Vaccination, Herd Behavior, and Herd Immunity
Vaccination, Herd Behavior, and Herd Immunity
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DOI：
10.1177/0272989x13487946
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发表时间：
2013-11-01
影响因子：
3.6
通讯作者：
Chinitz, David
中科院分区：
文献类型：
--
作者：
Cohen, Matan J.;Brezis, Mayer;Chinitz, David
背景：2009 年新型 AH1N1 流感爆发期间，没有足够的数据让决策者充分了解疫苗接种和疾病的益处和风险。我们假设，在没有更好的决策锚的情况下，个人会选择模仿他们的同龄人。我们使用博弈论、决策分析和传播模型来模拟主观风险和偏好估计对疫苗接种行为的影响。方法：我们要求 95 名学生提供有关 AH1N1 感染、并发症以及疫苗益处和风险预期的风险估计和健康状况评估。这些估计包含在一系列连续的模型中：动态流行病模型、决策树和人口水平模型。此外，还记录了参与者以不同的疫苗接种率接种或不接种疫苗的意图。结果：模型显示，在疫苗接种率较低的情况下，疫苗接种占主导地位。当疫苗接种率增加到 78% 以上时，不接种疫苗成为主导策略。我们发现，疫苗接种意图与策略主导地位的转变并不对应，并且分为 3 种意图：无论其他人做什么，29/95 (31%) 打算接种疫苗，而 27/95 (28%) 则没有； 95 人中有 39 人 (41%) 的意愿与假定的疫苗接种率呈正相关。结论：有些人遵循大多数人的选择，要么将流行病动态转向群体免疫，要么相反，限制社会目标。政策领导人应谨慎使用模型，注意其局限性和理论假设。本研究没有明确探讨行为驱动因素，不同的结果需要进一步调查。包含具有经验或主观概率的真实主观感知的模型可以深入了解与预期理性行为的偏差，并建议干预措施，以提供更好的人口结果。
Background: During the 2009 outbreak of novel influenza AH1N1, insufficient data were available to adequately inform decision makers about benefits and risks of vaccination and disease. We hypothesized that individuals would opt to mimic their peers, having no better decision anchor. We used Game Theory, decision analysis, and transmission models to simulate the impact of subjective risks and preference estimates on vaccination behavior. Methods: We asked 95 students to provide estimates of risk and health state valuations with regard to AH1N1 infection, complications, and expectations of vaccine benefits and risks. These estimates were included in a sequential chain of models: a dynamic epidemic model, a decision tree, and a population-level model. Additionally, participants' intentions to vaccinate or not at varying vaccination rates were documented. Results: The model showed that at low vaccination rates, vaccination dominated. When vaccination rates increased above 78%, nonvaccination was the dominant strategy. We found that vaccination intentions did not correspond to the shift in strategy dominance and segregated to 3 types of intentions: regardless of what others do 29/95 (31%) intended to vaccinate while 27/95 (28%) did not; among 39 of 95 (41%) intention was positively associated with putative vaccination rates. Conclusions: Some people conform to the majority's choice, either shifting epidemic dynamics toward herd immunity or, conversely, limiting societal goals. Policy leaders should use models carefully, noting their limitations and theoretical assumptions. Behavior drivers were not explicitly explored in this study, and the discrepant results beg further investigation. Models including real subjective perceptions with empiric or subjective probabilities can provide insight into deviations from expected rational behavior and suggest interventions in order to provide better population outcomes.