Vaccination and the theory of games

 


The policy of voluntary vaccination against childhood diseases poses a subtle challenge to parents: if a sufficient part of the population is already immune naturally or through vaccination, the lower risk of vaccination outweighs the risk of infection. As a result, individual self-interest could prevent the complete eradication of a vaccine-preventable disease. We show that a formal game theory analysis of this problem leads to new insights that help explain human decision-making regarding vaccines. An increase in the perceived risk of the vaccine tends to translate into a greater decrease in the intake of vaccines for the pathogens that cause more secondary infections (such as measles and whooping cough). Even if the perceived risk of vaccination is greatly reduced, after a vaccination fear it will be relatively difficult to restore pre-vaccination coverage. In the history of vaccination policy there has been great public resistance, often in the form of vaccination horrors. For example, in the UK, anxiety about pertussis vaccination in the 1970s led to a decline in vaccination coverage, leading to a significant increase in pertussis morbidity and mortality. Uptake of the measles, mumps and rubella vaccine is currently declining in the UK, raising concerns that widespread measles outbreaks may recur. When deciding whether to vaccinate their children, parents take into account the risk of morbidity from the vaccination, the likelihood that their child will be infected, and the risk of morbidity from the infection. The decisions of individual parents are indirectly influenced by the decisions of all other parents, because the sum of these decisions gives the vaccination rates in the population and, therefore, the course of epidemics. Game theory attempts to predict individual behavior in an environment in which the reward for strategies chosen by individuals depends on the strategies of other members of the population. Here we integrate the modeling of epidemics in a theoretical framework of games to analyze the behavior of the population in the context of the policy of voluntary vaccination against childhood diseases. This approach allows us to quantify how risk perception affects the expected uptake and coverage of the vaccine, and what role the epidemiological properties of the pathogen play in this situation.

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