Information, education, and health behaviors: Evidence from the MMR vaccine autism controversy

Health Econ. 2018 Jul;27(7):1043-1062. doi: 10.1002/hec.3645. Epub 2018 May 2.


In the wake of strong, although later refuted, claims of a link between autism and the measles-mumps-rubella (MMR) vaccine, I examine whether fewer parents immunized or delayed vaccinations for their children and if there was a differential response by mother's education level. Using various controls and a differencing strategy that compares in MMR take-up with other vaccines, I find that the MMR-autism controversy led to a decline in the immediate years and that there were negative spillovers onto other vaccines. I also find evidence that more highly educated mothers responded more strongly to the controversy either by not immunizing their children altogether or, to a lesser degree, delaying vaccination. Moreover, the educational gap was greater in states where there was greater media attention devoted to the controversy. This is consistent with the health allocative efficiency hypothesis whereby part of the education gradient in health outcomes is due to more-educated individuals absorbing and responding to health information more quickly. However, unlike in the United Kingdom, where previous studies find that the gap was eliminated after the link was refuted, the evidence for the United States suggests that the educational gap persisted.

Keywords: MMR vaccine; autism; education; infant immunizations.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Autistic Disorder / chemically induced
  • Child, Preschool
  • Health Behavior*
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Infant
  • Information Dissemination / methods*
  • Mass Media / statistics & numerical data
  • Measles-Mumps-Rubella Vaccine / administration & dosage
  • Measles-Mumps-Rubella Vaccine / adverse effects*
  • Measles-Mumps-Rubella Vaccine / agonists
  • United States
  • Vaccination / adverse effects*
  • Vaccination / statistics & numerical data


  • Measles-Mumps-Rubella Vaccine