Rolling out the vaccine

Add a comment

By Clare Purser (Bsc Economics & Finance)

In this second instalment of our flu vaccine blog, we move to apply economics in relation to  increasing care home staff flu vaccination rates. We investigate a few of the many reasons why care home staff may not receive their flu vaccine including misconceptions and the need for encouragement by a senior figure, and we finish by considering a simple model of uncertainty. But, why is it so important for social care staff to receive the flu vaccine each year? For this flu season, October-March 2020/21, the main reason is simply because the symptoms of the flu and COVID are similar. As such, more care staff being vaccinated against the flu will help to avoid further disruption of the care services.

Challenging misconceptions

With the flu vaccine or any vaccine, there are many misconceptions preventing people from accepting their free flu (or other) vaccine. Some of the main misconceptions of the flu vaccine have been highlighted by Harvard Health (2020):

  1. The flu vaccine will give me the flu
  2. I don’t need to be vaccinated
  3. The flu is just a bad cold
  4. You can’t spread the flu if you are asymptomatic (no symptoms)
  5. You don’t need to flu jab every year

There are a few cognitive biases (systematic errors in thinking) that can be attributed to these misconceptions, including:

  • Selection bias- People tend to notice something more because they have been made aware of it. For example, a family member having the flu after being vaccinated leading to others believing that the vaccine gave the person the flu.
  • Continued influence effect- People believe misinformation even after being discredited. A famous example is the MMR vaccine being linked to autism.

The simplest way to reduce the selection bias is for the government to release a consistent flow of accurate information surrounding these common misconceptions.

But, what about the continued influence effect? From the example of the MMR vaccine, it seems that the most effective method would be to stop the spread via social media and the news before it is too late. The effect of the report linking the MMR vaccine to autism by Andrew Wakefield 1998 has been described as “the most damaging medical hoax of the last 100 years” (Flaherty, 2011). It has taken the UK government many years to improve coverage of the MMR vaccine which plummeted to 80% in 2003/4 compared to 92% in 1995, and according to NHS digital 2019/2020 rates are up at 90.3%, which is still below the 95% herd immunity level estimated by WHO. As such, it seems the best option for the government is to prevent this misinformation from being revealed in the first place. The only solution to such a bias seems to be time, time for the information to be forgotten/unknown by future generations.

Leading by example

Authority figures leading by example can help rally more people to accept their vaccines, and sends a message that they consider the vaccine to be safe. A prime example of this in recent times is when senior members of the royal family revealed they received their COVID vaccines in January and February 2021. To support this, a YouGov study in November 2020 found that 21% of all Britons were unwilling to have the COVID vaccine and of that cohort, 10% wanted to wait and see if the COVID vaccine is safe first.

This idea of leading by example can be linked back to behavioural economics through authority bias. This is where people are more likely to follow the actions of an authority figure. This concept can be readily applied to care home flu vaccine uptake with care home managers publicising the fact that they have received their flu vaccination to staff members.

The main issue with this is that it can be misinterpreted: in the case of COVID, it was reported that the executive team at University Hospitals Birmingham were given the vaccine before the frontline workers and this was described as a scandal by the Independent. To make such a policy work it needs to be planned and should be done at a suitable time where the workers see the vaccination as setting an example, not jumping the queue.

Incentives

From our previous blog and the problem of herd immunity as a public good and the free-riding effect, there is a need for strong incentives to encourage care staff to accept their free flu jab. Currently, with the COVID jab some care homes are enforcing a ‘no jab, no job’ policy however, there is still much debate over this.

To apply economics to the concept of flu jab incentives, we attempt to model it in a simple format considering uncertainty and risk. In the scenario, we do not include the assumption of the ‘no jab, no job’ policy because, while the flu jab is of increased importance due to the similarities in the symptoms for the flu and COVID, as we pointed out earlier, there is much debate over this policy. However, some care homes such as Barchester Healthcare and Care UK, both of which are large care home chains have stated that they will not hire recruits who refuse the COVID vaccine (Beioley et al., 2021; Roach, 2021).

Hypothetical scenario- all figures and probabilities are hypothetical

In this hypothetical scenario, we consider the tangible negative payoffs of having/not having the flu jab. We assume that there are some risks of the flu jab such as having a sore arm, bad side effects and catching the flu, as it is not 100% effective. For simplicity, we assume that the individuals are risk-neutral such that their utility function is linear.

