Universally Recommended Vaccinations:Monetary Sanction Policies
Monetary sanction policies are government requirements that link continuing financial assistance to families to maintenance of up-to-date vaccination status of the client. Sanction policies can be established by legislative action or agency dictate. Actual penalties are applied only after families are given one or more warnings and fail to produce documentation of status or demonstration of progress. Sanctions may range from penalties on the amount of assistance to loss of benefits.
Summary of Task Force Recommendations & Findings
The Community Preventive Services Task Force finds insufficient evidence to determine the effectiveness of monetary sanction policies to increase vaccination rates in children of families on government assistance. The Task Force finding is based on the small number of studies; differences in the type of sanction policies evaluated; inconsistent results on vaccination rates; and limited information on potential harms of these policies.
Results from the Systematic Review
The Task Force finding is based on evidence from a Community Guide systematic review of Client or Family Incentives published in 2000 (search period 1980-1997) combined with more recent evidence (search period 1997-2009).
Learn more about the original review and Task Force finding in the Vaccinations to Prevent Diseases section of our publications page.
Two studies qualified for this review.
- One study from the state of Georgia found a significant improvement in the vaccination rate in children (absolute difference: +11.8 percentage points). This was a three-year randomized controlled trial of 2500 families receiving Aid to Families with Dependent Children (AFDC). Families that did not show proof of up-to-date vaccination status for their children could lose AFDC benefits.
- Another study from Maryland evaluated outcomes in children ages 3 to 24 months and found no improvement in the vaccination rate (absolute difference: -0.7 percentage points). This was a two-year study of AFDC participants who were assessed a financial penalty of $25 per month for failure to document the receipt of well-child preventive care.
The review findings are based on a systematic review of all available studies, conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice and policy related to vaccinations to prevent diseases.
An economic review of this intervention was not conducted because the Task Force found insufficient evidence to determine its effectiveness.
The findings and results of this systematic review have not been published. Read other Community Guide publications about Vaccinations to Prevent Diseases in our library, including articles about the previous review. You may also subscribe to be notified as new materials on this topic become available.
The findings and conclusions on this page are those of the Community Preventive Services Task Force and do not necessarily represent those of CDC.
The content of publications of the Guide to Community Preventive Services is in the public domain. Citation as to source, however, is appreciated. Sample citation: Guide to Community Preventive Services. Universally recommended vaccinations: monetary sanction policies. www.thecommunityguide.org/vaccines/universally/MonetarySanctions.html. Last updated: MM/DD/YYYY.
Review Completed: April 2011
- Page last reviewed: July 17, 2012
- Page last updated: July 17, 2012
- Content source: The Guide to Community Preventive Services