{
  "meta": {
    "title": "Vaccine Endgames \u2014 a structural taxonomy of vaccine-preventable diseases",
    "slug": "vaccine-endgames",
    "updated": "2026-09-30",
    "method": "Each disease is scored on five structural facts (person-to-person spread, human-only reservoir, whether the vaccine durably blocks infection/transmission, antigenic stability of the target, existence of a carrier/latent reservoir). Group membership is derived from those facts by fixed rules \u2014 no judgment calls in the scoring path. Rules: NOT contagious \u2192 personal; contagious AND human-only reservoir AND vaccine blocks transmission AND stable target AND no carrier state \u2192 eradicable; vaccine leaky/waning AND (moving target OR non-human reservoir) \u2192 damage_control; everything else contagious with real herd protection \u2192 herd.",
    "groups": {
      "eradicable": {
        "label": "Winnable wars",
        "desc": "Human-only reservoir, transmission-blocking vaccine, stable target, no carrier state. Vaccination compounds: every cohort buys down the future, and the endpoint is 'stop vaccinating forever.' Smallpox proved the category is real.",
        "endgame": "Eradication \u2014 the disease ceases to exist"
      },
      "herd": {
        "label": "Forever shields",
        "desc": "Strong herd protection, but something blocks eradication \u2014 a carrier or latent reservoir, waning immunity, or a vaccine that stops disease better than it stops spread. The win is elimination and control, maintained indefinitely.",
        "endgame": "Elimination/control \u2014 permanent maintenance"
      },
      "damage_control": {
        "label": "Damage control",
        "desc": "Leaky or short-lived vaccine protection against a moving target and/or an animal reservoir. Vaccination mainly converts severe outcomes into milder ones, season by season. There is no endpoint.",
        "endgame": "Severity reduction \u2014 forever, per season"
      },
      "personal": {
        "label": "Personal armor",
        "desc": "No person-to-person spread, so no herd immunity exists to build. The vaccine protects exactly one person: you. Public policy here is occupational-safety logic, not public-good logic.",
        "endgame": "Individual protection only"
      }
    },
    "criteria": [
      {
        "id": "contagious",
        "label": "Spreads person-to-person",
        "desc": "Without this there is no herd effect at all. Tetanus is the canonical exception: 'infectious but not contagious' (CDC Pink Book, ch. 21)."
      },
      {
        "id": "human_only",
        "label": "Human-only reservoir",
        "desc": "One of the classic eradicability criteria (Dowdle, CDC MMWR 1999): the pathogen has nowhere to hide when human transmission stops."
      },
      {
        "id": "blocks_transmission",
        "label": "Vaccine blocks transmission",
        "desc": "Sterilizing-ish, durable immunity that interrupts spread \u2014 vs 'leaky' protection that mostly prevents disease in the vaccinated person."
      },
      {
        "id": "stable_target",
        "label": "Stable antigenic target",
        "desc": "The vaccine aims at something the pathogen can't easily mutate away (measles H protein) vs a drifting target (influenza HA)."
      },
      {
        "id": "no_carrier",
        "label": "No carrier/latent reservoir",
        "desc": "Chronic carriers (hepatitis B), asymptomatic carriage (Hib, diphtheria) or latency (varicella-zoster, TB) keep a pathogen circulating even at high coverage."
      }
    ],
    "frozen": {
      "what": "Stu's independent vaccine dataset, frozen at repo commit c49102d \u2014 the last state before Instinct's independent audit.",
      "frozen_at": "2026-09-30",
      "superseded_by": "/data/vaccine-groups.json",
      "warning": "Contains values later withdrawn as unsupported, kept deliberately so the artifact records what was actually published. Do NOT use this file as a source. The corrected dataset is /data/vaccine-groups.json."
    }
  },
  "diseases": [
    {
      "slug": "smallpox",
      "name": "Smallpox",
      "group": "eradicable",
      "status": "ERADICATED 1980",
      "contagious": true,
      "human_only": true,
      "blocks_transmission": true,
      "stable_target": true,
      "no_carrier": true,
      "r0": [
        5,
        7
      ],
      "ve": 95,
      "ve_note": "historical estimates, vaccinia vaccination",
      "burden_then": "~300M deaths in the 20th century; ~2M/yr in the mid-1960s",
      "burden_now": "0 \u2014 the only human disease ever eradicated",
      "pct_reduction": 100,
      "note": "The existence proof for the whole 'winnable war' category. Certified eradicated by WHO in 1980; routine vaccination then stopped worldwide \u2014 the dividend pays forever."
