Lauren Witty

Honors 220 B
11/26/2019

To Vaccinate or to Not Vaccinate?: A Game Theory Analysis of Current Vaccination Trends.

Vaccines have been incredibly influential in the health of our society. Ever since the first
vaccine was invented, severe diseases like smallpox have been eradicated, with other diseases
like polio being eliminated from many places in the world. With immunizations preventing
roughly 2 to 3 million deaths per year, it seems like there would be no argument against
vaccination (Immunization). However, vaccines have the power to protect people who do not
actually receive the vaccine. In every population, there is a defined percentage of people that
must be vaccinated in order to protect everybody else from a disease. This value, also known as
the herd immunity level, varies between different diseases. Some communities might only have
to reach a 70% immunization rate in order to be protected, while another community that faces a
different disease might need a 95% vaccination rate. Either way, some people do not have to get
vaccinated in order to ensure that they do not get sick. Usually these people include those that are
physically unable to get the vaccine or elderly people whom the vaccine is more likely to cause
adverse effects. However, some people take advantage of the herd immunity concept, and do not
get vaccinated in order to maximize their own utility. While getting a vaccine usually ensures
minimal infectivity, it also costs energy, money and time to actually go and get the
immunization. Therefore, if a community has reached the herd immunity level, there is no
incentive to waste an individual’s utility in order to get vaccinated (Liu). Due to this, vaccination
becomes a game of balancing utility and trying to guess the approximate vaccination rate within
a community. By understanding the utility that comes from getting vaccinated or refusing the
immunization, a deeper comprehension of society’s true values and selfishness can be devised.
Every society plays this “vaccination game” whether they know it or not. Many topics of
game theory are applicable in vaccination and are utilized in order to coerce others into a certain
immunization decision. One major topic that greatly influences vaccination trends is
non-credible threats. Non-credible threats occur when one player assures the other player that
they are unable to make the other move, essentially binding themselves to that option. This
usually influences the other player to make a move that they were not originally planning on
making. This happens in vaccination opportunities as some people are physically unable to get
the vaccine or they claim that it is against their spiritual and personal beliefs. These explanations
bind those players to only one choice: no vaccinations. This can influence the rest of society into
getting vaccinated because they do not want to lose utility due to becoming infected with the
disease. Therefore, the rest of the community may have opted to not receive the vaccine, but due
to the other player’s inability to get vaccinated, they feel forced into getting the immunization.
Non-credible threats are also applicable when one player appears irrational. While this is not true
in many communities, some people do behave irrationally when choosing whether or not to
vaccinate. Whether they believe fake news or they actively choose to disregard specific studies
that have proven that vaccines do not cause other medical conditions such as autism, some
people still choose to not vaccinate for seemingly irrational reasons. This irrationality just
incentivizes the rest of the community to get immunized due to the uncertainty surrounding the
irrational players potential actions.
The percent of people choosing to vaccinate in a community can also be affected by their
perception of the risk of contracting a disease. There are many people who are risk-averse, and
opt to get the vaccination at the small chance that they would contract the disease without it.
However, others simply choose to get vaccinated because they misinterpret the infectivity rates.
If there is an 8.5% chance that a person could contract a disease without an immunization, some
people might read this percentage as fairly high and convince themselves that they must get the
vaccination. Both of these concepts tend to be heightened when talking about one’s health.
Percentages start to get inflated when a person is considering the risk that not getting immunized
can put on their health. Due to the sometimes life or death decisions that are associated with
health choices, people tend to be more risk-averse than if they were playing a different game.
Finally, vaccination efforts tend to model the topics of risk and payoff dominance. For
each of the players, there are risk and payoff dominant moves. The payoff dominant option
would be to not get vaccinated as that player would waste less utility on the effort it takes to
actually get immunized. However, this is only the case if the rest of the community chose to get
vaccinated and actually reached the herd immunity level. If this coordination fails, then not
getting vaccinated would no longer be the move that maximizes the player’s utility. This is why
getting vaccinated is always the risk dominant option. Even though the player will lose some
utility due to the actual immunization process, they are generally safer from contracting the
disease, making the chance of achieving some positive utility higher for those that are
vaccinated. This is the risk dominant move because if coordination fails, the individual will still
be protected from the disease and will be able to experience a utility gain from the game.
Since there are so many connections between vaccination strategy and game theory, a
variety of different studies and experiments have been conducted on the topic. One of these
studies was interested in analyzing whether society acted more altruistically or if people played
according to selfish intentions. To model this interaction, the researchers assigned participants
into an either “elderly” or “young” role. Each of these roles had slightly different payoffs, as the
effectiveness of vaccinations tend to vary with age. In this experiment, each participant was
given the same amount of points to begin with. Throughout the game, participants could lose
