Mandates can increase vaccine uptake,¹ but their effectiveness is associated with who is covered, penalties, and exemptions.² The US federal government recently required federal employees to be vaccinated against SARS-CoV-2 and developed standards for large employers.³ However, individual states traditionally take the lead in regulating public health via vaccine mandates.⁴ Some states have attempted to introduce requirements to increase uptake of COVID-19 vaccines.⁵ However, others have attempted to impede COVID-19 vaccine mandates. Most efforts have been considered by legislatures; also, some governors and regulatory agencies have issued executive orders. We assessed state-level legal interventions to promote or impede COVID-19 vaccine mandates since the beginning of the pandemic.

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Article Information

Accepted for Publication: November 22, 2021.

Published Online: December 2, 2021. doi:10.1001/jama.2021.22122

Corresponding Author: Breanna Fernandes, University of Western Australia, Perth, 35 Stirling Hwy, Crawley, WA 6009, Australia (22981317@student.uwa.edu.au).

Author Contributions: Ms Fernandes had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Fernandes, Navin, Omer, Attwell.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Fernandes, Navin, Attwell.

Critical revision of the manuscript for important intellectual content: Fernandes, Navin, Reiss, Omer.

Statistical analysis: Fernandes.

Administrative, technical, or material support: Fernandes, Navin, Attwell.

Supervision: Attwell.

Conflict of Interest Disclosures: Dr Reiss reported owning stock in GlaxoSmithKline and serving as an unpaid member of Moderna’s advisory ethics committee. Dr Attwell is a member of the Australian Technical Advisory Group on Immunization COVID-19 working group 2 and is a current recipient of a Discovery Early Career Researcher Award funded by the Australian Research Council of the Australian government (DE19000158). No other disclosures were reported.

References

Delamater PL , Pingali SC , Buttenheim AM , Salmon DA , Klein NP , Omer SB . Elimination of nonmedical immunization exemptions in California and school-entry vaccine status. Pediatrics. 2019;143(6):1-9. doi:10.1542/peds.2018-3301 PubMed Google Scholar Crossref

Omer SB , Betsch C , Leask J . Mandate vaccination with care. Nature. 2019;571(7766):469-472. doi:10.1038/d41586-019-02232-0 PubMed Google Scholar Crossref

The White House. Path out of the pandemic: President Biden’s COVID-19 action plan. Published 2021. Accessed November 25, 2021. https://www.whitehouse.gov/covidplan/

Omer SB , Peterson D , Curran EA , Hinman A , Orenstein WA . Legislative challenges to school immunization mandates, 2009-2012. JAMA. 2014;311(6):620-621. doi:10.1001/jama.2013.282869 PubMed Google Scholar Crossref

Stephenson J . As employers and colleges introduce COVID-19 vaccine mandates, wider use “remains an open question.” JAMA Health Forum. 2021;2(4):e210874. doi:10.1001/jamahealthforum.2021.0874 Google Scholar

Immunizations; Exemption; Requirements, HB 2423, 55th Leg (AZ 2021).

US State-Level Legal Interventions Related to COVID-19 Vaccine Mandates

Mandatory SARS-CoV-2 Vaccinations in Schools and Businesses

COVID-19 Vaccine Mandates—A Wider Freedom

US State-Level Legal Interventions Related to COVID-19 Vaccine Mandates

Mandatory SARS-CoV-2 Vaccinations in Schools and Businesses

COVID-19 Vaccine Mandates—A Wider Freedom

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