Kiss me, I’m vaccinated

by on November 12, 2007 at 7:55 am in Economics, Medicine | Permalink

I just had my flu shot.  Please send your checks to my George Mason address.

People who have the flu spread the virus so getting a flu shot not only reduces the probability that I will get the flu it reduces the probability that you will get the flu.  In the language of economics the flu shot creates an external benefit, a benefit to other people not captured by the person who paid the costs of getting the shot.  The external benefits of a flu shot can be quite large.  Under some conditions each person who is vaccinated reduces the expected number of other people who get the flu by 1.5.

Since a large fraction of the benefits of the flu shot, perhaps even a majority of the benefits, go to other people and not to the person paying the costs, the number of people who get a flu shot in the United States is well below the efficient level.  I only got the shot because, as you well know, I’m altruistic.  I care about you.  But do send your checks, that will help.

In lieu of a check I’m thinking of having some buttons made up to encourage people to get their shot.  Here are some possible slogans:

  • Kiss me, I’m vaccinated.
  • Take one for the herd!
  • Get a flu shot.  The life you save may not be your own.

Madison Avenue here I come!

Of course, we know from the Coase Theorem that there is an alternative approach.  We could charge people who do not get their flu shots. (Thus, if you haven’t had a shot you must still must send me a check.)  Or to reduce transaction costs we could fine people who get the flu.  I kind of like that last one.  (But what to do about the 36,000 a year who die from the flu – charge their estates?)

What do you think?  Leave your suggestions/slogans for how to encourage getting a flu shot in the comments.

1 Chris Meisenzahl November 12, 2007 at 8:09 am

>> Take one for the herd!

LOL! 😉

2 Sandy November 12, 2007 at 8:35 am

I’d be all for it if the supply wasn’t so notoriously prone to shortages. The ones who benefit most are the elderly, children, and those with compromised immune systems. So as a rule until I hear that the supply is good in a given year, I hold off.

3 Ned November 12, 2007 at 8:39 am

It’s called herd immunity – a very good way to reduce the spread of infectious diseases.

4 Joe Grossberg November 12, 2007 at 9:18 am

Thank you for doing your part to exacerbate (not cause, natch) vaccine shortages and speed the rate of flu variability.

If you’re not elderly, young, or immune-system-compromised, there’s no need to get vaccinated.

While it isn’t on par with overusing antibiotics, your decision to get vaccinated is not a total “win” for those around you.

5 MostlyAPragmatist November 12, 2007 at 9:20 am

Yes! Flu vaccination should be easy and encouraged for everyone!

I’d like to hear your thoughts about why shortages of vaccine are so common. I’m sure it’s All the Fault of the Government (and the FDA, right, Alex? ;-). But seriously, the two of you regularly surprise me, so I’d love to hear what you think.

6 Scott W November 12, 2007 at 9:36 am

From Darwin’s standpoint, the flu shot has negative externalities for the immunity of future generations. This is not really relevant for older people who will not have anymore kids, but certainly relevant for children who get flu shots. Though, immunity may be less relevant as we figure out how to cure more disease. Nonetheless, with respect to our “herd’s” immunity, we may be getting too many flu shots and be taking too many drugs.

I think “Take one for the herd” can also be a slogan for the anti-flu shot (Darwinian) campaign. “Take one for the herd: don’t get a flu shot. The weak will die off, leaving only a stronger herd.” Due to its ruthlessness, I don’t think this will much catch on.

7 Peter November 12, 2007 at 9:40 am

Would universal flu vaccination really save many lives except on a very short-term basis? If I’m not mistaken – someone please correct me if I am – most of the people who die from the flu already are in pretty bad shape, and would have died soon after even if they hadn’t gotten the flu. In other words, the flu doesn’t so much strike down the healthy, as push the already-dying over the edge. If you balance this against the known risks of the vaccine, universal flu vaccination might not be worthwhile.

8 ZBicyclist November 12, 2007 at 9:53 am

Are you elderly, young, or immune-system compromised?

If not, you’ve likely done something pretty much useless.

Well, not useless. If there’s not a shortage of vaccine, they have to sell it to somebody. Admitting that they have little value for healthy people doesn’t go very far in that direction.

If my employer believes that flu shots are effective, then my employer should provide them for free out of self-interest. For that matter, Humana (the company’s insurance carrier) should be providing them out of self-interest.

