Many times have I heard that anti-vaccine people are dangerous even to the vaccinated population. Is that true? If so, how can it be? People say that germs will attack them, and soon they would eventually grow and spread even toward general population which actually got its vaccines.

I mean it's so counter-intuitive: if I'm vaccinated even when disease will spread I shouldn't be in danger.

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    $\begingroup$ I'm upvoting because this is an important question. There are problems with the assumptions (if i'm vaccinated even when disease will spread I shouldn't be in danger), but that's exactly what makes it important. $\endgroup$ – De Novo Jul 18 '18 at 16:27
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    $\begingroup$ The only way to prevent a species to evolve is by extinguish (eradicate) it. If some people continue to carry a disease, those germs can evolve into a new, more resistant, more pestilent form that could attack even the immunized individuals. $\endgroup$ – J. Manuel Jul 19 '18 at 11:17
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    $\begingroup$ Putting aside people who do get vaccines, there are some people who can't get some vaccines and rely on everyone who can getting the vaccine and ideally eradicating the disease altogether, or, second-best case, not contracting it themselves so they can't give it to anyone who can't get the vaccine $\endgroup$ – Au101 Jul 20 '18 at 21:22
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    $\begingroup$ the more it can spread the larger chance it can mutate and become dangerous to those who are vaccinated for the first unmutated version. $\endgroup$ – mathreadler Jul 21 '18 at 16:16
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    $\begingroup$ Vaccines do not protect 100% from the disease. When enough people are vaccinated the disease outbreaks die out quickly. The problem is that when not enough people are vaccinated, the diseases do not die out, but linger in population. So, you keep bumping into sick people, and eventually get sick too. That's the simplest explanation I could come up with. If you're not satisfied, I'm afraid some differential equations will be in order. $\endgroup$ – Aksakal Jul 23 '18 at 15:29

Biology is rarely black or white, all or nothing. Protective immunity is generally not an on/off switch, where from the moment you're vaccinated you're infinitely resistant for the rest of your life. You shouldn't expect that, having received a smallpox vaccine, you could have billions of smallpox viruses squirted directly into your lungs and shrug it off without noticing.

Given that (fairly obvious) fact, you should immediately think of scenarios where vaccinated people are still at risk of disease following exposure to unvaccinated people. What about older people who were vaccinated 20 years ago, 50 years ago? What about people whose immune systems are slightly weakened through lack of sleep or obesity or stress? Any of these vaccinated people might well be protected against a brief encounter, but not against, say, being in an airplane seat for 18 hours beside an infected child shedding huge amounts of virus, or caring for their sick child.

It's all sliders, not switches. You can have a slight loss of immunity (4 hours sleep last night) and be protected against everything except a large exposure (your baby got infected and won't rest unless you hold him for 8 hours). You can have a moderate loss of immunity (you were vaccinated twenty years ago) and be protected against most exposures, but you're sitting next to someone on the subway for an hour. You may have a significant loss of immunity (you're a frail 80-year-old) and still be protected against a moderate exposure, but your grandchild is visiting for a week.

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    $\begingroup$ I think one point you can add to this is that unvaccinated people who host a virus allow it to propagate and evolve, which can undermine the efficacy of the vaccination. $\endgroup$ – BlackThorn Jul 18 '18 at 22:37
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    $\begingroup$ You could add that, depending on the disease, some percentage of the vaccinated may show a low immune response and will never develop immunity, although vaccinated. $\endgroup$ – Dubu Jul 19 '18 at 12:09
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    $\begingroup$ to restate Blackthorn, unvaccinated people also provide a place for the disease to reproduce and potentially mutate into a new strain that the vaccine does not help with. This happens constantly with the flu. $\endgroup$ – John Jul 19 '18 at 15:17
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    $\begingroup$ I like this answer, except for the "(fairly obvious)" part. It sounds condescending, and it is not something that is obvious to everyone. $\endgroup$ – Beska Jul 19 '18 at 19:09
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    $\begingroup$ @BlackThorn viral escape mutants are rarely observed in an effective vaccine, and generally are not the public health challenge they seem to be in fiction. They are an issue during vaccine development. Influenza variation (and subsequent vaccine failure) is due to recombination in non-human hosts. The unvaccinated certainly cause harm to the vaccinated, but this is not a significant mechanism for that harm. $\endgroup$ – De Novo Jul 22 '18 at 3:31

Since 2000, in the United States alone, there were 16 reports of outbreaks or groups of outbreaks where the outbreak started with an initial case in an unvaccinated individual and resulted in disease in previously vaccinated individuals. The epidemiology of pertussis is a little different, and transmission happens in many cases apart from a clear outbreak, but there are several documented pertussis outbreaks that led to disease in vaccinated individuals as well. This JAMA report provides a good summary.

Herd immunity is important, especially in highly contagious diseases with no significant non-human reservoir, e.g., measles and pertussis. @iayork's answer is correct that vaccination is not an on/off switch. About 15% of measles cases in the US involve vaccinated individuals, and these have all been the result of transmission that started with an initial unvaccinated case (see previous reference).

These are bad diseases. They can cause serious illness. Half of infants who get pertussis need care in the hospital. For measles, 25% of all cases involve hospitalization. For both, life long disability (deafness, brain damage) and death are real possibilities. 1 in 100 infants with pertussis die, 1-2 in 1000 measles cases die. The harm intentionally unvaccinated people cause to vaccinated people and people who can't get vaccinated (because of their age or other health problems) is real and well documented.


In light of another answer and some comments, I'm adding a couple paragraphs putting vaccination in context with other strategies for prevention of infectious disease.

