Abstract
Regions with insufficient vaccination have hindered worldwide poliomyelitis eradication, as they are vulnerable to sporadic outbreaks through reintroduction of the disease. Despite Israel's having been declared polio-free in 1988, a routine sewage surveillance program detected polio in 2013. To curtail transmission, the Israel Ministry of Health launched a vaccine campaign to vaccinate children-who had only received the inactivated polio vaccine-with the oral polio vaccine (OPV). Determining the degree of prosocial motivation in vaccination behavior is challenging because vaccination typically provides direct benefits to the individual as well as indirect benefits to the community by curtailing transmission. However, the Israel OPV campaign provides a unique and excellent opportunity to quantify and model prosocial vaccination as its primary objective was to avert transmission. Using primary survey data and a game-theoretical model, we examine and quantify prosocial behavior during the OPV campaign. We found that the observed vaccination behavior in the Israeli OPV campaign is attributable to prosocial behavior and heterogeneous perceived risk of paralysis based on the individual's comprehension of the prosocial nature of the campaign. We also found that the benefit of increasing comprehension of the prosocial nature of the campaign would be limited if even 24% of the population acts primarily from self-interest, as greater vaccination coverage provides no personal utility to them. Our results suggest that to improve coverage, communication efforts should also focus on alleviating perceived fears surrounding the vaccine.
Highlights
Regions with insufficient vaccination have hindered worldwide poliomyelitis eradication, as they are vulnerable to sporadic outbreaks through reintroduction of the disease
We found that the prosocial model is more consistent with both the vaccination coverage reported by the Israeli Ministry of Health and that estimated from the survey, irrespective of the population-level perception of wild-type polio risk (SI Appendix, Fig. S3)
To understand the vaccination uptake during the Israel oral polio vaccine (OPV) campaign, it is important to quantify the extent to which individuals accepted OPV vaccination because of self-interest and prosocial motivations or due to a misperception regarding their personal risk of paralysis
Summary
Regions with insufficient vaccination have hindered worldwide poliomyelitis eradication, as they are vulnerable to sporadic outbreaks through reintroduction of the disease. VAPP is circumvented by deploying a sequential schedule, initially immunizing with two IPV doses prior to OPV This regimen protects recipients from the wild virus as well as VAPP, as was the case for the children targeted by the 2013 campaign. The final phases of polio eradication have been unexpectedly protracted [1,2,3,4] due to the persistence of cases in areas with variable vaccination coverage—Pakistan, Afghanistan, and Nigeria [5, 6] Insufficient vaccination in these regions has led to sporadic outbreaks and reemergence of the disease into countries where it has otherwise been eliminated [5,6,7]. Since the initial IPV doses were sufficient to protect the individual against polio-associated morbidities, agreeing to receive OPV to prevent transmission entails a considerable degree of altruistic or prosocial behavior
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