News-stimulated public-attention dynamics and vaccination coverage during a measles outbreak: An observational study.

Rationale: Measles is a highly contagious disease that is responsible for about 110,000 annual deaths worldwide, even though a safe, effective, and inexpensive vaccine is available. Given that full vaccination coverage is below the desired threshold in many countries, increasing the vaccination coverage is an important public health goal, aiming to contribute to a reduction of measles deaths.

Objective: This study investigates the dynamics between media and public attention on measles and vaccination coverage during the 2015 measles outbreak in Berlin, Germany. It was hypothesized that the epicentral distance would influence the observed effects of the outbreak on public attention due to a higher perceived threat susceptibility in more proximal states.

Method: Using observational macro-level data from German federal states, the study taps into news-stimulated public-attention dynamics around the outbreak. We assessed public attention, media attention, and vaccination coverage among 24-month-old children.

Results: Findings indicate that public attention increased exponentially as the epicentral distance lessened. Distance mattered more in states surrounding Berlin-a discovery we termed the "Rubicon effect." Importantly, within a small radius of the epicenter, the decay in public attention was slower, and higher rates of public attention were related to an increase in vaccination coverage among children aged 24 months.

Conclusions: Given that full vaccination coverage for measles (after receiving the second dose) is below the desired value in Germany (and many other countries), the observed increase in vaccination coverage, in response to news-stimulated increases in public attention, can be deemed a beneficial public health outcome. The findings, including the Rubicon effect, are discussed in light of optimal resource allocation for vaccination programs.