Direct and spillover effects of middle school vaccination requirements

Abstract

We study the direct and spillover effects of state requirements that middle school youths obtain a tetanus, diphtheria, and pertussis (Tdap) booster prior to middle school entry. These mandates significantly increased Tdap vaccine take-up and reduced pertussis (whooping cough) incidence by about 32 percent. We also document cross-vaccine spillovers: the mandates significantly increased adolescent vaccination rates for meningococcal disease and human papillomavirus (HPV)-which is responsible for 98 percent of cervical cancers-by 8-34 percent, with particularly large effects for children from low SES households. We find important roles for both parents and providers in generating these spillovers.