Immunization for herd immunity?

Measles is on the rise

Check out this short advertisement that supports childhood immunizations: http://www.businessinsider.com/anti-vaxxers-vaccinate-kids-measles-2015-1.  The video clip is rather edgy, but the point is clear.  With dropping vaccination rates, there is risk for a measles epidemic as we get below the threshold for “herd immunity.”  Herd immunity is the benefit that a group receives from the majority of group being immunized.  When a community benefits from herd immunity, basically there aren’t enough “at risk” people for the disease to take hold.

The video clip also explores the decision using game theory.  The risk/benefit ratio of the decision to vaccinate depends on size of the sphere that is being considered (family vs. community).

Measles Cases with decreased immunization

Influenza Vaccination

This is another contentious issue with some people.  Many hospitals require the physicians and staff to be immunized.  But even with it being “required” there are ways to opt-out: signing a form, watching a short video on the risks of infection, etc.  Virginia Mason in Seattle went a step futher, and had excellent immunization rates (Transforming Healthcare, by Gary Kaplan, MD).  They required all staff that weren’t immunized against influenza to wear a mask for the entirety of flu season.  This was even supported by a legal challenge, and was upheld due to the risk of infecting other staff/patients with influenza.  As this relates to game theory, the costs of not being immunized was increased due to the organization requiring the employee to wear a mask.

Organ donation

Some countries have very different rates of organ donation.  After rigorous study, Nobel Laureate, Daniel Kahneman, found an interesting point.  Countries that required the citizens to “check a box” to become organ donors had rates in the 10-25% range, while countries that had a box to “opt-out” had 75-90% organ donation rates.  In each scenario most people didn’t “check the box.”  Simply reframing the question in a slightly different way can lead to markedly different results.

Take home point to improve immunization rates…

People are more likely to affirm a positive response when asked a question.  Therefore if you want someone to do a task for you, you should ask, “Would you like to do xxxx?” as opposed to asking the negative, “You don’t want to do xxxx, right?” In either scenario, the response is more likely to be affirmed.

This also relates to our medical roles and working to educate parents on immunizations.  If we ask “You want immunizations today, right” they are more likely to answer yes than asked in the opposite manner. People that are strongly against the immunizations won’t acquiesce, but you will still improve your immunization rates.  Lastly it is important not to be confrontational with parents that aren’t in favor of vaccines as this will bring an emotional component to the discussion, and only solidify their stance in not getting them.