Direct and crowding-out effects of a Hepatitis B vaccination campaign

Abstract

We evaluate the direct and spillover causal effects of a Hepatitis B (HB) vaccination campaign in French schools on the vaccination adherence of the targeted pupils. Using a regression discontinuity design, we show that this campaign created an exogenous shock on vaccination behavior, increasing the HB vaccination rate for children aged 11 and above. At the same time, we show a drop in the measles, mumps, and rubella (MMR) vaccination rate of the targeted pupils and an increase in the parental belief that measles is a benign disease. We interpret these results as a salience effect: the focus on HB vaccination leads to a decrease in the belief that other vaccines are as important. The effect on MMR vaccination was relatively unexpected and may imply a negative externality. Measles is an extremely contagious disease. If the vaccination rate falls, the disease will spread further, raising the question of the net effect of the HB vaccination campaign on the well-being of the population.

Keywords: Hepatitis B; Measles, Mumps, Rubella; Regression discontinuity design; Spillover effects; Vaccination campaign.