Recent increases in vaccine-preventable diseases have led policymakers to reconsider the scope of vaccine requirement exemptions. Yet eliminating these provisions is politically difficult. Beginning in 2009, sixth grade girls in Washington, DC were required to receive the HPV vaccine or submit a one-time opt-out form. In 2014, the requirement was expanded to all students grades 6–12, and those not vaccinating were required to opt-out annually. I show that the movement from a one-time opt-out provision to an annual requirement increased the probability that teen girls in Washington, DC initiated HPV vaccination by 11 percentage points. Teen boys were 20 percentage points more likely to be vaccinated. Back-of-the-envelope calculations suggest 7 fewer cases of cervical cancer and 41 fewer cases of oropharyngeal cancer for the 33,000 enrolled during the 2017/2018 year. Using the initial value of cancer care and the value of a statistical life year, my estimates imply nearly $36 million in savings compared to $1.5 million spent on vaccination. In generalizing these results to other states, effect sizes even one-tenth the size of my most conservative estimate would imply meaningful reductions in the nationwide incidence of HPV-related cancers.

最近疫苗可预防疾病的增加导致政策制定者重新考虑疫苗要求豁免的范围。然而，取消这些规定在政治上是困难的。从 2009 年开始，华盛顿特区的六年级女生被要求接种 HPV 疫苗或提交一次性退出表格。2014 年，该要求扩大到所有 6-12 年级的学生，未接种疫苗的学生必须每年选择退出。我表明，从一次性选择退出条款到年度要求的转变使华盛顿特区的少女开始接种 HPV 疫苗的可能性增加了 11 个百分点。十几岁的男孩接种疫苗的可能性要高出 20 个百分点。粗略计算表明，33 人中宫颈癌病例减少了 7 例，口咽癌病例减少了 41 例，000 在 2017/2018 年度注册。使用癌症护理的初始价值和统计生命年的价值，我的估计意味着节省近 3600 万美元，而在疫苗接种上花费了 150 万美元。将这些结果推广到其他州时，即使是我最保守估计的十分之一，也意味着全国范围内 HPV 相关癌症发病率的显着降低。