Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

On the benefits of explaining herd immunity in vaccine advocacy

Nature Human Behaviour volume 1, Article number: 0056 (2017) Cite this article

Subjects

Abstract

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.

The concept of herd immunity requires a deeper understanding of disease transmission and vaccinations — an understanding of the fact that the vaccine reduces not only the probability of infection, but also the likelihood of spreading the disease to others2. The more individuals who are vaccinated, the higher the indirect protection for non- or under-vaccinated individuals in the community, such as babies who are too young for vaccinations, or immune-compromised patients who cannot be vaccinated. On their website, the US Centers for Disease Control and Prevention (CDC), for example, only briefly mention the concept of herd immunity, providing a link to an external site that offers an interactive simulation4. Other forms of publications are similarly silent about herd immunity, such as the CDC’s Parents’ Guide to Childhood Vaccinations5, which marginally refers to herd immunity only in the glossary and when explaining why schools require vaccinations. Thus, although herd immunity is crucial for the elimination of infectious diseases, its complexity and explicit relationship to health politics cause it to remain under-explained and under-used in vaccine advocacy. Additionally, understanding the concept of herd immunity might invite free-riding, based on the idea that it is individually rational to opt out and save costs (such as time, money or adverse events), given that a sufficiently large part of society takes up vaccination and builds up herd immunity6–8. Free-riding occurs when the individual intention to vaccinate declines, given generally high vaccine uptake in the community.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Learn more

Prices may be subject to local taxes which are calculated during checkout

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).

Similar content being viewed by others

References

  1. Fine, P., Eames, K. & Heymann, D. L. ‘Herd immunity’: a rough guide. Clin. Infect. Dis. 52, 911–916 (2011).

    Article  Google Scholar 

  2. Anderson, R. M. & May, R. M. Vaccination and herd immunity to infectious diseases. Nature 318, 323–329 (1985).

    Article  CAS  Google Scholar 

  3. Shim, E., Chapman, G. B., Townsend, J. P. & Galvani, A. P. The influence of altruism on influenza vaccination decisions. J. R. Soc. Interface 9, 2234–2243 (2012).

    Article  Google Scholar 

  4. Herd immunity. The History of Vaccineshttp://www.historyofvaccines.org/content/herd-immunity-0 (2016).

  5. Parents’ Guide to Childhood Immunizations (Centers for Disease Control and Prevention, 2015); http://www.cdc.gov/vaccines/pubs/parents-guide

  6. Bauch, C. T., Galvani, A. P. & Earn, D. J. D. Group interest versus self-interest in smallpox vaccination policy. Proc. Natl Acad. Sci. USA 100, 10564–10567 (2003).

    Article  CAS  Google Scholar 

  7. Vietri, J. T., Li, M., Galvani, A. P. & Chapman, G. B. Vaccinating to help ourselves and others. Med. Decis. Mak. 32, 447–458 (2012).

    Article  Google Scholar 

  8. Böhm, R., Betsch, C. & Korn, L. Selfish-rational non-vaccination: experimental evidence from an interactive vaccination game. J. Econ. Behav. Organ. 131, 183–195 (2016).

    Article  Google Scholar 

  9. Betsch, C., Böhm, R. & Chapman, G. B. Using behavioral insights to increase vaccination policy effectiveness. Policy Insights Behav. Brain Sci. 2, 61–73 (2015).

    Article  Google Scholar 

  10. Fischoff, B., Brewer, N. T. & Downs, J. Communicating Risks and Benefits: An Evidence-Based User’s Guide (FDA, 2011); http://www.fda.gov/ScienceResearch/SpecialTopics/RiskCommunication/default.htm

    Google Scholar 

  11. Au, W. T. & Kwong, J. Y. Y. in Contemporary Psychological Research on Social Dilemmas (eds Suleiman, R., Budescu, D., Fischer, I. & Messick, D. ) 71–98 (Cambridge Univ. Press, 2004).

    Google Scholar 

  12. Murphy, R. O. & Ackermann, K. A. Social value orientation: theoretical and measurement issues in the study of social preferences. Pers. Soc. Psychol. Rev. 18, 13–41 (2014).

    Article  Google Scholar 

  13. McClintock, C. G. & Allison, S. T. Social value orientation and helping behavior. J. Appl. Soc. Psychol. 19, 353–362 (1989).

    Article  Google Scholar 

  14. Hofstede, G. Culture’s Consequences: Comparing Values, Behaviors, Institutions and Organizations across Nations (Sage, 2001).

    Google Scholar 

  15. Triandis, H. C. & Gelfand, M. J. Converging measurement of horizontal and vertical individualism and collectivism. J. Pers. Soc. Psychol. 74, 118–128 (1998).

    Article  Google Scholar 

  16. Oyserman, D., Coon, H. M. & Kemmelmeier, M. Rethinking individualism and collectivism: evaluation of theoretical assumptions and meta-analyses. Psychol. Bull. 128, 3–72 (2002).

    Article  Google Scholar 

  17. Markus, H. R. & Kitayama, S. Culture and the self: implications for cognition, emotion, and motivation. Psychol. Rev. 98, 224–253 (1991).