9 Biomed Tim November 12, 2007 at 10:38 am

Alex, it wouldn’t be cool to punish people for getting the flu because the flu shot only protects against certain strains of the virus. In other words, one can still get the flu even after getting the shot.

This piece is from a long time ago but you guys might still find it relevant: Why we run out of vaccines

10 lee November 12, 2007 at 10:51 am

Actually my employer has provided free flu shots for 2 years now. It is the first enlightened thing I remember them doing.

11 COD November 12, 2007 at 10:57 am

My wife (who is in a high risk group) gets the shot every year. She drops by the doctor and pays a $10 copay, with the other $80 odd dollars for the office visit being billed to to insurance company. Meanwhile, she could have gotten the shot for a $30 total cost at the grocery store, but the entire $30 would be our responsibility. There is probably an interesting economic discussion somewhere in there…

Personally, I never get the flu shot. I’ve made it age 39 and 51 weeks without ever contracting the flu. I don’t see any reason to voluntarily introduce the virus to my system, even if it is dead.

12 Matthew C. November 12, 2007 at 11:39 am

Actually Tim the scientific case for flu vaccination in the young and healthy is very weak. . .

13 Mike November 12, 2007 at 11:46 am

My father is a doctor so I grew up in hospitals. The one thing he never stopped telling me is how fundamentally irrational, if not out-and-out stupid, a sizeable proportion of patients tend to be. His colleagues always agreed.

The flu vaccine can’t give you the flu. Full stop. It doesn’t contain any live virus. However, it can provoke your immune system and give you brief “flu-like” symptoms for a short period after receiving it. This is not the flu. (FYI homeopathy, sonic crystal resonance, therapeutic touch and magnets also do not guard against the flu.)

And just because you haven’t gotten the flu and haven’t received a shot doesn’t mean that you won’t get the flu in the future.

Get the flu shot. It may or may not protect you, but it sure as hell won’t hurt you.

14 Alex Tabarrok November 12, 2007 at 12:01 pm

The commentators who argue that the benefits of the shot are low for “young and healthy” people have missed the point. What you mean is that the *private benefits* for young and healthy people are low. The benefits to other people, however, could still be quite large. Indeed, the young and healthy may be the worst spreaders.

15 Sam November 12, 2007 at 12:04 pm

I think this is ignoring the importance of social networks. There have been randomized studies that show that per-shot, the most useful people to vaccinate are school age children. Perhaps we need to bribe our kids to get shots instead of trying to fine the country at large for getting the flu.

http://www.sciencemag.org/cgi/content/full/306/5699/1123?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=flu+vaccine+shortage&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT

16 Christina November 12, 2007 at 12:20 pm

The office building complex where I work brought in INOVA to administer flu shots to anyone who wants one in the complex for $23. My company paid for everyone in the company to get one. I signed up because as a pregnant woman I’m now a member of the high-risk group. For this reason my husband will also take advantage of his office’s free flu shot offering.

My company’s HR director told me that this is the last year that they will pay for flu shots in this manner. From now on they will only reimburse employees who have gotten them from their doctors, since the $10 co-pay is less than the $23 they are paying now. I suspect this will result in lower participation, and more cases of the flu within the office.

17 dearieme November 12, 2007 at 1:03 pm

“Thank you state provided healthcare.” It wasn’t the state that provided, Jamie, it was all the tax paid by me.

18 Jeff H. November 12, 2007 at 1:44 pm

“Get vaccinated: It’s the only shot that’ll stop Enza from flying in the window.”

Yes it sucks, but it has a pun and a learned historical reference.

19 mobile November 12, 2007 at 1:59 pm

“I took a prick so that you won’t get sick.”

On second thought, never mind.

20 Doctor Jay November 12, 2007 at 2:33 pm

I get flu shots ever since the time all four of us had the flu at the same time. This include two young children, one of which was pre-school age. That really sucked. No, I did’t die, and neither did they, but it really sucked, just the same.

I also discovered that while, as a programmer, I could go to work for most of the days when I had the flu symptoms, it wasn’t actually worth it. When I later looked at the work I had done while sick, I discovered that it was basically worthless. Full of holes and problems, it mostly had to be rewritten. That’s some pretty good reasons for getting flu shot, not to mention a good reason for my employer to pay 25 bucks for it.

