US state vaccine mandates did not influence COVID-19 vaccination rates but reduced uptake of COVID-19 boosters and flu vaccines compared to bans on vaccine restrictions
Edited by Mary Waters, Harvard University, Cambridge, MA; received August 9, 2023; accepted December 11, 2023
Abstract
During the COVID-19 pandemic, some US states mandated vaccination for certain citizens. We used state-level data from the CDC to test whether vaccine mandates predicted changes in COVID-19 vaccine uptake, as well as related voluntary behaviors involving COVID-19 boosters and seasonal influenza vaccines. Results showed that COVID-19 vaccine adoption did not significantly change in the weeks before and after states implemented vaccine mandates, suggesting that mandates did not directly impact COVID-19 vaccination. Compared to states that banned vaccine restrictions, however, states with mandates had lower levels of COVID-19 booster adoption as well as adult and child flu vaccination, especially when residents initially were less likely to vaccinate for COVID-19. This research supports the notion that governmental restrictions in the form of vaccination mandates can have unintended negative consequences, not necessarily by reducing uptake of the mandated vaccine, but by reducing adoption of other voluntary vaccines.
Data, Materials, and Software Availability
Anonymized Data were aggregated from multiple existing sources. The data and script necessary to replicate our analyses are available at the OSF have been deposited in Open Science Framework (https://osf.io/j3tqd/) (13). Previously published data were used for this work (14–17).
Acknowledgments
There is no funding source to report.
Author contributions
S.A.R. and A.S.R. designed research; S.A.R. analyzed data; and S.A.R. and A.S.R. wrote the paper.
Competing interests
The authors declare no competing interest.
Supporting Information
Appendix 01 (PDF)
- Download
- 323.41 KB
References
1
J. W. Brehm, A Theory of Psychological Reactance (Academic Press, 1966).
2
P. Sprengholz, C. Betsch, Zero-sum or worse? Considering detrimental effects of selective mandates on voluntary childhood vaccinations. J. Pediatr. 240, 318–319 (2022).
3
P. Sprengholz, C. Betsch, R. Böhm, Reactance revisited: Consequences of mandatory and scarce vaccination in the case of COVID-19. Appl. Psychol. Health Well-Being 13, 986–995 (2021).
4
P. Sprengholz, L. Felgendreff, R. Böhm, C. Betsch, Vaccination policy reactance: Predictors, consequences, and countermeasures. J. Health Psychol. 27, 1394–1407 (2022).
5
D. Albarracin, H. Jung, W. Song, A. Tan, J. Fishman, Rather than induing psychological reactance, requiring vaccination strengthens intentions to vaccinate in US populations. Sci. Rep. 11, 20796 (2021).
6
P. Sprengholz, L. Henkel, R. Böhm, C. Betsch, Different interventions for COVID-19 primary and booster vaccination? Effects of psychological factors and health policies on vaccine uptake. Med. Dec. Mak. 43, 239–251 (2023).
7
A. de Figueiredo, H. J. Larson, S. D. Reicher, The potential impact of vaccine passports on inclination to accept COVID-19 vaccinations in the United Kingdom: Evidence from a large cross-sectional survey and modeling study. EClinicalMedicine 40, 101109 (2021).
8
I. A. M. Verpaalen et al., Psychological reactance and vaccine uptake: A longitudinal study. Psychol. Health, https://doi.org/10.1080/08870446.2023.2190761 (2023).
9
J. B. Dimick, A. M. Ryan, Methods for evaluating changes in health care policy: The difference-in-differences approach. JAMA 22, 2401–2402 (2014).
10
R. A. Wicklund, Freedom and Reactance (Lawrence Erlbaum, 1974).
11
K. Bardosh et al., The unintended consequences of COVID-19 vaccine policy: Why mandates, passports and restrictions may cause more harm than good. BMJ Global Health 7, e008684 (2022).
12
S. B. Omer, C. Betsch, J. Leask, Mandate vaccination with care. Nature 571, 469–472 (2019).
13
S. A. Rains, A. S. Richards, State COVID-19 Vaccination Mandatesand Vaccine Adoption Dataset. Open Science Framework. https://osf.io/j3tqd/. Deposited 3 August 2023.
14
CDC, COVID-19 vaccinations in the United States [Dataset] (2022), https://data.cdc.gov/Vaccinations/COVID-19-Vaccinations-in-the-United-States-Jurisdi/unsk-b7fc. Accessed 16 June 2022.
15
CDC, Cumulative influenza vaccination coverage by race/ethnicity and age group, NIS-ACM [Dataset] (2023), https://data.cdc.gov/Vaccinations/Cumulative-Influenza-Vaccination-Coverage-by-Race-/8dyx-9z99. Accessed 6 January 2023.
16
CDC, Weekly cumulative influenza vaccination coverage, children 6 months through 17 years, United States [Dataset] (2023), https://data.cdc.gov/Vaccinations/Weekly-Cumulative-Influenza-Vaccination-Coverage-C/eudc-n39h. Accessed 6 May 2023.
17
D. Lazer et al., The COVID States Project [Dataset] (2022), https://lazerlab.shinyapps.io/Behaviors_During_COVID/. Accessed 12 July 2022.
Information & Authors
Information
Published in
Classifications
Copyright
Copyright © 2024 the Author(s). Published by PNAS. This open access article is distributed under Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND).
Data, Materials, and Software Availability
Anonymized Data were aggregated from multiple existing sources. The data and script necessary to replicate our analyses are available at the OSF have been deposited in Open Science Framework (https://osf.io/j3tqd/) (13). Previously published data were used for this work (14–17).
Submission history
Received: August 9, 2023
Accepted: December 11, 2023
Published online: February 15, 2024
Published in issue: February 20, 2024
Keywords
Acknowledgments
There is no funding source to report.
Author contributions
S.A.R. and A.S.R. designed research; S.A.R. analyzed data; and S.A.R. and A.S.R. wrote the paper.
Competing interests
The authors declare no competing interest.
Authors
Metrics & Citations
Metrics
Altmetrics
Citations
Cite this article
US state vaccine mandates did not influence COVID-19 vaccination rates but reduced uptake of COVID-19 boosters and flu vaccines compared to bans on vaccine restrictions, Proc. Natl. Acad. Sci. U.S.A.
121 (8) e2313610121,
https://doi.org/10.1073/pnas.2313610121
(2024).
Copied!
Copying failed.
Export the article citation data by selecting a format from the list below and clicking Export.
Cited by
Loading...
View Options
View options
PDF format
Download this article as a PDF file
DOWNLOAD PDFLogin options
Check if you have access through your login credentials or your institution to get full access on this article.
Personal login Institutional LoginRecommend to a librarian
Recommend PNAS to a LibrarianPurchase options
Purchase this article to access the full text.