It's worth a shot: urban density, endogenous vaccination decisions, and dynamics of infectious disease.

We develop an agent-based model of vaccine decisions across a heterogeneous network model with urban and rural regions. In the model, agents make rational decisions to vaccinate or not, based on the relative private costs of vaccinations and infections as well as an estimated probability of infection if not vaccinated. The model is a methodological advance in that it provides an economic rationale for traditional threshold models of vaccine decision-making that are commonly used in agent-based network models of vaccine choice. In the model, more dense urban regions have more connections between agents than less dense rural regions. Higher density leads to higher levels of vaccine usage and lower rates of infection in urban regions within the model. This finding adds to the more commonly discussed socio-economic reasons for higher levels of vaccination usage in urban areas compared to rural areas. In addition to this direct contribution, the paper emphasizes the importance of endogenous decision-making in models of epidemiology. For instance, we find that networks that lead to larger epidemics in exogenous vaccination models lead to smaller epidemics in our model because agents use vaccinations to offset the additional risk introduced by these network structures. Endogenous agent responses to risk need to be incorporated into theoretical and empirical models of economic epidemiology.