School vaccine mandates

Vaccines, as explained by the National Library of Medicine’s MedlinePlus.gov website, “are injections (shots), liquids, pills, or nasal sprays that you take to teach your body’s immune system to recognize and defend against harmful germs,” and a vaccination is the act of administering a vaccine; the common result of vaccination is immunization (the process by which your body uses the vaccine to build a defense to fight a disease). No U.S. federal laws mandate vaccination, but all 50 states require certain vaccinations for children to attend public schools. Public schools require vaccinations to prevent the outbreak and spread of contagious diseases within the schools’ densely populated environments. Another reason schools encourage vaccinations is to create herd immunity. As the Cleveland Clinic explains: [1]

Herd immunity means that enough people in a group or area have immunity to a germ (for instance, a virus) that it no longer spreads easily. Immunity means your immune system has learned to fight off a specific infection so it doesn’t make you sick.

Herd immunity—also called population immunity—often results from a combination of people getting vaccinated and people getting infected with the germ (natural immunity). Both natural and vaccine immunity cause your body to make antibodies and immune cells that recognize a specific germ. Your body can then fight the germ off more easily the next time it sees it. It usually takes a large percentage of people with immunity to achieve herd immunity.[2]

Although the medical establishment strongly recommends vaccinations, some parents fear the side effects, safety, and long-term impact of certain vaccines, and most states offer medical, religious, or philosophical exemptions for parents not wanting their children to be vaccinated. Public schools, however, will generally refuse entry to children who are not compliant with government-recommended vaccinations or do not have a valid exemption.[121]

Early history of vaccines

Inoculation was an early form of modern vaccination. It involved intentionally infecting someone with a disease (a mild form of it) in order to build up the body’s natural immunity (resistance) to the disease; the procedure was risky, because the patient would intentionally be infected with the disease and could be contagious for weeks, requiring strict quarantine so as not to cause an epidemic of the very disease that the procedure was hoping to control. The Chinese used inoculation techniques against smallpox as early as 1000 AD, and similar techniques were also used in ancient Africa and Turkey. Puritan minister Cotton Mather pioneered inoculation (called variolation) in America, during the Boston smallpox epidemic of 1721; he learned the practice from his enslaved African servant, Onesimus. Benjamin Franklin became a major champion of inoculation after his son died from smallpox in 1736. The success of the procedure convinced General George Washington, who had seen the devastating effect of smallpox on his troops during the Canadian Campaign and Battle of Quebec of 1775-76, to order the mass inoculation of his troops in 1777; it was the first medical directive in American history, and it saved thousands of lives, contributing to Washington’s victory in the American Revolution.[3]

Vaccination as practiced today was discovered by English physician Edward Jenner, who administered the first successful vaccine on May 14, 1796, when he inoculated 8-year-old James Phipps with cowpox, demonstrating that it provided immunity against smallpox. This groundbreaking work laid the foundation for modern immunology (the study of the immune system, the body’s defense mechanism against disease) and the eventually eradication of smallpox in 1980.[3]

In 1800 Benjamin Waterhouse, physician and co-founder of Harvard Medical School, began using the “Cowpox Vaccine,” becoming the primary popularizer of Edward Jenner’s vaccination method in the United States. His work lead to Massachusetts becoming the first U.S. state to promote the use of vaccination. In 1809, Milton, Massachusetts, became the first U.S. town to offer free smallpox vaccinations, which was followed by a state law that same year requiring the smallpox vaccination.[4]

On February 27, 1813, U.S. President James Madison signed into law “An Act to Encourage Vaccination,” which created the National Vaccine Agency (now part of the U.S. Department of Health & Human Services).[5]

In 1855 Massachusetts passed the first U.S. state law mandating vaccinations for schoolchildren, followed by New York (1862), Connecticut (1872), Indiana (1881), Arkansas (1882), Illinois (1882), Virginia (1882), Wisconsin (1882), California (1888), Iowa (1889), and Pennsylvania (1895). By 1963, 20 states required immunization for attending public schools; by 1970, 29 states had the same requirement.[4] [5] [6]

