Anaya Nolan
The COVID-19 pandemic saw the enactment of vaccine mandates by several states, municipalities, and private entities in the United States. While federal laws apply nationwide, there are instances where state laws prevail. In the context of vaccine mandates, the Supremacy Clause of the United States Constitution dictates that federal law generally takes precedence over state law. However, certain circumstances allow state laws to supersede federal laws, such as when additional liberties are granted to state residents without infringing on federal powers. This dynamic between federal and state laws has been highlighted in legal disputes surrounding vaccine mandates and exemptions. For example, in North Carolina, a family was allowed to sue over COVID-19 vaccination without consent, as the state's top court ruled that a federal law did not preempt charges that the mother's constitutional rights were violated. Similarly, in Iowa, proposed legislation seeks to waive federal legal protections for vaccine manufacturers, allowing them to be sued by individuals who believe they have been harmed by vaccines. These cases illustrate the complex interplay between federal and state laws in the realm of vaccine mandates and exemptions.
| Characteristics | Values |
|---|---|
| Supremacy Clause | Federal law takes precedence over state law |
| Preemption Doctrine | State laws in conflict with federal laws are powerless |
| State-level claims | State laws can require vaccination for school children |
| Federal law | Can mandate vaccination for federal employees and contractors |
| State laws | Can require vaccination for healthcare workers and patients/residents of healthcare facilities |
| State laws | Can require vaccination for students in public institutions of higher education |
| Federal law | Can grant immunity to vaccine administrators and manufacturers from lawsuits |
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What You'll Learn
Federal law vs. state law
Federal law generally supersedes state law in the United States due to the Supremacy Clause in the U.S. Constitution. This is especially true when it comes to vaccine mandates, as the federal government has the power to regulate vaccines and immunization policies to ensure public health and safety.
During the COVID-19 pandemic, several federal vaccine mandates were imposed by the Biden administration, requiring vaccination for certain groups such as federal employees and contractors, and healthcare workers in Medicare and Medicaid-certified facilities. These mandates were based on the authority of the federal government and federal agencies, and they took precedence over state laws. However, some of these mandates were later suspended by courts or withdrawn by the administration itself.
While states typically have the authority to establish vaccination requirements for school children and healthcare workers, their laws can be preempted by federal laws in certain situations. For example, the Public Readiness and Emergency Preparedness Act (PREP Act) provides immunity to covered individuals, such as vaccine administrators, from "all claims for loss" during a declared health emergency. This federal law has been interpreted by courts to preempt various state-level claims related to vaccination.
It's worth noting that the relationship between federal and state laws regarding vaccines is complex and can vary depending on the specific circumstances and the interpretation of the laws by courts. In some cases, states have challenged federal vaccine mandates, and in other cases, they have enacted their own mandates or legislation to limit vaccination requirements. Ultimately, the interplay between federal and state laws in this context is a dynamic and evolving area of legal discussion.
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The Supremacy Clause
While the Supremacy Clause generally gives precedence to federal laws and treaties, it is important to note that the enforceability of treaties has been limited by Supreme Court decisions. In the 1957 case of Reid v. Covert, the Court held that treaties and laws made under them must comply with the Constitution. Furthermore, the 2008 case of Medellín v. Texas ruled that treaties are not binding domestic law unless implemented by an act of Congress or explicitly self-executing. These rulings demonstrate that while the Supremacy Clause elevates the status of treaties, they are still subject to constitutional scrutiny and must align with the nation's fundamental laws.
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State law exemptions
While federal public health officials at the Centers for Disease Control and Prevention (CDC) make national vaccination policy recommendations, the actual legislation regarding their enforcement is decided at the state level. This means that state laws establish vaccination requirements for school children, healthcare workers, and patients/residents of healthcare facilities.
State laws and rules on immunization requirements vary from state to state, and individual states allow for various exemptions to vaccination requirements. These exemptions can include medical, religious, and philosophical reasons. All states allow exemptions for medical reasons, and almost all states (except California, Mississippi, and West Virginia) grant religious or philosophical exemptions for people with sincerely held beliefs that prohibit immunizations.
