Mandatory vs. Recommended Vaccines: An Overview

It is common for parents to take their child in for an annual checkup and learn their child needs one or more vaccines. Many parents consent to the vaccines without any doubts. But plenty others also wonder how necessary the vaccines truly are.

There is a lot of confusion—even among doctors—about whether certain vaccines are recommended or mandated. So it's not too unfair to question if your child should get every vaccine their pediatrician says they should.

This article takes a closer look at vaccine mandates and why they vary depending on where you live. It includes a few reasons why people choose to opt out of vaccines. It also dispels a few myths that stop people from getting them.

A little girl gets a bandaid after receiving her shot
asiseeit / Getty Images

Who Sets Vaccine Recommendations?

Every year, the Centers for Disease Control and Prevention (CDC) publish a recommended immunization schedule for the United States. This schedule is put together by a panel of 15 experts known as the Advisory Committee on Immunization Practices (ACIP).

The ACIP panel is comprised of experts in medical and public health fields. Doctors, researchers, infectious disease specialists, and community representatives are all part of the panel.

The schedule's purpose is to provide people with the maximum protection from vaccine-preventable diseases as safely as possible. The schedule is organized according to the age ranges in which the recommended vaccinations should be given.

Currently, there are 16 vaccines recommended by the ACIP, scheduled from birth through the age of 18.

This schedule is updated every year to ensure that it is always based on the most up-to-date research. Medical professionals across the country use it to immunize their patients, and state governments follow the recommendations to determine which vaccines should be required (or mandated) for school.

Mandatory Vaccinations

Though the vaccines listed on the ACIP schedule are only recommended, some states may opt to mandate them to prevent the spread of vaccine-preventable diseases among school children.

For school-mandated vaccinations, each state makes its own list of vaccines that are required for a certain age or grade. Parents who don't comply and provide evidence of the vaccination will typically be barred from having their kids attend school.

As straightforward as this might seem, there are challenges and barriers that affect how these mandates are issued and implemented. These include:

  • Variations by region: Vaccine mandates vary widely throughout the country, and sometimes within individual cities or school districts. For example, students in one city may be required to have at least one dose of the meningococcal vaccine before 8th grade, while students in a neighboring city may not.
  • Variations by governing authorities: The body authorized to issue mandates also varies by state. Some states might pass legislation to mandate vaccinations statewide, while others let the state health department decide. Others still may offer city councils or school districts room to effect their own mandates when appropriate.
  • Variations in legislation sessions: The frequency of mandate reviews can also vary depending on how often the state legislature meets and how long it takes for legislation to be passed. In such cases, it may take years to update vaccine requirements after a new ACIP recommendation.

The federal government does not mandate vaccinations.

Challenges in Implementation

A number of variables can also influence how policies are enacted, including politics, cultural norms, and practicality. None of these issues should be minimized.

For example, while annual flu vaccination is recommended by the CDC and may be mandated for school children within a state, requiring families to prove compliance every year would not only be burdensome but costly.

Parents and public opinion also play a role. In recent years, states that have mandated the human papillomavirus (HPV) vaccine to prevent the spread of the sexually transmitted disease have been faced with protests from community members who believe that doing so promotes teen sex.

Such an event occurred in New York State in 2019 when state officials mandated the HPV vaccination for students age 11 to 12.

States can also require vaccines for specific groups, such as college students or nursing home employees, while individual schools or employers may issue mandates as well (such as hepatitis B and COVID-19 vaccinations for hospital workers).

Opting Out

The concept of "forced vaccination" is a concept largely promoted by anti-vaccination ("anti-vaxxing") activists. It suggests that the government is forcing them or their kids to receive medications they don't want out of the threat of retribution.

The reality is far less dramatic. All 50 states currently have vaccine requirements for children, but that doesn't mean kids are being forced to be vaccinated. The requirements are limited to those attending school, and, even then, parents who don't want to vaccinate their kids still have options.