Many people resisted these mandated vaccinations, fearing their side effects. As the National Anti-Compulsory Vaccination Reporter argued in 1878, “the dangerous illnesses following the vaccine process are … on the whole … a greater evil to humanity than small-pox itself!” The Anti-Vaccination Society of America, founded in 1879, echoed these sentiments, declaring it “undignified” to mandate vaccinations and that the “efficacy of vaccination as a disease preventative is a matter of individual opinion.” In 1882 the New England Anti-Compulsory Vaccination League was founded, and in 1885 the Anti-Vaccination League of New York City was created. As a result of their work and influence, these anti-vaccination groups successfully got vaccine mandates repealed in California, Illinois, Indiana, Minnesota, Utah, West Virginia, and Wisconsin.[7] [8]

The first laboratory-created vaccine was developed by French chemist and microbiologist Louis Pasteur in 1879, for avian cholera (which most commonly infects chickens). In 1885, he created the rabies vaccine, which was the first effective post-exposure treatment for a universally fatal disease. His groundbreaking work launched the era of lab-developed vaccines that changed the world, including vaccines (some of the following dates vary in historical accounts) for typhoid (1899), cholera (1911), diphtheria (1914), tuberculosis (1921), and tetanus (1924), among others. Vaccines for polio (1955), measles (1963), mumps (1967), and rubella (1969) followed in the mid-20th century.[2]

During this active period of vaccine development, the first Nobel Prize in Physiology or Medicine (1901) was awarded to Emil von Behring, a German physiologist, for his work on developing serum therapy in connection to a diphtheria vaccination. [10]

On July 1, 1902, Congress passed An Act to Regulate the Sale of Viruses, Serums, Toxins, and Analogous Products (also referred to as the Biologics Control Act), which was the first legislation to control the quality of drugs, specifically the quality of vaccines. [2]

On February 20, 1905, mandatory vaccination was upheld by the U.S. Supreme Court in Jacobson v. Massachusetts (in a 7-2 decision). In the aftermath of the ruling more states across the country began to implement mandatory child vaccination as a condition of public school attendance. On November 13, 1922, the constitutionality of mandatory vaccination of school children was once again challenged and upheld in the Zucht v. King; the U.S. Supreme Court declined to hear the case, stating that it was “within the police power of a state to provide for compulsory vaccination.”[5] [9] [11]

In 1951, Jonas Salk and his team developed a method to cultivate the polio virus in monkey kidney tissue for the production of large amounts of the vaccine. On April 12, 1955, the results of the Salk vaccine trials showed that the vaccine was 80-90 percent effective, leading the U.S. government to license the IPV polio vaccine the same day. The vaccination program was suspended on May 8, 1955, to investigate paralysis resulting from the vaccine injection; changes to the production method were made and vaccinations were resumed on May 27. The total number of paralytic polio cases after the vaccine re-formulation decreased from 28,985 in 1955 to 72 in 1965. The last case of the disease in the United States was reported in 1993, and polio was declared eliminated in the Western Hemisphere on September 29, 1994, by the Pan American Health Organization. [12] [13] [27]

National Childhood Vaccine Injury Act and Vaccine Adverse Event Reporting System

In 1986 the National Childhood Vaccine Injury Act was passed in response to a large number of lawsuits filed about vaccines causing adverse reactions including brain damage and even death. The act shielded medical professionals and vaccine manufacturers from liability if an individual suffered injury from receiving vaccines; it required vaccine injury claims to be filed with the U.S. Court of Federal Claims rather than directly against physicians or vaccine manufacturers in civil court. Unlike civil court, people filing injury claims are not required to prove negligence or failure to warn; they only need to prove that a vaccine caused injury. [14] [15] [16]

On October 1, 1988, the National Vaccine Injury Compensation Program (VICP) was created under the National Childhood Vaccine Injury Act. The VICP was “established to ensure an adequate supply of vaccines, stabilize vaccine costs, and establish and maintain an accessible and efficient forum for individuals found to be injured by certain vaccines.”[17]

