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

Thomas May, Ross D. Silverman

Research output: Contribution to journalArticle

78 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)1048-1051
Number of pages4
Issue number11-12
StatePublished - Mar 7 2003
Externally publishedYes


  • Clustering of exemptions
  • Herd immunity
  • Vaccination

ASJC Scopus subject areas

  • Molecular Medicine
  • Immunology and Microbiology(all)
  • veterinary(all)
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

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