Optional Influenza Vaccine And Population Adherence

描述（由申请人提供）：接种疫苗不仅保护接种疫苗的人，而且保护社区中因此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，他们既对自己承担了风险，也使家庭和社区中的其他人处于危险之中。我们将制定流感疫苗接种战略，考虑到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，以及改善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疫苗接种决策。当疫苗接种是自愿的，医疗决定是由个人做出的。总的来说，个人决定决定了人口免疫水平，从而决定了随后流行病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，但与之相关的发病率和死亡率最高的是老年人。因此，向儿童分配疫苗对人口的效用大于对儿童本身的效用。我们将在三个具体目标中讨论拟议研究的长期目标，即确定鼓励在社区范围内控制流感中遵守最佳疫苗接种战略的政策。(1)为了评估个体层面的决策对人群遵守不同策略的影响，我们将构建第一个将流感进化流行病学模型与年龄特异性疫苗接种需求博弈论模型相结合的模型。我们将应用马尔可夫决策理论来计算效用，并开发一种算法来确定由自身利益控制的疫苗接种行为的纳什均衡，以及功利主义疫苗分配策略。(2)我们将确定对调整个体最优和群体最优疫苗接种有最大影响的因素。为了确定改善流感及其疫苗信息传播的可能影响，我们将计算实际感染与疫苗风险的决策效用，并将其与从我们的心理学数据中得出的感知成本和收益进行比较。我们还将评估补贴等激励机制，以鼓励认真的国际监测、干预和报告禽流感爆发。(3)我们将进行问卷调查和实验博弈研究，以检验个体的疫苗接种决策如何受到总体疫苗接种行为的影响。我们将使用我们的心理学数据来参数化我们的模型并验证它的预测。这个基本的跨学科建议将数学建模与心理学数据收集和参数化相结合，将经济学与流行病学相结合，将个人决策与人口水平的公共卫生结果相结合。

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.