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Policy Points:

• From 2011 to 2013, immunization proponents won significant legislative victories that tightened philosophical exemptions in Washington, Oregon, and California.
• Highlighting data on the high rates of unvaccinated children and subsequent, preventable infectious disease outbreaks has proven to be quite compelling to state lawmakers, especially when combined with physician expert testimony. Even vigorous protest from vaccine‐critical organizations failed to defeat recent legislative wins when other political conditions were favorable. 
• Our research suggests that immunization proponents have not been as active as they could be, and that much of the energy in pressing for new policies over the past 15 years has been on the vaccine‐critical side of the aisle. 

This article examines trends in state‐level childhood vaccine policies in the United States from 1998 to 2012 and explains the …