Association for Public Policy Analysis & Management

A substantial literature has examined the effects of state laws requiring infants and children to be vaccinated against certain diseases prior to childcare and preschool entry, but there is far less work on the effects of similar requirements for middle school entry despite that 45 states have adopted such policies over the past decade.  We fill this gap in the literature by examining the direct and indirect effects of such requirements in a quasi-experimental framework.  Preliminary analyses suggest that middle school entry requirements for Tdap (tetanus, diphtheria, and pertussis) and meningococcal vaccines significantly increased age-targeted vaccination rates by 16 and 15 percentage points, respectively.   We also document that these vaccination requirements had important spillover effects: they significantly increased the likelihood that adolescent girls received the Human Papillomavirus (HPV) vaccine by about fifteen percent.  Future analyses will examine the direct and spillover effects on morbidity and will quantify the economic costs and benefits of the mandates.