I've read a backgrounder on US [state] vaccination laws in the US and (according to that) US states have fairly similar vaccination requirements for children attending public schools. (Grounds for grating individual exemptions are more varied between states though.) However it's not clear to me how much of the requirements are by consensus and how much (if any) are tied to federal benefits of some kind.

If a US state decided to play maverick on this for some reason, and e.g. no longer require measles vaccination in public schools, what would the repercussions be according to current federal laws, e.g. what kind of federal funding would they lose access to? (I'm leaving out here what political repercussions there might be, e.g. new riders adding new conditionality.)

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    I am removing the "Federalism" tag mostly because the legal mechanism for establishing the balance of power between states and the Federal government is already stipulated in the question. It's controlled through funding. It's not a "states' rights" issue.
    – grovkin
    Commented Sep 8, 2021 at 2:50

1 Answer 1


The closest that the federal government could come to penalizing a state for removing a measles vaccination requirement is via 42 USC 264 which authorizes the Surgeon General

to make and enforce such regulations as in his judgment are necessary to prevent the introduction, transmission, or spread of communicable diseases from foreign countries into the States or possessions, or from one State or possession into any other State or possession.

An important limit on that law is that

Nothing in this section or section 266 of this title, or the regulations promulgated under such sections, may be construed as superseding any provision under State law (including regulations and including provisions established by political subdivisions of States), except to the extent that such a provision conflicts with an exercise of Federal authority under this section or section 266 of this title.

There are various state-level exemptions (religious or philosophical opposition) which cannot be overridden. However, in the case of a complete lack of requirement for vaccination, there is nothing at the state level to override.

However, without a change in laws, the Surgeon General could not on his own create a regulation that deprives a state of it funding for something – that is beyond the scope of this law (and any regulation authorized by it). The available actions, other than apprehending the infected are limited to

inspection, fumigation, disinfection, sanitation, pest extermination, destruction of animals or articles found to be so infected or contaminated as to be sources of dangerous infection to human beings, and other measures, as in his judgment may be necessary.

That last clause is a pretty big loophole, but the courts will not interpret it to mean "including curtailing funding". Nor can Congress pass a law depriving states of existing funding if they fail to mandate measles vaccination, see NFIB v. Sebelius.

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    It could be used to justify ordering the physical destruction of a state's school buildings, though, if they're "found to be ... sources of dangerous infection to human beings".
    – nick012000
    Commented Jun 5, 2022 at 12:26
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    Not convinced that Sebelius which is a highly fractured decision relating to federal ACA legislation is as clear as suggested. It could be cited to support such a decision but it hardly compels that decision. Many other withdrawals of funding for failure to meet a governmental condition have been upheld.
    – ohwilleke
    Commented Oct 3, 2022 at 19:20

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