The Vaccinee's Dilemma: Individual-level Decisions, Self- Organization&Influenza Epidemics

1 Inspired by Minority Games, we constructed a novel individual-level game of adaptive decision-making based on the dilemma of deciding whether to participate in voluntary influenza vaccination programs. The proportion of the population vaccinated (i.e., the vaccination coverage) determines epidemic severity. Above a critical vaccination coverage, epidemics are prevented; hence individuals find it unnecessary to vaccinate. The adaptive dynamics of the decisions directly affect influenza epidemiology and, conversely, influenza epidemiology strongly influences decision-making. This feedback mechanism creates a unique self-organized state where epidemics are prevented. This state is attracting, but unstable; thus epidemics are rarely prevented. This result implies that vaccination will have to be mandatory if the public health objective is to prevent influenza epidemics. We investigated how collective behavior changes when public health programs are implemented. Surprisingly, programs requiring advance payment for several years of vaccination prevents severe epidemics, even with voluntary vaccination. Prevention is determined by the individuals' adaptability , memory, and number of prepaid vaccinations. Notably, vaccinating families exacerbates and increases the frequency of severe epidemics.