---
title: "Modeling counter-intuitive effects of COVID-19 vaccination by coupling transmission and human beha"
id: "pubmed-42385992"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42385992"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42385992/"
doi: "10.1016/j.jtbi.2026.112548"
published_at: "2026-10-07T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Modeling counter-intuitive effects of COVID-19 vaccination by coupling transmission and human beha
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42385992
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42385992/)
- **DOI:** [10.1016/j.jtbi.2026.112548](https://doi.org/10.1016%2Fj.jtbi.2026.112548)
- **Published At:** 2026-10-07T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- The study develops a **multi-scale model** that couples COVID-19 transmission dynamics with the evolution of human behaviors using **game theory**, explicitly distinguishing vaccinated and unvaccinated populations. - The authors link shifts in **risk awareness** to behavioral changes and quantify how perceived immunity after vaccination can reduce protective behaviors, producing paradoxical increases in transmission when vaccine effectiveness is low. - The model was calibrated to vaccination and epidemic data for the **Omicron** variant in Tokyo Metropolis, Japan, covering 23 December 2021 to 20 September 2022 and two epidemic waves. - Calibration showed the **vaccinated group** adjusted risk perception more slowly and had a higher mental threshold for changing protective behaviors than the unvaccinated group. - The analysis estimates that if vaccinated individuals had maintained the same level of **NPI adherence** and behavioral responses as the unvaccinated, cumulative confirmed cases in the study period would have been reduced by about **40%** (with the exact proportion depending on time window choice). - The model identifies an **optimal vaccination coverage** that minimizes cumulative infections by balancing the vaccines’ protective effects against the behavioral counter-intuitive effects of mass vaccination. - The authors emphasize the importance of collecting and disclosing epidemic data stratified by vaccination status and of evaluating effective transmission while accounting for human behavior dynamics. - Recommendations from the study include improving **vaccine effectiveness** and maintaining high **risk-awareness** among vaccinated individuals as key measures to control epidemics and flatten epidemic curves. - The study used data-driven calibration but specific mathematical details, parameter values, or full model equations are provided in the full text; the abstract does not report those technical specifics.
## Clinical Analysis & Structured Key Points
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Epub 2026 Jul 1. # Quantifying the counter-intuitive effects of vaccination by coupling the transmission dynamics of COVID-19 and the evolution of human behaviors [Qian Li](https://pubmed.ncbi.nlm.nih.gov/?term=Li+Q&cauthor_id=42385992)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42385992/#full-view-affiliation-1 "Department of Applied Mathematics, Xi'an University of Technology, Xi'an, 710054, PR China."), [Biao Tang](https://pubmed.ncbi.nlm.nih.gov/?term=Tang+B&cauthor_id=42385992)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42385992/#full-view-affiliation-2 "School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an, 710049, PR China. Electronic address: biaotang@xjtu.edu.cn."), [Yanni Xiao](https://pubmed.ncbi.nlm.nih.gov/?term=Xiao+Y&cauthor_id=42385992)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42385992/#full-view-affiliation-3 "School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an, 710049, PR China.") Affiliations Expand ### Affiliations * 1 Department of Applied Mathematics, Xi'an University of Technology, Xi'an, 710054, PR China. * 2 School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an, 710049, PR China. Electronic address: biaotang@xjtu.edu.cn. * 3 School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an, 710049, PR China. * PMID: **42385992** * DOI: [ 10.1016/j.jtbi.2026.112548 ](https://doi.org/10.1016/j.jtbi.2026.112548) Item in Clipboard # Quantifying the counter-intuitive effects of vaccination by coupling the transmission dynamics of COVID-19 and the evolution of human behaviors Qian Li et al. J Theor Biol. 2026. Show details Display options Display options Format Abstract PubMed PMID J Theor Biol Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22J+Theor+Biol%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22J+Theor+Biol%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42385992/) . 2026 Oct 7:633:112548. doi: 10.1016/j.jtbi.2026.112548. Epub 2026 Jul 1. ### Authors [Qian Li](https://pubmed.ncbi.nlm.nih.gov/?term=Li+Q&cauthor_id=42385992)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42385992/#short-view-affiliation-1 "Department of Applied Mathematics, Xi'an University of Technology, Xi'an, 710054, PR China."), [Biao Tang](https://pubmed.ncbi.nlm.nih.gov/?term=Tang+B&cauthor_id=42385992)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42385992/#short-view-affiliation-2 "School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an, 710049, PR China. Electronic address: biaotang@xjtu.edu.cn."), [Yanni Xiao](https://pubmed.ncbi.nlm.nih.gov/?term=Xiao+Y&cauthor_id=42385992)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42385992/#short-view-affiliation-3 "School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an, 