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ASTHO Legislative Prospectus | Prevention 2025 state legislative action on infectious disease control and prevention.

States Reassessing Vaccine Policy and Public Health Powers Shalini Nair, Andy Baker-White Review of state policies to weaken vaccine requirements and reduce public health powers. Immunization is a key pillar of public health, crucial for protecting communities and preventing infectious diseases from spreading. State and territorial health officials and their departments play critical roles in setting and implementing immunization requirements, managing disease surveillance and outbreak response, and ensuring access to vaccines. In recent years, however, the immunization landscape has evolved as legislative changes alter public health authority and access to vaccines. As these challenges persist, public health officials must be informed and prepared to navigate the dynamic policy environment to ensure immunization programs’ continued effectiveness at protecting public health. The True Cost of Vaccine Skepticism and Misinformation In the years since the pandemic, rates of routine vaccinations among U.S. children have steadily declined; there has simultaneously been an increase in non-medical exemptions. While reasoning behind personal decisions about vaccination are not always clear, increasing prominence of vaccine-related myths is a significant contributor to this phenomenon. Perhaps the most glaring consequence of this decrease is best illustrated by the 2025 measles outbreak and the first measles-associated deaths in more than a decade. Previously considered to have been eliminated, measles is now under threat of resurgence as vaccine rates fall below the thresholds to uphold herd immunity. Health officials are also seeing declines in coverage for several other vaccine preventable diseases like pertussis, mumps, hepatitis, and even polio. Legislation Restricts Innovation and Sows Doubt About Vaccine Components The use of mRNA technology expanded in 2020 following its breakthrough success in COVID-19 vaccines. These mRNA vaccines prevented more than 120 million additional COVID-19 infections and 3.2 million additional deaths. Researchers are currently assessing mRNA technology to address pandemic influenza, HIV, Zika, and even cancer. During 2025 sessions, at least seven states introduced legislation to ban or limit using mRNA vaccines. Iowa’s SF 360 sought to prohibit any “gene-based vaccines” (i.e., those developed using mRNA or DNA technology); the bill was based on a widely debunked myth that mRNA vaccines can interact with and alter human DNA (they can’t). New York’s A 4798 would prevent administering COVID-19 mRNA vaccines until the department of health conducts a risk-benefit analysis. Several states have introduced legislation to prohibit selling — or require labeling foods that contain — vaccine or vaccine material. This bill is based on another common internet rumor that mRNA vaccines are being introduced into the food supply via livestock and produce (they aren’t). Nonetheless, Utah enacted a bill (HB 84) requiring that food intended for human consumption that contains a vaccine or vaccine material be designated as a drug. Similar bills were introduced in Florida (HB 525), Alabama (HB 316), and Tennessee (SB 616, HB 1100). Vaccine Authority’s Shifting Landscape While the federal government plays an important role in putting forth policy recommendations, the ultimate power to impose or revoke vaccine requirements and determine exemptions outside of health emergencies rests with states. In many jurisdictions, state health agency expertise determines the vaccines required for school enrollment. These decisions, while ultimately at the feet of state health officials, rely heavily on input from experienced, knowledgeable, and skilled agency staff. Recent legislative actions in several states seek to shift authority for determining school-based immunization requirements solely to the legislature. Idaho’s new law (H 290) removes the state board of health’s authority to determine which immunizations are required for daycare and school enrollment, as well as the manner and frequency of their administration. The bill also repeals a former law establishing the Idaho Childhood Immunization Policy Commission, created in 2010 to issue recommendations to the legislature and board of health. A similar effort in Maine (LD 727) would remove health department authority to determine school vaccine requirements as part of a larger repeal effort responding to the 2019 law disallowing vaccine exemptions based on religious or philosophical grounds. In New Hampshire, existing statutes define required immunizations for school attendance and allow the state health official to add to this list via the rulemaking process. Recently, lawmakers introduced a bill (HB 357) that would remove this add-on ability. If passed, existing commissioner-led requirements for vaccines such as varicella, hepatitis B, and Hib would expire in June 2026 and no future amendments could occur under this authority. Several other bills introduced in Texas (HB 468, HB 3304, SB 94, SB 117, HB 3852), West Virginia (SB 108, HB 2203), and North Carolina (HB 89) target shifting authority and/or modifying vaccine requirements for certain school types. Evidence-Based Policy as the Path Forward State and territorial health agencies are foundational to preventing the spread of infectious diseases through vaccine education and administration. ASTHO has identified public health expertise in developing vaccination policy as one of three recommended strategies that prioritize evidence-based public health authority and support agencies to protect and improve health. As this landscape further evolves, ASTHO will continue tracking legislative and executive action on this important public health issue. article yes

PrEP is a powerful tool to reduce new HIV infections; expanding access to PrEP is a priority within the federal Ending the HIV Epidemic in the U.S. initiative. One way to increase access to PrEP is by allowing pharmacists to prescribe and dispense it.

