Long-standing influenza vaccination policy is in accord with individual self-interest but not with the utilitarian optimum

Influenza vaccination is vital for reducing infection-mediated morbidity and mortality. To maximize effectiveness, vaccination programs must anticipate the effects of public perceptions and attitudes on voluntary adherence. A vaccine allocation strategy that is optimal for the population is not necessarily optimal for an individual. For epidemic influenza, the elderly have the greatest risk of influenza mortality, yet children are responsible for most of the transmission. The long-standing recommendations of the Centers for Disease Control follow the dictates of individual self-interest and prioritize the elderly for vaccination. However, preferentially vaccinating children may dramatically reduce community-wide influenza transmission. A potential obstacle to this is that the personal utility of vaccination is lower for children than it is for the elderly. We parameterize an epidemiological game-theoretic model of influenza vaccination with questionnaire data on actual perceptions of influenza and its vaccine to compare Nash equilibria vaccination strategies driven by self-interest with utilitarian strategies for both epidemic and pandemic influenza. Our results reveal possible strategies to bring Nash and utilitarian vaccination levels into alignment.