The Case for Vaccine Exemptions in Vermont -> Part 2

The debate around vaccine exemptions often hinges on the concept of herd immunity—the idea that maintaining a high percentage of vaccinated individuals protects even those who are unvaccinated. But is the science as clear-cut as it seems? And does Vermont’s history of exemptions and vaccination rates truly justify the alarmism surrounding this issue?

In this second part of the series, we’ll explore the math behind herd immunity, critically assess outbreak narratives like the 2018–2019 New York measles outbreak, and expand on the actual infection risks of vaccine-preventable diseases and tuberculosis (TB) to demonstrate how Vermont’s public health priorities might be misaligned.

The Math Behind Herd Immunity

Herd immunity thresholds (HIT) are calculated using the formula:

HIT = 1 – 1/R₀

Here, R₀—the basic reproduction number—represents the average number of secondary infections produced by a single infected individual in a fully susceptible (unvaccinated) population. Importantly, R₀ is a theoretical construct, not hard data. It is derived from mathematical models that rely on assumptions about transmission dynamics, population density, and social behaviors. As such, R₀ provides a generalized understanding of disease spread rather than precise, universally applicable predictions.

This limitation is critical to understanding why HIT values, while useful, should not dictate policy decisions without considering real-world data. Vermont’s public health record demonstrates that theoretical HIT values for diseases like measles or pertussis have not translated into actual outbreaks, revealing a significant disconnect between these models and real-world outcomes.

Localized Clusters and Imported Risks

Critics of vaccine exemptions often highlight localized clusters of under-vaccinated children as potential vulnerabilities in public health defenses. The 2018–2019 measles outbreaks in New York illustrate how these dynamics unfolded. The outbreak began when an unvaccinated U.S. child traveled overseas, contracted measles, and introduced it into their community upon returning.

In this case, the affected community exacerbated the spread by hosting “measles parties”—gatherings where unvaccinated children were intentionally exposed to the virus to instill natural immunity. While controversial today, these gatherings reflect a practice that was considered normal for decades before the advent of widespread vaccination programs. Families often viewed such events as a way to ensure immunity to diseases like measles, chickenpox, and mumps during childhood, which were seen as less severe in younger individuals. In this outbreak, however, the practice significantly contributed to the size and duration of the epidemic.

Nearly all reported cases occurred in unvaccinated individuals, primarily within communities with low vaccination rates. Vaccinated individuals faced little to no risk during the outbreak, underscoring the efficacy of the MMR vaccine. Additionally, there were no widely reported cases of measles affecting immunocompromised individuals, likely due to high surrounding vaccination rates offering indirect protection.

By contrast, Vermont’s consistently high vaccination compliance rates have remained within the 90–95% range—both before and after the removal of the philosophical exemption in 2015. With the religious exemption still in place, Vermont continues to meet herd immunity thresholds for most vaccine-preventable diseases, demonstrating that exemptions have not compromised public health outcomes. Measles, eradicated in the U.S. in 2000, has remained absent in Vermont despite national surges.

This historical success highlights the speculative nature of alarmist arguments surrounding vaccine exemptions. Vermont’s public health infrastructure and community compliance rates have proven sufficient to prevent outbreaks, even in the presence of exemptions and despite national surges.

The Real Risk: Comparing Infection Rates

When comparing the actual infection rates of vaccine-preventable diseases, Vermont’s record speaks for itself. Despite national attention on measles, pertussis, and other illnesses, the data shows that Vermont’s public health outcomes are well-controlled:

Measles:
- Vermont: 0 cases annually since 2000.
- U.S.: Average 0.1 per 100,000, with all cases linked to imported infections.
Pertussis (Whooping Cough):
- Vermont: 3.2 per 100,000 annually.
- U.S.: 3.1 per 100,000 annually.
Mumps:
- Vermont: Rare, with localized outbreaks.
- U.S.: 0.9 per 100,000.

