rapid emergence of free-riding behavior in new pediatric immunization programs快速崛起的搭便车行为新的儿童免疫程序.pdfVIP

Rapid Emergence of Free-Riding Behavior in New Pediatric Immunization Programs 1 1 2 Chris T. Bauch *, Samit Bhattacharyya , Robert F. Ball 1 Department of Mathematics and Statistics, University of Guelph, Guelph, Ontario, Canada, 2 Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, United States Food and Drug Administration, Rockville, Maryland, United States of America Abstract Background: Mathematical models have formalized how free-rider effects can threaten the stability of high vaccine coverage levels under established voluntary vaccination programs. However, little research has addressed the question of when free-riding begins to develop when a new vaccine is first introduced in a population. 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, where a new vaccine is free to all children of a specified age. The model captures how successive birth cohorts face different epidemiological landscapes that have been shaped by the vaccinating decisions of previous birth cohorts, resulting in a strategic interaction between individuals in different birth cohorts. The model predicts a Nash equilibrium coverage level of 100% for the first few birth cohorts under the new program. However, free-riding behavior emerges very quickly, with the Nash equilibrium vaccine coverage dropping significantly within 2-5 years after program initiation. Subsequently, a rich set of coupled dynamics between infection prevalence and vaccinating behaviors is possible, ranging from relatively stable (