If An Ounce of Prevention is Worth a Pound of Cure, Why Aren’t Vaccination Campaigns Working?

Measles continues to spread throughout the Southwestern United States, bringing the media buzz surrounding vaccinations and the “anti-vax” movement to a fever pitch over the last few weeks. Although public discourse tends to focus primarily on the scientific validity of vaccination safety studies, economists have also begun researching the factors at play in contemporary behavioral trends towards non-vaccination through the use of economic modeling and game theory. Additionally, these studies contribute to the broader realm of public health and aid policy analysts as global entities continue their work to battle infectious disease epidemics around the world.

One such economist, Fredrick Chen, worked with students from Wake Forest University to design a virtual game where participants make a series of choices about vaccinations during a simulated influenza disease outbreak. Their reactions were recorded and used to identify various factors that affect vaccination rates, with the ultimate goal of “deciphering the incentives people need to get vaccinated.” Identifying himself as an epidemiological economist, Chen’s work focuses on the intersection of economics and public health, specifically the cost effectiveness of various prevention methods mobilized prior to or during epidemics.

Most epidemiological economic models assume that subjects are going to act with maximum rationality and utility when making decisions. Historically, this notion is the basic premise for public health policy, but behavioral and social economists have criticized it recently for its arguably flawed or simplistic conceptions of human rationality. The game designed by Chen subverts the traditional model by allowing players to make irrational or more complex decisions, thereby allowing for a wider variety of outcomes and more closely mimicking human behavior. Had the results been analyzed under traditional economic modeling standards, the percentage of individuals who choose to vaccinate would indicate a fairly consistent threshold at the point where the safety or “payoffs” outweighs risk. However, the actual results indicate that this threshold did not exist for participants because Chen’s study took “backward-thinking” or less progressive behaviors into account, thereby complicating proposed policy solutions to raise overall vaccination rates. In short, simply increasing accessibility and spreading awareness about vaccination effectiveness is not necessarily enough to overcome cultural, economic, or psychological barriers to vaccination campaigns.

On the other hand, the study did find strong correlations between decreasing the cost of self-protection and increasing the rates of safe behavior. The prevalence of disease rates within the population was also proven to affect the subject’s willingness to vaccinate; the higher the prevalence, the more likely the person was to exhibit proactive, responsive behaviors. Given these results, recommended policy changes included increasing affordable, available preventative measures that account for socioeconomic or cultural population complexities, rather than a “one size fits all” vaccination campaign model. The incorporation of incentives such as subsidies for these protective measures was also proven to be effective at reducing risky behavior, thus decreasing overall disease transmission. Finally, due to the relationship between prevalence and safe behaviors, policy interventions “should be dynamic, flexible, and adaptable” in order to maximize their success.

Overall, the percentage of individuals who choose to vaccinate themselves or their children still tends to be higher than those who opt out. However, epidemiologists estimate that about 95% of a population should be vaccinated to prevent disease outbreaks or epidemics. While we still have a long way to go in terms of disease eradication and global prevention, contemporary epidemiological economic models such as the one used in Fredrick Chen’s study may prove invaluable in identifying previously underestimated factors or barriers to vaccination campaigns.

Works Cited

http://freakonomics.com/2015/01/08/why-doesnt-everyone-get-the-flu-vaccine-a-new-freakonomics-radio-podcast/

http://www.frederickchen.org/bio

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0052814#s4

http://www.livescience.com/49716-measles-outbreak-questions.html

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