How Partisan Policies Can Shape Health Behaviors: Executive Order Proof-of-Vaccine Mandate Bans Increased COVID-19 Vaccinations

Background/Objectives: COVID-19 vaccine resistance was detrimental to herd immunity and worsened COVID-19 morbidity and mortality during outbreaks. Despite more evidence showing reactionary behavior among residents exposed to vaccine mandates, little research has been conducted on the effects of state proof-of-vaccine (POV) mandate bans in the United States (US). We sought to investigate the causal effects of POV mandate bans, overall and stratified by policy passage via executive order or state legislature, on 1st-dose COVID-19 vaccinations. Methods: In the contiguous US, 21 states enacted POV mandate bans from 2/8/2021–10/25/2021. Using a geographic regression discontinuity design, we selected treatment and control counties within 150 miles of the POV mandate ban state border. The resulting sample was 4,612 county-observations and 2,466 unique counties. We conducted two-way fixed effects estimation to compare changes in bimonthly, 1st-dose COVID-19 vaccinations among individuals under 65 years old before and after POV mandate ban enactment between treatment and control counties. Results: Among executive order POV mandate ban counties, we saw a reduction in the decreasing 1st-dose COVID-19 trend following POV mandate ban enactment. This corresponded to an additional 32.6% increase in 1st-dose COVID-19 vaccinations in Weeks 1–2, 34.5% in Weeks 3–4, 35.0% in Weeks 5–6, and 36.9% in Weeks 7–8 post-POV mandate ban enactment when compared to control counties. Conclusions: These findings suggest that executive order POV mandate bans reversed reactance to vaccine mandates. Future public health efforts should consider potential reactance to mandatory policies and tailor efforts to community values.