Are Vaccines Required? Mandatory vs. Recommended Vaccines

Vaccines are recommended to prevent a variety of diseases, from the flu to shingles. Specific vaccines may or may not be required by schools or employers. Vaccine rules vary depending on the specific vaccine and the state and local laws in your area.

Are Vaccines Required in Schools?

All U.S. states have vaccine requirements, but these differ from state to state. Though the vaccination schedules published by medical experts are only recommendations, some states may opt to mandate specific vaccines.

For school-mandated vaccinations, each state makes its own list of vaccines that are required for a certain age or grade. There are challenges and barriers that affect how these mandates are issued and implemented, however. These include:

• Variations by region: Vaccine mandates vary widely throughout the country, and sometimes within individual cities or school districts. For example, students in one city may be required to have at least one dose of the meningococcal vaccine before 8th grade, while students in a neighboring city may not.
• Variations by governing authorities: The body authorized to issue mandates also varies by state. Some states might pass legislation to mandate vaccinations statewide, while others let the state health department decide. Still others may offer city councils or school districts room to implement their own mandates when appropriate.
• Variations in legislative sessions: The frequency of mandate reviews can also vary depending on how often the state legislature meets and how long it takes for legislation to be passed. In such cases, it may take years to update vaccine requirements after a new recommendation.

Since school vaccine mandates are intended to prevent the spread of diseases, children who don’t have evidence of vaccination could be barred from attending school. Many states, however, allow exemptions for medical, religious, or philosophical reasons. Unvaccinated children may also be permitted to attend school while completing vaccine requirements.

Vaccine requirements vary widely by state, and policies change often, so it’s important to keep up to date with the requirements in your state.

Can Vaccines Be Required by Employers?

In some states, employers are prohibited from mandating vaccinations. In others, employers can require vaccinations with certain limitations. Federal requirements have changed over time, and employer obligations vary by law, union contracts, and workplace protections.

Employers that have vaccine mandates are expected to allow religious and medical exemptions to employees who qualify for them, as long as those exemptions don’t create hardship for the business. This means the employer has to provide “reasonable accommodations” for employees who can not get vaccinated because of a disability or a legitimate religious belief.

When and if an employer terminates an employee for not complying with a mandate, they also have to be able to prove they did not discriminate against that person. 

Vaccine Mandates for Travel

If you are traveling from the U.S. to another country, it is important to check the travel restrictions for your destination. Some countries require that you be vaccinated against certain diseases before you can travel there.

Proof of COVID-19 vaccination is not required to fly within the United States.

Military Vaccine Mandates

In 2021, the U.S. Department of Defense announced that service members would be required to be vaccinated with an FDA-approved COVID-19 vaccine. In early 2023, that requirement was rescinded, along with the vaccine mandate for its civilian employees.

Other vaccines may be recommended for military service members who are traveling to areas where certain infectious diseases are present.

Who Sets Vaccine Recommendations?

Every year, the Centers for Disease Control and Prevention (CDC) publishes a recommended immunization schedule for the United States. This schedule is put together by a panel of experts known as the Advisory Committee on Immunization Practices (ACIP).

The ACIP panel is comprised of experts in the medical and public health fields. Doctors, researchers, infectious disease specialists, and community representatives are all part of the panel. The schedule’s stated purpose is to provide people with the maximum protection from vaccine-preventable diseases as safely as possible.

Recommendations for adult vaccines are based on age, lack of documentation of vaccination, evidence of lack of immunity, and/or specific risk factors.

Currently, vaccine recommendations for children are organized into three categories:

• Those broadly recommended for all children
• Those recommended for high‑risk groups
• Those recommended under “shared clinical decision‑making,” meaning parents should discuss risks and benefits with their child’s pediatrician

Other medical groups, such as the American Academy of Pediatrics (AAP), publish their own vaccination recommendations. The AAP’s schedule more closely resembles the ACIP’s previous recommendations, and it is endorsed by many other physicians’ groups.

These schedules are updated every year. Medical professionals across the country use them to immunize their patients, and state governments follow the recommendations to determine which vaccines should be required (or mandated) for school.

Challenges in Implementation

A number of variables can also influence how policies are enacted, including politics, cultural norms, and practicality. None of these issues should be minimized.

For example, while annual flu vaccination is recommended by most healthcare providers and may be mandated in some states for children in childcare settings, requiring families to prove compliance every year would not only be burdensome but costly.

Parents and public opinion also play a role. In recent years, states that have mandated the human papillomavirus (HPV) vaccine to prevent the spread of this sexually transmitted disease have been faced with protests from community members who believe that doing so promotes teen sex.

States can also require vaccines for specific groups, such as college students or nursing home employees, while individual schools or employers may issue mandates as well (such as hepatitis B and COVID-19 vaccinations for hospital workers).

Opting Out

The concept of “forced vaccination” is a concept largely promoted by anti-vaccination (“anti-vaxxing”) activists. It suggests that the government is forcing people to receive dangerous vaccines or medications they don’t want.

The reality is far less dramatic. Vaccine requirements don’t mean kids are being forced to be vaccinated. The requirements are limited to those attending school, and, even then, parents who don’t want to vaccinate their kids still have options.

In every state, children who shouldn’t receive vaccines for medical reasons—such as organ transplants or severe allergies—can receive medical exemptions.

Opting out for non-medical reasons may be more difficult. In most U.S. states, parents are permitted to opt out of vaccines for religious objections or other beliefs, but four states do not allow opting out for non-medical reasons.

Where non-medical exemptions are allowed, the process for obtaining one may be as simple as signing a form. Other states require parents to undergo an educational module or counseling by a physician on the risks and benefits of vaccination before they can get an exemption.

Are Current Mandates Enough?

While states continue to expand school vaccine requirements, they are not always comprehensive, and therefore may not protect children from all diseases that can spread in schools.

For example, all states require the TDaP (tetanus-diphtheria-pertussis) vaccine for school children, but only a few require the HPV vaccine. This is even though the CDC estimates 4,000 people per year die from cervical cancer, and that more than 90% of these cancers are caused by HPV.

Additionally, influenza vaccination mandates are usually specific to childcare/pre‑K programs, not all schoolchildren, even though influenza killed an estimated 12,000 to 52,000 people per year between 2010 and 2020.