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On the benefits of explaining herd immunity in vaccine advocacy


Most vaccines protect both the vaccinated individual and the community at large by building up herd immunity. Even though reaching disease-specific herd immunity thresholds is crucial for eliminating or eradicating certain diseases1,2, explanation of this concept remains rare in vaccine advocacy3. An awareness of this social benefit makes vaccination not only an individual but also a social decision. Although knowledge of herd immunity can induce prosocial vaccination in order to protect others, it can also invite free-riding, in which individuals profit from the protection provided by a well-vaccinated society without contributing to herd immunity themselves. This cross-cultural experiment assesses whether people will be more or less likely to be vaccinated when they know more about herd immunity. Results show that in cultures that focus on collective benefits, vaccination willingness is generally higher. Communicating the concept of herd immunity improved willingness to vaccinate, especially in cultures lacking this prosocial cultural background. Prosocial nudges can thus help to close these immunity gaps.

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Figure 1: Detail from the interactive herd immunity simulation used in the study.
Figure 2: Communicating herd immunity has an overall positive effect on vaccination intention against the less contagious disease in western countries with individualistic cultural backgrounds.
Figure 3: The intention to be vaccinated against the less contagious disease increases when the concept of herd immunity is communicated, particularly in the interactive simulation condition.
Figure 4: Risks associated with diseases (solid lines, lifetime incidence in unvaccinated individuals) and vaccination (horizontal dotted line).

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Funding from the Asia Pacific Alliance for the Control of Influenza (APACI) for C.B. and R.B., as well as from the Excellence Initiative (ZUK II) of the German Research Foundation (DFG) for R.B., is gratefully acknowledged. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. We thank colleagues in the participating countries for support during data collection (W. J. Kim, S. Kim, M. Kim, M. C. van Egmond, D. Thi The, P. K.S. Chan, M. Khanna, K. Sampson and U. Kühnen), especially K. Sampson of APACI for continuous support during all stages of the study. We thank L. Jennings and F. Renkewitz for comments on earlier versions of this manuscript, and K. Eames for support with the epidemiological underpinnings.

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C.B. and R.B. designed the study, analysed the data and wrote the article. L.K. and C.H. assisted in this process and were responsible for data collection and data management.

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Correspondence to Cornelia Betsch.

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The authors declare no competing interests.

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Supplementary Figures 1–2, Supplementary Tables 1–8, Supplementary Note, Supplementary Methods, Supplementary References. (PDF 266 kb)

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Betsch, C., Böhm, R., Korn, L. et al. On the benefits of explaining herd immunity in vaccine advocacy. Nat Hum Behav 1, 0056 (2017).

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