Anti-Vaccine Legislating was Common and Deeply Partisan in 2023
In December 2023, the Politics & Health Lab (PHL) at Boston University’s School of Public Health (BUSPH) launched the State Vaccine Policy Project (SVPP). SVPP’s goal is to track all vaccine-related legislation introduced across state houses in the United States from the mid-1980s to the present day. Please see our project’s first press release for additional information about the project.
In this brief report, we assess the state of anti-vaccine policymaking (i.e., bills that aim to undermine vaccination efforts) in the calendar year 2023.
Top line findings include the following:
- Hundreds of Vaccine-Related Bills Were Introduced Across State Legislatures. State legislatures across the United States introduced 813 vaccine-related bills in 2023.
- Anti-Vaccine Legislating is Common. Of the 813 bills introduced in 2023, a nearly identical number were classified as pro- vs. anti-vaccine. Whereas 46% (372) were classified as pro-vaccine, a nearly-identical number 46% (N = 376) were classified as anti-vaccine (with 8%, or 65 bills falling into neither category).
- Republicans were Responsible for Most Anti-Vaccine Legislating. Republican state lawmakers were more likely than Democrats to introduce anti-vaccine legislation. Of the 376 anti-vaccine bills introduced in 2023, 84% (317) were introduced by Republican lawmakers, compared to just 3% (10) by Democrats.
- Dozens of Anti-Vaccine Bills Were Enacted Into Law. Although a majority of anti-vaccine bills are either pending legislative action (N = 271, 71%) or have been rejected (N = 63, 7%), dozens of anti-vaccine bills from 2023 state legislative sessions (N = 42, 5%) have been enacted into law.
Finding #1: Hundreds of Vaccine-Related Bills Were Introduced Across State Legislatures in 2023
SVPP identified 813 vaccine-related bills that were introduced in state legislatures across the United States from January 1 — December 31 2023. Additional information about how we identified vaccine-related bills can be found in our technical supplement.
As we document in Table 1, New York led the nation with 73 vaccine-related bill introductions. Just 16 of those bills (22%) were classified as being anti-vaccine in focus. Texas, in sharp contrast, introduced the second most (N = 62) vaccine-related bills; 45 (75%) of which were classified as anti-vaccine. With the exception of Delaware, all US states introduced at least one vaccine-related bill in 2023.
Table 1. Vaccine-Related Legislation Introduced Across States in 2023
State | Promote Oppose Unclass.| Total
-----------+---------------------------------+----------
NY | 52 16 5 | 73
TX | 14 45 3 | 62
MN | 19 28 6 | 53
MS | 33 11 0 | 44
IL | 26 9 6 | 41
WV | 12 22 2 | 36
VA | 24 8 3 | 35
IA | 16 12 2 | 30
OR | 11 17 2 | 30
FL | 8 13 0 | 21
MO | 5 10 5 | 20
UT | 9 8 3 | 20
RI | 4 11 3 | 18
NC | 3 13 0 | 16
AL | 5 7 3 | 15
AZ | 6 7 2 | 15
DC | 7 7 1 | 15
WA | 8 6 1 | 15
OK | 1 13 0 | 14
ID | 1 12 0 | 13
ME | 4 9 0 | 13
PA | 4 8 1 | 13
MI | 7 4 0 | 11
TN | 2 8 1 | 11
VT | 7 3 1 | 11
CA | 10 0 0 | 10
KY | 5 3 2 | 10
MA | 8 1 1 | 10
KS | 6 3 0 | 9
SC | 3 4 2 | 9
WI | 4 4 1 | 9
CO | 7 1 0 | 8
CT | 3 5 0 | 8
NE | 5 2 1 | 8
AK | 3 2 2 | 7
HI | 4 3 0 | 7
MD | 5 2 0 | 7
ND | 0 7 0 | 7
OH | 0 4 3 | 7
GA | 2 4 0 | 6
IN | 3 3 0 | 6
NH | 2 4 0 | 6
NV | 3 2 1 | 6
LA | 1 3 1 | 5
MT | 2 3 0 | 5
AR | 1 3 0 | 4
NJ | 3 1 0 | 4
NM | 2 1 0 | 3
WY | 1 1 1 | 3
SD | 0 2 0 | 2
-----------+---------------------------------+----------
Total | 372 376 65 | 813 Note. Source = State Vaccine Policy Project. Please review our technical supplement for additional information about data collection and bill subject classification.