Relevant to this question, as is clear from the epidemiological data discussed above, vaccines are not 100% effective. Some vaccines are more effective than others. Measles vaccine, for example, is in the mid to high 90s. Flu vaccine effectiveness, depending on the population and year, can range from the 40s to the 80s. You can read about vaccine effectiveness in the CDC pink book, Epidemiology and Prevention of Vaccine-Preventable Diseases.

Other strategies for preventing infectious diseases depend on the great diversity of host/pathogen interactions. A few things are generally useful, and often effective. Wash your hands, wear a condom, and stay home when you have a fever. There is no good data on the general advice to stay home when you have a fever, but quarantine is effective for specific illnesses, especially in concert with vaccination and other preventative measures (see the CDC pink book). Limiting the isolation and sedentary behavior associated with staying home to cases where there is a fever has biological plausibility and minimizes the negative immune and other health effects of those behaviors (see Cecil Medicine, Chapter 288).

Along with vaccines, each of the strategies mentioned in the previous paragraph helps protect the individual who uses them as well as other people. So they are good for you and the people around you. You can practice all of them. I'm confused, but not surprised, when the effectiveness of some other strategy is used as an argument against the use of any of the others. You can compare the measured preventative efficacy and effectiveness of each strategy, and come to the conclusion that vaccines generally give the best results (both on an individual and population level), but I'm not sure why, for example, you would decide not to wash your hands because you got a particular vaccine, or not to get vaccinated because you washed your hands.

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    $\begingroup$ Can you expand on people who can't be vaccinated? You mention them in the last paragraph and I don't want to just add another very similar answer. Though the amounts of people who can't get vaccinated for medical reasons isn't great (roughly a 1000 children a year in the US states I checked) that's still some and probably doesn't cover children who just have delayed vaccinations for health reasons which can also be a problem. $\endgroup$ – DRF Jul 18 '18 at 16:45
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    $\begingroup$ @DRF that's a reasonable answer in itself. Feel free to add it. You start by looking at the JAMA article I linked (it's on PMC, so no paywall). Table 1 includes numbers on non-medical exemptions. If you subtract unvaccinated cases from unvaccinated with non-medical exemptions, you'll get the number of cases in individuals who couldn't get vaccinated (prior to getting measles). It wouldn't be a bad idea to include a little bit on what level of vaccination coverage is required to have herd immunity. $\endgroup$ – De Novo Jul 18 '18 at 16:52
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    $\begingroup$ @DRF sorry, CAN start, or COULD start. You're free to answer however you like; I just wanted to give you some helpful data :) $\endgroup$ – De Novo Jul 18 '18 at 18:13
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    $\begingroup$ @DennisWilliamson it's a different denominator. For pertussis, infants get severe illness much more frequently. Half of all infants with pertussis need to be hospitalized, but very few otherwise healthy adults. For measles, 25% of everyone (all cases) ends up needing hospitalization. $\endgroup$ – De Novo Jul 18 '18 at 23:08
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    $\begingroup$ +1 for mentioning herd immunity $\endgroup$ – JollyJoker Jul 19 '18 at 7:46

Something which may help is a model. There is a standard model based on a key number called R₀, the basic reproductive number. This is a highly boiled up number which indicates how many uninfected people will be infected by a single infected individual. Trivially, if R₀>1, the disease will spread through society, and if R₀<1, it will vanish because each infected generation infect fewer new people each generation. R₀ is basically derived from the number of contacts a person can make before showing enough symptoms to sequester them at home, times the chance of any interaction transmitting the infection. The longer the incubation period and the more infectious the disease, the higher R₀ is.

It's a massively massively boiled up model. You can look to science for more accurate models which account for all sorts of features. However, it is a good enough model to demonstrate a concept called herd immunity. Herd immunity decreases the odds of a contact with an infected person spreading the disease. After all, a vaccinated individual is far more likely to go unaffected. This is typically modeled with an extra factor S, such that the reproductive rate of the disease is R₀S. If q is the vaccinated portion of the society, then (1-q) is the number of succeptable people, so the reproductive rate is R₀(1-q).

Now remember, if the reproducitve rate is greater than 1, the disease flourishes. If it's less than 1, it dies off. Having a strong vaccinated base has been shown to be a very effective way of keeping that reproductive rate down.

Consider, as an example, Measles. Measles is considered to be an excellent disease for demonstrating herd immunity. Its R₀ is somewhere between 12-18, meaning each infected person is likely to infect 12-18 people before getting quarantined. If a populus is 95% vaccinated, then the reproductive rate drops to R₀*(1-.95), which is somewhere between .6 and .9. This means the disease will die out if the population is that vaccinated.

Again, modeling based on the basic reproductive number is considered to be a gross tool, but it is effective at demonstrating the risks associated with insufficient vaccinations. If there is a large enough unvaccinated pool to let the disease flourish, everyone is exposed to the disease every day as it runs rampant in the society. Vaccines are awesome, but they are not magic bullets. You can still get diseases after being vaccinated, it's just much more rare (the term to look up is Vaccine Efficacy). The more you're around a disease, the more likely it is that you just get unlucky. Even a vaccinated person benefits from a reproductive rate less than 1, so that the disease never flourishes in the first place. The less effective a vaccine is, the more one is dependent on a high rate of immunization to drive the reproductive rate down below 1.

Also, another strong argument for vaccination is the presence of immunocompromized individuals. Many individuals cannot receive vaccinations for one medical reason or another. For instance, immunizing someone with HIV is a tricky business which I would refer one to a doctor for more information. Those on transplant lists may be advised against receiving vaccinations. These individuals are entirely dependent on the so-called herd immunity effect to insulate them from these diseases. As the reproductive rate for a disease gets closer or above one, it becomes hard to protect these individuals.


protected by AliceD Jul 19 '18 at 7:48

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