Five days of my time costs them a LOT more than that. Fully loaded, I might well cost 10 times per hour but let’s just say its 5x. I work more than eight-hour days, but let’s leave it at a 40 hour week just to be conservative, since I don’t spend every minute programming. That gives the flu shot a 200-to-one payoff. That seems like a no-brainer to me.

21 mobile November 12, 2007 at 3:14 pm

Lawrence,

Fuck what? That the cost is >$0? The cost is free to some but not to others? The the cost is >$0 but it used to be $0? Or that $15 (over your sunk costs) is so much higher than your risk adjusted expect costs of getting through the flu season unvaccinated?

22 HappyConservative November 12, 2007 at 3:59 pm

In the language of economics the flu shot creates an external benefit, a benefit to other people not captured by the person who paid the costs of getting the shot.

You only think it is not a benefit to you not to give someone else the flu if your a libertarian asshole.

Most socially conscious people would rightly feel guilty about giving other people the flu if they could have taken actions that easily would have prevented that.

Not feeling guilty and being guilty = benefit.

23 HappyConservative November 12, 2007 at 4:01 pm

In the language of economics the flu shot creates an external benefit, a benefit to other people not captured by the person who paid the costs of getting the shot.

You only think it is not a benefit to you not to give someone else the flu if your a libertarian asshole.

Most socially conscious people would rightly feel guilty about giving other people the flu if they could have taken actions that easily would have prevented that.

Not feeling guilty and being guilty = benefit.

24 st4rbux November 12, 2007 at 4:08 pm

geez HappyConservative, troll much?

I sneeze in your general direction.

25 HappyConservative November 12, 2007 at 4:27 pm

st4rbux,

geez HappyConservative, troll much?

I don’t know, do you ever say anything of substance, or do you just stick to the ad hominen.

I will say it again. Anyone who does not fully internalize the benefits that others receive from not getting the flu from them when it can be easily prevented is an asshole.

See, that is where you libertarian scum go wrong. Thinking that there is no moral imperative for individuals to internalize the costs they impose on others without monetary incentives, but rather, just because it is the right thing to do. If you don’t want to live in a society or a community, then you should be banished.

26 HappyConservative November 12, 2007 at 4:53 pm

josh,

You are correct. Apparently you are not aware of the implications of your beliefs. The implications of saying that there is an external benefit to a flu shot that is not captured by individual is to imply that the individual has not psychologically internalized this benefit.

While it is true that some particular immoral individuals would be indifferent about whether they cause unnecessary suffering in others, this is not the norm for humans. The implicit assumption of libertarians that this is the norm tells us more a about the sociopathic tendencies of libertarians than it tells us about how we should structure incentives.

27 HappyConservative November 12, 2007 at 5:21 pm

Also note that it probably isn’t optimal for everybody to get vaccinated

Who do you think should get flu shots and who do you think should not get them then?

28 Jooky November 12, 2007 at 6:09 pm

I trust then that HC would also stand by the converse of his assertion:

If one claims that a positive externality should not be subsidized because the individual has obviously already internalized the benefit, then it follows that no costs should be imposed on any transactions with a negative externality because the persons involved have obviously already internalized the guilt involved.

29 B November 12, 2007 at 7:04 pm

The last year I got a flu shot was the last year I got sick with anything resembling a full-blown flu. That was 1999. It’s also worth mentioning that I worked in a hospital until the end of 2005.

Typically around the end of November/beginning of December, I come down with a very mild fever. If I take boatload of acetaminophen and go to bed at the first sign of it, I usually kick it in 24 hours or less. It seems to me my immune system is working just fine.

I realize I may be engaging in superstitious behavior here, but as long as this pattern holds, I’m not getting one.

30 HappyConservative November 12, 2007 at 7:34 pm

Jooky,

If people behaved in a moral manner, then there would be no need to correct for certain negative externalities. Someone who had already carefully considered the claims of the community but decided not to get a flu shot (hypothetically, say, if they had an unusually weak immune system, rendering a flu shot dangerous to their health) need not be penalized.

I should note that the that asserting that it is the norm for people to internalize the negative effects of certain behaviors on others typically does not mean that this describes the typical libertarian. Thus, a system of penalties may be necessary, precisely because certain people lack the moral qualities necessary in a good citizen.

