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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Childhood Vaccination with MMR, Flu, and HPV.

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Strategy. Policy Interventions

Approach. Enforce policy interventions that result in increased vaccination rates among children.

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Overview. Enforcing policy interventions around childhood vaccinations involves ensuring vaccine access and affordability, developing clear communication campaigns to address public concerns and build trust in vaccines, and establishing fair and transparent exemption process for medical or religious reasons.[1] Examples of successful public health programs utilizing policy interventions include mandatory vaccination requirements for school entry in Mississippi, which resulted in significant increases in immunization rates.[2] Peer-reviewed research suggests that enforcement of vaccination policies, when coupled with robust public health infrastructure and educational efforts, can demonstrably increase childhood vaccination rates and contribute to herd immunity, ultimately protecting populations who have additional health needs.[3]

Evidence. Scientifically Rigorous Evidence. Strategies with this rating are most likely to be effective...

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

Potential Data Sources. Data to support this strategy can be accessed through:

  • School-specific immunization exemption data
  • Provider-to-school communication logs
  • School-level absenteeism and outbreak data

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Policy Development and Enforcement (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Population/Systems-Focused

Examples from the Field. There are currently no ESMs that use this strategy. Search similar intervention components in the ESM database.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort (“What/how much did we do?”)

  • Number of policies and mandates supported by Title V enacted to increase childhood vaccination rates, such as school entry requirements and provider performance incentives. (Measures breadth of policy implementation)
  • Number of monitoring and enforcement mechanisms established to ensure adherence to vaccination policies, such as tracking systems and reporting requirements. (Measures vaccine policy adherence and tracking accountability infrastructure)

Quadrant 2:
Measuring Quality of Effort (“How well did we do it?”)

  • Percent of vaccination policies supported by Title V that are based on scientific evidence, expert recommendations, and public health guidelines. (Measures policy alignment with child and adolescent vaccination best practices)
  • Percent of individuals and organizations that receive clear and timely communication from Title V about vaccination requirements and compliance process. (Measures timeliness and effectiveness of vaccine policy communication)

Quadrant 3:
Measuring Quantity of Effect (“Is anyone better off?”)

  • Number of local health jurisdictions partnered with Title V that adopt and harmonize vaccination policies to create a consistent framework for implementation. (Measures vaccination policy alignment and coordination across communities)
  • Number of research studies and evaluations conducted by Title V to assess the impact and effectiveness of different policy interventions for increasing vaccination rates. (Measures evidence generation for vaccination policy optimization)
  • Number of communities that experience sustained reductions in childhood vaccine-preventable diseases and associated healthcare costs due to policy-driven immunization programs. (Measures long-term vaccination policy impact on population health and efficiency)
  • Number of pro-vaccination policies and norms that become institutionalized and resilient against shifting political and social pressures. (Measures policy sustainability and durability over time)

Quadrant 4:
Measuring Quality of Effect (“How are they better off?”)

  • Percent of vaccination policy development and implementation process that involve partners and communities, particularly those most impacted. (Measures engagement in vaccination policy development and implementation process)
  • Percent of vaccination policy communications and enforcement resources tailored to populations and areas with low uptake of vaccinations. (Measures focus on addressing differences in vaccination rates)
  • Percent of communities that experience sustained reductions in childhood vaccine-preventable diseases and associated healthcare costs due to policy-driven immunization programs. (Measures long-term vaccination policy impact on population health and efficiency)
  • Percent of pro-vaccination policies and norms that become institutionalized and resilient against shifting political and social pressures. (Measures policy sustainability and durability over time)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

[1] Giubilini, A. (2019). Chapter 3, Vaccination policies and the principle of least restrictive alternative: An intervention ladder. Giubilini A, The ethics of vaccination. Cham (Suisse): Palgrave Pivot.

[2] “School Immunizations.” School Immunizations - Mississippi State Department of Health, msdh.ms.gov/page/14,8569,71.html.

[3] Ventola, C. L. (2016). Immunization in the United States: recommendations, challenges, and measures to improve compliance: part 1: childhood vaccinations. Pharmacy and Therapeutics, 41(7), 426.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.