All 50 states have legislation requiring specified vaccines for students. Although exemptions vary from state to state, all school immunization laws grant exemptions to children for medical reasons. There are 45 states and Washington D.C. that grant religious exemptions for people who have religious objections to immunizations. Currently, 15 states allow philosophical exemptions for those who object to immunizations because of personal, moral or other beliefs.

Source: Adapted from the LexisNexis StateNet Database and the Immunization Action Coalition, May 2019.

* The existing statute in Minnesota and Louisiana does not explicitly recognize religion as a reason for claiming an exemption, however, as a practical matter, the non-medical exemption may encompass religious beliefs.

**In Virginia, parents can receive a personal exemption only for the HPV vaccine.

***Missouri’s personal belief exemption does not apply to public schools, only child care facilities.

Enacted Legislation 2019

Washington House Bill 1638 removes the personal belief exemption for the measles, mumps and rubella vaccine requirement for public schools, private schools and day care centers.

Maine House Bill 586 removes personal and religious belief exemptions for public school immunization requirements.

New York Senate Bill 2994 removes the religious exemption for public school immunization requirements.

Enacted Legislation 2017

Indiana House Bill 1069 adds meningitis to the required immunizations a student enrolling in a residential campus of an approved postsecondary educational institution must be immunized against.

Utah House Bill 308 requires the Department of Health to create an online education module regarding certain preventable diseases; amends the grounds for exemptions from required vaccines; requires the renewal of a student's vaccination exemption under certain conditions; create a new vaccination exemption form; allows for the vaccination exemption form to be completed online in conjunction with the education module and discontinues the practice of allowing local health departments to vaccinate students and recover costs.

Enacted Legislation 2016

Delaware House Bill 91 adds language around its existing religious exemption, explaining that in the event that the Division of Public Health declares that there is an outbreak of a vaccine preventable disease, or if in the estimation of the Division of Public Health, an unvaccinated child has had, or is at risk of having an exposure to a vaccine preventable disease, the child shall be temporarily excluded from attendance at the public school. It also gives the Division of Public Health the authority to review medical exemptions signed by a physician.

Minnesota House Bill 2749 applied its statutes related public school immunization requirements and exemption criteria to its free voluntary prekindergarten program.

Enacted Legislation 2015

With the passage of Senate Bill No. 277, California removed exemptions based on personal beliefs, which are defined in that state as also including religious objections.

Connecticut HB 6949 requires an annual, notarized, statement from parents or guardians specifying religious objection to required vaccinations.

Illinois SB1410, awaiting the governors’ action in June 2015, would require each public school district to make exemption data available to the public. It also would require parents or guardians who claim a religious exemption to detail their objections for specific immunizations, obtain a health care provider’s signature, and submit an exemption certificate for each child before kindergarten, sixth and ninth grade. Local school authorities would determine if the exemption request constitutes valid religious objection, as philosophical exemption is not permitted in Illinois.

South Dakota’s new law requires a child’s immunization records to be shared among health care providers, federal and state health agencies, child welfare agencies, and schools, unless the patient or guardian signs a refusal. It requires providers to inform parents or guardians that they have the right to refuse disclosure of records.

With passage of H. 98, Vermont became the first state to repeal its personal belief exemption. (The legislation does not change the existing exemption for parents who wish to opt out for religious reasons.) , Vermont H. 98 also requires schools and child care facilities to provide school immunization rates to parents.

West Virginia Senate Bill No. 286, among other things, requires certification by a licensed physician for medical exemption requests. It also authorizes the commissioner of the Bureau for Public Health to appoint an immunization officer to make determinations about requests for exemptions.

Religious exemption indicates that there is a provision in the statute that allows parents to exempt their children from vaccination if it contradicts their sincere religious beliefs.

Philosophical exemption indicates that the statutory language does not restrict the exemption to purely religious or spiritual beliefs. For example, Maine allows restrictions based on "moral, philosophical or other personal beliefs," and Minnesota allows objections based on “conscientiously held beliefs of the parent or guardian.”

Sources: Chart adapted from Immunization Action Coalition, "Exemptions Permitted for State Immunization Requirements," 2017; LexisNexis; StateNet 2017

Note: List may not be comprehensive, but is representative of state laws that exist. NCSL appreciates additions and corrections.

NCSL Resources: "Vaccination Policies: Requirements and Exemptions for Entering Schools," NCSL LegisBrief, December 2017

"Calling the Shots," State Legislatures Magazine Article, February 2015