States set school vaccine requirements. Trump’s new executive order doesn’t change that

By Deidre McPhillips, CNN

(CNN) — As students prepare for a new school year across the US, families are confronted with a fraught national discussion around vaccines and questions about which they’re required to get in order to attend school.

An executive order signed by President Donald Trump on Monday is the administration’s latest move to reduce the number of vaccinations recommended for children. Like some related efforts to reshape the federal government’s approach to childhood vaccines, the executive order offers recommendations — but the authority to set and enforce vaccine requirements still lies with states.

The administration signaled that it will push states to rework their vaccine requirements to incorporate the new federal guidelines, effectively upending longstanding practices aimed at improving childhood immunization rates. It’s unclear exactly how officials plan to reinforce this, but the Department of Justice, the Department of Education and the Department of Health and Human Services have been directed to tie compliance with federal funding.

State authority to set vaccine policy has been challenged before but broadly upheld by the US Supreme Court.

States are still reviewing the executive order, but many – including those that follow federal guidance for vaccine policy and those that have broken from federal recommendations – say that it does not require any changes at the state level.

“Federal recommendations do not change the requirements in Texas,” the state health department said in an email to CNN.

Others responded to the president’s action with a commitment to science-based vaccine policy.

“Vaccines are our most effective defense against vaccine-preventable illnesses,” Dr. Puthiery Va, director of the Maine Center for Disease Control and Prevention, said in a statement. “In Maine, vaccines remain available at no cost to eligible children through the Maine CDC’s Immunization Program. Maine’s school and child care immunization requirements remain unchanged by federal actions to date.”

The new executive order emphasizes the administration’s aim to “maximize parental choices over vaccinations for their children,” specifically noting that states should “provide religious and medical exemptions” to vaccine requirements.

All 50 states have their own laws requiring certain vaccines for students to attend school, and all allow students to be exempted from school vaccine requirements for medical reasons. The vast majority of states also allow vaccine exemptions for non-medical reasons, which may be categorized as religious or personal.

According to the National Conference of State Legislatures, only four states do not allow exemptions that are not for medical reasons: California, Connecticut, Maine and New York.

New York removed the option for religious exemptions for school vaccines in 2019 after measles outbreaks in the state grew to some of the largest the US had seen in decades, and Connecticut removed its religious exemption option in 2021.

Changes to any state vaccine exemption laws would need to be passed by state legislatures, many of which will not meet again until January.

But courts can get involved, too. Mississippi started allowing religious exemptions in 2023 after a federal court order, and a move to allow religious exemptions in West Virginia is facing legal challenges. Before these changes, both states were known to have exceptionally high childhood vaccination coverage under some of the strictest laws.

Childhood vaccination coverage has been falling for years as exemption rates reach record levels.

About 3.6% of incoming kindergartners in the 2024-25 school year had an exemption for a required vaccine, leaving about 138,000 new schoolchildren without full coverage for at least one state-mandated vaccine, according to data from the US Centers for Disease Control and Prevention. Exemptions jumped more than a full percentage point over the past four years, and the vast majority – all but 0.2% – were for non-medical reasons.

Public health experts say that building trust in the safety and effectiveness of vaccines is key to reversing the decline in childhood immunization rates.

“If more and more parents choose not to vaccinate their children for non-medical reasons, we will no doubt see a rise in disease outbreaks,” Dr. William Moss, an associate professor with Johns Hopkins Bloomberg School of Public Health, has said.

Measles cases in the US have reached a 35-year-high this year, the vast majority of which are in people who have not been vaccinated with the measles-mumps-rubella (MMR) vaccine.

But the new executive order advises that the MMR be separated into three individual shots — a dramatic change that goes against broad scientific consensus and a suggestion that could raise doubts.

States have typically aligned their policies for vaccine requirements with recommendations from the CDC and its Advisory Committee on Immunization Practices (ACIP). But ACIP has undergone sweeping changes under US Department of Health and Human Services Secretary Robert F. Kennedy Jr., and actions by the federal agency and the advisory board to overhaul the childhood vaccine schedule — including a reduction in the number of diseases covered by routine vaccinations — have led many states to break from this longstanding practice.

According to KFF, 28 states have announced that they will no longer follow federal vaccine recommendations. Most have indicated that they will instead follow recommendations from the American Academy of Pediatrics, an independent medical association.

“For decades, the U.S. childhood immunization schedule was developed through a rigorous scientific process required by law that evaluates the safety and effectiveness of vaccines and how they should be given to patients. This transparent, expert-led process has helped prevent serious diseases, reduce hospitalizations, and save millions of lives,” the Governors Public Health Alliance said in a statement. The coalition includes more than a dozen governors who represent about a third of the US population.

“President Trump’s Executive Order directing changes to longstanding federal vaccine recommendations circumvents that process and defies scientific consensus. It also risks causing confusion and endangering our children,” the alliance said.

“Parents should know that vaccines currently available in the United States remain available and that the Executive Order does not change that. Governors and state public health leaders hold the power to continue working with healthcare providers, schools, and local health agencies to ensure that parents have access to trusted information and can make informed decisions regarding the health of their children.”

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