Subsequently, in 1990, the CDC and FDA created the Vaccine Adverse Event Reporting System (VAERS). VAERS collects information about adverse events via reports filed by anyone, including medical professionals and family members. VAERS receives about 30,000 reports each year. 85-90 percent of VAERS reports are for “mild adverse events such as fever, local reactions [such as redness at the injection site], and episodes or crying or mild irritability.” The other 10-15 percent of VAERS reports is for “serious adverse events involving life-threatening conditions, hospitalization, permanent disability, or death, which may or may not have been caused by a vaccine.” [18]

In 1993 the U.S. Congress passed the Comprehensive Childhood Immunization Act that created the Vaccines for Children (VFC) program. The latter sought to increase immunization rates by providing free vaccinations for children. [19]

Between October 1, 1988, and September 1, 2025, a total of 28,991 petitions for vaccine injury compensation were filed; 12,339 of the petitions were compensated and 13,166 were dismissed. Petitioners were awarded a cumulative total of over $4.9 billion, but total outlays for attorneys fees (including lawyers for dismissed cases) added another $590.8 million to costs.[63]

Andrew Wakefield and the autism controversy

In February 1998 Lancet published an article by Andrew Wakefield titled “Ileal-Lymphoid-Nodular Hyperplasia, Non-Specific Colitis, and Pervasive Developmental Disorder in Children.” The article claimed that the “rubella virus is associated with autism and the combined measles, mumps, and rubella [MMR] vaccine … has also been implicated.” Anti-vaccination groups and parents began using Wakefield’s article as rationale for refusing to vaccinate their children.[20]

Between 2003 and 2012, Brian Deer, an investigative reporter, examined the story and published 36 articles that accused Wakefield of

falsifying medical histories of children and essentially concocting a picture, which was the picture he was contracted to find by lawyers hoping to sue vaccine manufacturers and to create a vaccine scare.

On March 3, 2004, ten of the twelve co-authors of Wakefield’s article released a “Retraction of an Interpretation” in Lancet, stating

We wish to make it clear that in this paper no causal link was established between MMR vaccine and autism as the data were insufficient.

Lancet retracted Wakefield’s article on February 2, 2010, stating “it has become clear that several elements of the 1998 paper by Wakefield et al are incorrect.” On January 5, 2011, the British Journal of Medicine published an article stating that Wakefield received over $674,000 from lawyers and that, of 12 children examined, five had developmental problems before being vaccinated and three never had autism. [21] [22] [23] [24]

As a result, on May 24, 2011, Britain stripped Wakefield of his medical license, stating Wakefield had “abused his position of trust” and “brought the medical profession into disrepute.” Wakefield contends that the investigation of his work is part of a conspiracy to “discredit and silence his research” in order to “shield the government from exposure on the vaccine scandal.”[21] [25]

Thimerosal and autism

On July 9, 1999, in response to growing concern over a link between vaccination and autism, the American Academy of Pediatrics (AAP) and the U.S. Public Health Service (PHS) recommended that thimerosal be removed from vaccines “as soon as possible.” However, they also stated,

there are no data or evidence of any harm caused by the level of exposure that some children may have encountered in following the existing immunization schedule . . . [and that] the large risks of not vaccinating children far outweigh the unknown and probably much smaller risk, if any, of cumulative exposure to thimerosal-containing vaccines over the first 6 months of life.[26]

In May 2003, U.S. Representative Dan Burton (R-IN) released a report titled “Mercury in Medicine–Taking Unnecessary Risks” in which he requested that the FDA remove thimerosal from the flu vaccine and recommended independent research on the link between thimerosal in vaccines and autism. [27]

In 2005, Robert F. Kennedy, Jr. wrote an article co-published by Salon (June 16) and Rolling Stone (July 14) titled “Deadly Immunity,” arguing that the 2000 Simpsonwood CDC Conference was spent “discussing how to cover up the damaging data” and that there were a “staggering number of earlier studies that indicate a link between thimerosal and speech delays, attention-deficit disorder, hyperactivity, and autism.” The article was corrected multiple times within days of publication and then retracted and deleted by Salon and Rolling Stone on January 16, 2011.[28] [29] [30] [112]

The controversy resulted in an 18-month investigation by the U.S. Senate Committee on Health, Education, Labor and Pensions, which concluded that Kennedy’s allegation was unsubstantiated and “thimerosal was [being] voluntarily removed from childhood vaccines distributed in the United States as a precaution,” prompted by a joint request by the American Academy of Pediatrics and the U.S. Public Health Service.[28] [29] [30] [112]

