Optional Influenza Vaccine And Population Adherence

说明(申请人提供)：接种疫苗不仅保护接种疫苗的人，而且保护社区中不太可能感染疾病的其他人。相反，当人们选择不接种疫苗时，他们都会给自己带来风险，并将家庭和社区中的其他人置于危险之中。我们将制定流感疫苗接种战略，考虑人们如何选择是否接种疫苗，他们的选择对社区其他人的影响，以及提高疫苗接种计划的成本效益。最优疫苗接种政策的实施取决于个人如何做出关于疫苗接种的决定。如果疫苗接种是自愿的，则医疗决定由个人做出。总体来说，个人的决定决定了人群的免疫力水平，从而决定了随后流行的规模和疫苗接种工作的最终成本效益。虽然儿童是流感传播的主要原因，但与此相关的发病率和死亡率最高的是老年人。因此，分配给儿童的疫苗对人口的效用大于对儿童本身的效用。这项拟议研究的长期目标是确定政策，鼓励在社区范围内控制流感时遵守最佳疫苗接种战略。我们将在三个具体目标中加以阐述。(1)为了评估个体层面的决策对人群坚持不同策略的影响，我们将构建第一个流感进化流行病学模型，将其与年龄特定疫苗接种需求的博弈论模型相结合。我们将应用马尔可夫决策理论来计算效用，并开发一个算法来确定受自身利益支配的疫苗接种行为的纳什均衡，以及功利性的疫苗分配策略。(2)我们将找出对个人最优和群体最优疫苗接种量影响最大的因素。为了确定改进流感及其疫苗信息传播的可能影响，我们将根据实际感染和疫苗风险计算决策效用，并将这些与我们的心理数据得出的感知成本和收益进行比较。我们还将评估奖励结构，如补贴，以鼓励对禽流感疫情进行认真的国际监测、干预和报告。(3)我们将进行问卷调查和实验博弈研究，以考察个人的疫苗接种决策如何受到总体接种行为的影响。我们将使用我们的心理数据来参数化我们的模型，并验证它的预测。这一基本跨学科的建议将数学建模与心理数据收集和参数化、经济学与流行病学、个人决策与人口水平的公共卫生结果结合在一起。

DESCRIPTION (provided by applicant): Vaccination protects not only the people who are vaccinated, but others in the community who are thereby less likely to catch the disease. Conversely, when people choose not to get vaccinated, they both take on a risk to themselves and put others in their family and community at risk. We will develop strategies for flu vaccination, taking into account how people choose whether to be vaccinated, the effect of their choices on others in their community and the cost-effectiveness of programs to improve vaccination. The implementation of optimal vaccination policies is governed by how individuals make decisions about vaccination. When vaccination is voluntary, medical decisions are made by individuals. Collectively, individual decisions determine the level of population immunity and thus the magnitude of subsequent epidemics and the ultimate cost-effectiveness of vaccination efforts. While children are responsible for the majority of influenza transmission, it is the elderly that suffer the most associated morbidity and mortality. Consequently, the utility of vaccine allocation to children is greater for the population than it is for the children themselves. The long-term goal of the proposed research, which we will address in three Specific Aims, is to define policies that encourage adherence to optimal vaccination strategies in the community-wide control of influenza. (1) To evaluate the repercussions of individual-level decisions on the population's adherence to different strategies, we will construct the first model of the evolutionary epidemiology of influenza to be integrated with a game-theoretic model of age-specific demand for vaccination. We will apply Markov decision theory to calculate utilities and develop an algorithm for determining Nash equilibria of vaccination behavior governed by self-interest, in addition to utilitarian vaccine allocation strategies. (2) We will identify factors that have the greatest impact on aligning individual-optimal and group-optimal vaccination. To determine the likely influence of improving dissemination of information about influenza and its vaccine, we will calculate decision utilities from actual infection versus vaccine risks, and compare these with perceived costs and benefits derived from our psychological data. We will also evaluate incentive structures, such as subsidies, to encourage conscientious international surveillance, intervention and reporting of an avian influenza outbreak. (3) We will conduct questionnaire and experimental game studies to examine how an individual's vaccination decisions are influenced by aggregate vaccination behavior. We will use our psychological data to parameterize our model and verify its predictions. This fundamentally interdisciplinary proposal combines mathematical modeling with psychological data collection and parameterization, economics with epidemiology, and individual decision making with population-level public health outcomes.