This report analyzes way that public health officials can mitigate the impact of disasters on pregnant people, neonates, and infants through a variety of policies, including policies related to preparing for, responding to, and recovering from a public health emergency.

Learn how state and territorial legislatures can bolster or restrict public health legal authority, with examples from early COVID-19 as well as 2024.

The COVID-19 pandemic has impacted both the physical and mental health well-being of youth. Disruptions in both their home and school life have put youth at risk for poor mental health outcomes that include increased anxiety, depression, and risk of suicide. This Mental Health Month we examine state and territorial legislation that addresses youth mental health.

As many state legislatures seek to expand vaccine exemptions, it’s important to understand the fundamental differences in exemption type and their impact on a community.

Continuing ASTHO’s Legislative Prospectus series—which highlights the top 10 public health policy issues for 2022—we are focusing this week on mental and behavioral health as well as supporting the public health workforce.

Reconciling the tension between public health and civil liberties is one of the most significant challenges of public health law and ethics. The Supreme Court of the United States historically upheld state authority to enact and enforce public health laws that temporarily limit a person’s civil liberties, such as quarantine and isolation powers that restrict a person’s freedom of assembly in order to prevent the spread of contagious disease. There have been many legal challenges to the public health orders issued to slow the spread of COVID-19—many of the claims asserting violations of First Amendment rights of assembly, association, and expression—but they’ve largely been rejected by the courts. However, courts have treated claims asserting violations of the free exercise of religion more favorably, which may indicate an impending shift in how courts analyze the impact state and territorial actions may have on religious organizations.

Economic security and well-being, job stability, access to safe and affordable housing, access to healthy and nutritious foods, and access to resources to manage mental and physical health—all of these things impact individual, family, and community health. The COVID-19 pandemic has fundamentally impacted each of these social determinants of health for many Americans. Furthermore, some communities and industries have faced harder economic impacts than others, including households with low incomes, non-white households, and households with children. Human services and public health leaders can collaborate to make sure we are rebuilding systems and programs in a way that creates healthier, more resilient families and communities.

May is Mental Health Awareness Month and the importance of continued mental health promotion and suicide prevention efforts during the COVID-19 pandemic. As we address the physical effects of COVID-19 through social distancing, mask wearing, and vaccination, we still need to prioritize mental health and well-being during and after the pandemic. A recent Morbidity and Mortality Weekly Report found increases in adults reporting symptoms of anxiety or depression (36.4% to 41.5%) and unmet mental health care need (9.2% to 11.7%) between Aug. 2020 to Feb. 2021.

When rural hospitals close, it increases the distance people must travel for essential healthcare services. The COVID-19 pandemic has highlighted and magnified the factors leading to rural hospital closures across the country. Many healthcare facilities suspended elective procedures to conserve critically needed personal protective equipment and reduce the risk of exposure to COVID-19 by patients and hospital staff. For many rural hospitals, however, the suspension of elective procedures with the reduced the use of non-urgent services by apprehensive patients meant a loss of revenue and the furloughed healthcare staff. Since the onset of the COVID-19 pandemic, approximately half of all rural hospitals are experiencing negative operating margins due to reduced outpatient revenue. The rate increases in states that have not expanded Medicaid. Unfortunately, these kinds of challenges are not new to rural hospitals.

More than 100 rural hospitals have closed since 2010, and an additional 25% are at high risk of closure, and COVID-19 has magnified the existing stressors on rural healthcare. As a result, states are using a variety of measures to address and prevent more rural hospital closures.

The 2020 holiday season is coinciding with a nationwide surge of COVID-19 cases. With great concern that holiday travel to see loved ones may exacerbate community spread of the virus, many states are increasing public health measures before the winter holiday season. As of November 16, 2020, 13 states and D.C. had a quarantine requirement for out-of-state travelers. The U.S. territories also have instituted travel restrictions to limit the spread of COVID-19.

As COVID-19 spread across the country, misinformation and conspiracy theories led to beliefs that the virus was a hoax and prevention measures were unnecessary. Efforts to limit public health authority resulted in reduced confidence from the public and an inability for public health officials to lead. Our experts on this podcast episode explore what public health officials can do to build back public confidence in our public health infrastructure, and offer lessons that work. Our experts will discuss how and why this has happened, and how we can remedy this as we enter into COVID-19 recovery and the largest vaccination campaign in decades.

