The uproar over the flu vaccine shortage raises interesting questions about how our society allocates resources for such important goods. Before examining government vaccine policies, however, think about human behavior related to vaccinations.
Flu is serious. Even when vaccine supplies are sufficient so that everyone who wants a flu shot gets one, the disease kills more than 30,000 people a year. This is roughly the same as annual U.S. traffic deaths or battle deaths in the Korean War. Episodically, an especially virulent strain can kill millions worldwide, as in the 1918 epidemic that killed my grandmother.
Despite such death tolls, the majority of U.S. residents do not get annual vaccinations. I have gotten one only four or five times since they became widely available decades ago. Why do people take such chances?
The answer is that many people don’t feel they are taking a large risk. Most flu deaths hit the very old or the very young. Otherwise healthy teenagers or adults seldom die of flu. Just as murders don’t alarm many people as long as they occur in some “other part of town,” flu deaths don’t scare us if they largely affect age cohorts other than our own.
Moreover, flu is a common disease. Most of us have survived multiple cases of it with some discomfort and loss of work or study time, but no lasting harm. Apparently, many are fatalistic, assuming they are going to get a cold or the flu in any case.
Thus, people do not bother to take steps such as getting vaccinated or washing hands frequently, which might minimize their chance of infection. This agrees with research showing people tend to discount familiar risks such as auto accidents and overestimate unfamiliar ones such as airplane crashes.
The fact that the flu vaccine prepared in any year is not effective against all possible flu strains — and that a new injection is required each flu season — also decreases demand for the shots. When contemplating any medical treatment, people take out-of-pocket costs into account as well as any discomfort and the time spent in getting the treatment.
The time and nuisance effect of waiting are often more important deterrents to getting treatment for nonserious problems than the monetary cost. When there is doubt about the efficacy of the treatment, people are much less willing to spend the time.
If all the costs and benefits of flu vaccinations affected only the individual concerned, there would be little need for government action.
But this is not the case. There are important external effects in common communicable diseases.
The benefits of vaccinations for such diseases extend beyond the specific individuals who get shots. The higher the proportion of the population vaccinated, the harder it is for an epidemic to spread and thus the lower the probability that others who are not vaccinated get the disease.
This external benefit of “population immunity” may justify government action to increase vaccination rates. What actions are most appropriate is another question.
© 2004 Edward Lotterman
Chanarambie Consulting, Inc.