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Vaccine Approvals and Mandates Under Uncertainty: Some Simple Analytics

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  • Charles F. Manski

Abstract

Social interactions make communicable disease a core concern of public health policy. A prevalent problem is scarcity of empirical evidence that are informative about how interventions affect population behavior and illness. Randomized trials, which have been important to evaluation of treatments for non-infectious diseases, are less informative about treatment of communicable diseases because they do not shed light on population-wide disease transmission. In particular, trials do not reveal the indirect preventive (herd immunity) effect of vaccination on persons who are not vaccinated or who are unsuccessfully vaccinated. This paper studies the decision problems faced by health planners who must choose whether to approve a new vaccine or mandate an approved one, but who do not know the indirect effect of vaccination. I study vaccine approval as a choice between a zero vaccination rate (rejection of the new vaccine) and whatever vaccination rate the health-care system will yield if the vaccine is approved. I study the decision to mandate an approved vaccine as a choice between vaccinating the entire population (the mandate) and the vaccination rate that would be generated by decentralized health-care decisions. Considering decision making with partial knowledge, I show that it may be possible to determine optimal policies in some cases where the planner can only bound the indirect effect of vaccination. Considering settings where optimal policy is indeterminate, I pose several criteria for decision making--expected utility, minimax, and minimax-regret--and derive the policies they yield.

Suggested Citation

  • Charles F. Manski, 2014. "Vaccine Approvals and Mandates Under Uncertainty: Some Simple Analytics," NBER Working Papers 20432, National Bureau of Economic Research, Inc.
    • Handle: RePEc:nbr:nberwo:20432
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    References listed on IDEAS

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    1. Charles F. Manski, 1997. "Monotone Treatment Response," Econometrica, Econometric Society, vol. 65(6), pages 1311-1334, November.
    2. Charles F. Manski, 2013. "Identification of treatment response with social interactions," Econometrics Journal, Royal Economic Society, vol. 16(1), pages 1-23, February.
    3. Charles F. Manski, 2011. "Choosing Treatment Policies Under Ambiguity," Annual Review of Economics, Annual Reviews, vol. 3(1), pages 25-49, September.
    4. Hudgens, Michael G. & Halloran, M. Elizabeth, 2008. "Toward Causal Inference With Interference," Journal of the American Statistical Association, American Statistical Association, vol. 103, pages 832-842, June.
    5. Charles F. Manski, 2009. "The 2009 Lawrence R. Klein Lecture: Diversified Treatment Under Ambiguity," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 50(4), pages 1013-1041, November.
    6. Boulier Bryan L. & Datta Tejwant S. & Goldfarb Robert S, 2007. "Vaccination Externalities," The B.E. Journal of Economic Analysis & Policy, De Gruyter, vol. 7(1), pages 1-27, May.
    7. Brito, Dagobert L. & Sheshinski, Eytan & Intriligator, Michael D., 1991. "Externalities and compulsary vaccinations," Journal of Public Economics, Elsevier, vol. 45(1), pages 69-90, June.
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    More about this item

    JEL classification:

    • H23 - Public Economics - - Taxation, Subsidies, and Revenue - - - Externalities; Redistributive Effects; Environmental Taxes and Subsidies
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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