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

J Health Econ. 2011 Sep;30(5):966-76. doi: 10.1016/j.jhealeco.2011.06.003. Epub 2011 Jun 12.


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.

MeSH terms

  • Chickenpox / prevention & control*
  • Chickenpox Vaccine / administration & dosage*
  • Chickenpox Vaccine / economics
  • Child Day Care Centers
  • Child, Preschool
  • Cost-Benefit Analysis
  • Female
  • Humans
  • Immunization Programs / economics
  • Immunization Programs / legislation & jurisprudence*
  • Immunization Schedule
  • Infant
  • Longitudinal Studies
  • Male
  • Mandatory Programs / economics
  • Mandatory Programs / legislation & jurisprudence*
  • Program Evaluation* / economics
  • Schools
  • State Government
  • United States
  • Vaccination / legislation & jurisprudence


  • Chickenpox Vaccine