Vaccination as a Game: Behavioural Dynamics, Network Effects, and Policy Levers—A Comprehensive Review

Classical epidemic models treat vaccine uptake as an exogenous parameter, yet real-world coverage emerges from strategic choices made by individuals facing uncertain risks. During the last two decades, vaccination games, which combine epidemic dynamics with game theory, behavioural economics, and network science, have become a very important tool for analysing this problem. Here, we synthesise more than 80 theoretical, computational, and empirical studies to clarify how population structure, psychological perception, pathogen complexity, and policy incentives interact to determine vaccination equilibria and epidemic outcomes. Papers are organised along five methodological axes: (i) population topology (well-mixed, static and evolving networks, multilayer systems); (ii) decision heuristics (risk assessment, imitation, prospect theory, memory); (iii) additional processes (information diffusion, non-pharmacological interventions, treatment, quarantine); (iv) policy levers (subsidies, penalties, mandates, communication); and (v) pathogen complexity (multi-strain, zoonotic reservoirs). Common findings across these studies are that voluntary vaccination is almost always sub-optimal; feedback between incidence and behaviour can generate oscillatory outbreaks; local network correlations amplify free-riding but enable cost-effective targeted mandates; psychological distortions such as probability weighting and omission bias materially shift equilibria; and mixed interventions (e.g., quarantine + vaccination) create dual dilemmas that may offset one another. Moreover, empirical work surveys, laboratory games, and field data confirm peer influence and prosocial motives, yet comprehensive model validation remains rare. Bridging the gap between stylised theory and operational policy will require data-driven calibration, scalable multilayer solvers, and explicit modelling of economic and psychological heterogeneity. This review offers a structured roadmap for future research on adaptive vaccination strategies in an increasingly connected and information-rich world.