In every state, children who shouldn't receive vaccines for medical reasons—such as organ transplants or severe allergies—can receive medical exemptions.

Opting out for non-medical beliefs is far more difficult. In all but five U.S. states, parents are not permitted to opt out of vaccines for non-medical reasons, such as religious objections to vaccination.

Where non-medical exemptions are allowed, the process for obtaining one may be as simple as signing a form. Other states require parents to undergo an educational module or counseling by a physician on the risks and benefits of vaccination before they can get an exemption.

Even with these various options to opt out of mandated vaccinations, only around 2% of parents actually do, according to a 2014 study in the American Journal of Public Health. With that said, states with easy exemption policies have more than twice the number of exemptions as those with difficult ones.

Are Current Mandates Enough?

While states continue to expand school vaccine requirements, they are not as comprehensive—and therefore not as protective—as the recommended schedule issued by the CDC.

For example, while many states require meningococcal and pertussis (whooping cough) vaccination in schools, only two require the HPV vaccine, and none require the flu vaccine. This is despite the fact that HPV and influenza kill over 11,000 and 70,000 people, respectively, every year.

This is why the CDC recommends vaccines against all four of these diseases for adolescents 11 to 12. They are each considered equally important in the eyes of the ACIP but are rarely required by schools.

That is not to say that all vaccines are equally important. If a vaccine isn't necessary for everyone to get, the ACIP has ways of indicating that it is optional.

In 2015, the ACIP granted the meningococcal B vaccine a "provisional" recommendation, essentially leaving it up to healthcare providers to decide whether vaccination is appropriate on a case-by-case basis.

A Word From Verywell

It is important to note that school-mandated vaccine requirements are minimum standards. Because the ACIP schedule is more comprehensive, those who follow it will have no problem meeting requirements for school or work.

By contrast, getting only what is mandated may leave you vulnerable to preventable—and potentially serious—infections. If in doubt, speak with your healthcare provider to check if your child is getting all of the recommended vaccinations on the ACIP list, not just the mandated ones.

Vaccines Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Doctor Discussion Guide Child

Frequently Asked Questions

  • Can states require COVID-19 vaccines for school children?

    Yes. States can add COVID-19 to the list of vaccinations required for children who attend public schools. California was the first state to mandate it, adding it to the list of required vaccinations beginning in the 2022-2023 school year. 

  • Which vaccines are adults required to have in the U.S.?

    There are no national vaccine mandates. However, certain vaccinations may be required for military service, to work at some private and public organizations, or in order to enroll in certain schools or organizations.

  • Can you be exempted from vaccine requirements?

    Exemptions are available for specific situations. For schools, exemptions are determined by state or local laws. All states allow for medical exemptions for students under certain conditions, and 44 states plus Washington, D.C., allow for other exemptions such as religious beliefs. Vaccine exemptions for military service are reviewed on an individual basis. Work-related vaccine requirements must adhere to other legal regulations including those established by the Americans with Disabilities Act.

8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Centers for Disease Control and Prevention. Immunization schedules.

  2. Centers for Disease Control and Prevention. Recommended child and adolescent immunization schedule for ages 18 years or younger, United States.

  3. WBEN News. Protesters oppose potential HPV vaccine mandate.

  4. Pew Research Center. Amid measles outbreak, New York closes religious exemption for vaccinations – but most states retain it.

  5. Wang E, Clymer J, Davis-Hayes C, Buttenheim A. Nonmedical exemptions from school immunization requirements: A systematic review. Am J Public Health. 2014 Nov;104(11):e62-84. doi:10.2105/AJPH.2014.302190

  6. National Centers for Health Statistics. FastStats - Leading causes of death.

  7. Centers for Disease Control and Prevention. Advisory Committee on Immunization Practices (ACIP) summary report.

  8. National Conference of State Legislatures. States With Religious and Philosophical Exemptions From School Immunization.