The Economic and Health Effects of the United States' Earliest School Vaccination Mandates

Abstract

This dissertation evaluates the health and economic consequences of state laws that required children to be vaccinated against smallpox to attend school in the United States in the late 19th and early 20th centuries. Utilizing a novel dataset of vaccination legislation, I find mandates had substantial health and economic benefits. First, I show they reduced the prevalence of smallpox. Next, leveraging the staggered roll-out of mandates within a difference-in-differences framework, I demonstrate that childhood exposure to school vaccination increased average annual incomes by approximately three percent. Event studies confirm the causal nature of this relationship by illustrating that benefits only appeared for those who were of schooling age and younger when a mandate was passed. I attribute these benefits to vaccination incentivizing human capital investment. Difference-in-differences results show that vaccination laws increased teens' school enrollment by approximately three percent while decreasing their labor market participation by a similar magnitude. However, anti-vaccination beliefs muted the benefits of vaccination. Children of German immigrants, who were known for their resistance against vaccination, benefited significantly less from vaccination laws in the short- and long-run. Lastly, I show that states with school vaccination mandates for smallpox had higher diphtheria vaccination rates after the invention of the diphtheria vaccine. This suggests mandates may increase uptake for vaccines not available at the time of mandate passage. These findings speak to the importance of childhood vaccination for both health and human capital development. Moreover, they shed new light on the cost of American institutions that struggled to widely promote school vaccination mandates in the fight against smallpox.