How States Are Expanding Immunization Access Through Policy
August 10, 2026 | Shalini Nair, Kim Martin, Andy Baker-White
Recent data shows ongoing declines in childhood vaccination rates, increases in vaccine exemptions, and an overall rise in vaccine skepticism. As the country navigates shifting public health and funding priorities, state policymakers are considering actions to sustain and improve access to vaccines in their jurisdictions. During the 2026 session, at least 18 states introduced legislation addressing access to vaccines in clinical settings, provider scope of practice for vaccination, requirements for non-medical exemptions, and authority over vaccine recommendations.
Expanding Access Points for Routine Immunizations
The hospital setting often represents a crucial missed opportunity to address immunization needs, particularly for older adults. Many states have existing policies requiring hospitals to offer flu and other vaccines to patients at discharge to improve access and reduce the burden of preventable illness. Tennessee’s recently enacted HB 2569 builds on this approach by lowering the age threshold for offering the influenza and pneumococcal vaccines to hospital patients from 65 to 50 years of age. Similarly, Pennsylvania lawmakers are considering HB 2378, lowering the age for hospitals to offer the influenza vaccine to 50 and adding pneumococcal vaccine for those over 65.
Several states are also aiming to expand the list of providers able to order, administer, and reimburse for vaccines. For example, Maryland (HB 1135) and Maine (HP 1384), enacted bills expanding the role of pharmacists to include the authority to issue vaccine orders for those aged three and up. Additionally, Maine’s legislation also eliminates cost-sharing for pharmacist-administered vaccines.
Three other states introduced similar legislation aimed at pharmacists and other medical professionals. Wyoming’s SF 121, while ultimately passed, failed to maintain provisions necessary to lower the age at which pharmacists can administer vaccines to patients from seven to three. In Rhode Island, SB 2386 would require health insurance providers to cover pharmacists’ services, and HB 7934/SB 2856 would expand the type of vaccines pharmacists can administer to include all routine immunizations. In New York, several bills passed the first chamber that would expand vaccination authority across the health care workforce, including allowing medical assistants to vaccinate under supervision (S 5340), nursing students to administer certain vaccines under specified conditions (S 5706), pharmacy technicians to administer vaccines under pharmacist supervision (S 7025), dentists to administer HPV vaccines (S 4548), and pharmacists and certified nurse practitioners to administer mpox vaccines (A 4346).
Shifting the Landscape of Vaccine Exemptions
School immunization requirements help maintain high immunization coverage and reduce risk of preventable disease outbreaks in schools, which can spread to homes and communities. Non-medical exemptions allow individuals to opt out of vaccinations for religious or philosophical reasons. As states work to strengthen coverage, policymakers are increasingly examining how exemption policies affect vaccine uptake and access to routine immunizations. A few states are considering legislation that would modify non-medical exemption processes, for example, by eliminating religious exemptions (MA H 2554), removing conscientious exemptions (MN SF 4458), or adding administrative procedures such as notarization and provider consultation to obtain exemptions (MN HF 3775/SF 4017).
Strengthening State Leadership in Immunization Policy
As the federal immunization landscape continues to shift, legislatures are increasingly advancing policy options that strengthen state-level leadership and reinforce the role of state health officials in shaping vaccine recommendations. For example, Colorado recently passed HB 1027, which expressly authorizes the state board of health to determine the list of required immunizations for school attendance, and SB 32, which addresses vaccine purchasing and provider liability protections for administering vaccines. Similar efforts to expand the role of state health departments, health officials, or additional advisory organizations in vaccine decision-making have were enacted in Connecticut (HB 5044), the District of Columbia (B26-0414), Maine (LD 2146), Maryland (HB 637/SB 385), New Mexico (HB 156), New York (A 10711/S 9598, A 10007/S 9007, A 10710/S 9599), Oregon (SB 1598), Rhode Island (H 7625A/S 2379A), Vermont (H 545), and Washington (HB 2242). Legislation was also introduced in Hawaii (HB 1898/SB 3057, HB 2313/SB 3133) and Minnesota (HF 4439/SF 4416, SF 3295, HF 4373/SF 4419).
Additionally, at least two states — Minnesota (HF 3743, SF 3859) and Missouri (HB 3450, HB 3452, SB 1705) — introduced legislation that would create state-based advisory committees on immunization recommendations or insurance coverage guidelines.
The Road Ahead
These legislative trends reflect a growing emphasis on state leadership in shaping immunization policy. As these efforts move from enactment to implementation, they may provide important insights into how states can sustain vaccine access and continue supporting healthy communities in the years ahead.
ASTHO will continue tracking legislative actions on this important public health issue.
Reviewed by Susan Kansagra, MD, MBA, Chief Medical Officer; Danny Staley, MS, Senior Vice President, Public Health Practice and Programs; Meredith Allen, DrPH, MS, Vice President, Health Security; Ericka McGowan, MSPH, Senior Director, Emerging Infectious Disease; and Lillian Colasurdo, JD, Director, Public Health Law and Data Sharing.