points if they chose to get vaccinated or were infected with the disease. However, like in real life,
the elderly were subject to a much greater loss in utility if infected with the disease. Additionally,
the researchers chose to divide the groups further into a group that received their individual
payoffs and another group that received the average payoff of their entire group. By accounting
for herd immunity and these variable conditions, the researchers were able to carefully model the
complex system and game that is vaccination.
Before collecting their data, the researchers created two predictions of how the
participants would act: either according to utilitarian values or according to the Nash equilibrium
of the game. Under the utilitarian hypothesis, almost all of the young people would get
vaccinated in order to protect the elderly from the disease and from actually having to get
immunized. However, under the Nash equilibrium, both groups were expected to get vaccinated
less than 50% of the time, with the young people getting vaccinated less often than the elderly.
Both of these predictions turned out to be the extremes of the situation, as players found a sort of
middle strategy that fell between the total utilitarian strategy and purely logical prediction.
Similarly, in the group average payoff condition, the young people tended to get immunized
more often than they would have in the purely individualized conditions. These results can be
used to infer the beliefs and values of our society as they model how general civilians act when
selfless and selfish options are presented. While we do not know the true intentions of those that
chose to get vaccinated, we can assume that their payoffs for receiving the vaccine were different
and somehow outweighed the negative effects of the vaccine. Perhaps they valued helping
others, good citizenship, felt the effects of social pressure or thought of themselves as a hero for
potentially saving the life of an elderly community member. Through this same middle strategy,
our society somehow finds a way to coordinate in such a manner that many people choose to get
vaccinated in order to promote the common good. Although reaching the herd immunity level is
fairly rare, society still tends to promote immunizations and encourage enough people to proceed
with the vaccine in order to ensure a high utility benefit for all (Chapman).
Another similar study was conducted about human behavior and immunization trends,
but instead focused on the free-riding behavior that is granted by herd immunity. With a similar
experimental set up, the researchers ran multiple rounds of “immunizations” with each of the
participants receiving or losing points due to their decisions. Throughout their experiment, a few
trends emerged. Generally, participants would get vaccinated at higher proportions on the first
round of the experiment. But as more rounds were held, people began to realize that free-riding
was an option for them and vaccination rates subsequently dropped. However, if a participant
had become infected with the disease in a previous round, they were more likely to get
vaccinated in the following rounds of the experiment. Each of these rounds were grouped into
independent trials, with each trial reporting similar results. From these results, the researchers
were able to infer that most people will generally act in a manner that improves their individual
utility, rather than consider the society as a whole. However, even though these results were
collected from multiple independent trials, some holes in their experiment still remain. People
get vaccinated for many different reasons and incentives. These decisions are made due to
socioeconomic status, health status, individual beliefs, and fear. By simplifying this game into a
simple gamble for points, the true depth of these decisions are eliminated. Even though not much
could be assumed from this study, there are some key points about free riding that can be
 applicable. Free riding occurs in two scenarios: non-rivalry and non-exclusion of consumption.
These two conditions are met when the consumption of one person’s goods does not affect
another person and when you cannot restrict the benefits of the action to only one person. Since
immunization trends fulfill both of these requirements, free-riding, or at least the illusion of
free-riding, occurs often. As people forget to get immunized one year, they later assume that they
do not need to the next year, following the trend of the study. Therefore, free-riding occurs yearly
and causes the community vaccination proportion to slowly decline each consecutive year until
players realize that they are no longer maximizing their own utility (Ibuka).
While vaccination is a deeply complex social and health issue, it can be modeled by
simple games. In order to fit this issue into a game, I had to make a few generalizations and
neglect some of the social reasons for why someone might choose to vaccinate themselves or
their children. After making these assumptions, I decided to create a game that involves two
players. Player one represents the individual who is simply choosing whether or not they should
receive a vaccination. Player two represents the community, who can choose together whether to
unite the community and vaccinate at certain percentages, leading up to the percentage of herd
immunity (90% vaccine coverage in this case). Payoffs were allocated in the following manner:
+10 for no infection, -5 for the effort, time and money it takes to get a vaccine and -20 for
infection. However, I also attempted to account for infectivity. I did this by simply taking the -20
utility that one would lose if infected with the disease and then I multiplied this by 1- the
community vaccination proportion.While this assumes that the infectivity rate is roughly the
inverse of the vaccination rate of the community, it can still roughly model a general disease
outbreak. I also applied a similar methodology when accounting for the -5 utility that comes
from vaccination efforts in the community vaccination levels (for example: 75% vaccination rate
= -5(0.75) = -3.75 for money, time and effort to get vaccination ). After making those
assumptions, I was able to design the following game:

