Emergent dynamical features in behaviour-incidence models of vaccinating decisions

Abstract

Vaccination is a cornerstone of infectious disease prevention. However, individual vaccinating behaviour does not always result in population-level vaccine coverage patterns that are optimal for protecting public health. For example, vaccine coverage may fall below the elimination threshold due to nonvaccinators who free-ride on the herd immunity provided by vaccinators. Routine vaccination programs for many paediatric infectious diseases now have an almost worldwide coverage, but vaccine scares fuelled by such behaviours threaten eradication goals. This free-riding behaviour can be seen as a manifestation of policy resistance, where humans respond to an intervention in such a way that tends to undermine the intervention. However, policy resistance is only one such example of the types of dynamics that emerge from the interaction between vaccinating behaviour and disease incidence or prevalence. Here we explore four types of emergent dynamics of behaviour-incidence systems: policy resistance, policy reinforcement, outcome inelasticity, and outcome variability. We discuss examples of each of these dynamics in the behaviour-incidence modelling literature, and suggest potential implications for vaccination policy.