State Enforcement of School Immunization Requirements and Child Vaccination Rates

Bald, A. & Gold, S. (2025). “State Enforcement of School Immunization Requirements and Child Vaccination Rates.” Working paper here.

Abstract:

Child vaccination rates have fallen below the threshold for herd immunity in many states, prompting concerns over exposure to infectious disease outbreaks. In response, several states have repealed non-medical vaccine exemptions for children in school. We estimate that state repeal of non-medical exemptions raised kindergarten vaccination rates by 2 to 4 percentage points, with little substitution toward medical vaccine exemptions. We test whether state audits further increased vaccination rates using school-level data from California. We find no effect of auditing on future likelihood of audit or vaccination rates. Our results suggest that amidst growing vaccine hesitancy, state repeal of non-medical exemptions is effective at keeping vaccination rates high.