As pandemic fades, bills target vaccine makers, mandates

Conservative legislators in states across the country are introducing measures to impose new restrictions on those who manufacture, deliver or require vaccines, raising concerns among public health officials and experts about the long-term consequences that vaccine skepticism could have in spreading preventable disease.

At least 82 measures targeting some element of state-level vaccine policy have been introduced in 18 states already this year, according to a tally by Dorit Reiss, a professor at the University of California Hastings College of Law in San Francisco who studies vaccine policy.

Of those bills, at least 29 are specific to vaccines against the virus that causes Covid-19. Forty-six are related to vaccines in general, not just the coronavirus, while the rest are ambiguous or apply to some combination of vaccines, Reiss said.

“Some of the new bills have focus beyond Covid-19 and shifting to a focus on routine immunizations — removing vaccines from the list of required school immunizations or limiting these required immunizations to specific settings,” said Jennifer Laudano, communications director at the National Academy for State Health Policy, which is tracking vaccine-related legislation.

The bills vary widely: Some bar businesses, school districts and government agencies from requiring vaccinations. Others, dubbed “informed consent” laws, require vaccine providers to show recipients a list of ingredients or information about potential adverse effects. Some add steps that people must take to receive a vaccine.

Legislators in several states have proposed expanding the number of exemptions someone could cite in declining a common vaccine. While current law in many states allows people to cite a religious reason not to receive a vaccine, the new bills would also permit someone to cite a personal belief.

And, for the first time, several measures would hold vaccine makers liable for any adverse effects one might suffer after receiving a vaccine.

Arkansas Sen. Bryan King (R) has introduced measures to hold vaccine and drug makers criminally liable for adverse effects caused by their products. In an interview, King said that if illegal drug dealers can be punished for overdose deaths, executives should be held to the same standard.

“It puts more trust in the drug companies, in the executives, that they’re not misleading people,” King said. If his bill passes, his constituents will “know that these people can be sent to prison for doing something or hiding things.”

Lawmakers in at least 10 states have introduced bills to limit or ban vaccine mandates from employers, in schools or when accessing public services. Some lawmakers want to subject businesses to liability for imposing requirements at all.

“Should an individual take the vaccine and have an adverse reaction, the individual is left to shoulder the expense of dealing with the resulting health issues,” Texas Sen. Bob Hall (R) said in an email. “There are legitimate reasons why an individual may not want to take a mandated vaccine. If an employer makes an employee choose between continued employment or vaccine, they should be financially responsible for the consequences.”

Other bills would have broader impacts: One measure proposed in Tennessee would bar adding vaccine ingredients to the food supply. A North Dakota proposal would ban mandates aimed at experimental vaccines, though the measure includes language so ambiguous that it would lump virtually all vaccines into the experimental category.

Vaccine skepticism long predates the coronavirus pandemic, but bills challenging vaccine mandates — whether Covid-specific or not — have gained new momentum in the years since the pandemic’s onset. Vaccine policies became more politicized in the final year of the Trump administration, and after President Biden mandated vaccines for federal workers in 2021.

“Most of my district, and especially in the Republican primary, were not for the mandates of the vaccines. We do have some who think there are dangerous side effects and whatnot,” Arkansas Sen. King said. “I think there’s a lot of legitimate concerns about it. I myself chose not to get vaccinated.”

Studies of the efficacy of vaccines against the coronavirus show remarkable results: An estimate by the Commonwealth Fund suggested that Covid-19 vaccines prevented more than 18 million hospitalizations and 3.2 million deaths in the United States alone between December 2020 and November 2022. A study published in The Lancet Infectious Diseases estimated vaccines saved 18 million lives globally between December 2020 and December 2021.

But skepticism of those vaccines has continued nonetheless. A first wave of legislation targeting vaccines emerged in 2020, even before Covid-19 vaccines were widely available, in states such as North Dakota and Montana. Florida led a group of states the following year in adopting measures restricting mandates, either by government agencies or by business groups.

Reiss said the number of new bills that target vaccines beyond those that protect against Covid-19 surprised her. She and other health experts are worried that rising vaccine skepticism will lead to an increase in preventable disease.

“There is a correlation between weakening vaccine requirements and preventable diseases in an area,” Reiss said. “We know that the easier it is to get an exemption, the more exemptions we see. Stronger vaccine laws lead to higher vaccination rates.”

Anti-vaccine bills, or bills that reduce vaccine requirements, are introduced more often than bills that promote or require new vaccines, Reiss said. But those bills challenging vaccines are also less likely to pass.

Legislators in at least five states have introduced nine measures to increase vaccination requirements, according to Reiss’s tally. Most are designed to allow new categories of health care providers — including dentists and pharmacists — to administer vaccines in states where they are not currently allowed to do so.