Why Most People Still Haven't Gotten a Flu Shot

An online game elucidates the ways we calculate risk.

The Pug Father/Flickr

Widespread outbreaks in 47 states. A public health emergency in New York and Boston. And yet reducing the odds of getting the flu by 62 percent doesn't seem to be enough for most people, judging by the fact that when the CDC last checked, fewer than 40 percent of Americans had gotten themselves vaccinated.

If the no-shot strategy has worked for someone before, they're more likely to try it again, according to economists at Wake Forest University, who designed an online game that simulates public response to epidemics.

Even "highly educated, very smart" people tend to have funny attitudes about something that's universally recommended and relatively low-cost, as Michael Specter pointed out in a succinctly awesome New Yorker op-ed piece, "For God's Sake, Go Get a Flu Shot":

On Friday, a highly educated, very smart colleague at The New Yorker explained her decision to remain unvaccinated with these words: "I never get a flu shot, and I never get the flu."

O.K. Let's play her game. Turn to whomever you are with and say these sentences out loud: "I never wear seat belts, and I never get killed in car crashes"; "I never use condoms, and I never become infected with sexually transmitted diseases"; "I eat red meat seven times a week, only exercise once a year, and I've never had a heart attack or a stroke."

While there's no cure for flu denialism aside from snark, the researchers did find that lowering the costs -- in terms of price, access, potential side effects and, naturally, pain -- can help increase vaccination rates.

In the simulation, instead of playing to avoid fever, sore through, headaches, chills, and/or vomiting, participants were trying to win a giftcard. So, the stakes were about equivalent to real life, if a bit less easy to immediately rationalize:


After two rounds of play, with varying costs for self-protection, the results were fairly predictable:

People's willingness to engage in safe behavior waxes or wanes over time, depending on the severity of an epidemic: when prevalence is high, people are more likely to adopt self-protective measures as time goes by; when prevalence is low, a 'self-protection fatigue' effect sets in whereby individuals are less willing to engage in safe behavior over time.

Some people, they concluded, are always going to vaccinate, and some will always accept the risk and not bother. But as infection rates rise in the population, and particularly when the duration of flu season is drawn out, more people do decide to take the cautious route.

So expect a rise in flu shots along with increased media hype of this season's epidemic. And, of course, if you haven't already, go get one before they run out.