    Article  Google Scholar 

  18. Thomson, A. & Watson, M. Listen, understand, engage. Sci. Transl. Med. 4, 138ed6 (2012).

    Article  Google Scholar 

  19. Reyna, V. F. Risk perception and communication in vaccination decisions: a fuzzy-trace theory approach. Vaccine 30, 3790–7 (2012).

    Article  Google Scholar 

  20. Hofstede, G. H. Cultural Dimensions (2016); https://geert-hofstede.com/cultural-dimensions.html

  21. Aiken, L. S., West, S. G. & Reno, R. R. Multiple Regression: Testing and Interpreting Interactions (Sage, 1991).

  22. Gross National Income per Capita 2015, Atlas Method and PPP (World Bank, 2015); http://databank.worldbank.org/data/download/GNIPC.pdf

  23. Tuberculosis Case Detection Rate (%, All Forms) (World Bank, 2016); http://data.worldbank.org/indicator/SH.TBS.DTEC.ZS

  24. State of Vaccine Confidence 2016: global Insights through a 67-Country Survey. The Vaccine Confidence Projecthttp://www.vaccineconfidence.org/we-are-pleased-to-announce-the-publication-ofthe-state-of-vaccine-confidence-2016/ (2016).

  25. Hayes, A. F. Introduction to Mediation, Moderation, and Conditional Process Analysis 3–4 (Guilford, 2013).

  26. Chen, R. T. Vaccine risks: real, perceived and unknown. Vaccine 17, S41–S46 (1999).

    Article  Google Scholar 

  27. Roush, S. W. & Murphy, T. V. Historical comparisons of morbidity and mortality for vaccine-preventable diseases in the United States. J. Am. Med. Assoc. 298, 2155–2163 (2007).

    Article  CAS  Google Scholar 

  28. Omer, S. B., Salmon, D. A., Orenstein, W. A., DeHart, M. P. & Halsey, N. Vaccine refusal, mandatory immunization, and the risks of vaccine-preventable diseases. N. Engl. J. Med. 360, 1981–1988 (2009).

    Article  CAS  Google Scholar 

  29. Deterding, S., Dixon, D., Khaled, R. & Nacke, L. From game design elements to gamefulness. In Proc. 15th Int. Academic MindTrek Conf. Envisioning Future Media Environments 9–15 (ACM, 2011).

  30. Deterding, S. Gamification: designing for motivation. Interactions 19, 14–17 (2012).

    Article  Google Scholar 

  31. Gorodnichenko, Y. & Roland, G. in Institutions and Comparative Economic Development (eds Aoki, M., Kuran, T. & Roland, G. ) 213–236 (Palgrave Macmillan, 2012); http://dx.doi.org/10.1057/9781137034014_12

    Book  Google Scholar 

  32. Talhelm, T. et al. Large-scale psychological differences within China explained by rice versus wheat agriculture. Science 344, 603–608 (2014).

    Article  CAS  Google Scholar 

  33. Betsch, C. et al. Improving medical decision making and health promotion through culture-sensitive health communication: an agenda for science and practice. Med. Decis. Making 36, 811–833 (2016).

    Article  Google Scholar 

  34. Sheeran, P. Intention–behavior relations: a conceptual and empirical review. Eur. Rev. Soc. Psychol. 12, 1–36 (2002).

    Article  Google Scholar 

  35. Lehmann, B. A., Ruiter, R. A. C., Chapman, G. & Kok, G. The intention to get vaccinated against influenza and actual vaccination uptake of Dutch healthcare personnel. Vaccine 32, 6986–6991 (2014).

    Article  Google Scholar 

  36. Hofstede, G. H., Hofstede, G. J. & Minkov, M. Cultures and Organizations: Software of the Mind (McGraw-Hill, 2010).

    Google Scholar 

  37. Betsch, C., Böhm, R., Korn, L. & Holtmann, C. On the Benefits of Explaining Herd Immunity in Vaccine Advocacy (OSF, 2017); https://osf.io/9a7sb/

Download references

Acknowledgements

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.

Author information

Authors and Affiliations

  1. Center for Empirical Research in Economics and Behavioral Sciences, University of Erfurt, Nordhäuser Straße 63, Erfurt, 99089, Germany

    Cornelia Betsch, Lars Korn & Cindy Holtmann

  2. Media and Communication Science, University of Erfurt, Nordhäuser Straße 63, Erfurt, 99089, Germany

    Cornelia Betsch & Lars Korn

  3. School of Business and Economics, RWTH Aachen University, Templergraben 64, Aachen, 52062, Germany.

    Robert Böhm

Authors
  1. Cornelia Betsch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert Böhm
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lars Korn
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cindy Holtmann
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

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.

Corresponding author

Correspondence to Cornelia Betsch.

Ethics declarations

Competing interests

The authors declare no competing interests.

Supplementary information

Supplementary Information

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

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Betsch, C., Böhm, R., Korn, L. et al. On the benefits of explaining herd immunity in vaccine advocacy. Nat Hum Behav 1, 0056 (2017). https://doi.org/10.1038/s41562-017-0056

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1038/s41562-017-0056

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing