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J Theor Biol. 2020 Jan 21;485:110028. doi: 10.1016/j.jtbi.2019.110028. Epub 2019 Sep 28.

Cost effectiveness and policy announcement: The case of measles mandatory vaccination.

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University of Lyon, Lyon, F-69007, France; CNRS, GATE Lyon Saint-Etienne, F-69130, France. Electronic address:
University of Lyon, École centrale de Lyon, France; CNRS UMR 5208, Institut Camille Jordan, 36 avenue Guy de Collongue, F-69134 Ecully Cedex, France. Electronic address:


In a vaccination game, individuals respond to an epidemic by engaging in preventive behaviors that, in turn, influence the course of the epidemic. Such feedback loops need to be considered in the cost effectiveness evaluations of public health policies. We elaborate on the example of mandatory measles vaccination and the role of its anticipation. Our framework is a SIR compartmental model with fully rational forward looking agents who can therefore anticipate on the effects of the mandatory vaccination policy. Before vaccination becomes mandatory, parents decide altruistically and freely whether to vaccinate their children. We model eager and reluctant vaccinationist parents. We provide numerical evidence suggesting that individual anticipatory behavior may lead to a transient increase in measles prevalence before steady state eradication. This would cause non negligible welfare transfers between generations. Ironically, in our scenario, reluctant vaccinationists are among those who benefit the most from mandatory vaccination.


Backward induction; Behavior; Game theory; MMR; Vaccination; Vaccination game; Vaccination policy


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