Giving Teens a Boost? Effects of Adolescent Meningococcal Vaccine Recommendations

This study provides the first quasi-experimental evidence on the effects of non-binding vaccine recommendations targeted at high school-aged adolescents. These recommendations, which are issued by the Advisory Committee on Immunization Practices (ACIP), form the basis for the recommended vaccine schedule in the United States and are one of the most commonly implemented vaccine policies. Previous work that has examined their effects has focused on infants and young children; given differences in the utilization of health care and the pre-existing vaccine policy environment of infants relative to 16- and 17-year olds, a priori it is unclear the extent to which the findings from these studies may apply to the adolescent population.

In this paper I specifically examine the 2011 ACIP recommendation that 16-year-olds receive a booster dose of the quadrivalent meningococcal conjugate vaccine. Using data from the National Immunization Survey –Teen and a triple-difference strategy that leverages variation in the targeting of the recommendation across age groups and vaccines, I find that these simple recommendations significantly increased meningococcal vaccination rates among 16- and 17-year olds by 21 percentage points, or 133% relative to the baseline mean. I also find that the recommendations resulted in a substantial reduction in meningococcal disease incidence in the population. Meningococcal disease is a severe and deadly disease, and even small reductions in incidence result in substantial social savings.

I further provide evidence on the mechanisms through which the recommendations affect vaccination rates, and show that the results are primarily driven by changes in provider behavior. Additional analyses demonstrate that, in this context, the ACIP recommendation exacerbated pre-existing disparities in receipt of preventive care. In particular, lower SES groups, which had lower rates of vaccination and provider contact prior to the recommendation, were also less responsive to the policy. These results are broadly informative for policymakers regarding the mechanisms through which ACIP recommendations affect vaccination rates, and the responsiveness of adolescents (and their parents) to simple non-binding recommendations for preventive care.