  • The cost of catching the flu is on average for care home staff £487.50 which we have taken from the previous blog post, and the 40% probability of still catching the flu has come from the estimated flu vaccine efficacy from the CDC.
  • The cost of mild side effects such as a sore arm or slight flu-like symptoms are very common and is very subjective. We place the cost at £2 for pain medication such as ibuprofen and paracetamol. The probability of such mild side effects is approximately 65% according to the CDC.
  • The cost of serious side effects from the flu jab a much greater, to estimate the costs we consider the costs of an anaphylaxis shock as this is one of the main causes of serious complications (but not the only one). The cost of an anaphylaxis shock is approximated to be £700 with complications and comorbidities and a one-night hospital stay (Nice, 2014). The estimated probability of such events is close to 1 in a million according to Trombetta et al. (2017).

The expected disutility from receiving the vaccine is less than not receiving the vaccine such that in our model a rational individual would accept the flu vaccine. So why do many care home staff not have the flu vaccine? This is partly due to the cognitive biases discussed earlier which are examples of the additional non-tangible costs adding disutility to receiving the jab. The hypothetical scenario has shown that when we are to eliminate these additional costs that only have an expected payoff due to systematic errors, flu vaccine uptake amongst social care staff and society can increase.

Conclusion

There are many potential policies the government could introduce to increase flu vaccine uptake amongst care home staff. What we have covered in this blog is just the start and clearly, trial and error will help to determine which changes are the most effective in increasing vaccine uptake. Certainly, many lessons can and have been learnt from the COVID vaccine drive that has been taking place to increase uptake. Overall, perception of the vaccine is one of the biggest areas that should be focused on as perceptions can change when exposed to facts and figures leading to changes in the expected disutility of receiving the flu vaccine.

Bibliography

  1. Beioley, K., Parker, G., Strauss, D., Hancock, A. and Venkataramakrishnan, S., 2021. UK companies look to make Covid-19 vaccinations mandatory. Financial Times, [online] Available at: <https://www.ft.com/content/965dfaf0-f070-4dae-93a6-28bedbdb75da&gt; [Accessed 2 March 2021].
  2. CDC. 2020. Vaccine Effectiveness: How Well Do the Flu Vaccines Work? | CDC. [online] Available at: <https://www.cdc.gov/flu/vaccines-work/vaccineeffect.htm&gt; [Accessed 2 March 2021].
  3. Drury, C., 2020. Fury after hospital bosses given coronavirus vaccine ahead of front line medics. [online] The Independent. Available at: <https://www.independent.co.uk/news/uk/home-news/coronavirus-vaccination-university-hospitals-birmingham-b1778031.html&gt; [Accessed 9 February 2021].
  4. Flaherty, D., 2011. The Vaccine-Autism Connection: A Public Health Crisis Caused by Unethical Medical Practices and Fraudulent Science. Annals of Pharmacotherapy, 45(10), pp.1302-1304.
  5. GOV.UK. 2021. Measles, mumps, rubella (MMR): use of combined vaccine instead of single vaccines. [online] Available at: <https://www.gov.uk/government/publications/mmr-vaccine-dispelling-myths/measles-mumps-rubella-mmr-maintaining-uptake-of-vaccine&gt; [Accessed 9 February 2021].
  6. Harvard Health., 2020. 10 Flu Myths – Harvard Health. [online] Harvard Health. Available at: <https://www.health.harvard.edu/diseases-and-conditions/10-flu-myths&gt; [Accessed 9 February 2021].
  7. NHS Digital. 2021. Statistics published for all routine childhood vaccinations in England in 2019-20 – NHS Digital. [online] Available at: <https://digital.nhs.uk/news-and-events/news/childhood-vaccination-coverage-statistics&gt; [Accessed 9 February 2021].
  8. Nice. 2014. Costing statement: Drug allergy: diagnosis and management of drug allergy in adults, children and young people. [online] Available at: <https://www.nice.org.uk/guidance/cg183/resources/costing-statement-pdf-193155805&gt; [Accessed 2 March 2021].
  9. Roach, A., 2021. Care home company introduces ‘no jab no job’ Covid policy. Evening Standard, [online] Available at: <https://www.standard.co.uk/news/uk/care-home-no-jab-no-job-covid-vaccine-policy-b921162.html&gt; [Accessed 2 March 2021].
  10. Trombetta et al. (2017) Influenza vaccines: Evaluation of the safety profile. Human vaccines & Immuotherapeutics.
  11. YouGov. 2020. How many Britons are willing to take a coronavirus vaccine? | YouGov. [online] Available at: <https://yougov.co.uk/topics/health/articles-reports/2020/11/16/how-many-britons-are-willing-take-coronavirus-vacc&gt; [Accessed 9 February 2021].

Banner Photo by Macau Photo Agency on Unsplash

Leave a Reply