Abstract
BackgroundTheoretical studies predict that it is not possible to eradicate a disease under voluntary vaccination because of the emergence of non-vaccinating “free-riders” when vaccination coverage increases. A central tenet of this approach is that human behaviour follows an economic model of rational choice. Yet, empirical studies reveal that vaccination decisions do not necessarily maximize individual self-interest. Here we investigate the dynamics of vaccination coverage using an approach that dispenses with payoff maximization and assumes that risk perception results from the interaction between epidemiology and cognitive biases.MethodsWe consider a behaviour-incidence model in which individuals perceive actual epidemiological risks as a function of their opinion of vaccination. As a result of confirmation bias, sceptical individuals (negative opinion) overestimate infection cost while pro-vaccines individuals (positive opinion) overestimate vaccination cost. We considered a feedback between individuals and their environment as individuals could change their opinion, and thus the way they perceive risks, as a function of both the epidemiology and the most common opinion in the population.ResultsFor all parameter values investigated, the infection is never eradicated under voluntary vaccination. For moderately contagious diseases, oscillations in vaccination coverage emerge because individuals process epidemiological information differently depending on their opinion. Conformism does not generate oscillations but slows down the cultural response to epidemiological change.ConclusionFailure to eradicate vaccine preventable disease emerges from the model because of cognitive biases that maintain heterogeneity in how people perceive risks. Thus, assumptions of economic rationality and payoff maximization are not mandatory for predicting commonly observed dynamics of vaccination coverage. This model shows that alternative notions of rationality, such as that of ecological rationality whereby individuals use simple cognitive heuristics, offer promising new avenues for modelling vaccination behaviour.
Highlights
Vaccination has greatly reduced the burden of infectious diseases worldwide
Assuming that individuals are rational, that is, agents that optimize their utility i.e. individuals make a logical and coherent choice depending on choices of others, it was concluded that it is not possible to eradicate a disease under voluntary vaccination because of the emergence of non-vaccinating free riders when vaccination coverage is sufficiently high [4,5,6]
For the purpose of this paper, which aims to investigate the role of cognitive biases for predicting commonly observed dynamics of vaccination coverage such as the failure to reach herd immunity and oscillations between high and low levels of coverage, we focus on those heuristics or cognitive shortcuts that are likely to allow for heterogeneity and change in opinion about vaccination
Summary
Vaccination has greatly reduced the burden of infectious diseases worldwide. by 2015, only smallpox has been eradicated by programs of voluntary vaccination and global outbreaks of measles, mumps, whooping cough, polio and rubella are repeatedly being reported in both developed and developing regions. We propose an alternative to classic behavioural epidemiology studies by considering a revised version of rationality, that of an ecological rationality [8,9], enabled by the mind’s “adaptive toolbox” [10] This framework dispenses with optimization and with complex calculations of utilities altogether and views decision-making as the expression of evolved cognitive dispositions (e.g. heuristics or rules of thumb including social learning abilities). This enables us to develop a behaviour-incidence model explicitly considering cognitive mechanisms with the aim to investigate how the feedback between cognition and epidemiology may influence the dynamic of disease transmission. We investigate the dynamics of vaccination coverage using an approach that dispenses with payoff maximization and assumes that risk perception results from the interaction between epidemiology and cognitive biases
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