Vaccines exist not only to prevent disease to the individual getting vaccinated but also to prevent the spread of disease. When someone is vaccinated that is one fewer person to spread the disease. I benefit if my neighbor gets vaccinated since I have decreased chance of becoming infected when I go see them. Therefore, even if a non-priority group receives the vaccine there is a decreased chance for others to contract the disease. This positive externality associated with vaccines is often called “herd immunity” [1]. If disease weren’t contagious, we may draw better comparisons here with a water shortage.

Furthermore, vaccines are not quantitative in regards to the individual. For instance, I gain very little by getting two vaccines in comparison to one. Therefore, we won’t see people stock piling vaccines for better immunity when we see shortages, whereas, in the case of water, great quantities are needed throughout our daily lives. The average person has 42L of water in their body; 60% of their total body weight. It makes sense that we are naturally selfish when it comes to water since the quantity we possess correlates to our health and well-being.

While a pricing system is almost always the most logical way to proceed, we may see otherwise here. While a free market may in fact satisfy the individual willingness to pay, we will fall short of the target for society. Society’s willingness to pay should be higher due to herd immunity. In a market the private individual will not feel society’s willingness to pay, and thus fewer people will be vaccinated resulting in a lower than optimal social benefit.

Overall, I see very little analogy to water shortage with vaccine shortages; however, I do see connections to a shortage of military personnel during times of war. More thought on this would be interesting.

In medicine we try to minimize the negative consequences starting with the most severe (death from disease) and then prevent what we can from there. We accomplish this by targeting the “priority” groups (old, sickly, healthcare workers), that is those people at greatest risk of death from disease and those people that could potentially spread disease to the “death risk” individuals. Therefore, we want to vaccinate those with the highest economic costs and those that would contribute the greatest to spread. From an economic standpoint, we might argue that those people facing the high economic costs would have a high willingness to pay, and the free market will drive all to equilibrium. However, the healthcare field is filled with asymmetries. The patients that most health experts would consider at high risk of complications may not know they are. On the same note, they may not be able to afford to pay for a vaccine if it were not subsidized. In short, those who most “need” the vaccine will not always be those who want it, leading to a less than optimal social benefit and likely decreased herd immunity (since the effect of herd immunity is not felt by the individual). Vaccinating the optimal number of people and targeting those at high risks can be difficult, but we do so by compulsion and subsidies.

Compulsion will indeed bring into play some costs to individuals who prefer not to vaccinate for religious or personal beliefs, or those who see negative health consequences from the vaccine itself. This seems to be the more heavily debated topic of the day. Consider this hypothetical: Nurse X refuses flu vaccination because she feels it infringes upon her personal freedoms. Nurse X contracts the flu, which could have otherwise been prevented. Nurse X comes in contact with thirty patients, four of which contract swine flu. Patient Y, one of the four that contracted the disease, dies due to complications. Does the cost of infringement upon Nurse X’s personal beliefs outweigh the cost of Patient Y’s life? These are the potential situations that trigger spite towards those healthcare workers refusing vaccination.

By now I’ve spent enough time worrying about the economic consequences of contagious disease and vaccination. I must get back to studying pulmonary physiology. I welcome and look forward to your comment. Thank you.

[1] Phelps, CE. Health Economics. 3rd Edition. pp. 471-474.