The Roles of Cost and Recommendations in Driving Vaccine Take-Up

Vaccination has been called one of the greatest public health success stories, yet little is known about how to successfully increase adult vaccination rates. Analyzing shingles vaccination, we show that 60-year-olds—who were recommended by the Advisory Committee on Immunization Practices to receive the vaccine—were no more likely to be vaccinated than their 59-year-old counterparts prior to the Affordable Care Act. After the ACA’s preventive services provision required private insurance plans to cover recommended vaccines without patient cost-sharing, adults aged 60 or older were more likely to receive the vaccine, and we document a similar increase for 50- to 59-year-olds after the recommendation age was lowered to 50. Because shingles is not a communicable disease, the benefits of vaccination are largely internalized. After accounting for the $6,000 medical and productivity savings associated with preventing a shingles episode, back-of-the-envelope calculations imply adults would have to price the leisure costs at $22,000 per episode for the coverage increase to have been welfare neutral.