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Effectiveness of state-level vaccination mandates: Evidence from the varicella vaccine


  • Abrevaya, Jason
  • Mulligan, Karen


This paper utilizes longitudinal data on varicella (chickenpox) immunizations in order to estimate the causal effects of state-level school-entry and daycare-entry immunization mandates within the United States. We find significant causal effects of mandates upon vaccination rates among preschool children aged 19–35 months; these effects appear in the year of mandate adoption, peak two years after adoption, and show a minimal difference from the aggregate trend about six years after adoption. For a mandate enacted in 2000, the model and estimates imply that roughly 20% of the short-run increase in state-level immunization rates was caused by the mandate introduction. We find no evidence of differential effects for different socioeconomic groups. Combined with previous cost–benefit analyses of the varicella vaccine, the estimates suggest that state-level mandates have been effective from an economic standpoint.

Suggested Citation

  • Abrevaya, Jason & Mulligan, Karen, 2011. "Effectiveness of state-level vaccination mandates: Evidence from the varicella vaccine," Journal of Health Economics, Elsevier, vol. 30(5), pages 966-976.
  • Handle: RePEc:eee:jhecon:v:30:y:2011:i:5:p:966-976
    DOI: 10.1016/j.jhealeco.2011.06.003

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    References listed on IDEAS

    1. Leora Friedberg, 1998. "Did Unilateral Divorce Raise Divorce Rates? Evidence from Panel Data," NBER Working Papers 6398, National Bureau of Economic Research, Inc.
    2. Justin Wolfers, 2006. "Did Unilateral Divorce Laws Raise Divorce Rates? A Reconciliation and New Results," American Economic Review, American Economic Association, vol. 96(5), pages 1802-1820, December.
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    Cited by:

    1. Lawler, Emily C., 2017. "Effectiveness of vaccination recommendations versus mandates: Evidence from the hepatitis A vaccine," Journal of Health Economics, Elsevier, vol. 52(C), pages 45-62.
    2. Christopher S. Carpenter & Emily C. Lawler, 2017. "Direct and Spillover Effects of Middle School Vaccination Requirements," NBER Working Papers 23107, National Bureau of Economic Research, Inc.

    More about this item


    Vaccination; State mandates; Varicella; Longitudinal data;

    JEL classification:

    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • C23 - Mathematical and Quantitative Methods - - Single Equation Models; Single Variables - - - Models with Panel Data; Spatio-temporal Models


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