Association for Public Policy Analysis & Management

There is no national immunization policy in the United States, and the strictness of regulations allowing vaccine exemption for school attendance varies greatly by state. Furthermore, despite substantial evidence on the safety and health benefits of immunization, there has been a recent upsurge in skepticism amongst parents regarding vaccine safety and efficacy for their children. In this paper, we analyze whether or not the strength of state vaccine exemption policies affect the enrollment rates for prekindergarten and kindergarten youth in U.S. counties from 2000 to 2014.  The strength of state immunization exemption policies are captured both by a recently published index, and by indicators for various components of exemption policies. Given the significant positive effects that pre-k and kindergarten have for a child’s future educational attainment, understanding negative unintended consequences from vaccination policy will be of interest to policy makers who seek to optimize public health and educational policy. We hypothesize that states with stricter exemption policies will have lower average enrollment in prekindergarten and kindergarten amongst children in the relevant age ranges.  To test these hypotheses, we construct a long panel of data on county level enrollment rates, state characteristics and utilize a recently validated measure of state vaccination policy effectiveness.