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Do Stricter Immunization Laws Improve Coverage? Evidence from the Repeal of Non-medical Exemptions for School Mandated Vaccines

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Listed:
  • Chelsea J. Richwine
  • Avi Dor
  • Ali Moghtaderi

Abstract

Nonmedical exemptions are widely shown to be associated with outbreaks of vaccine-preventable disease. In response to a recent measles outbreak in 2015, California acted to increase immunization coverage by removing all nonmedical exemptions effective in 2016. Employing a unique dataset of county-level vaccination and exemption rates at Kindergarten entry, we exploit the recent policy change in California to estimate the impact of the repeal of nonmedical exemptions on immunization coverage for school-mandated vaccines. Relative to a diverse group of control states, our findings indicate that vaccination coverage increased for all required vaccines following the repeal, ranging from 2.5% for MMR to 5% for Polio. We also find a significant 3.4 percentage-point decline in nonmedical exemptions, accompanied by a 2.1 percentage-point increase in medical exemptions in counties that previously had high rates of nonmedical waivers. Our findings indicate that the repeal of nonmedical exemptions in California was only partially effective in improving vaccination coverage, and may have led parents to substitute between medical and nonmedical exemptions, leading to a net decline in total exemptions of just 1 percentage-point.

Suggested Citation

  • Chelsea J. Richwine & Avi Dor & Ali Moghtaderi, 2019. "Do Stricter Immunization Laws Improve Coverage? Evidence from the Repeal of Non-medical Exemptions for School Mandated Vaccines," NBER Working Papers 25847, National Bureau of Economic Research, Inc.
    • Handle: RePEc:nbr:nberwo:25847
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    References listed on IDEAS

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    Cited by:

    1. Hair, Nicole L. & Gruber, Anja & Urban, Carly, 2021. "Personal belief exemptions for school-entry vaccinations, vaccination rates, and academic achievement," Journal of Health Economics, Elsevier, vol. 78(C).
    2. Churchill, Brandyn F., 2021. "How important is the structure of school vaccine requirement opt-out provisions? Evidence from Washington, DC's HPV vaccine requirement," Journal of Health Economics, Elsevier, vol. 78(C).
    3. Alex Rees-Jones & Kyle Rozema, 2023. "Price Isn’t Everything: Behavioral Response Around Changes In Sin Taxes," National Tax Journal, University of Chicago Press, vol. 76(1), pages 5-35.
    4. Hair, Nicole L. & Gruber, Anja & Urban, Carly, 2020. "Personal Belief Exemptions for School-Entry Vaccinations, Vaccination Rates, and Academic Achievement," IZA Discussion Papers 12978, Institute of Labor Economics (IZA).
    5. Hirani, Jonas Cuzulan & Wüst, Miriam, 2022. "Nurses and infant vaccination coverage," Journal of Economic Behavior & Organization, Elsevier, vol. 196(C), pages 402-428.

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    More about this item

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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