Imperfect vaccine can yield multiple Nash equilibria in vaccination games.

As infectious diseases continue to threaten communities across the globe, people are faced with a choice to vaccinate, or not. Many factors influence this decision, such as the cost of the disease, the chance of contracting the disease, the population vaccination coverage, and the efficacy of the vaccine. While the vaccination games in which individuals decide whether to vaccinate or not based on their own interests are gaining in popularity in recent years, the vaccine imperfection has been an overlooked aspect so far. In this paper we investigate the effects of an imperfect vaccine on the outcomes of a vaccination game. We use a simple SIR compartmental model for the underlying model of disease transmission. We model the vaccine imperfection by adding vaccination at birth and maintain a possibility for the vaccinated individual to become infected. We derive explicit conditions for the existence of different Nash equilibria, the solutions of the vaccination game. The outcomes of the game depend on the complex interplay between disease transmission dynamics (the basic reproduction number), the relative cost of the infection, and the vaccine efficacy. We show that for diseases with relatively low basic reproduction numbers (smaller than about 2.62), there is a little difference between outcomes for perfect or imperfect vaccines and thus the simpler models assuming perfect vaccines are good enough. However, when the basic reproduction number is above 2.62, then, unlike in the case of a perfect vaccine, there can be multiple equilibria. Moreover, unless there is a mandatory vaccination policy in place that would push the vaccination coverage above the value of unstable Nash equilibrium, the population could eventually slip to the "do not vaccinate" state. Thus, for diseases that have relatively high basic reproduction numbers, the potential for the vaccine not being perfect should be explicitly considered in the models.