710049, PR China.") ### Affiliations * 1 Department of Applied Mathematics, Xi'an University of Technology, Xi'an, 710054, PR China. * 2 School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an, 710049, PR China. Electronic address: biaotang@xjtu.edu.cn. * 3 School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an, 710049, PR China. * PMID: **42385992** * DOI: [ 10.1016/j.jtbi.2026.112548 ](https://doi.org/10.1016/j.jtbi.2026.112548) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract Vaccination is widely used to control the spread of infectious diseases. However, there is substantial evidence suggesting that the perceived immunity from vaccine drives the decrease of risk-awareness among vaccinated individuals, which results in the paradoxical increase of transmission risk, consequently leads to the counter-intuitive outcomes in disease control in the case of low vaccine effectiveness. In this study, we propose a novel method to quantify the counter-intuitive effects of vaccination in a complex environment with integrated dynamic factors. To this end, we begin by linking shifts in risk awareness to human behavior changes, and subsequently, we couple the evolution dynamic of human behaviors with the disease transmission dynamic system by applying game theory within a multi-scale model, distinguishing between vaccinated and unvaccinated populations. We calibrate the proposed model using vaccination data and epidemic data for the Omicron variant of COVID-19, spanning from 23/12/2021 to 20/09/2022 with two epidemic waves in Tokyo Metropolis, Japan. The calibration results provide the quantitative evidence that the vaccinated group exhibits a slower rate of risk perception to adjust their behaviors and a higher mental threshold for behavioral changes needed to protect themselves against infection. The model estimates that if vaccinated individuals had maintained the same level of NPI adherence and behavioral responses to infection prevalence as unvaccinated individuals, the accumulative confirmed cases during the study period would have been reduced by approximately 40% (although the exact proportion depends on the chosen time window). This finding highlights the importance of post-vaccination behavioral responses. Additionally, our analysis suggests an optimal vaccination coverage that minimizes accumulative infections by balancing the protective effects and the counter-intuitive effects of mass vaccination. Therefore, it's of significant meaning to collect and disclose the epidemic data with vaccination status and timely evaluate the effective transmission among the population involving human behavior dynamics for designing the proper vaccination strategy, and improve the vaccine effectiveness and maintain high risk-awareness for vaccinated individuals would still be the key to flatten the epidemics. **Keywords:** Behavioral change; COVID-19; Counter-intuitive effects; Game theory; Multi-scale model; Vaccination. Copyright © 2026 Elsevier Ltd. All rights reserved. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Declaration of competing interest The authors declare no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. ## Similar articles * [ The effect of framing and communicating COVID-19 vaccine side-effect risks on vaccine intentions for adults in the UK and the USA: A structured summary of a study protocol for a randomized controlled trial. ](https://pubmed.ncbi.nlm.nih.gov/34488843/) Sudharsanan N, Favaretti C, Hachaturyan V, Bärnighausen T, Vandormael A.Sudharsanan N, et al.Trials. 2021 Sep 6;22(1):592. doi: 10.1186/s13063-021-05484-2.Trials. 2021.PMID: 34488843Free PMC article. * [ Emerging Variants of SARS-CoV-2 and Novel Therapeutics Against Coronavirus (COVID-19) (Archived). ](https://pubmed.ncbi.nlm.nih.gov/34033342/) Aleem A, Akbar Samad AB, Vaqar S.Aleem A, et al.2023 May 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–.2023 May 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–.PMID: 34033342Free Books & Documents. * [ Dynamics of COVID-19 based on spontaneous individual behaviors of vaccination. ](https://pubmed.ncbi.nlm.nih.gov/40335019/) Zhou Y, Liu X, Wei Y.Zhou Y, et al.Math Biosci. 2025 Jul;385:109452. doi: 10.1016/j.mbs.2025.109452. Epub 2025 May 5.Math Biosci. 2025.PMID: 40335019 * [ Folic acid supplementation and malaria susceptibility and severity among people taking antifolate antimalarial drugs in endemic areas. ](https://pubmed.ncbi.nlm.nih.gov/36321557/) Crider K, Williams J, Qi YP, Gutman J, Yeung L, Mai C, Finkelstain J, Mehta S, Pons-Duran C, Menéndez C, Moraleda C, Rogers L, Daniels K, Green P.Crider K, et al.Cochrane Database Syst Rev. 2022 Feb 1;2(2022):CD014217. doi: 10.1002/14651858.CD014217.Cochrane Database Syst Rev. 2022.Update in: [Cochrane Database Syst Rev. 2026 Feb 18;2:CD014217. doi: 10.1002/14651858.CD014217.pub2.](https://pubmed.ncbi.nlm.nih.gov/41705996/)PMID: 36321557Free PMC article.Updated. * [ Safety and effectiveness of vaccines against COVID-19 in children aged 5-11 years: a systematic review and meta-analysis. ](https://pubmed.ncbi.nlm.nih.gov/37084750/) Piechotta V, Siemens W, Thielemann I, Toews M, Koch J, Vygen-Bonnet S, Kothari K, Grummich K, Braun C, Kapp P, Labonté V, Wichmann O, Meerpohl JJ, Harder T.Piechotta V, et al.Lancet Child Adolesc Health. 2023 Jun;7(6):379-391. doi: 10.1016/S2352-4642(23)00078-0. Epub 2023 Apr 18.Lancet Child Adolesc Health. 2023.PMID: 37084750Free PMC article. 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