“Due to actions by the Trump administration, which has questioned the safety and effectiveness of vaccines and sought to reduce the number of recommended childhood vaccines, a growing number of states has begun to delink their recommendations from those of the federal government,” according to an August 21^st report by KFF.

“As of August 2026, 30 states and DC had announced that they would no longer follow Centers for Disease Control and Prevention’s (CDC) Advisory Committee for Immunization Practices (ACIP) recommendations for one or more childhood vaccines, with 27 states delinking from CDC/ACIP recommendations for all childhood vaccines,” the report explains.

The Trump administration put out a new federal childhood vaccine schedule at the beginning of 2026 and in August 2026, an Executive Order (EO) called for “changes to the federal childhood vaccine schedule” and asked states and territories to “consider updating laws and regulations that define the scope of immunization requirements for contexts such as school enrollment and attendance.” 

According to the KFF report, currently “no states have made policy changes in line with the August 2026 Executive Order.” Additionally, it points out that 10 states and local governments “have announced specifically that their school vaccine requirements have not changed as a result of the EO.”

The constitution gives states and localities – not the federal government – authority to set school vaccine requirements. While requirements for some vaccines vary, KFF reports that all jurisdictions require a set of common vaccines (such as those for MMR (measles, mumps and Rubella), polio and DTaP (diphtheria, tetanus, and acellular pertussis.) 

Another important management and policy issue is the allowed exemptions to the requirements. These exemptions “fall into two general categories: ‘medical’ (exemptions based on medical contraindications) and ‘nonmedical’ (exemptions based on religious beliefs or other personal/philosophical beliefs).”

All states allow for medical exemptions, according to the report; thirty states allow religious exemptions only; fifteen allow religious and personal belief exemptions, and one (Minnesota) allows personal belief exemptions only.

Not surprisingly, state and local exemption policy, management and implementation differ. According to the report, “Since 2025, at least nine states have enacted changes that make non-medical exemptions more permissive, including by reducing documentation or procedural requirements. Research indicates that easier-to-obtain non-medical exemptions are associated with higher exemption rates and, in turn, declining childhood vaccination coverage.”

Another difference between the states is the difficulty in obtaining an exemption and oversight of exemption requests. At one extreme in California, “physicians issuing medical exemptions must use a centralized system, all exemption requests are reviewed by the state’s health department that has the authority to invalidate inappropriate requests, and justifications must adhere to standards for medical contraindications.”

At the other extreme, reports KFF, “In states such as Arizona, Idaho, Oklahoma, and Texas, nonmedical exemptions are granted after parents submit a form requesting them, with no counseling or health professional certification required.”

This is, of course, a contentious issue, with a wide-ranging debate over the value or potential harm of vaccinations altogether. But reports WebMD, “States that make it easy to get nonmedical exemptions have more exemptions, and higher rates of vaccine-preventable diseases, than states with tougher laws, research finds.”

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