Medical exemptions typically must be written by an MD or doctor of osteopathy (DO), although some states allow other healthcare workers to certify that administering a vaccination would be detrimental to an individual's health. Religious exemptions are based on the First Amendment right to freely hold and exercise religious beliefs. However, if the state can provide a compelling reason for vaccination, such as preventing the spread of serious communicable diseases, the exemption can be withdrawn. Philosophical, conscientious, or personal belief exemptions must include all vaccinations, and in some states, parents seeking this type of exemption must do so in collaboration with an MD or other designated healthcare worker and may be required to complete a state-provided vaccine education program.
The American College of Physicians (ACP) has a policy that supports the elimination of exemptions, except for medical reasons, from immunization laws. The ACP encourages chapters to advance policies at the state level that eliminate any existing exemptions, except for medical ones, and oppose legislation to expand exemptions. The CDC also encourages states to strengthen the rigor of the application process for exemptions and analyze their enforcement policies to limit the overuse of exemptions.
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Federal vaccine mandates
In September 2021, President Joe Biden announced his administration's COVID-19 action plan, which included executive orders directing federal agencies to mandate the vaccination of their employees. This plan set deadlines for federal employees and contractors to be fully vaccinated. However, these mandates faced legal challenges and were either overturned through litigation or withdrawn. By May 2023, all federal vaccine mandates had been lifted.
The Public Readiness and Emergency Preparedness Act (PREP Act), a federal law enacted in 2005, grants broad immunity to vaccine administrators and relevant entities during public health emergencies. This act was invoked during the COVID-19 pandemic, providing protection from "all claims for loss" with some exceptions. Despite this, a North Carolina Supreme Court ruling in March 2025 allowed a family to sue over COVID-19 vaccination without consent, stating that the PREP Act does not preempt constitutional claims.
While the federal government has issued vaccine mandates for its employees and contractors, it is important to note that there is no federal requirement for informed consent relating to immunization. State laws typically establish vaccination requirements, especially for school children and healthcare workers. Some states have also enacted executive orders or legislation to limit or prohibit vaccine mandates.
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State vs. federal powers
In the United States, the Federal Government and state governments share certain powers. One example of this is the establishment of vaccination requirements, which are often determined by state laws. These laws typically apply to school-going children, encompassing both public and private schools, as well as day care facilities. Additionally, states may mandate immunizations for healthcare workers and individuals within healthcare facilities.
However, it's important to note that the absence of a Federal requirement for informed consent relating to immunization does not bar claims brought by parents or individuals. This is exemplified in the case of Emily Happel and her teenage son, Tanner Smith, in North Carolina. Despite lower courts initially citing the Public Readiness and Emergency Preparedness Act (PREP Act), a federal law, as grounds for preempting their claims, the North Carolina Supreme Court ruled that the family could indeed sue over the COVID-19 vaccination administered to Tanner without his mother's consent.
The North Carolina Supreme Court's decision hinged on the interpretation of "loss" within the PREP Act. The Act provides immunity to "all claims for loss," which Congress defines as including death and loss of property. However, Chief Justice Paul Newby, writing for the majority, clarified that the law pertains primarily to situations involving tort law, such as serious injury, and does not supersede constitutional violations. In this specific case, the Court recognized the rights of parents to make medical decisions for their children under the North Carolina constitution.
While the PREP Act does offer protection to vaccine administrators and others during health emergencies, the North Carolina Supreme Court's ruling underscores that constitutional rights take precedence. This case sets a significant precedent, highlighting the interplay between state and federal powers and the importance of upholding constitutional rights, even in times of crisis.
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Frequently asked questions
Under the Supremacy Clause of the United States Constitution, federal law generally takes precedence over state law. However, there are certain circumstances where state law prevails, such as when additional liberties are afforded to state residents without infringing on federal powers.
Yes, states can mandate vaccines for their residents. During the COVID-19 pandemic, several states and municipalities enacted vaccine mandates. However, these mandates were later lifted when the national emergency ended in May 2023.
Yes, federal vaccine mandates can be challenged in court. Several federal vaccine mandates have been suspended or withdrawn due to litigation or administrative decisions. For example, a federal appeals court blocked Biden's vaccine mandate for healthcare workers in ten Republican-led states in December 2021, but the Supreme Court overturned this injunction in January 2022.
In March 2025, the North Carolina Supreme Court ruled that a family could sue over COVID-19 vaccination without consent. The court found that the Public Readiness and Emergency Preparedness Act (PREP Act), a federal law granting immunity to vaccine administrators, did not preempt charges that an individual's constitutional rights were violated.
