School Immunization Reporting,” dhhs.ne.gov, accessed September 21, 2021
134 Clark County School District, “Student Enrollment Information,” ccsd.net, accessed September 21, 2021; Nevada Vaccines for Children Program, “Exemption Rules,” vfcnevada.org, accessed September 24, 2021
135 State Of New Hampshire, Department of Health And Human Services, “New Hampshire School Immunization Requirements 2021-2022,” dhhs.nh.gov, February 2021; New Hampshire Department of Health and Human Services, “Exemptions for Children,” dhhs.nh.gov, accessed September 24, 2021
136 New Jersey Department of Health, “Summary of NJ School Immunization Requirements,” nj.gov, updated September 2020
137 New Mexico Department of Health, “New Mexico Childcare/Pre-School/School Entry Immunization Requirements: 2021-22 school year,” nmhealth.org, updated March 3, 2021; New Mexico Department of Health, “Exemption from Immunization Form Instructions,” nmhealth.org, revised August 2019
138 New York State Department of Health, “2021-22 School Year New York State Immunization Requirements for School Entrance/Attendance,” health.ny.gov, April 2021; New York State Department of Health, “Immunization Requirements for School Attendance,” health.ny.gov, accessed September 23, 2021
139 North Carolina Department of Health and Human Services, “K-12 School Requirements,” immunize.nc.gov, updated July 23, 2020; North Carolina Department of Health and Human Services, “N.C. Exemptions,” immunize.nc.gov, updated August 5, 2020; North Carolina Department of Health and Human Services, “Highlights of N.C. Rules and Laws,” immunize.nc.gov, updated September 11, 2019
140 North Dakota Health, “2021-2022 School Immunization Requirements,” health.nd.gov, updated January 5, 2021
141 Ohio Department of Health, “Ohio Immunization Summary for School Attendance…Fall 2021 Immunizations For School Attendance,” ohio.gov, September 14, 2021; Ohio Laws and Administrative Rules, “Section 3313.671 | Proof of required immunizations – exceptions.” codes.ohio.gov, effective October 15, 2015
142 Oklahoma State Department of Health, “Guide to Immunization Requirements in Oklahoma: 2021-22 School Year,” oklahoma.gov, revised May 7, 2021; Oklahoma State Department of Health, “Certificate Of Exemption,” oklahoma.gov, July 6, 2021
143 Oregon State, “School Year 2021-2022,” oregon.gov, dated January 2021; Oregon Health Authority, “Oregon Certificate of Immunization Status,” oregon.gov, accessed September 24, 2021; Oregon Health Authority, “Exemptions and Immunity,” oregon.gov, accessed September 26, 2021
144 Kimberly Snyder, “Immunizations Required for Attendance During the 2021-2022 School Year,” hempfieldsd.org, July 13, 2021; Commonwealth of Pennsylvania, “§ 23.84. Exemption from immunization.” pacodeandbulletin.gov, effective through June 26, 2021; Commonwealth of Pennsylvania, “Subchapter C. Immunization,” pacodeandbulletin.gov, effective through June 26, 2021
145 State of Rhode Island, Department of Health, “Immunization Information for Schools and Child Care Workers,” health.ri.gov, accessed September 21, 2021; Rhode Island Department of Health, “Medical Immunization Exemption Certificate For Use in Public and Private Daycare Preschool, School & College,” health.ri.gov, July 2017
146 South Carolina Department of Health and Environmental Control, “5K–12 Immunization Info For Parents,” scdhec.gov, April 2021; South Carolina Department of Health and Environmental Control, “General Guidance for South Carolina Immunization Requirements,” scdhec.gov, March 30, 2021; South Carolina Department of Health and Environmental Control, “Exemptions from School Vaccine Requirements,” scdhec.gov, accessed September 23, 2021
147 South Dakota Department of Health, “Kindergarten Vaccination Requirements,” doh.sd.gov, revised July 16, 2021; South Dakota Department of Health, “Certificate Of Immunization,” doh.sd.gov, revised May 2020
148 Tennessee Immunization Program, “Diseases Covered by Tennessee Child Care and School Immunization Requirements,” tn.gov, updated January 2020; Tennessee Department of Health, “Required Immunizations,” tn.gov, accessed September 26, 2021
149 Texas Department of State Health Services, “2021-2022 Texas Minimum State Vaccine Requirements for Students Grades K–12,” dshs.texas.gov, revised January 2021
150 Utah Department of Health Immunization Program, “Utah Immunization Guidebook 2021-2022,” immunize.utah.gov, revised April 2021
151 Vermont Department of Health, “School Year 2021-22 Immunization Entry Requirements,” healthvermont.gov, accessed September 21, 2021; Vermont Department of Health, “Immunization Exemptions,” healthvermont.gov, accessed September 26, 2021
152 Virginia Department of Health, “School and Day Care Minimum Immunization Requirements,” vdh.virginia.gov, accessed September 27, 2021; Commonwealth of Virginia, “Commonwealth Of Virginia Certificate Of Religious Exemption,” vdh.virginia.gov, accessed September 26, 2021; Commonwealth of Virginia, “Administrative Code… 12VAC5-110-80. Exemptions from immunization requirements.” virginia.gov, accessed September 26, 2021
153 Washington State Department of Health, “Parents– Are Your Kids Ready for School? Required Immunizations for School Year 2021-2022,” doh.wa.gov, October 2020; Washington State Department of Health, “ Certificate of Exemption— Personal/Religious,” doh.wa.gov, October 2019
154 West Virginia Department of Health and Human Resources, “West Virginia Immunization Requirements for New School Enterers,” oeps.wv.gov, accessed September 21, 2021; West Virginia Department of Health and Human Resources, Bureau for Public Health, “Medical Exemptions Information,” eps.wv.gov, accessed September 26, 2021
155 Wisconsin Department of Health Services Division of Public Health Bureau of Communicable Diseases Immunization Program, “Wisconsin School Immunization Requirements 2021-2022,” dhs.wisconsin.gov, revised July 2021
156 Wyoming Department of Health, “Wyoming Immunization Requirements,” health.wyo.gov, updated June 30, 2021; Wyoming Department of Health, Immunization Unit, “Medical Waiver Request,” health.wyo.gov, updated May 2021