Communicating About Disease Forecasting Effectively Communicating About Disease Forecasting Clearly communicating about disease forecasting helps policymakers, the media, and the public make informed decisions in public health emergencies. Communicating effectively about disease forecasting data is essential for the public to understand the associated risks, implications, and recommended actions. It’s also critical for policymakers who can use the data to determine effective, equitable strategies for outbreak response. In turn, the public can make informed decisions to keep safe. Each audience, including the media, will likely need tailored messages about the indications and limitations of a given forecast. Approaches for communicating about disease forecasts/models with policymakers and the public align with many of the key tenets of public health communications more broadly. Public health practitioners should consider integrating Crisis and Emergency Risk Communication (CERC) principles, which suggest that communications be first, right, credible, empathetic, actionable, and respectful to help the public make informed decisions during challenging circumstances. Communicating with Policymakers Policymakers—public health or elected—have important decision-making and rule-making authority; additional considerations may be needed when communicating with them about disease forecasting. Interactions frequently occur through staffers, who may have limited knowledge and/or time. In addition to CERC principles, communications should also be: Relevant. Tailor communications to policymakers’ priorities to emphasize potential impacts on resource allocation, public health outcomes, local or regional policies, and public sentiment. Collaborative. Foster relationships with policymakers and offer subject matter expertise on forecasting to inform policy decisions. Timely. Provide frequent updates, allowing for proactive collaboration, decision-making, and communication with the public. Concise. Develop briefs that summarize forecasts and their implications for constituents. Consistent. Build trust with policymakers and their staff between emergencies to highlight disease forecasting as a useful tool whose methodologies, data sources, and limitations are clear. Communicating with the Public In addition to CERC principles and in collaboration with media partners, communication about disease forecasts/models with the public should be: Accessible. Provide easily accessed information about methodology, data sources, and limitations in the forecasts. Clear. Use jargon-free, non-technical language to convey critical messages. Contextualized. Frame forecasts within the broader public health context, emphasizing how individual and community actions can mitigate risk, and reinforce the effects of collective actions as part of an outbreak response. Empowering. Give the public reasonable, actionable steps to protect themselves and their communities. Local. Use social media, news releases, listening sessions, and other relevant means to reach as broad an audience as possible. Collaborate with community leaders and health care providers to amplify messaging and reduce misinformation. Frequent. Keep the public informed with regular updates on forecast products including changes in local risk levels, new trends, guidance, and recommendations. Utah’s Best Practices for Communicating Forecasts During the COVID-19 response, the Utah Department of Health and Human Services (DHHS) modeled potential disease transmission and shared how to effectively communicate with the media and public. DO Create diverse forecasting and communications teams that include public health, universities, and ‘bonus’ team members (e.g., political representatives, laboratories, and health economists). Clarify the purpose for which a given model was developed. Discuss the limitations of the disease model. Communicate about future outcomes (i.e., what would happen without further intervention). Provide language on how to alter the current path (e.g., ‘With this intervention, we could potentially avoid…’) Remind audiences that models can affect the future, not only predict it. Share information and data that are digestible for the public. DON’T Sound definitive when outcomes aren’t clear or make predictions using absolute terms. Omit a variety of scenarios or tools when presenting a forecast. Disregard inherent uncertainties in forecasts. Show models with conflicting results. Utah DHHS also recognized that members of the media are key partners in communicating public health messages; closely coordinating and contextualizing forecasts helps communicate accurate conclusions and/or recommendations. Communicators and staff should be prepared and have information ready to share for more complex questions as needed. Storytelling with forecasts and models helps the reader internalize them and make informed decisions. CDC-RFA-OT18-1802 2018-2024 article yes

This week might have marked the beginning of summer, but many policymakers and health officials have their eye on the upcoming school year and what that might mean in terms of getting students vaccinated against COVID-19. According to a recent MMWR, COVID-19 related hospitalizations among adolescents increased in March and April 2021, potentially related to increased circulation of new COVID-19 variants, changes in physical distancing, and a larger number of children returning to school or other in-person indoor activities. This increase indicates an urgent need for vaccination against COVID-19, which is currently authorized for use in youth as young as 12.

The COVID-19 pandemic has further amplified the need for strong tobacco prevention and cessation policies. Research indicates that tobacco use is associated with increased rate of COVID-19 disease progression and increased likelihood of death among hospitalized patients, and that e-cigarette use is associated with a greatly increased risk of COVID-19 diagnosis in youth and young adults.

As leaders of their state agency, state and territorial health officials can be named parties in lawsuits alleging that an action taken by a public health agency was unlawful. These officials are typically sued in their “official capacity,” meaning the lawsuit is brought against them as the representative of the agency and not as an individual. This post contains three examples of state health officials who have found themselves named in lawsuits.

The ASTHO State Health Policy team provides brief updates on 5 of the ten state health policy issues to watch in 2022: public health authority, immunization, data privacy and modernization, public health workforce, and health equity.