    },
    {
      "slug": "measles",
      "name": "Measles",
      "group": "eradicable",
      "status": "eradicable (ITFDE)",
      "contagious": true,
      "human_only": true,
      "blocks_transmission": true,
      "stable_target": true,
      "no_carrier": true,
      "r0": [
        12,
        18
      ],
      "ve": 97,
      "ve_note": "two-dose MMR vs measles (CDC)",
      "burden_then": "~2.6M deaths/yr before the 1963 vaccine (WHO)",
      "burden_now": "107,000 deaths in 2023 (WHO); ~60M deaths averted 2000\u20132023",
      "pct_reduction": 96,
      "note": "The most contagious human virus with a routine vaccine \u2014 R0 12\u201318 means ~95% coverage is needed, which is why it's always the first thing back when coverage slips. Antigenically stable since 1963; still one serotype."
    },
    {
      "slug": "polio",
      "name": "Polio",
      "group": "eradicable",
      "status": "eradication in progress",
      "contagious": true,
      "human_only": true,
      "blocks_transmission": true,
      "stable_target": true,
      "no_carrier": true,
      "r0": [
        5,
        7
      ],
      "ve": 99,
      "ve_note": "IPV vs paralytic polio (CDC)",
      "burden_then": "~350,000 paralytic cases/yr across 125 endemic countries in 1988 (GPEI)",
      "burden_now": "wild virus endemic in only Afghanistan + Pakistan; 14 wild cases reported in 2026 to date",
      "pct_reduction": 99.99,
      "note": "99.99% of the way to the smallpox outcome. The rare vaccine-caused harm (VAPP, ~1 per 3.2M OPV doses, CDC 1975\u201384) is itself endgame logic: countries switch to injected IPV as wild virus disappears."
    },
    {
      "slug": "rubella",
      "name": "Rubella",
      "group": "eradicable",
      "status": "eradicable (ITFDE); eliminated in the Americas 2015",
      "contagious": true,
      "human_only": true,
      "blocks_transmission": true,
      "stable_target": true,
      "no_carrier": true,
      "r0": [
        6,
        7
      ],
      "ve": 97,
      "ve_note": "one dose, vs rubella (CDC)",
      "burden_then": "congenital rubella syndrome \u2014 deafness, cataracts, heart defects in infants infected in utero",
      "burden_now": "eliminated in the Americas since 2015; CRS persists where coverage is low",
      "pct_reduction": null,
      "note": "The burden lands almost entirely on unborn children of susceptible mothers \u2014 herd immunity IS the product. A mild childhood illness vaccinated against mostly to protect other people's pregnancies."
    },
    {
      "slug": "mumps",
      "name": "Mumps",
      "group": "herd",
      "status": "eradicable in principle (ITFDE), blocked by waning immunity",
      "contagious": true,
      "human_only": true,
      "blocks_transmission": "partial",
      "stable_target": true,
      "no_carrier": true,
      "r0": [
        4,
        7
      ],
      "ve": 88,
      "ve_note": "two-dose MMR vs mumps (CDC)",
      "burden_then": "near-universal childhood infection; leading cause of acquired deafness",
      "burden_now": "periodic outbreaks even in vaccinated communities (waning immunity)",
      "pct_reduction": null,
      "note": "The ITFDE lists mumps as potentially eradicable, but two-dose effectiveness of ~88% plus waning immunity keeps transmission alive in close-contact settings \u2014 so by this taxonomy's rules it falls out of the eradication group. The rules bite."
