Prosocial polio vaccination in Israel

Proc Natl Acad Sci U S A. 2020 Jun 9;117(23):13138-13144. doi: 10.1073/pnas.1922746117. Epub 2020 May 26.


Regions with insufficient vaccination have hindered worldwide poliomyelitis eradication, as they are vulnerable to sporadic outbreaks through reintroduction of the disease. Despite Israel's having been declared polio-free in 1988, a routine sewage surveillance program detected polio in 2013. To curtail transmission, the Israel Ministry of Health launched a vaccine campaign to vaccinate children-who had only received the inactivated polio vaccine-with the oral polio vaccine (OPV). Determining the degree of prosocial motivation in vaccination behavior is challenging because vaccination typically provides direct benefits to the individual as well as indirect benefits to the community by curtailing transmission. However, the Israel OPV campaign provides a unique and excellent opportunity to quantify and model prosocial vaccination as its primary objective was to avert transmission. Using primary survey data and a game-theoretical model, we examine and quantify prosocial behavior during the OPV campaign. We found that the observed vaccination behavior in the Israeli OPV campaign is attributable to prosocial behavior and heterogeneous perceived risk of paralysis based on the individual's comprehension of the prosocial nature of the campaign. We also found that the benefit of increasing comprehension of the prosocial nature of the campaign would be limited if even 24% of the population acts primarily from self-interest, as greater vaccination coverage provides no personal utility to them. Our results suggest that to improve coverage, communication efforts should also focus on alleviating perceived fears surrounding the vaccine.

Keywords: altruism; disease prevention; game theory; vaccination motives.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Altruism*
  • Child
  • Disease Outbreaks / prevention & control*
  • Game Theory
  • Humans
  • Immunization Programs / methods
  • Immunization Programs / statistics & numerical data
  • Israel / epidemiology
  • Mass Vaccination / psychology*
  • Mass Vaccination / statistics & numerical data
  • Middle Aged
  • Models, Neurological
  • Poliomyelitis / epidemiology
  • Poliomyelitis / prevention & control*
  • Poliomyelitis / virology
  • Poliovirus / isolation & purification
  • Poliovirus Vaccine, Inactivated / therapeutic use
  • Poliovirus Vaccine, Oral / therapeutic use*
  • Sewage / virology
  • Surveys and Questionnaires
  • Vaccination Coverage / statistics & numerical data
  • Young Adult


  • Poliovirus Vaccine, Inactivated
  • Poliovirus Vaccine, Oral
  • Sewage