Vaccination Under “Health Federalism”: How the U.S. Constitution Splinters American Vaccination Policy

Abstract: The 10th Amendment reads, “The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.” Public health is one of these “powers.” Historically, each state has been responsible for creating and executing its own public health system. Because of this “health federalism,” states have diverged from one another to create competing visions of public health that align with political priorities, sometimes taking opposite positions on issues like abortion, Medicaid, and vaccination. In particular, the intensified politicization of vaccines has deepened the divides between the federal and state governments. The federal government acts only in an advisory role, approving the safety and efficacy of vaccines and recommending a vaccine schedule. However, except for rare instances such as Biden v. Missouri (2022), it is essentially powerless in enforcing vaccination behavior. The presenter will explore how health federalism creates vaccination disparities, using the example of human papillomavirus (HPV) vaccines. HPV vaccines are effective at preventing several HPV-caused cancers, including cervical cancer, a leading cause of death among women worldwide. Several nations are on track to eliminate cervical cancer, but the U.S. has no elimination timeline. The presenter will argue that while health federalism allows states to build strong vaccination policies, the free movement between states undermines those states’ ability to deliver intended goals. Moreover, they will argue that health federalism creates fragmentary national vaccination policy that cannot deliver nationwide goals.

Keywords: vaccine ethics, constitutional law, cervical cancer