Association Between State-Issued COVID-19 Vaccine Mandates and Vaccine Administration Rates in 12 US States and the District of Columbia

Question What is the association between the announcement of state-issued COVID-19 vaccine mandates for workers in the US and vaccine administration rates in terms of first-dose administration and series completion coverage? Findings In this cross-sectional study of 12 states and the District of Columbia with state-issued COVID-19 vaccine mandates, the state-issued vaccine mandates were associated with an increase in the percentage of the population receiving the first dose of the vaccine compared with 14 states without such mandates. Meaning The findings of this study suggest that state-issued COVID-19 vaccine mandates may have encouraged state populations to seek vaccinations, even if the population was not specifically required to do so under the order. Importance Some US states have issued COVID-19 vaccine mandates; however, the association of these mandates with vaccination rates remains unknown. Objective To examine the association between announcing state-issued COVID-19 vaccine mandates that did not provide a test-out option for workers and the vaccine administration rates in terms of state-level first-dose vaccine administration and series completion coverage. Design, Setting, and Participants This cross-sectional study used publicly available, state-level aggregated panel data to fit linear regression models with 2-way fixed effects (state and time) estimating vaccine coverage changes 8 weeks before and 8 weeks after a state-issued COVID-19 vaccine mandate was announced. Mandates were announced on or after July 26, 2021, and were included only if they went into effect before December 31, 2021. Data were included from 13 state-level jurisdictions with a vaccine mandate in effect as of December 31, 2021, that did not allow recurring testing in lieu of vaccination (mandate group), and 14 state-level jurisdictions that allowed a test-out option and/or did not restrict vaccine requirements (comparison group). Interventions/Exposures The event of interest was the announcement of a state-issued COVID-19 vaccine mandate applicable to specific groups of workers. Main Outcomes and Measures The outcome measures were state-level daily COVID-19 vaccine first-dose administration and series completion coverage, reported as mean percentage point changes. Results Of 5 508 539 first-dose administrations in the 8-week postannouncement period, an estimated 634 831 (11.5%) were associated with the mandate announcement. First-dose administration coverage among 13 jurisdictions increased starting at 3 weeks after the mandate announcement, with statistically significant differences of 0.20, 0.33, 0.39, 0.45, 0.49, and 0.59 percentage points higher than the referent category coverage of 62.9%. Increases in vaccine series completion coverage were observed from 5 to 8 weeks after the announcement, but statistically significant differences from the referent category coverage of 56.3% were observed only during weeks 7 and 8 after the announcement (both differed by 0.2 percentage points; P = .05 and P = .02, respectively). Conclusions and Relevance The findings of this cross-sectional event study suggest that the announcement of state-issued vaccine mandates may be associated with short-term increases in vaccine uptake. This observed association may be a product of both a direct outcome experienced by groups governed by the mandate as well as the spillover outcome due to a government signaling the importance of vaccination to the general population of the state. This cross-sectional study examines the association between the announcement of state-issued COVID-19 vaccine mandates for workers and the rates of vaccine administration in terms of first-dose vaccine administration and series completion coverage, in 12 US states and the District of Columbia from May 31 to October 12, 2021.

Automated summary

The findings of this study suggest that state-issued COVID-19 vaccine mandates may have encouraged state populations to seek vaccinations, even if the population was not specifically required to do so under the order. This cross-sectional study provides important insights into the association between vaccine mandates and vaccination rates.