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2021 Vaccine Policy State Legislative Scorecard 

Updated October 6, 2021

2021 Vaccine Policy State Legislative Scorecard 
Executive Summary

2021 has seen an uptick in the number of vaccine-related bills filed in state legislatures compared to recent years, which should come as no surprise as states attempt to adapt in order to address the ongoing COVID-19 pandemic. Because several states are still in session, final conclusions cannot be drawn, but through ongoing tracking, analysis, and scoring of the vaccine-related legislation to date, certain observations and trends have become apparent looking back on the first three quarters of the year. 

The number of anti-vaccine bills introduced and passed in the states far exceed the number of pro-vaccine bills introduced and passed.

Health Policy Advocates (“HPA”) reviewed all vaccine-related bills introduced during the 2021 state legislative sessions. Nearly 900 bills have been introduced across the 50 states. This report was initially prepared in June when the vast majority of state legislatures had adjourned for the year; however, over the summer, thirteen states held special sessions, some of which are still underway, and several dozen additional vaccine-related bills have been filed over that span, including thirty bills from those special sessions. . This memo is an interim, yet current, scorecard based on the vaccine bills passed and signed into law. A final vaccine legislation scorecard will be issued at the end of the calendar year to accommodate the variable timings of sessions.

Seven states saw their scores change enough to change their letter grade since the initial report and all seven cases resulted in a lower grade than previously reported. Changes in the grades were primarily due to vaccine bills introduced and/or enacted during 2021 special legislative sessions. Some states did see their numerical scores increase, but those increases were not substantial enough to receive a higher letter grade when compared to the previous report.

HPA defines pro-vaccine bills as legislation that can have a positive impact improving vaccination coverage rates, access to vaccination, and/or improve immunization awareness and education. Anti-vaccine bills are defined as legislation that can have a negative impact on immunization coverage rates, decrease access to vaccination, and/or impede immunization awareness and education. In reading the bills, more than half of bills introduced were obviously pro vaccination or anti vaccination. 

A significant number of vaccine related legislation filed did not clearly fit into either of those buckets, therefore were labeled as “neutral.” For example, Wisconsin’s AB 132 is related to “immunization-related mail.” This legislation does not impact vaccination rates or improve immunization education, nor does it have a negative impact on immunization rates; hence, we categorized it as “neutral.”

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Summary of Methodology

The following describes the methodology used by HPA to generate the Vaccine Bill Scorecard.

Source of Data

HPA searched the FiscalNote repository to find all vaccine bills. HPA manually reviewed all vaccine bills introduced in every state and coded those bills as “Pro,” “Anti,” or “Neutral.”  The bill was assigned a weighting depending upon whether a bill was simply introduced or a bill was introduced and passed. We consider a bill passed when the bill makes it through the legislative process and is signed into law by the Governor. Failure of anti-vaccination bills also received weighting given the complexities and effort required to stop bills from moving through the legislative process. The sum of the weightings generated a score. That score is then converted to an A, B, C, D or F grade.


Scores were calculated by multiplying the number of bills in each category by the weighting in the chart below. The grading criteria was based on a score range to determine the letter grade.

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Updated 10/06/2021 (no weighting given to failed av bills)

Vaccine Legislation Scorecard by State
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