Impact of Vaccine Behavior on the Resurgence of Measles

  • Eunha Shim
  • John J. Grefenstette
  • Steven M. Albert
  • Brigid E. Cakouros
  • Larissa Bohn
  • Donald S. Burke


Widespread avoidance of the measles-mumps-rubella vaccination (MMR) demonstrates that the effectiveness of vaccination programs can be thwarted by public misperceptions of vaccine risk. By coupling game theory and epidemic models, we examine vaccination choice among populations stratified into vaccine skeptics and vaccine believers. The two behavioral groups are assumed to be heterogeneous with respect to their perceptions of vaccine and infection risks. We demonstrate that the pursuit of self-interest among vaccine skeptics often leads to vaccination levels that are suboptimal for a population, even if complete coverage is achieved among vaccine believers. Furthermore, as the number of vaccine skeptics increases, the probability of infection among vaccine skeptics increases initially, but it decreases once the vaccine skeptics begin receiving the vaccination, if both behavioral groups are vaccinated according to individual self-interest. This research illustrates the importance of public education on vaccine safety and infection risk in order to achieve vaccination levels that are sufficient to maintain herd immunity.


Vaccination Strategy Endemic Equilibrium Herd Immunity Measle Vaccine Measle Vaccination 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We are grateful for the support by the National Institute of General Medical Sciences MIDAS grant 5U54GM088491-02. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.


  1. 1.
    Bauch, C.T. Bhattacharyya, S., Ball, R.F.: PLoS ONE 5(9), e12594 (2010)CrossRefGoogle Scholar
  2. 2.
    Bellman, R.: Dynamic Programming. Princeton University Press, Princeton (1957)MATHGoogle Scholar
  3. 3.
    Berger, B.E., Omer, S.B.: Hum. Vaccin. 6, 1016 (2010)CrossRefGoogle Scholar
  4. 4.
    Bhattacharyya, S., Bauch, C.T.: J. Theor. Biol. 267, 276 (2010)CrossRefGoogle Scholar
  5. 5.
    Centers for Disease Control and Prevention: Measles–United States, January 1-April 25, 2008. MMWR 57, 494–498 (2008)Google Scholar
  6. 6.
    Centers for Disease Control and Prevention: Increased transmission and outbreaks of measles–European Region, 2011. MMWR 60, 1605–1610 (2011)Google Scholar
  7. 7.
    Diekema, D.S.: Pediatrics 115, 1428 (2005)CrossRefGoogle Scholar
  8. 8.
    d’Onofrio, A., Manfredi, P.: J. Theor. Biol. 264, 2, 237 (2010)Google Scholar
  9. 9.
    d’Onofrio, A., Manfredi, P., Poletti, P.: J. Theor. Biol. 273(1), 63 (2011)Google Scholar
  10. 10.
    Fine, P.E.M., Clarkson, J.A.: Amer. J. Epidemiol. 124, 1012 (1986)Google Scholar
  11. 11.
    Godlee, F., Smith, J., Marcovitch, H.: Wakefield’s article linking MMR vaccine and autism was fraudulent. Br. Med. J. 342, c7452 (2011)CrossRefGoogle Scholar
  12. 12.
    Gust, D.A., Strine, T.W., Maurice, E., Smith, P., Yusuf, H., Wilkinson, M., Battaglia, M., Wright, R., Schwartz, B.: Pediatrics 114, e16 (2004)CrossRefGoogle Scholar
  13. 13.
    Manfredi, P., Posta, P.D., d’Onofrio, A., Salinelli, E., Centrone, F., Meo, C., Poletti, P.: Vaccine 28, 98 (2009)Google Scholar
  14. 14.
    Miller, M.A., Redd, S., Hadler, S., Hinman, A.: Vaccine 16(20), 1917 (1998)CrossRefGoogle Scholar
  15. 15.
    Nash, J.F.: Proc. Natl. Acad. Sci. USA 36(1), 48 (1950)MathSciNetMATHCrossRefGoogle Scholar
  16. 16.
    Omer, S.B., Salmon, D.A., Orenstein, W.A., deHart, M.P., Halsey, N.: N. Engl. J. Med. 360 1981 (2009)Google Scholar
  17. 17.
    Parker Fiebelkorn, A., Redd, S.B., Gallagher, K., Rota, P.A., Rota, J., Bellini, W., Seward, J.: J. Infect. Dis. 202, 1520 (2010)CrossRefGoogle Scholar
  18. 18.
    Poland, G.A., Jacobson, R. M.: Vaccine 30(2), 103 (2012)CrossRefGoogle Scholar
  19. 19.
    Reluga, T.: J. Biol. Dyn. 3, 515 (2009)MathSciNetCrossRefGoogle Scholar
  20. 20.
    Shim, E., Grefenstette, J.J., Albert, S.M., Cakouros, B.E., Burke, D.S.: J. Theor. Biol. 295 194 (2012)MathSciNetCrossRefGoogle Scholar
  21. 21.
    Shim, E., Kochin, B., Galvani, A.P.: Math. Biosci. Eng. 6, 841 (2009)MathSciNetCrossRefGoogle Scholar
  22. 22.
    Shim, E., Meyers, L.A., Galvani, A.P.: BMC Public Health. 11, Suppl 1, S4 (2011)Google Scholar
  23. 23.
    Zhou, F., Reef, S., Massoudi, M., Papania, M.J., Yusuf, H.R., Bardenheier, B., Zimmerman, L., McCauley, M.M.: J. Infect. Dis. 189, Suppl 1, S131 (2004)Google Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Eunha Shim
    • 1
  • John J. Grefenstette
    • 2
  • Steven M. Albert
    • 3
  • Brigid E. Cakouros
    • 3
  • Larissa Bohn
    • 4
  • Donald S. Burke
    • 1
  1. 1.Department of Epidemiology, Graduate School of Public HealthUniversity of PittsburghPittsburghUSA
  2. 2.Department of Biostatistics, Graduate School of Public HealthUniversity of PittsburghPittsburghUSA
  3. 3.Department of Behavioral and Community Health Sciences, Graduate School of Public HealthUniversity of PittsburghPittsburghUSA
  4. 4.School of Arts and ScienceUniversity of PittsburghPittsburghUSA

Personalised recommendations