As of 2007, vaccines for children 6 years old and younger contain no thimerosal or only trace amounts, except for inactivated flu vaccines, which are available in both thimerosal-containing and preservative-free versions. By November 30, 2009, the mercury-based preservative thimerosal had been phased out of all vaccines in the United States with the exception of certain influenza, meningococcal, and tetanus vaccines. [28] [29] [30] [112]

On August 27, 2010, the U.S. Court of Appeals for the Federal Circuit ruled (3-0) that there is no link between vaccination and autism in the case of Cedillo v. Secretary of Health and Human Services. The decision upheld two earlier rulings: a 2007 ruling by the United States Court of Federal Claims Office of Special Masters and an affirmation of that ruling by the Court of Federal Claims. On February 22, 2011, the U.S. Supreme Court ruled (6-2) in the case of Bruesewitz v. Wyeth that vaccine injury claims must continue to be filed with the U.S. Court of Federal Claims set up under the National Childhood Vaccine Injury Act of 1986 and cannot be filed directly against physicians or vaccine manufacturers in civil court.[31] [32]

On August 25, 2011, the Institute of Medicine (IOM) issued a report, “Adverse Effects of Vaccines: Evidence and Causality.” The report stated that “evidence favors rejection of a causal relationship” between the Measles-Mumps-Rubella (MMR) vaccine and autism. The Cochrane Collaboration, in a February 15, 2012, independent investigation of studies on vaccines and autism, concluded,

We could assess no significant association between MMR immunisation and the following conditions: autism, asthma, leukaemia, hay fever, type 1 diabetes, gait disturbance, Chrohn’s disease, demyelinating diseases, or bacterial or viral infections.[33] [34] [35] [114] [115] [122]

A study published in the Proceedings of the National Academy of Sciences of the United States of America (PNAS) on October 6, 2015, found that infant rhesus macaques, whose physiology closely resembles human infants, injected with human childhood vaccines from the early 1990s (that contained thimerosal) and from 2008 (after thimerosal was phased out of childhood vaccines) exhibited no behavioral or neuropathological changes that could be linked to autism. A March 5, 2019, study published in the Annals of Internal Medicine, examined 657,461 children over ten years in Denmark and concluded,

The study strongly supports that MMR vaccination does not increase the risk for autism, does not trigger autism in susceptible children, and is not associated with clustering of autism cases after vaccination.[33] [34] [35] [114] [115] [122]

COVID-19 vaccine

On October 20, 2022, the CDC voted to add the coronavirus vaccine to the schedule of recommended vaccines for children and adults. However, in 2025, the CDC “updated [the COVID-19 vaccination recommendation] to reflect individual-based decision-making (also known as shared clinical decision-making) for people ages 6 months and older.” The COVID-19 vaccine is, therefore, no longer on the CDC’s schedule of recommended vaccines but can be obtained via a prescription from a healthcare provider.[136] [60]

Robert F. Kennedy, Jr. and the Trump Administration

On February 13, 2025, Robert F. Kennedy, Jr. was sworn in as the U.S. Secretary of Health and Human Services. Kennedy and Trump launched the “Make America Healthy Again” (MAHA) Movement, which has targeted gender-affirming care for minors, ultra-processed foods, synthetic food dyes, and vaccines. [47] [46]

Early in his tenure, Kennedy pushed to remove the COVID-19 vaccine from the CDC’s schedules of vaccines for children and adults, which resulted in changes to the availability of the vaccine for Americans.

