The Impact of Vaccine Mandates and Exemptions on Childhood Immunization Coverage

Principal Investigators
George Washington University
Funded on

Childhood vaccines play a major role in minimizing the incidence of vaccine-preventable disease. While all states accommodate medical vaccine exemptions, certain states also allow for waivers on the basis of religious or philosophical objections.

This study will investigate if and how changes in states' vaccination exemption laws affect subsequent vaccination coverage rates. The researchers will focus on measles-mumps-rubella (MMR), diphtheria-tetanus-pertussis (DTP), and DTP-MMR combined with the Polio vaccine (the 4:3:1 series), as well as chickenpox (varicella), Polio, Hepatitis B, and Pneumococcal (PCV). 

Data on the evolution of exemption laws will be combined with the National Immunization Survey in the period 2008-2018 to establish the degree to which vaccine uptake is affected by non-medical exemptions as a whole. The study will also explore the existence of differing types of non-medical exemptions and the different attributes controlling existing exemption laws.

The overarching purpose of the research is to understand whether existing vaccination policies and regulations are compatible with the public health objectives of improving immunization coverage and population health.


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The rising rate of non-medical exemptions is a driving force behind our nationwide measles crisis. Chelsea J. Richwine, Avi Dor, and Ali Moghtaderi of George Washington University examine the effect of California’s 2016 decision to repeal all non-medical exemptions on immunization coverage in a new working paper.