Direct and Spillover Effects of Middle School Vaccination Requirements

67 Pages Posted: 30 Jan 2017 Last revised: 20 Feb 2022

See all articles by Christopher S. Carpenter

Christopher S. Carpenter

Vanderbilt University; National Bureau of Economic Research (NBER)

Emily Lawler

Vanderbilt University

Date Written: January 2017


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 increased vaccine take-up by 29 percent and reduced pertussis (whooping cough) incidence in the population by a much larger 53 percent due to herd immunity effects. We also document cross-vaccine spillovers: the mandates increased adolescent vaccination for meningococcal disease and human papillomavirus (which is responsible for 98 percent of cervical cancers) by 8-34 percent, with particularly large effects for children from low SES households.

Suggested Citation

Carpenter, Christopher S. and Lawler, Emily, Direct and Spillover Effects of Middle School Vaccination Requirements (January 2017). NBER Working Paper No. w23107, Available at SSRN:

Christopher S. Carpenter (Contact Author)

Vanderbilt University ( email )

Box 1819 Station B
Nashville, TN 37235
United States

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National Bureau of Economic Research (NBER)

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Emily Lawler

Vanderbilt University ( email )

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