{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T23:05:01Z","timestamp":1791327901204,"version":"4.3.1"},"reference-count":38,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2023,6,5]],"date-time":"2023-06-05T00:00:00Z","timestamp":1685923200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["221719, 203132"],"award-info":[{"award-number":["221719, 203132"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Moh Foundation"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Med Ethics"],"accepted":{"date-parts":[[2022,11,25]]},"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:p>The public health benefits of herd immunity are often used as the justification for coercive vaccine policies. Yet, \u2018herd immunity\u2019 as a term has multiple referents, which can result in ambiguity, including regarding its role in ethical arguments. The term \u2018herd immunity\u2019 can refer to (1) the herd immunity threshold, at which models predict the decline of an epidemic; (2) the percentage of a population with immunity, whether it exceeds a given threshold or not; and\/or (3) the indirect benefit afforded by collective immunity to those who are less immune. Moreover, the accumulation of immune individuals in a population can lead to two different outcomes: elimination (for measles, smallpox, etc) or endemic equilibrium (for COVID-19, influenza, etc). We argue that the strength of a moral obligation for individuals to contribute to herd immunity through vaccination, and by extension the acceptability of coercion, will depend on how \u2018herd immunity\u2019 is interpreted as well as facts about a given disease or vaccine. Among other things, not all uses of \u2018herd immunity\u2019 are equally valid for all pathogens. The optimal conditions for herd immunity threshold effects, as illustrated by measles, notably do not apply to the many pathogens for which reinfections are ubiquitous (due to waning immunity and\/or antigenic variation). For such pathogens, including SARS-CoV-2, mass vaccination can only be expected to delay rather than prevent new infections, in which case the obligation to contribute to herd immunity is much weaker, and coercive policies less justifiable.<\/jats:p>","DOI":"10.1136\/jme-2022-108485","type":"journal-article","created":{"date-parts":[[2023,6,5]],"date-time":"2023-06-05T13:20:12Z","timestamp":1685971212000},"page":"636-641","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":37,"title":["Herd immunity, vaccination and moral obligation"],"prefix":"10.1136","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1071-5651","authenticated-orcid":false,"given":"Matthew","family":"Bullen","sequence":"first","affiliation":[{"name":"Box Hill Hospital, Eastern Health, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George S","family":"Heriot","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Euzebiusz","family":"Jamrozik","sequence":"additional","affiliation":[{"name":"Ethox Centre and Pandemic Sciences Institute, University of Oxford, Oxford, UK"},{"name":"Royal Melbourne Hospital Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia"},{"name":"Monash Bioethics Centre, Monash University, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,6,5]]},"reference":[{"key":"2025092415290870000_49.9.636.1","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.aje.a121310"},{"key":"2025092415290870000_49.9.636.2","doi-asserted-by":"crossref","unstructured":"Betsch C , B\u00f6hm R , Korn L , et al . On the benefits of explaining herd immunity in vaccine advocacy. Nat Hum Behav 2017;1. doi:10.1038\/s41562-017-0056","DOI":"10.1038\/s41562-017-0056"},{"key":"2025092415290870000_49.9.636.3","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1007\/s11019-018-9829-y","article-title":"The moral obligation to be vaccinated: Utilitarianism, Contractualism, and collective easy rescue","volume":"21","author":"Giubilini","year":"2018","journal-title":"Med Health Care Philos"},{"key":"2025092415290870000_49.9.636.4","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir007"},{"key":"2025092415290870000_49.9.636.5","doi-asserted-by":"publisher","DOI":"10.1023\/A:1007626510002"},{"key":"2025092415290870000_49.9.636.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.immuni.2020.04.012"},{"key":"2025092415290870000_49.9.636.7","doi-asserted-by":"publisher","DOI":"10.1016\/S0025-5564(02)00102-5"},{"key":"2025092415290870000_49.9.636.8","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jis570"},{"key":"2025092415290870000_49.9.636.9","doi-asserted-by":"crossref","first-page":"1691","DOI":"10.1038\/s41591-020-1083-1","article-title":"Seasonal Coronavirus protective immunity is short-lasting","volume":"26","author":"Edridge","year":"2020","journal-title":"Nat Med"},{"key":"2025092415290870000_49.9.636.10","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.82.10.1407"},{"key":"2025092415290870000_49.9.636.11","doi-asserted-by":"crossref","first-page":"1314","DOI":"10.1056\/NEJMoa2119658","article-title":"Population immunity and COVID-19 severity with Omicron variant in South Africa","volume":"386","author":"Madhi","year":"2022","journal-title":"N Engl J Med"},{"key":"2025092415290870000_49.9.636.12","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1016\/S1473-3099(22)00069-X","article-title":"SARS-Cov-2 incidence, transmission, and Reinfection in a rural and an urban setting: Results of the PHIRST-C cohort study, South Africa, 2020\u201321","volume":"22","author":"Cohen","year":"2022","journal-title":"Lancet Infect Dis"},{"key":"2025092415290870000_49.9.636.13","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(21)00675-9"},{"issue":"suppl_1","key":"2025092415290870000_49.9.636.14","doi-asserted-by":"crossref","first-page":"S559","DOI":"10.1093\/infdis\/jir098","article-title":"Two case studies of modified measles in vaccinated physicians exposed to primary measles cases: High risk of infection but low risk of transmission","volume":"204 Suppl 1","author":"Rota","year":"2011","journal-title":"J Infect Dis"},{"key":"2025092415290870000_49.9.636.15","first-page":"118","article-title":"Infection-acquired versus vaccine-acquired immunity in an SIRWS model","volume":"3","author":"Leung","year":"2018","journal-title":"Infect Dis Model"},{"key":"2025092415290870000_49.9.636.16","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3201\/eid2501.171901","article-title":"Complexity of the basic reproduction number (R0)","volume":"25","author":"Delamater","year":"2019","journal-title":"Emerging Infectious Disease Journal"},{"key":"2025092415290870000_49.9.636.17","doi-asserted-by":"crossref","DOI":"10.1155\/2011\/527610","article-title":"The failure of R0","volume":"2011","author":"Li","year":"2011","journal-title":"Comput Math Methods Med"},{"key":"2025092415290870000_49.9.636.18","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jiac109"},{"key":"2025092415290870000_49.9.636.19","unstructured":"Mill JS . On Liberty. London: J.W. Parker and son, 1859."},{"key":"2025092415290870000_49.9.636.20","doi-asserted-by":"crossref","unstructured":"Roberts D , Jamrozik E , Heriot GS , et al . Quantifying the impact of individual and collective compliance with infection control measures for ethical public health policy. 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