It should be pointed out, however, that many externalities are not really about morality. (When you breathe, you emit carbon dioxide which contributes to global warming.) For these sort of externalities, systems of incentives/penalties are perfectly appropriate.

But for externalities that involve moral considerations we should only consider penalties, not incentives. But, those penalties should not be considered corrections for the externality in question, but rather as punishment for its own sake. Thus, it is entirely justified to have punishments that are much harsher than necessary to merely bring about optimal compliance.

31 920222421 November 12, 2007 at 11:01 pm

This is such an interesting topic of study! I must admit that the title is what really caught my attention. I think it’d be a great campaign; people would be more prone to get vaccinated, knowing that they could be helping spread the resistance. However, it could go both ways; people may think twice before getting the shot, knowing that they could just feed off of the ones that do.

It’s hard to say. Personally, I’ve never gotten a flu shot. I’ve also never contracted it either. I may be one of those that is feeding off of the ones that do. If so, take this as my shout out to all you brave souls that go to the doc to get the shot at the beginning of every season. Can I still take you up on that kiss offer?

32 Bill November 13, 2007 at 2:19 am

Except for a few unreconstructed Randians, most people really don’t *mind* being in a win-win situation, where doing something that’s good for themselves is also good for other people, even if those other people are free-riding. Flu shots are especially that way – getting the shot reduces your chances of getting the flu, and having the flu sucks even if you’re not an extra-vulnerable baby or old person, plus the free riders are usually people you know, so even if they’re not your family you probably don’t want them to get the flu, especially since they’ll infect other people and/or miss work. I’m very happy to pay the cost of the shot for myself and my family even if there weren’t free riders around. (And back when the government helpfully screwed up the production and distribution of flu vaccine, I was in the right age group to use the nasal vaccine that’s not for use by little kids and old people, so there was no reason to feel guilty about getting mine.)

The tricky vaccination questions are for diseases like polio, where near-universal vaccination has reduced the risk of getting the disease naturally to below the (low) risk of getting it from the vaccine, and it’s a serious enough disease that even a small risk of getting it is bad. We’d nearly wiped the stuff out, but recently some greedy evil politicians in Nigeria have been playing “Infidel Yankee Whitey’s trying to sterilize our Muslim children” games, and enough people believed them that there are kids getting paralyzed from polio again, and the bastards don’t care. I can’t say that Americans aren’t immune to that kind of fear, though – I know a number of hippie types who worry about the preservatives used in vaccines and are scared to vaccinate their kids.

33 Jamie November 13, 2007 at 6:05 am

OK. Here’s another benefit; Yearly vaccination against flu is building up a catalogue of flu virus proteins that your immune system is familiar with. There is a current risk that Avian Flu such as the H5N1 strain could jump to and be transmissable in humans. The last time this happened was in 1918 with the so called Spanish Flu Pandemic. (Recent work proved this was an avian flu virus). Death occurred mostly in the age range which this discussion considers low risk – ages 18 to 36. The primary cause of death was a so called Cytokine Storm (en.wikipedia.org/wiki/Cytokine_storm). This is where the strong healthy immune systems of the victims were overreacting to a virus whose surface proteins were highly unfamiliar (because it had come from another species originally).

So, to cut to the chase, theres a chance that yearly vaccination *might* make young and healthy people less likely to die in an Avian Flu Pandemic as their immune systems are primed to a wide range of flu virus proteins already, lessening the chance of a cytokine storm. (Granted the vaccine isn’t based on the avian strain, but there will be some overlap). So, there’s a benefit for everybody, an insurance policy against something that may happen and will be very serious if it does.

34 mobile November 13, 2007 at 11:52 am

If people behaved in a moral manner, then there would be no need to correct for certain negative externalities.

And this explains why the Soviet Union failed.

35 9747 November 13, 2007 at 12:57 pm

The flu vaccination has two main problems: the cost and the side effects. How can you fine people for not getting the vaccination, or for getting the flu, if they can’t even afford the thing in the first place? A large percentage of the American popluation do not have insurance so they cannot afford medical care (most of these can barely afford the most essential costs of living), so things such as vaccinations that are not absolutely neccessary get pushed out of the way in order to pay for the neccessities. Secondly, you have to take into account that a good percent of the population shy away from vaccinations in general, because the vaccination itself contains the disease/virus you are vaccinating for. Yes, it’s true that you will more than likely not get the disease you are being vaccinated for, however there is a slight chance. I myself get the shot but I know some people who don’t, such as a woman from my town who doesn’t get any kind of vaccinations since her son was rendered mentally handicapped because a childhood vaccination caused him to get the disease they were trying to prevent. So, if you really stop and think about it, while the vaccination is a very beneficial tool in the medical world, we cannot force people to get something like a vaccination by holding fines or other forms of punishment over their head.

