Vaccine Requirements: School Exemptions and Federal Vaccine Policy

The basics

For more than 60 years, a federal panel of experts, the Advisory Committee on Immunization Practices, reviewed evidence and recommended vaccines to the Centers for Disease Control and Prevention¹. Many federal and state laws, including rules on insurance coverage, refer to those recommendations¹.

On June 9, 2025, the U.S. Health and Human Services Secretary removed all 17 committee members and appointed new ones¹. The new committee changed COVID-19 vaccine advice from a universal recommendation to a decision made by patients and doctors together, recommended against a combined measles, mumps, rubella, and chickenpox shot, and in December 2025 made the hepatitis B shot for newborns whose mothers test negative a shared decision instead of universal¹. On January 5, 2026, the CDC issued a new childhood schedule, without a committee vote, that recommends fewer vaccines for all children¹.

Medical groups led by the American Academy of Pediatrics sued. On March 16, 2026, a federal judge in Massachusetts paused the 2026 schedule, the appointments of 13 committee members, and the committee's votes after June 11, 2025, which mostly returns federal recommendations to their January 2025 versions for now¹. The government appealed to the First Circuit on April 29, 2026, and the appeal was still pending as of September 2026²⁶.

In 2026, HHS revised the committee's charter to widen the kinds of expertise members can have, such as toxicology, and to focus more on vaccine safety; CDC published the renewed charter on May 19, 2026, which may lead to new appointments¹². On May 29, 2026, an executive order directed the CDC and the committee to review the January 2026 schedule and update the childhood schedules¹. The court's order does not stop HHS from issuing new recommendations in the future¹.

Key terms

ACIP

The Advisory Committee on Immunization Practices, a federal expert panel that advises the CDC on which vaccines to recommend¹.

Shared clinical decision-making

A recommendation that patients and doctors discuss a vaccine's benefits and risks and decide together, instead of a routine shot for everyone¹.

Conscientious exemption

A Texas exemption from school vaccine requirements for reasons of personal belief, including religious belief³⁴.

Medical exemption

An exemption signed by a doctor when a vaccine could harm a particular child's health³.

Exclusion during an outbreak

A Texas rule that lets schools and child care facilities keep students with exemptions home during an official emergency or a disease outbreak³.

In Texas

Texas requires certain vaccines for students in schools and childcare, with exemptions for medical reasons, military status, and reasons of conscience, including religious beliefs³. Texas has allowed conscientious exemptions since 2003, and requests for the exemption form rose from 45,900 in 2018 to more than 93,000 in 2024⁴. Students with exemptions can be kept out of school during an official emergency or disease outbreak³.

House Bill 1586, effective September 1, 2025, lets parents download the exemption form online instead of requesting a mailed copy from the state health department⁴³. A 2025 measles outbreak centered in West Texas caused 762 confirmed cases, 99 hospitalizations, and the deaths of two school-aged children before it was declared over on August 18, 2025⁵.

How people see it

The strongest case for each view, in terms its supporters would recognize. We don't pick a side.

Questions to ask a candidate

• Should Texas keep, tighten, or end conscientious exemptions from school vaccine requirements?
• Who should decide which vaccines are recommended for all children, and how?
• What should schools do when a disease like measles is spreading?
• Should parents be told how many students at their child's school are not vaccinated?