University of Duisburg-Essen, Germany.
Soc Sci Med. 2023 Aug;331:116050. doi: 10.1016/j.socscimed.2023.116050. Epub 2023 Jul 5.
This paper examines the role of perceived disease risk in vaccination behavior. Using health insurance claims data, I estimate the effect of local measles outbreaks in Germany on first- and second-dose measles vaccinations in children as well as catch-up vaccinations in adults.
In my analytic strategy, I exploit the variation in timing and location of regional disease outbreaks and estimate a two-way fixed effects model with birth cohort and region fixed effects. The basic underlying assumption is that measles outbreaks alter perceptions regarding the disease risk. The robustness of this approach concerning possible bias due to heterogeneous treatment effects under differential treatment timing is assessed through the use of alternative estimators.
Measles outbreaks within a region increase the share of children who receive their vaccination on time by 0.8 percentage points for both the first and second vaccination. This corresponds to a reduction in the share of not timely vaccinated children of about 1.0% and 1.6% for the first and second doses, respectively. Results further show an increase in the rate of monthly catch-up vaccinations in adults by about 10% for the age group 20-30 to up to 46% for those at ages 40-50 in the first six months after an outbreak. One important finding is that regional outbreaks do not lead to increases in vaccinations in other regions even if public attention extends beyond the affected region.
These results suggest that behavioral responses are driven by affective rather than deliberative risk perception. Also, vaccination effects can be observed only in the few months following the outbreak, which indicates that changes in the perceived disease risk due to a local measles outbreak are short-lived and fade away quickly once the disease outbreak is over.
本文探讨了感知疾病风险在疫苗接种行为中的作用。利用健康保险索赔数据，我估计了德国局部麻疹疫情对儿童第一剂和第二剂麻疹疫苗接种以及成人补种疫苗的影响。
在我的分析策略中，我利用区域疾病爆发的时间和地点的变化，并通过出生队列和地区固定效应来估计双向固定效应模型。基本的假设是，麻疹爆发改变了人们对疾病风险的看法。通过使用替代估计量，评估了这种方法在处理效果因不同处理时间而异时可能存在的偏差的稳健性。
一个地区内的麻疹爆发使按时接种疫苗的儿童比例增加了 0.8 个百分点，无论是第一剂还是第二剂。这相当于未按时接种疫苗的儿童比例分别减少了约 1.0%和 1.6%。结果还表明，在疫情爆发后的头六个月内，20-30 岁年龄组的成年人每月补种疫苗的比例增加了约 10%，40-50 岁年龄组的成年人每月补种疫苗的比例增加了高达 46%。一个重要的发现是，即使公众的注意力超出了受影响的地区，区域疫情也不会导致其他地区的疫苗接种增加。
这些结果表明，行为反应是由情感而不是深思熟虑的风险感知驱动的。此外，仅在疫情爆发后的几个月内才能观察到疫苗接种效果，这表明由于局部麻疹爆发而导致的感知疾病风险的变化是短暂的，一旦疫情结束，这种变化很快就会消失。
