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Erring on the side of rare events? A behavioural explanation for COVID-19 vaccine regulatory misalignment.

Costa-Font, Joan ORCID: 0000-0001-7174-7919, Asaria, Miqdad ORCID: 0000-0002-3538-4417 and Mossialos, Elias ORCID: 0000-0001-8664-9297 (2021) Erring on the side of rare events? A behavioural explanation for COVID-19 vaccine regulatory misalignment. Journal of Global Health, 11. 1 - 4. ISSN 2047-2986

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Identification Number: 10.7189/JOGH.11.03080


The development of new vaccines against COVID-19 has triggered a debate about which of the vaccines should be chosen, and in some countries which vaccines to authorise. The choice of vaccines in Western countries seems to be largely driven by trust in the vaccine manufacturers, with safety concerns regarding potential rare side effects rather than relative efficacy playing the pivotal role in this choice [1]. So far, vaccines developed by China, Russia and India have largely been ignored in Western countries. Amongst the vaccine candidates currently in use in many western countries, access to the AstraZeneca (AZ) and Johnson & Johnson’s (JJ) vaccine has been restricted and, in some cases, suspended as they hav been perceived to be the least safe despite being approved by the European Medicines Agency (EMA) [2] and recommended by the WHO [3]. We argue that regulatory vaccine misalignment can be explained by an ‘erring on the side of rare events’ phenomena. That is, when rare events are heavily publicised, regulators tend to favour a precautionary approach, even when the fatalities from vaccine side effects are only 10% as likely to occur as the risks arising from COVID-19 infection [3]. Furthermore, we argue that such decisions have detrimental consequences for vaccine trust and the success phenomena logically follow not just from the overestimation of the risk of such events, but also from a combination of ambiguity aversion, joint risk, and benefit formation. All of which add to a background of limited trust in government decisions with regards to vaccines, which weaken the vaccination rollout. This note will provide a discussion of these arguments. The next section argues that vaccine regulation follows a clear regulatory misalignment resulting from some countries ‘erring on the side of rare events. We examine the erosion of public trust, followed by a discussion on different behavioural explanations for the ‘erring on the side of rare events’ phenomena. Finally, we conclude with suggestions for a way forward.

Item Type: Article
Official URL:
Additional Information: © 2021 The Authors
Divisions: Health Policy
LSE Health
Subjects: H Social Sciences > HV Social pathology. Social and public welfare. Criminology
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
B Philosophy. Psychology. Religion > BF Psychology
Date Deposited: 17 May 2021 10:39
Last Modified: 19 Jul 2024 18:57

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