`Clustering of exemptions' as a collective action threat to herd immunity

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http://www.elsevier.nl/gej-ng/10/42/35/80/51/28/abstract.html

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Vaccine, Vol. 21 (11-12) (2003) pp. 1048-1051
© 2002 Published by Elsevier Science Ltd. All rights reserved.
PII: S0264-410X(02)00627-8
 

`Clustering of exemptions' as a collective action threat to herd immunity

Thomas May a * tmay@mcw.edu and Ross D. Silverman b

a Medical College of Wisconsin, Watertown Plank Road, P.O. Box 26509, Milwaukee, WI 53226-0509, USA
b Department of Medical Humanities, Southern Illinois University, School of Medicine, Springfield, IL, USA

Received 29 April 2002; accepted 20 October 2002

Abstract

In this paper, we examine the phenomenon of `clustering of exemptions' to childhood vaccination, and the dangers this poses both to those exempted as well as the general population. We examine how clusters of exemptions might form through collective action as described by Thomas Schelling, and how religious groups who live in close proximity to one another can "self-select" in a way that exacerbates this phenomenon. Given the growing number of exemptions and the increasing visibility of the anti-vaccine movement, policy makers must be vigilant for dangerous clustering in order to avoid loss of herd immunity.

Keywords: Clustering of exemptions; Herd immunity; Vaccination

*Corresponding author. Tel.: +1-414-456-8498; fax: +1-414-456-6511.

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