Finding #2: Anti-Vaccine Legislation is Common
We also find that “anti-vaccine” bills aiming to undermine vaccine promotion (e.g., by curtailing or eliminating vaccine mandates in different employment or educational settings) are quite common. Of the 813 bills introduced in 2023 a nearly identical number were classified as pro- vs. anti-vaccine. Whereas 46% (372) were classified as pro-vaccine, a nearly-identical number 46% (N = 376) were classified as anti-vaccine (with 8% or 65 bills falling into neither category).
Again, please see our technical supplement for additional information on how we classified bills as pro-vaccine vs. anti-vaccine.
Figure 1 provides additional information about the subject of anti-vaccine bills introduced across state legislatures. The figure plots the number of bills that aim to weaken vaccine mandates in five areas: health care settings (e.g., hospitals), government offices, private businesses, students attending public schools, and educators working in public schools.
We find that nearly a third (N = 117, 31%) of anti-vaccine bills introduced in 2023 take aim at weakening vaccine mandates for children attending public schools, while over a quarter (N = 97, 26%) aim to weaken vaccine mandates in private employment settings. Few bills take aim at weakening vaccine mandates in health care settings, or for educators who work in public schools.
Figure 1. The Number of Anti-Vaccine Bills Introduced that Aim to Weaken Vaccine Mandates in Different Settings.
Note. Source = State Vaccine Policy Project. Please review our technical supplement for additional information about data collection and bill subject classification.
Finding #3: Republicans are Responsible for Most Anti-Vaccine Legislating
The overwhelming majority of anti-vaccine bills introduced across state legislatures in 2023 were sponsored by members of the Republican Party. Figure 2 plots the count (left-hand panel) and proportion (right-hand panel) of anti-vaccine bills introduced by Democrats and Republicans in 2023. It also displays bills introduced by Independents, or which were co-sponsored by both Republicans and Democrats (“Bi-Partisan.”)
We find that, of the 376 anti-vaccine bills introduced in 2023, 84% (317) were introduced by Republican lawmakers, compared to just 3% (10) by Democrats. The 317 anti-vaccine bills introduced by Republicans represented a significant portion of their vaccine-related legislative workload; comprising 69% of all vaccine-related legislation introduced by members of the GOP. Democrats, on the other hand, introduced nearly two hundred (N = 195) bills that aimed to promote vaccination.
Figure 2. The Count (Left) and Proportion (Right) of Pro- vs. Anti-Vaccine Legislation Introduced in 2023, by Sponsor Party Affiliation
Note. Source = State Vaccine Policy Project. Please review our technical supplement for additional information about data collection and bill subject classification.
Finding #4: Most Anti-Vaccine Legislation Does Not Pass, but Dozens of Anti-Vaccine Bills Have Been Enacted Into Law
Finally, we find that although most anti-vaccine legislation is not ultimately passed into law, a concerning number of anti-vaccine bills were adopted by state legislatures in 2023.
Figure 3 plots the count (left-hand panel) and proportion (right-hand panel) of bills introduced at different stages of the legislative process: from whether they have been introduced (with no further action), referred to committee, advanced from committee, or adopted into law. We also provide information about whether bills were not adopted (rejected) in the state legislature.
The figure suggests that a majority of anti-vaccine bills introduced in 2023 are either pending legislative action (N = 271, 71%) or have been rejected (7%, N = 63). Worryingly, though, dozens of anti-vaccine bills (N = 42, 5% of all bills introduced) have been enacted into law. Anti-vaccine bills consist of nearly 30% (N = 42) of the 141 vaccination bills adopted into law by state legislatures in 2023.
Pro-vaccine bills, on the other hand, were somewhat more likely to be enacted into law (N = 84, 10% of all bills introduced). But, most pro-vaccine legislation remains pending further legislative action.
Figure 3. The Count (Left) and Proportion (Right) of Pro- vs. Anti-Vaccine Legislation Introduced in 2023, by Legislative Progress
Note. Source = State Vaccine Policy Project. Please review our technical supplement for additional information about data collection and bill subject classification.
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SVPP consists of Dr. Matt Motta (mmotta@bu.edu) and Dr. Tim Callaghan (timcal@bu.edu). Please contact Dr. Motta with technical questions about this report. Please reach out to us directly for press inquires.
SVPP is funded by a seed grant from the Boston University School of Public Health. We thank Boston University for their generous support. Coders for SVPP include MPH student Emma Mears, and BUSPH MPH alumnus Ali Rivera. This report is made possible by their hard work and dedication to the project, and for that we are immensely thankful.