    },
    {
      "slug": "pertussis",
      "name": "Pertussis",
      "group": "herd",
      "status": "control only \u2014 vaccine protects against disease, not spread",
      "contagious": true,
      "human_only": true,
      "blocks_transmission": false,
      "stable_target": true,
      "no_carrier": false,
      "r0": [
        12,
        17
      ],
      "ve": 85,
      "ve_note": "acellular vaccine vs disease, first year; wanes (CDC)",
      "burden_then": "a leading killer of infants pre-vaccine",
      "burden_now": "infant deaths concentrated in babies too young to vaccinate; cocooning + maternal Tdap strategy",
      "pct_reduction": null,
      "note": "The famous FDA baboon study (Warfel et al., PNAS 2014): acellular-vaccinated animals were protected from disease but still got colonized and transmitted to contacts. You vaccinate to not get sick \u2014 and it takes maternal vaccination to shield the newborns."
    },
    {
      "slug": "diphtheria",
      "name": "Diphtheria",
      "group": "herd",
      "status": "controlled; carriage persists",
      "contagious": true,
      "human_only": true,
      "blocks_transmission": "partial",
      "stable_target": true,
      "no_carrier": false,
      "r0": [
        6,
        7
      ],
      "ve": 97,
      "ve_note": "toxoid vs disease (est.)",
      "burden_then": "'the strangling angel' \u2014 a top killer of children in the pre-vaccine West",
      "burden_now": "rare where coverage holds; outbreaks follow system collapse (1990s ex-USSR)",
      "pct_reduction": null,
      "note": "The vaccine targets the toxin, not the bacterium \u2014 vaccinated people can still carry and pass C. diphtheriae. Control is a subscription, not a purchase."
    },
    {
      "slug": "hib",
      "name": "Hib (H. influenzae b)",
      "group": "herd",
      "status": "near-eliminated where vaccinated",
      "contagious": true,
      "human_only": true,
      "blocks_transmission": true,
      "stable_target": true,
      "no_carrier": false,
      "r0": null,
      "ve": 95,
      "ve_note": "conjugate vaccine vs invasive disease",
      "burden_then": "leading cause of bacterial meningitis in under-5s pre-1990",
      "burden_now": "invasive Hib down ~99% in vaccinated countries",
      "pct_reduction": 99,
      "note": "Conjugate vaccines actually cut nasopharyngeal carriage, so herd protection is strong \u2014 but widespread asymptomatic carriage in the unvaccinated world means elimination is local and maintained, not global and final."
    },
    {
      "slug": "hepb",
      "name": "Hepatitis B",
      "group": "herd",
      "status": "WHO 2030 elimination-as-public-health-threat target",
      "contagious": true,
      "human_only": true,
      "blocks_transmission": true,
      "stable_target": true,
      "no_carrier": false,
      "r0": null,
      "ve": 98,
      "ve_note": "3-dose series, vs infection",
      "burden_then": "~250M+ chronic carriers; cirrhosis + liver cancer decades later",
      "burden_now": "birth-dose vaccination collapsing new chronic infections",
      "pct_reduction": null,
      "note": "A genuinely sterilizing vaccine \u2014 but hundreds of millions of existing chronic carriers form a reservoir that takes a human lifetime to age out. Eradication is a century project even at perfect coverage; the 2030 target is elimination as a public-health threat."
    },
    {
      "slug": "hpv",
      "name": "HPV",
      "group": "herd",
      "status": "cervical-cancer elimination target (WHO: <4 cases/100k)",
      "contagious": true,
      "human_only": true,
      "blocks_transmission": true,
      "stable_target": true,
      "no_carrier": false,
      "r0": null,
      "ve": 88,
      "ve_note": "vs cervical cancer, vaccinated at 12\u201313 (England, Lancet; Sweden NEJM ~88%)",
      "burden_then": "cervical cancer: ~350k deaths/yr globally",
      "burden_now": "England cohort vaccinated at 12\u201313: cervical cancer down 87%",
      "pct_reduction": 87,
      "note": "The newest member of the elimination club \u2014 a vaccine against a cancer. Sweden and England cohort data show ~87\u201388% cervical cancer reduction for those vaccinated before exposure. Persistent infection reservoir keeps it in the maintenance group."
    },
    {
      "slug": "varicella",
      "name": "Varicella (chickenpox)",
      "group": "herd",
      "status": "controlled; virus retires into every infected nervous system",
      "contagious": true,
      "human_only": true,
      "blocks_transmission": "partial",
      "stable_target": true,
      "no_carrier": false,
      "r0": [
        10,
        12
      ],
      "ve": 92,
      "ve_note": "two-dose vs any varicella (CDC)",
      "burden_then": "near-universal childhood infection; ~100\u2013150 US deaths/yr pre-1995",
      "burden_now": "US cases down >97% since vaccination began",
      "pct_reduction": 97,
      "note": "Every person who ever had chickenpox carries the virus for life (it returns as shingles) \u2014 a built-in latent reservoir that makes eradication structurally impossible with this vaccine."