Top: Community Vaccination 0% 50% 75% Required Herd

Level Immunity Percentage
Bottom: Individual Choice (example: 90%)

Get Vaccinated -20 -12.5 -8.75 5

5 5 5 5

Do Not Get Vaccinated -20 -12.5 -8.75 5

-20 -10 5 8

After assuming these basic standards, we can recognize that there is a pure Nash Equilibrium. If
the whole community gets vaccinated according to the herd immunity level, the individual is
then incentivized to not get vaccinated. This is because if herd immunity is reached, it is
extremely unlikely that an individual would get infected. Therefore, there seems to be no reason
to get vaccinated, as the individual would essentially be spending money on something that is
unnecessary and would not actually improve their health chances. This is the pure Nash
equilibrium because neither party is incentivized to unilaterally switch moves. This might feel
weird, as one person acts selfishly while the rest of the community is acting in a utilitarian
fashion. However, this scenario is very unlikely, as it is extremely difficult to get whole
communities to coordinate around one move. However, this model still allows us to see all of the
vaccination possibilities and the incentives and risks associated with different vaccination
scenarios.
Due to these various models of vaccination trends, society can begin to decide which
policies and educational initiatives would be most beneficial to enact. This proves very important
when deciding whether or not mandatory vaccination should be imposed by the government. As
seen in the above games, if more people are vaccinated, herd immunity can be reached, and
players are forced to play according to the risk-dominant strategy. However, this can cause some
backlash due to the fact that individuals are incentivized to be free-riders and refuse the
vaccination. This backlash can also affect how other policies are received by the public, causing
the government to be very wary with imposing vaccination laws. Governments are also seen as
completely responsible for the vaccine. If they make these overarching laws, they will be
accredited with bad outcomes and have to provide funding for those that cannot afford the price
of the immunization (Salmon). In order to overcome these obstacles, the government can turn to
game theory. By analyzing the incentives of the public, their payoffs, and the payoffs for the
government, politicians can devise policies that attempt to maximize the utility of all involved
parties.
Vaccination trends are also essential in the context of schools. When choosing whether or
not to vaccinate their children, some parents view it as a completely individualized decision.
They assume that the vaccination will, or will not, reduce the infectivity rates for their own
children, and usually fail to consider how their decision to vaccinate is indirectly related to the
decisions made by other parents. These individual decisions eventually lead to the vaccination
coverage and payoff conditions of all the children, resulting in the culmination of various
individual decisions that dictate the community payoff (Bauch and Earn). While some parents
claim that they “do not feel a moral responsibility to have [their] child get a vaccination that
could make [them] sick in order to protect other children,” others do claim some responsibility
(Parents Speak Out). By modeling these interactions and different payoff options, state
legislatures and school districts can determine what policies would maximize their constituents’
utility. They would take into account the social climate of their districts, the severity of the
disease in question, and the impact of the vaccination on young children to determine what
would be the best policy to implement. By using the basic game that I have created, school
districts and local politicians can manipulate the payoffs to model their constituents’ beliefs and
come up with a comprehensive solution to their specific vaccination issues.
 Vaccination ultimately tells us a lot about society. Are we altruistic, selfish, or indifferent
to the climate around us? By vaccinating, society can begin to pay their dues forward.
Vaccinating young people not only gives the youth protection against some diseases, but it also
protects the elderly from having to subject themselves to vaccinations for which their immune
systems are more sensitive. By understanding this cycle, people can devise their own payoffs and
understand that if they get vaccinated in their youth, when they are elderly, hopefully others will
continue the trend in order to protect them. This system of “paying it forward” allows society to
follow a utilitarian and altruistic path which can be beneficial when preserving the stability of a
community. By understanding the theory behind vaccination, new policies can be implemented
and our society can come to learn that a utilitarian model of vaccination can actually be
beneficial for every individual in the future.
 WORKS CITED

Bauch, Chris and David Earn. “Vaccination and the Theory of Games.” Proceedings of the
National Academy of Sciences of the United States of America. 7 Sep. 2004.
https://www.pnas.org/content/pnas/101/36/13391.full.pdf

Chapman, Gretchen. “Using Game Theory to Examine Incentives in Influenza Vaccination

Behavior.” Psychological Science, vol. 23, no. 9, Sept. 2012.
https://journals.sagepub.com/doi/pdf/10.1177/0956797612437606

Ibuka, Yoko. “Free-Riding Behavior in Vaccination Decisions: An Experimental Study.” PLOS.

