Panel Paper: Increasing Immunization Compliance Among Schools and Daycare Centers

Friday, November 9, 2018
8219 - Lobby Level (Marriott Wardman Park)

*Names in bold indicate Presenter

Jessica Leight, American University


School-level report cards are becoming increasingly common signals of academic quality within state-level accountability systems. Scholars have connected these school-level reports cards to gains in mathematics performance (Carnoy & Loeb, 2002), increases in voluntary or private contributions (Figlio & Kenny, 2009), impact college going behaviors (Kramer, Dougherty, & Kamin, 2017) and the mobility of students and teachers (Kramer & Lane, 2018). There exists a limited but suggestive body of evidence that suggest that report cards may be an effective intervention for immunization compliance as well. Work by Findley et. al. (2003) found that an initiative to increase 0-3 year old immunization rates, which included distributing immunization report cards to health practices, was effective. Evidence suggests that report cards providing comparative information can be successful in increasing immunization rates: for example, healthcare providers who received feedback that compared their performance to top physicians increased flu vaccinations from 40 to 58 percent (Kiefe, et. al, 2001). States such as Oregon, Washington, and Michigan have all begun to implement immunization-based report cards as a mechanism to increase rates statewide.

Given that schools serve as an effective mechanism for the delivery of information, we worked with a state-level Department of Health to answer the following research question: To what extent do personalized school-level immunization report cards impact immunization compliance rates?

Program Change & Methods

We collaborated with a state-level DOH to conduct a school-level randomized control trial (RCT) across all public, private, charter, and parochial schools and Licensed Childcare Development Centers (LCDCs). In total our sample includes 304 schools, and 396 LCDCs. All education sites were randomly assigned to either the control condition (status quo with no report card) or the report card treatment condition. Report cards were mailed to school leaders to highlight their school’s immunization compliance rates relative to schools in their category, e.g., elementary, middle, high, LCDC, etc. The comparison rates were calculated based on category averages, the top 10%, and the district target of 98% compliance. The design of our study included two treatment deliveries during the school year, in the fall and spring.


This study does not yet have results as the school year has not concluded yet. However, it illustrates how state immunization information systems (IIS) can provide school-level data on immunization rates to school leaders as well as comparative immunization rates across a set of peer schools. Additionally, we have demonstrated that state, district, and educational policymakers could use an IIS to automate the creation of personalized non-academic report cards. This study is able to capitalize on robustness of data within the IIS to present summaries of all school-age vaccine rates and develop tools that could further personalize and emphasize vaccines with particularly low rates. Findings from this research will show the potential of site-level report cards to stimulate improvements in health-related outcomes of school-aged children.