The Minority Rules the Herd
Dec 03, 2010

By Christine Vara
“What?” you say.  “Minority rules?” 
“How can that be?”
Living in the suburbs of DC I’m constantly reminded about the power of the majority.  In these post-election days, references to the majority and the minority are intended to declare political influence within our government.  People accept that the majority rules because we live in a democracy and that is how it was intended.     
However, this may be why many vaccine advocates grow frustrated with the anti-vaccination sentiment.  People who favor vaccinations are clearly the majority in regards to numbers.  More people vaccinate than don’t – plain and simple.  History shows that immunizations have been effective at significantly reducing the prevalence of vaccine preventable diseases.  Yet, what concerns many vaccine advocates is that the actions of a small percentage of people – a definite minority percentage of the population – can adversely threaten public health.    
Take for instance the concept of herd immunity.  It is based on a delicate balance of numbers.  If the number of people immune to a disease (by means of vaccination or other natural immunity) can be sustained at a high enough percentage of the population, than it severely incapacitates that disease and the ability for it to flourish and spread throughout a community.  Interestingly enough, this “magic” number can differ according to the contagious nature of the various diseases.  Typically, for most diseases, it falls somewhere in the neighborhood of an 80-90% vaccination rate in order to provide protection to the “herd”.  
Fortunately, in most areas of this country, public health efforts have been able to maintain vaccination rates that fall within these percentages.  However, this is not the case in every area and for every disease.  (Take for instance reports of low vaccination rates in areas of CA.) 
In a recent comment thread here on Shot of Prevention, one person who was arguing against vaccines, pointing to the high percentage of people who are vaccinated, saying,

“I find it hard to understand the need for “vaccine advocates”. The CDC reports vaccine uptake rates are at an all time high. Hardly seems like the kind of cause someone would decide to devote their life to. I can think of a lot of things more dire than this.”

While the CDC data may report high rates of vaccination, there is also a host of growing concerns.  First, there is the increasing number of unvaccinated children that are being identified in the more affluent population.  In the past, vaccination barriers were often attributed to financial and medical access, but that is not the case in these more affluent areas and there is concern that this trend may continue. 
Another consideration is that there are often concentrated areas of unvaccinated children within a specific school or community, which then provides a safe-haven for diseases to thrive.  Even if vaccinated, a child can still be exposed to considerable risk of contracting a disease if a large enough percentage of students are not immunized.    (And by large percentage, we could be looking at only 10-15% un-immunized.)
This is when I think about comments I have often heard from parents who do not vaccinate their children. 

“If vaccination is as effective as you suggest,” they comment, “why are you worried about MY un-vaccinated child.  Your child should be protected.” 

Again, this type of comment fails to acknowledge the concept of herd immunity and the unfortunate, but realistic fact that immunizations are not 100% effective, 100% of the time.    Which is exactly why public health advocates must remain vigilant.  They understand that those who fore-go vaccination – even though they are a minority – still have the potential to push us past a tipping point.  
What is disconcerting about this is that our country expects that “majority rules”.  Yet, I wonder how many vaccinated people realize that the minority of unvaccinated people can have a direct effect on their majority decision? 
Everyone is entitled to their beliefs and to vaccine exemptions by the very nature of this great democracy we live in.  But am I too idealist in my vision of Americans as a people who care for their fellow man? Parents who choose not to vaccinate may be just as concerned about their children’s welfare as parents who do vaccinate.  However, their choice to not vaccinate impacts the health of those who do.  Somehow that doesn’t seem fair.  Yet this is the dichotomy that exists when we analyze opinions regarding vaccination.    
Even though the majority of people will vaccinate in a greater effort to protect themselves and others from illness and death…their actions can be “over-ruled” by the minority.  Meanwhile, those people who refuse vaccinations accept the risk that they may contract a potentially deadly disease – or even worse – spread it.  But do they realize that they are mostly protected from the herd immunity that their actions now threaten? 
I think of Shannon Peterson, who was advised not to vaccinate her children, only to lose her daughter Abigale to a vaccine preventable form of pneumonia.  Then I think of young Christina Adame, who just this week, at the age of 23, died of bacterial meningitis, despite being vaccinated.   With vaccination, there are certainly no guarantees.  But I can’t help but wonder, what can be done to prevent further loses like these? 
Do you think that people who choose not to vaccinate will have a change of heart once they are no longer protected by herd immunity?  Hopefully it doesn’t come to that.  But I do wonder, how much longer we all can rely on the protection of the pack?

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