In comparison, tuberculosis (TB) presents a far greater public health challenge, yet it is not treated with the same urgency:

TB has an annual infection rate of 0.5 per 100,000 in Vermont, slightly below the national average of 2.7 per 100,000.
It is airborne, spreads without close contact, and can remain latent in infected individuals for years.
Drug-resistant strains like MDR-TB and XDR-TB are increasing globally, posing additional risks.

Vermont has successfully controlled TB—a disease more lethal and persistent than most vaccine-preventable illnesses—through targeted public health efforts like screening, isolation, and treatment, all without a widely-used vaccine. This success challenges the logic of focusing on exemptions for diseases like measles or pertussis, which are already well-contained, while a truly dangerous pathogen like TB persists.

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Vaccine Safety and Ethical Concerns

Concerns around vaccine safety and ethics are often dismissed as fringe, yet they remain central to public trust:

Use of Aborted Fetal Cell Lines:
Certain vaccines are developed using fetal cell lines, such as WI-38 and MRC-5, derived from fetuses aborted in the 1960s. These cell lines are instrumental in culturing viruses for vaccines like rubella, hepatitis A, and varicella. Additionally, newer cell lines like HEK 293 (developed in the 1970s) and PER.C6 (developed in the 1980s) have been utilized in testing and production of COVID-19 vaccines. While these cell lines are several decades removed from their origins, their use raises ethical and moral concerns for some individuals, given their historical connections.
Residual DNA Fragments:
Vaccines produced using human cell lines, such as WI-38 and MRC-5, may contain residual DNA fragments from these cells. Regulatory agencies, including the World Health Organization (WHO), consider these fragments biologically insignificant due to their minimal quantities and degraded state. However, some researchers have raised concerns about potential risks. For example, a study published in PubMed suggests that under certain conditions, residual DNA fragments could theoretically integrate into the human genome, posing risks such as insertional mutagenesis (PubMed, PMID: 26103708). While no direct evidence has linked residual DNA fragments in vaccines to adverse health outcomes, this hypothesis underscores the need for ongoing research and careful monitoring to address these theoretical risks and ensure vaccine safety.
Adjuvants and Quality Control:
Aluminum-based adjuvants, widely used in vaccines to enhance immune responses, are generally regarded as safe within established thresholds. Regulatory agencies such as the U.S. Food and Drug Administration (FDA) and the World Health Organization (WHO) point to extensive studies supporting their safety. However, some studies and advocacy groups, like the Informed Consent Action Network (ICAN), have raised concerns about discrepancies between labeled and actual aluminum content in vaccines. ICAN’s 2021 petition to the FDA highlighted peer-reviewed research suggesting inconsistencies, calling for transparency and stricter quality control.

While regulatory agencies continue to affirm the safety of aluminum adjuvants, critics argue that greater oversight is essential to prevent potential lapses. Documented instances of manufacturing anomalies, including elevated or inconsistent aluminum levels, have sparked calls for more rigorous monitoring. Ensuring transparency and accountability in vaccine production remains critical for maintaining public trust and confidence in immunization programs.

Conclusion

Vermont’s robust public health record demonstrates that vaccine exemptions have not undermined the state’s ability to control diseases like measles and pertussis. Instead, its high vaccination rates and strong infrastructure have effectively prevented outbreaks, even as exemptions remain in place. By contrast, tuberculosis—a far greater public health threat—has been successfully managed without a vaccine, highlighting the effectiveness of targeted, evidence-based strategies.

This comparison raises critical questions about the necessity of targeting exemptions for diseases that are already well-contained. Alarmist rhetoric overlooks Vermont’s real-world successes, creating unnecessary division while ignoring the state’s capacity to balance public health goals with parental and individual rights.

In Part 3, we will explore how these dynamics impact public trust in immunization programs and examine the broader implications of maintaining exemptions in a rights-respecting democracy.

Dave Soulia | FYIVT

#fyivt #PublicHealth #VaccineExemptions #Vermont

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