In 2003, anti-vaccine activists successfully advocated to change Texas law to make it easier for parents to send their children to public school without school required vaccinations. Over fifteen years ago, 2,314 non medical exemptions were filed. The Texas Department of State Health Services recently reported in the 2018-19 school year, 64,176 exemptions were submitted. As the number of non-medical exemptions increase, the risk for a vaccine preventable outbreak also increases.

Enacting strong immunization laws and policies, which includes improving access to vaccination, increasing education, and enhancing data collection, is cyclical. In the past ten years, over 17 pieces of pro-immunization legislation were turned into law. However, the three recent legislative cycles (84th, 85th, and 86th Legislative sessions) have not resulted in meaningful change to address the rising tide of exemptions. Almost two decades later, immunizations have become one of the Texas Legislature’s most hotly debated and controversial issues.

The sensitive political climate within the Texas Legislature and the Texas anti-vaccine movement, one of the nation’s most organized and well financed, is putting the state’s public health security in peril. This paper examines the origins and political tactics employed by the anti-vaccine movement and lessons learned from twenty years of advocating for public health and passing pro-immunization legislation. Up until recently, vaccine limiting legislation was practically non- existent.

The authors will discuss clear strategies for scientists, advocates, parents, and others who want strong vaccine policies to protect and achieve high immunization coverage rates. As anti-vaccine activism grows elsewhere, advocates and parents can learn from their counterparts in Texas. In turn, the Texas story clearly demonstrates the need for new ideas and fresh perspectives in the ongoing struggle to stop the reemergence of vaccine preventable diseases through misinformation and the attempts to politicize public health.

Key Take Away Points

  • Immunization laws and policies have bipartisan support and is a non-partisan issue.
  • The majority of Texans and Americans support vaccination despite small yet vocal opposition.
  • Pro-vaccine advocates must continue to organize and be visible and vocal to lawmakers to protect and advance public health.

Author Biography

Rekha Lakshmanan, MHA is the Director of Advocacy and Policy for The Immunization Partnership, a non-profit non-partisan organization. Lakshmanan develops and implements the organization’s public policy strategy at the Texas Legislature and overseas its statewide grassroots community engagement program. She has worked three state legislative cycles and successfully passed legislation to improve immunization delivery and vaccine access to children and adults. Additionally, she advises other states and organizations about advocacy capacity building, teaching health care professionals how to advocate with lawmakers, and frequently speaks on advocacy and policy. Previous to The Immunization Partnership, Lakshmanan spent over twelve years in the private sector helping health care organizations develop preventative and chronic care protocols to improve health outcomes. Lakshmanan holds a master’s degree in Health Care Administration from Texas Woman’s University- Houston Medical Center and a B.A. in Government from The University of Texas in Austin. Jason Sabo is the Founder of Frontera Strategy and works as a political strategist, philanthropy advisor, and coalition builder in multiple states. He focuses his work on public health, education, human services, and foundation and nonprofit issues. Jason specializes in assisting organizations and philanthropists develop advocacy strategies for challenging fiscal and political circumstances. Prior to launching Frontera, Jason worked on local, state, and federal policy issues for more than fifteen years as a policy analyst and lobbyist. Jason has developed and implemented complex multi-year advocacy efforts that have resulted in changes to law and policy impacting millions of children and families. His work also involves assisting foundations and other philanthropists to most strategically invest their dollars to achieve policy change. Jason has received numerous awards for his advocacy and public interest lobbying. Jason lives in Austin, Texas and received a Master’s degree in History from Indiana University.


The authors thank Dr. Lisa Kerber for editing and proofreading this manuscript.