Rapid Emergence of Free-Riding Behavior in New Pediatric Immunization Programs 英文参考文献.docVIP

RapidEmergenceofFree-RidingBehaviorinNew PediatricImmunizationPrograms ChrisT.Bauch1*,SamitBhattacharyya1,RobertF.Ball2 1DepartmentofMathematicsandStatistics,UniversityofGuelph,Guelph,Ontario,Canada,2OfficeofBiostatisticsandEpidemiology,CenterforBiologicsEvaluationand Research,UnitedStatesFoodandDrugAdministration,Rockville,Maryland,UnitedStatesofAmerica Abstract Background: Mathematical models have formalized how free-rider effects can threaten the stability of high vaccine coveragelevelsunderestablishedvoluntaryvaccinationprograms.However,littleresearchhasaddressedthequestionof whenfree-ridingbeginstodevelopwhenanewvaccineisfirstintroducedinapopulation. Methodology/Principal Findings: Here, we combine a game theoretical model of vaccinating behavior with an age- structured compartmental model to analyze rational vaccinating behavior in the first years of a universal immunization program,whereanewvaccineisfreetoallchildrenofaspecifiedage.Themodelcaptureshowsuccessivebirthcohorts face differentepidemiological landscapes thathavebeenshapedby thevaccinating decisions ofprevious birth cohorts, resulting in astrategic interaction between individuals in different birth cohorts. The model predicts a Nash equilibrium coveragelevelof100%forthefirstfewbirthcohortsunderthenewprogram.However,free-ridingbehavioremergesvery quickly, with the Nash equilibrium vaccine coverage dropping significantly within 2-5 years after program initiation. Subsequently,arichsetofcoupleddynamicsbetweeninfectionprevalenceandvaccinatingbehaviorsispossible,ranging fromrelativelystable(butreduced)coverageinlaterbirthcohortstowidefluctuationsinvaccinecoveragefromonebirth cohorttothenext.Individualtoleranceforvaccineriskalsostartsoutatrelativelyhighlevelsbeforedroppingsignificantly withinafewyears. Conclusions/Significance: These results suggest that even relatively new immunization programs can be vulnerable to dropsinvaccinecoveragecausedbyvaccinescaresandexacerbatedbyherdimmunityeffects,necessit