Universally Recommended Vaccinations: Monetary Sanction Policies

Task Force Finding & Rationale Statement

Definition

Monetary sanction policies are government requirements that link continuing 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.

Task Force Finding

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.

Rationale

The Task Force considered two studies identified during the search period (January 1980-November 2009). Both studies were conducted in the United States and evaluated the implementation of monetary sanction policies for families receiving assistance through the Aid to Families with Dependent Children (AFDC) program. The first study, a two-year randomized controlled trial of AFDC recipients in Maryland, evaluated outcomes in 1324 children aged 3 to 24 months and observed no significant improvements in vaccination rates (absolute difference -0.7 percentage points). The second study, a three-year randomized controlled trial of 2500 families on AFDC assistance in Georgia, observed significant improvements in vaccination rates in children (absolute difference +11.8 percentage points).

The potential harms of sanction policies include the loss of financial support for families in need of assistance, whether through sanction, program drop-out, or reductions in applications for assistance. In addition, these policies may affect the other activities of program staff and their interactions with families in need of assistance. Evidence on the broad range of potential outcomes of monetary sanction policies is insufficient to inform considerations on their use as an intervention option to increase vaccination rates. Programs that are considering the adoption of monetary sanctions should first determine the range of potential harms that may occur from these policies.