36 Randall Parker November 13, 2007 at 9:09 pm

Regarding comments about whether the young and healthy benefit from flu shots they get for themselves:

First off, you are speculating in the wrong direction. The real controversy in medical research circles is whether the elderly benefit from flu shots. The biggest evidence against this supposed benefit is that the death rate of old folks from flu hasn’t dropped as larger numbers of them have gotten yearly flu shots. This outcome is contrary to expectations.

The problem with the old folks is they have old immune systems. They don’t respond as vigorously to the vaccinations. The young folks have stronger immune systems and gain greater immunity from vaccination.

Parenthetically, the weakening of immune systems with age might be the biggest contributor to higher rates of cancer with age. Click thru and I’ll tell you a couple of things you can do to improve your immune function. That’ll reduce your risk of both cancer and flu.

37 Zack November 14, 2007 at 11:27 am

CORRECTION TO MY PREVIOUS POST:

Antigenic drift, not antigenic shift. My apologies.

38 jolani November 14, 2007 at 4:18 pm

Before expressing an opinion, it sometimes helps to get educated on the subject. Wikipedia is a good place to start. http://en.wikipedia.org/wiki/Spanish_Flu

39 Mats November 16, 2007 at 7:16 pm

from above:
>>”We could charge people who do not get their flu shots.”

You’ve just proposed bigger gouvernment. That must be a first.
>>

brilliant!

40 Anonymous November 22, 2007 at 4:47 am

“I myself get the shot but I know some people who don’t, such as a woman from my town who doesn’t get any kind of vaccinations since her son was rendered mentally handicapped because a childhood vaccination caused him to get the disease they were trying to prevent.”

Yes, here is a case of what I was talking about. (I’m the above poster)

41 Serg December 16, 2007 at 1:50 pm

In men for whom sexual activity is not recommended because of their underlying cardiovascular status, any treatment for erectile dysfunction, including Levitra,
generally should not be used. In patients taking certain CYP3A4 inhibitors (eg, ritonavir, indinavir, saquinavir, atazanavir, ketoconazole, itraconazole, erythromycin, and clarithromycin), lower doses of Levitra are recommended, and time between doses
of Levitra may need to be extended. See prescribing information for Levitra for
dosing guidance.In clinical trials, the most commonly reported adverse events with Levitra were headache, flushing, and rhinitis. Adverse events were generally transient.

42 Serg December 16, 2007 at 1:52 pm

The recommended starting dose of Levitra is 10 mg. Titrate up to 20 mg or down
to 5 mg based on efficacy and side effects. The maximum recommended dosing frequency is once daily. Levitra is available in
2.5-mg, 5-mg, 10-mg and 20-mg tablets. For Prescribing Information please visit New Online Pharmacy

43 Serg December 16, 2007 at 1:57 pm

In men for whom sexual activity is not recommended because of their underlying cardiovascular status, any treatment for erectile dysfunction, including Levitra,
generally should not be used. In patients taking certain CYP3A4 inhibitors (eg, ritonavir, indinavir, saquinavir, atazanavir, ketoconazole, itraconazole, erythromycin, and clarithromycin), lower doses of Levitra are recommended, and time between doses
of Levitra may need to be extended. See prescribing information for Levitra for
dosing guidance.In clinical trials, the most commonly reported adverse events with Levitra were headache, flushing, and rhinitis. Adverse events were generally transient.

44 Serg December 16, 2007 at 2:00 pm

The recommended starting dose of Levitra is 10 mg. Titrate up to 20 mg or down
to 5 mg based on efficacy and side effects. The maximum recommended dosing frequency is once daily. Levitra is available in
2.5-mg, 5-mg, 10-mg and 20-mg tablets. For Prescribing Information please visit New Online Pharmacy

45 鑽石 April 2, 2008 at 11:20 pm
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