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. 2026 Jan;35(1):36-51.
doi: 10.1002/hec.70037. Epub 2025 Sep 24.

Vaccination and Risk Aversion: Evidence From a Flu Vaccination Campaign

Clémentine Garrouste  1 , Arthur Juet  2 , Anne-Laure Samson  3
Affiliations

Vaccination and Risk Aversion: Evidence From a Flu Vaccination Campaign

Clémentine Garrouste et al. Health Econ. 2026 Jan.

Abstract

We examine the causal effect of a French flu vaccination campaign on vaccination behavior. Individuals aged 65 and over receive an invitation letter with a voucher for a free flu shot, while those who are not eligible have to cover the costs themselves. Using a Fuzzy Regression Discontinuity Design, we find that receiving the invitation letter with the voucher leads to a significant increase in the likelihood of getting vaccinated. This effect is driven by individuals who are risk-averse. As illustrated in our theoretical model, for them, the costs of influenza infection outweigh the costs of the vaccine's side effects.

Keywords: influenza; regression discontinuity design; risk aversion; vaccination campaign.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Timeline of the 2013–2014 national influenza campaign.
FIGURE 2
FIGURE 2
Percentage of individuals with a chronic disease by age (in months) on the whole sample ‐ zero cutoff for the 65 years old and bandwidth of 44 months. Source: ESPS 2014.
FIGURE 3
FIGURE 3
Flu vaccination invitation rate by age, on the whole sample. (a) Flu vaccination invitation rate by age (in years). (b) Flu vaccination invitation rate by age (in months) ‐ zero cutoff for the 65 years old and bandwidth of 44 months. Source: ESPS 2014.
FIGURE 4
FIGURE 4
Flu vaccination rate by age, on the whole sample. (a) Flu vaccination rate, by age in years. (b) Flu vaccination rate by age in months ‐ zero cutoff for the 65 years old and bandwidth of 44 months. Source: ESPS 2014.
FIGURE 5
FIGURE 5
Observed proportion of risk‐averse individuals in the threshold‐based sample, and estimated proportions among the sub‐populations of compliers, never‐takers and always takers. The proportions of risk‐averse individuals in all groups are estimated using the approach presented in Marbach and Hangartner (2020). Bootstrapped 95% confidence intervals are provided. Source: ESPS 2014.
FIGURE 6
FIGURE 6
Regression discontinuity estimates of Equation (3), using different bandwidths. (a) Point estimates using different bandwidths ‐ whole sample. (b) Point estimates using different bandwidths ‐ threshold‐based sample. Estimates are obtained using a non‐parametric specification; 95% confidence intervals are presented. Source: ESPS 2014.
FIGURE 7
FIGURE 7
Regression discontinuity estimates of Equation (5), using different bandwidths ‐ point estimates for risk averse individuals. (a) Point estimates using different bandwidths ‐ whole sample. (b) Point estimates using different bandwidths ‐ threshold‐based sample. Estimates are obtained using a non‐parametric specification; 95% confidence intervals are presented. Source: ESPS 2014.
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