The Roles of Cost and Recommendations in Driving Vaccine Take-Up: Evidence from the Herpes Zoster Vaccine for Shingles Prevention

Vaccination has been called one of the greatest public health success stories, and policymakers have adopted a variety of strategies to increase and keep coverage rates at socially optimal levels. While researchers have documented successful strategies for increasing coverage rates in children and adolescents, little is known about how to successfully increase adult vaccination rates – a fact that has been highlighted by the COVID-19 pandemic. Using data from the 2008-2019 National Health Interview Survey, we show that 60-year-olds – who were recommended by the Advisory Committee on Immunization Practices to receive the shingles vaccine – were no more likely to be vaccinated than their 59-year-old counterparts prior to the Affordable Care Act. After the ACA’s preventive services provision required insurance plans to cover recommended vaccines without patient cost-sharing, adults 60 or older were more likely to receive the vaccine, and we document a similar increase for 50-59-year-olds after the recommendation age was lowered to 50. Using both difference-in-differences and regression discontinuity identification strategies, we estimate that the ACA increased vaccine take-up of the shingles vaccine by 3.0-5.2 percentage points.