Vaccine policy & vaccine politics: an analysis of United States vaccine uptake by state-level school and childcare vaccination mandate policies and state-level election results

Childhood vaccinations have transformed public health both in the United States (US) and internationally and are credited with saving millions of lives and trillions of dollars in direct and societal costs. Despite overwhelming evidence supporting vaccine safety and effectiveness, skepticism and hostility toward childhood vaccination has grown in recent decades, and has recently become a partisan political issue in the US. Statewide vaccination mandates in schools and childcare centers have existed for several decades. However, these mandates have not guaranteed vaccination coverage sufficient for herd immunity for several infectious diseases in many states. Exemption processes, provisional enrollment policies, and mandate enforcement all vary widely by state. This dissertation aims to characterize the associations between vaccination coverage and both statewide vaccination policies and statewide political leanings using National Immunization Survey data from 2015-2023. In the first aim, we assess the association between statewide childcare vaccination policies and vaccination coverage in 19–35-month-old children for ten childhood vaccines. In the second aim, we assess the association between statewide childcare vaccination policies and vaccination coverage and reasons for non-vaccination in 13–17-year-old children. In the third and fourth aims, we assess the associations between statewide political leaning and vaccination coverage for 19–35-month-old and 13–17-year-old children, respectively, as well as reasons for non-vaccination in 13–17-year-old children. We found that associations between statewide vaccination mandates and higher vaccination coverage were present for influenza vaccines and, for some years, hepatitis A vaccines in childcare settings and for meningococcal disease ACWY vaccines in K12 schools. We also found that influenza vaccination coverage in 19–35-month-old children was higher in liberal states and moderate states than conservative states in all years in the analysis, and higher in liberal states than moderate states in most years in the analysis. HPV vaccination coverage in 13–17-year-old children was also higher in liberal states compared to conservative states in all years except 2023. These studies provide insight into the associations between policy, partisan leanings, and vaccination coverage during a time of rapid political and public health change, which may inform policy making decisions and vaccination outreach during a time of increasingly volatile vaccine politics.

Author dc:creator

• Redepenning, Sydney

• Health policy
• Immunization
• Vaccination
• Vaccine
• Vaccine mandate

Language dc:language.iso

en

Handle dc:identifier.uri

https://hdl.handle.net/11299/278069

OAI identifier oai:identifier

oai:conservancy.umn.edu:11299/278069