Vaccine Exemptions/Elimination of Non-Medical Exemptions from State Immunization Laws

ACP Chapter Action Tool Kit
Prepared by ACP’s Division of Governmental Affairs and Public Policy
January 28, 2020

Call to Action

ACP urges chapters to advance policies at the state level that eliminate any existing exemptions, except for medical reasons, from their immunization laws and/or oppose legislation to expand exemptions.

Why should your chapter take action now?

Vaccines protect the health of children and adults and save lives. They prevent life-threatening diseases and certain forms of cancer. Vaccines have been part of the fabric of our society for decades and are one of the most significant medical innovations of our time.  Globally, vaccines prevent the deaths of roughly 2.5 million children per year. And, data shows that just for children born in the United States in 2009, routine childhood immunizations will prevent approximately 42,000 early deaths and 20 million cases of disease with savings of more than $82 billion in societal costs.

Although vaccines are the safest and most cost-effective way of preventing disease, disability and death, this country still witnesses outbreaks of vaccine-preventable diseases, as highlighted by the recent measles outbreak. In 2019, there were 1,282 confirmed cases of measles in 31 states. In addition, between 140,000 – 810,000 individuals are hospitalized and between 12,000 – 61,000 deaths occur from influenza-related complications annually since 2010 in the U.S. according to the Centers for Disease Control and Prevention (CDC).

Misinformation about vaccines as a cause of autism and/or containing toxic chemicals have some parents choosing not to vaccinate their children even though evidence shows that there are no links between vaccines and autism. Claims that vaccines are unsafe or may cause autism have been disproven by a robust body of medical literature, including a recent Danish study, published in the Annals of Internal Medicine, that demonstrates 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.”

State Actions

According to the National Conference of State Legislators (NCSL), state laws and rules on immunization requirements vary from state to state. All states allow exemptions for medical reasons, and almost all states (except California, Mississippi and West Virginia) grant religious or philosophical exemptions for people who have sincerely held beliefs that prohibit immunizations. Currently, 29 states and DC have a religious exemption law and 17 states have religious and philosophical exemption laws allowing parents to claim an exemption based on their personal, moral or other beliefs.

According to the American Academy of Pediatrics, at least 21 states (AZ, CT, GA, HI, IA, ID, IL, MD, ME, MO, MS,MT, OH, OK, OR, PA, RI, TX, VT, WA, and WV) have introduced bills this year that would:

  • broaden the reasons why parents can exempt kids from getting vaccines even if there isn't a medical need
  • require doctors to provide more information on the risks of vaccines that are not based in evidence
  • limit state health department’s authority from adding new immunization requirements and put it in the hand of the state legislatures

"The volume of legislative activity is greater than in past years," the organization said. "But adverse bills outnumbering supportive ones conforms with trends from prior years."

ACP Chapter Advocacy

ACP requests that chapters engage with their state legislatures and state governors on the need to enact policies on the state level that would eliminate vaccine exemptions, except for medical reasons, from immunization laws or oppose legislation to establish/expand exemptions.

The American College of Physicians (ACP) has policy that supports the elimination of exemptions, except for medical reasons, from immunization laws. 

Specifically, ACP supports:

  • the immunization of all children, adolescents, and adults, according to the recommendations and standards established by the U.S. Advisory Committee on Immunization Practices (ACIP), National Vaccine Advisory Committee (NVAC), and the Centers for Disease Control and Prevention (CDC).
  • state laws designed to promote all recommended immunizations.
  • legislation to eliminate any existing exemptions, except for medical reasons, from their immunization laws.



Chapters interested in advocating for policies that would eliminate non-medical exemptions from vaccines in their state should contact their state governor and/or legislators and urge them to introduce and pass legislation, as applicable, that would eliminate non-medical exemptions from state immunization laws or oppose legislation to expand exemptions. A sample letter that chapters can customize is available.

Additional Suggested Chapter Actions:

  • The above sample letter could be customized for all chapter members to send to their elected state lawmakers (changing the introduction and closing so it is coming from the individual member rather than the chapter and its governor) and distributed with your membership to urge them to take action.
  • A news release could be drafted and sent to local media when your chapter letter is sent to lawmakers and your state’s governor.  If you would like to do this, ACP’s communications staff can help.
  • You can promote your efforts using social media, by posting content to your chapter’s Facebook or Twitter pages.  If you post on twitter, we encourage you to include @ACPinternists so we are aware of, and can retweet, your tweets.
  • Please let Shuan Tomlinson know what you are doing.  She can also address any questions you may have or put you in touch with one of our policy experts.