On January 5, 2026, the CDC removed six vaccines from the childhood schedule: hepatitis A, hepatitis B, influenza (flu), meningitis, respiratory syncytial virus (RSV), and rotavirus. Children who are considered high-risk or whose parents participate in “shared clinical decision making” (basically a discussion and health recommendation reached with their child’s doctor) may still receive the vaccines.[46] [45] [44]

The CDC schedule still recommends 11 childhood vaccines: measles, mumps, and rubella (MMR vaccine), whooping cough, tetanus, and diphtheria (DTap vaccine), Hib, pneumonia, polio (IPV), chickenpox (varicella virus), and human papillomavirus (HPV). If and how state school vaccine mandates may change in response to the CDC guidance remains to be seen.[46] [45] [44]

Kennedy stated that the changes were made “after an exhaustive review of the evidence” to “align . . . the U.S. childhood vaccine schedule with international consensus while strengthening transparency and informed consent.” Experts largely disagree with the removal of six vaccines. Helen Chu, a physician and immunologist at the University of Washington in Seattle and a former member of the federal vaccine advisory committee, summarized the consensus of experts, “The abrupt change to the entire U.S. childhood vaccine schedule is alarming, unnecessary, and will endanger the health of children in the United States.” [43]

On February 8, 2026, in light of the ongoing measles outbreak across the country that could cause the U.S. to lose its “elimination status” when it comes to the disease, Mehmet Oz, administrator for the Centers for Medicare and Medicaid Services, said simply, “Take the vaccine, please.”[153]

On February 24, 2026, the attorneys general of 14 Democrat-led states and the governor of Pennsylvania filed a lawsuit against the Trump administration, asking the court, according to the New York Times, to “nullify the administration’s decision in January to reduce the number of diseases children are routinely immunized against to 11 from 17.”[149]

Potential consequences for unvaccinated children and their parents

Many states have laws that allow the public school system to suspend children who are not vaccinated. Approximately 2,000 seventh- to twelfth-grade children not vaccinated against pertussis (whooping cough) were barred from attending classes in San Francisco in 2011. On June 22, 2014, federal Judge William Kuntz upheld New York state law barring unvaccinated children from public school when other children have chickenpox. In 2025, some 254 unvaccinated students were still under a three-week quarantine in December, with some in a second quarantine, during an ongoing measles outbreak in Spartanburg, South Carolina.[36] [37] [38] [39] [59]

Furthermore, many pediatricians will not treat children who have not been vaccinated. Some legal experts believe that parents who do not vaccinate their children should be subject to criminal prosecution (including criminally negligent homicide and monetary damages) if their unvaccinated children infect and harm other children who are too young or immunocompromised to receive vaccines. [40] [41] [42]

Despite potential consequences, an August 7, 2024, Gallup poll found that

fewer Americans today consider childhood vaccines important, with 40 percent saying it is extremely important for parents to have their children vaccinated, down from 58 percent in 2019 and 64 percent in 2001. There has been a similar decline in the combined “extremely” and “very important” percentage, which was 94 percent in 2001 but sits at 69 percent today.[147]

Eradication and elimination of disease

Elimination means that the disease is not present in a region, while eradication means that the disease does not exist anywhere globally. The following diseases have been eliminated in the United States.

• 1951: Malaria declared eliminated.[54]
• 1952: Smallpox declared eliminated. In 1980 WHO officially declared the disease’s global eradication, making it the first and only human disease to be completely eliminated worldwide through vaccination and surveillance efforts. Rinderpest (also called the “cattle plague”) was the first and, thus far, only animal disease to be eradicated (2001).[51] [49]
• 1978: Cholera declared eliminated. Though vaccinations are available, the disease was eliminated with increased access to clean and safe water and food supplies, along with proper sewage disposal.[53]
• 1979: Polio declared eliminated in the United States. Polio was declared eliminated in the Western Hemisphere in 1994 and is close to being eradicated globally as of December 2025.[120] [50]
• 2000: Measles declared eliminated in the United States. However, this status is tenuous as measles cases spiked in 2025. The disease was eliminated in the Americas in 2016[55] [116]
• 2015: Rubella declared eliminated in the Americas on April 29.[118]

Many major health organizations argue that eradication and elimination are largely the product of vaccination programs that promote high rates of inoculation. Those opposed to vaccination state that only better sanitation and clean water led to the elimination of the diseases.

The United States is at risk of losing the measles elimination status due to 2025 outbreaks of the virus in Texas and South Carolina, both of which have continued into 2026 and spread to multiple states. Canada lost its measles elimination status in 2024 after an outbreak spread from a Mennonite gathering.[150] [151] [154]

So, should states be allowed to mandate vaccines for school attendance? Explore the debate below.