Optimal vaccination choice, vaccination games, and rational exemption: An appraisal

Abstract A threat for vaccination policies might be the onset of “rational” exemption, i.e. the family's decision not to vaccinate children after a seemingly rational comparison between the perceived risk of infection and the perceived risk of vaccine side effects. We study the implications of...

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Bibliographic Details
Published in:Vaccine 2009-12, Vol.28 (1), p.98-109
Main Authors: Manfredi, Piero, Posta, Pompeo Della, d’Onofrio, Alberto, Salinelli, Ernesto, Centrone, Francesca, Meo, Claudia, Poletti, Piero
Format: Article
Language:English
Subjects:
Allergy and Immunology
Children
Choice Behavior
Costs
Derivatives
Disease
Economic models
Game Theory
Games
Health Knowledge, Attitudes, Practice
Health risks
Herd immunity
Humans
Industrialized nations
Infections
Models, Theoretical
Mortality
Rational exemption
Refusal to Participate - psychology
Side effects
Social planning
Strategic behaviour
Vaccination - adverse effects
Vaccination - psychology
Vaccination choice
Vaccines
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Summary:Abstract A threat for vaccination policies might be the onset of “rational” exemption, i.e. the family's decision not to vaccinate children after a seemingly rational comparison between the perceived risk of infection and the perceived risk of vaccine side effects. We study the implications of rational exemption by models of vaccination choice. By a simple model of individual choice we first prove the “elimination impossible” result in presence of informed families, i.e. aware of herd immunity, and suggest that limited information might explain patterns of universal vaccination. Next, we investigate vaccination choice in a game-theoretic framework for communities stratified into two groups, “pro” and “anti” vaccinators, having widely different perceived costs of infection and of vaccine side effects. We show that under informed families neither a Nash nor a Stackelberg behaviour (characterized, respectively, by players acting simultaneously and by an asymmetric situation with a “leader” and a “follower) allow elimination, unless “pro-vaccinators” assign no costs to vaccine side effects. Elimination turns out to be possible when cooperation is encouraged by a social planner, provided, however, he incorporates in the “social loss function” the preferences of anti-vaccinators only. This allows an interpretation of the current Italian vaccination policy.
ISSN:0264-410X
1873-2518
DOI:10.1016/j.vaccine.2009.09.109