Mailing Vouchers, Take-Up, and Targeting Efficiency: Evidence From Rubella Immunization Programs

Collaborator

• Shusaku Sasaki (The University of Osaka)
• Fumio Ohtake (The University of Osaka)

Abstract

Outreach raises public-program take-up, but its effects on targeting efficiency depend on who responds. We study voucher mailing in Japan’s rubella immunization program, where pre-vaccination screening identifies antibody-negative individuals who should be vaccinated and allows evaluation of targeting efficiency. Exploiting an age-based mailing threshold in a regression discontinuity design with local administrative data, we find mailing increased antibody testing and vaccination by 19 and 5 percentage points, while maintaining average targeting efficiency at the population benchmark. Favorable selection concentrated immediately after mailing and attenuated over time. A complementary nationwide survey replicates these effects, highlighting awareness gains as a key mechanism.

Discussion Papers

• [Latest version] CiDER Discussion Paper (Center for Infectious Disease Education and Research, Osaka University), DP004, July 2026. [Full-text link]
  • The first version was published in October 2022 and revised in July 2026.