24 Jan. 2014. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0087164

“Immunization.” World Health Organization, World Health Organization, 18 July 2019.

https://www.who.int/news-room/facts-in-pictures/detail/immunization

Liu, Jingzhou. “Epidemiological Game-Theory Dynamics of Chickenpox Vaccination in the

USA and Israel.” Journal of the Royal Society Interface. 1 June. 2011.
https://royalsocietypublishing.org/doi/pdf/10.1098/rsif.2011.0001

“Parents Speak Out: Why we don’t vaccinate our children.” Anderson Cooper 360.
https://www.cnn.com/videos/health/2015/02/04/ac-dnt-tuchman-why-we-dont-vaccinate.
cnn

Salmon, David. “Compulsory Vaccination and Conscientious or Philosophical Exemptions: Past,

Present, and Future.” The Lancet, vol. 367, no. 9508, 4-10 Feb. 2006.
https://www.sciencedirect.com/science/article/pii/S0140673606681440
 REFLECTION

I originally chose this topic because I wanted to explore the topic of herd immunity. I
always found it strange as to why we, as a society, usually fail to achieve herd immunity in the
outbreaks of most diseases. From my perspective, it seems like the most logical decision is to get
vaccinated, not just in the name of the common good, but also because I can prevent myself from
developing severe symptoms from the disease. However, I know that this is not the case for all
people, as beliefs about vaccines vary greatly. I thought that exploring this subject would allow
me to explore the different ideals of people while also allowing me to gain some more
knowledge in the field of my major. If I choose to continue my course of study into the
workforce, then I will be working in some kind of Public Health or Global Health field. By
understanding the incentives, ideals and beliefs of a variety of people, I will be better equipped to
serve various communities and their vaccination needs.
I also chose this topic because vaccination has increased in prevalence in popular news
and social media. From the eyes of an observer, these internet debates seem to be extremely
polarized, with people adamantly arguing for their side. Arguments then get blown out of
proportion, and the whole idea of vaccination tends to get distorted. While this is what catches
the eye of most people, I wanted to understand why people make the decisions they do,
especially the people that fall into the middle of this argument. This is why I decided to draw
some focus to the idea of free-riding behavior. These people are not trying to convince others
that their opinions are correct. They are simply taking advantage of a system because they are
sometimes incentivized to. By understanding how this free-riding behavior arose and how our
policies protect it, we can begin to devise new systems that can better maximize the utility of
society as a whole.
As I was reading through some of the studies that tie game theory to vaccination trends, I
was really surprised by their projected Nash equilibriums. One of these studies was trying to
determine how altruistic our society actually is by classifying participants as either elderly or
young people and changing their payoffs accordingly. The results of the experiment were what I
expected, but I was truly surprised by the Nash equilibrium. The researchers had said that the
Nash was where less than 50% of participants in each group would choose to get vaccinated,
with young people getting vaccinated less often than the elderly. This kind of felt wrong to me
because the system was completely individualistic. But even then, some people were risking
their own health, and therefore utility, by not getting vaccinated. So, if we all played strictly
according to game theory logic, our society would have a much lower vaccination rate than we
have now. This struck me because I would have originally guessed that a Nash equilibrium for a
study like this one would be where herd immunity is reached, and a majority of people get
vaccinated. However, after reading more studies and gaining a better grasp on the subject, my
perspective changed as I began to see that for some people, the loss of utility that comes with
getting a vaccination outweighs the benefits that come with it.
 Through this project, I was able to broaden my perspective. By trying to create my own
game, I became more sensitive to the utility losses that some people endure when getting
immunized. I was also able to hear and read more about the beliefs of people that choose not to
vaccinate. Although this was not the first time that I had heard their arguments, I was able to
rationalize them into game theory by understanding why they did not feel incentivized to get
vaccinated. All of these ideas and applications allowed me to understand the depth of the topic of
vaccination, encouraged me to broaden my perspective, and will hopefully help me to create
change in the future.
Overall, I think that most people need to be more informed about vaccination. Everyone
is usually set in their own opinion and fail to see the logic in the other side. But, I think that
vocal supporters of vaccination, anti-vaxxers and politicians especially need to understand the
game theory behind immunization decisions. For those that strongly back one side, they are
never going to create change if they continue their arguments. By understanding incentives and
why people make the decisions the way they do, these promoters can be more efficient in their
policy lobbying and recruitment. For a similar reason, politicians also need to understand the
differing payoffs for their constituents. By understanding their district, state or country,
politicians can work to maximize the utility of their area as a whole by pushing constituents
towards a certain decision. By analyzing their constituents, politicians can also figure out what
methods of disseminating information are most effective. The knowledge of vaccination, game
theory, and how payoffs differ can help to create more constructive conversations in the
immunization debate while also allowing for the brainstorm of concrete and productive policy
ideas.
Another topic that I considered researching was education systems. I was thinking about
focusing on the effects of highly capable programs, and how that changes the learning of
students both in and out of the program. I was drawn to this because I have heard many people
reflect on their elementary, middle and high school education about how being in a “lower” math
or science class impacted their confidence in themselves, and therefore their grades. I wanted to
understand why those distinctions between different capabilities were made and how they
affected the utility of the students in the long run. While I was really excited about this topic, I
struggled to find resources and studies about the subject. After determining that maybe this topic
was a little too niche, I decided to focus on vaccination as it also involved delving into human
nature and variable payoffs of affected parties.