Despite overwhelming evidence about the safety and effectiveness of COVID-19 vaccines, vaccine hesitancy has intensified during the COVID-19 pandemic, increasing skepticism about other lifesaving vaccines for children, adults, and pets.
A new study led by researchers at Boston University School of Public Health (BUSPH) reveals another worrying trend. Anti-vaccine sentiment, once reserved for private beliefs and public debate, is turning into actual legislation across the United States that could hinder vaccine rollout and pose a threat to public health.
The study, published in the American Journal of Public Health, shows that proposed legislation aimed at reducing vaccine access, relaxing vaccination requirements, and expanding vaccine exemptions increased dramatically in state legislatures from 2021 to 2023, sometimes outpacing the number of bills seeking to strengthen vaccine access and mandates. At least 40% of the bills introduced in each legislative cycle since the start of the pandemic were anti-vaccine related.
Partisan polarization is clearly driving the bill, with Republican lawmakers supporting 86% of anti-vaccine bills introduced during this period. Meanwhile, Democratic lawmakers introduced 54% of the pro-vaccine bills, which are bills that increase access to vaccines or help fund and promote vaccines, across state legislatures.
“Our study shows that state legislators affiliated with the Republican Party are responsible for the overwhelming majority of anti-vaccine bills introduced in recent years,” says study lead author Dr. Matt Motta, who co-authored the study with Dr. Timothy Callahan. Both are associate professors of health law, policy, and management at BUSPH. “While most of these bills have not actually passed, we live in an increasingly connected and globalized world. Low vaccine coverage in one part of the country can make people thousands of miles away sick. As the current measles outbreak shows, weakening vaccine regulations in one state puts everyone’s health at risk.”
Additionally, a significant number of anti-vaccine bills (24%) were passed with sufficient state legislative support during this period. Several states have enacted laws expanding religious or personal belief exemptions for child care and school vaccinations or prohibiting employers from requiring certain vaccinations in the workplace.
“These anti-vaccine bills are indicative of the dissatisfaction that some people have with vaccines, as well as a policy environment that is more hostile to vaccination,” Dr. Callahan said. As the U.S. approaches its midterm elections in November, “whom society chooses in 2026 could shape vaccine policy decisions for years to come,” he said.
This analysis is the first to examine partisan differences between vaccine bills proposed before and after the pandemic. For this study, Dr. Motta and Dr. Callahan, along with a team of BUSPH student and graduate researchers, systematically cataloged partisan changes in 1,513 vaccine-related bills introduced in state legislatures between 2019 and 2023. The research team used preliminary data on all vaccine-related bills proposed in state legislatures from 2019 to 2023 through the State Vaccine Policy Project (SVPP). SVPP is a first-of-its-kind initiative created to understand and inform policies that address the politicization of public health. SVPP is housed at BUSPH under the Institute of Politics and Health, directed by Dr. Motta and Dr. Callahan.
A total of 1,154 vaccine-related bills were introduced in state legislatures in 2021, compared to just 386 vaccine-related bills in the 2019 legislative session. Over a four-year period, nearly 82% of bills proposed by Democrats were pro-vaccine, compared to less than 10% of anti-vaccine bills. Comparatively, more than 65% of bills proposed by Republicans were anti-vaccine, compared to 28% of pro-vaccine bills.
The surge in anti-vaccine bills may be due in part to electable Republicans eager to appease anti-vaxxer Republican voters who say they are not anti-vaxxers but champions of medical freedom, personal autonomy and parental rights. But health experts also stress that vaccine hesitancy is the result of widespread misinformation, evolving public health guidelines, and a widespread mistrust of science that persists in the United States during and after the pandemic.
“No one likes to be told what to do, but our government has the ability and obligation to take action to protect public health,” Dr. Motta said. “To the many people who base their opposition to vaccination on deeply held values, political views, or religious beliefs, I would like to say this: There is no moral or religious belief in infectious diseases. Taking actions to protect yourself and others is one of the safest and most effective actions you can take to live your life as you want. Vaccination is a way to regain freedom from the pathogens that have caused disease and death throughout human history.”
The researchers say the findings also highlight the importance of voter engagement in local elections and the need for continued efforts to improve communication to the public about vaccines.
“We need to recognize that the reasons why people are losing trust in science are multifaceted, and there is no one-size-fits-all solution to restoring trust,” Dr. Callaghan said. “We must also recognize that the messenger is just as important, if not more so, than the message. For public health, that also means recognizing that public health officials are not always the right messengers to encourage vaccine uptake. Identifying the right messages and messengers will require significant investment in vaccine communication research, which is currently severely underfunded.”
In future studies, the researchers plan to expand the SVPP dataset to analyze vaccine legislation over a longer period of time, as well as examine how the public’s experience with vaccination led to legislation, and vice versa. It will also consider health policies related to other themes, such as gender-affirming care, reproductive health, and water fluoridation.
“Our hope is to provide researchers with a large, up-to-date database that catalogs health policy legislative activity across states, allowing them to study how changes in the social and political world affect health policy, and how changes in health policy affect public health,” says Dr. Motta.
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Boston University School of Public Health
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DOI: 10.2105/AJPH.2026.308535
