The Impact of State employee Vaccine Mandate on COVID-19 Vaccination uptake in the United States

Abstract: Evidence on the effect of COVID-19 vaccine mandates on vaccination uptake in the United States is remarkably limited. We study this issue in the context of the state employee COVID-19 vaccine mandate applicable to state government employees which although framed as a mandate, allowed individuals unwilling to get vaccinated the option of testing for COVID-19 instead of vaccination. We use nationally representative individual level data of over 1.23 million respondents that took part in the Household Pulse Survey from January 2021 to March 2022 and combine this data with state level data on COVID19 vaccine mandates for state employees, COVID-19 infections and deaths, and distribution of COVID-19 vaccines across states. We exploit between- and within-state variation in exposure to the mandate due to the staggered implementation across states and selective applicability to state employees. Using a difference-in-differences, triple-differences, and an event study design for identification, we find that vaccination uptake in the United States decreased by 3 to 6 percentage points after implementation of the mandate. While trust in the government and the vaccine do not explain this negative effect, the testing alternative is a key mechanism. Probing intersectionality by race, education, and income reveals that among Whites, the negative effect on vaccination uptake is significant only among highly educated above median income earners. In contrast, among Blacks, the negative effect is significant only among low educated-below median income earners. The results have important implications for the design of policies aimed at improving vaccination uptake.