    },
    {
      "slug": "rotavirus",
      "name": "Rotavirus",
      "group": "herd",
      "status": "controlled \u2014 vaccination converts severe to mild",
      "contagious": true,
      "human_only": false,
      "blocks_transmission": "partial",
      "stable_target": true,
      "no_carrier": true,
      "r0": null,
      "ve": 90,
      "ve_note": "vs severe rotavirus gastroenteritis, high-income settings",
      "burden_then": "~500k under-5 diarrheal deaths/yr pre-vaccine",
      "burden_now": "major declines in hospitalization where introduced",
      "pct_reduction": null,
      "note": "Also the clearest quantified vaccine risk in the modern schedule: 1\u20135 extra intussusception cases per 100,000 first doses (post-licensure surveillance) \u2014 against tens of thousands of averted deaths. Risk math done in the open."
    },
    {
      "slug": "tetanus",
      "name": "Tetanus",
      "group": "personal",
      "status": "individual protection only \u2014 forever",
      "contagious": false,
      "human_only": false,
      "blocks_transmission": null,
      "stable_target": true,
      "no_carrier": true,
      "r0": [
        0,
        0
      ],
      "ve": 100,
      "ve_note": "CDC surveillance 2009\u20132023: zero deaths among people with 3+ doses",
      "burden_then": "unvaccinated case-fatality ~12.5% even with modern ICU care (CDC)",
      "burden_now": "spores permanently in soil worldwide; cases track vaccination status exactly",
      "pct_reduction": null,
      "note": "The only vaccine-preventable disease that is infectious but not contagious (CDC). The spores are in the dirt forever; your neighbor's shot does nothing for you and yours does nothing for them. 100% of the benefit is private \u2014 and it's enormous."
    },
    {
      "slug": "rabies",
      "name": "Rabies",
      "group": "personal",
      "status": "individual protection only \u2014 animal reservoir",
      "contagious": false,
      "human_only": false,
      "blocks_transmission": null,
      "stable_target": true,
      "no_carrier": true,
      "r0": [
        0,
        0
      ],
      "ve": 100,
      "ve_note": "post-exposure prophylaxis, given promptly",
      "burden_then": "~59,000 deaths/yr globally, nearly 100% fatal once symptomatic",
      "burden_now": "human vaccination is personal armor; the herd strategy that works is vaccinating DOGS",
      "pct_reduction": null,
      "note": "Human-to-human transmission is essentially nil, so human vaccination has no herd component at all. The population-level lever exists \u2014 but it's canine vaccination, which is why rabies control programs are veterinary programs."
    },
    {
      "slug": "influenza",
      "name": "Influenza (seasonal)",
      "group": "damage_control",
      "status": "permanent damage control",
      "contagious": true,
      "human_only": false,
      "blocks_transmission": false,
      "stable_target": false,
      "no_carrier": true,
      "r0": [
        1.3,
        2
      ],
      "ve": 40,
      "ve_note": "CDC season-adjusted VE 2009\u20132026 ranges 19%\u201360%",
      "burden_then": "290,000\u2013650,000 respiratory deaths/yr (WHO) \u2014 every year, with the vaccine",
      "burden_now": "same \u2014 the vaccine trims each season's toll; it cannot end the disease",
      "pct_reduction": 0,
      "note": "Antigenic drift means the target moves every season; avian and swine reservoirs mean it can never be eradicated no matter what humans do. The shot is genuinely worthwhile \u2014 and it is doing a categorically different job than MMR. Cam's buddy's hospital deadline lands mid-season on purpose: protection wanes within ~6 months, so you time it to peak."
    },
    {
      "slug": "covid19",
      "name": "COVID-19",
      "group": "damage_control",
      "status": "permanent damage control",
      "contagious": true,
      "human_only": false,
      "blocks_transmission": false,
      "stable_target": false,
      "no_carrier": true,
      "r0": [
        6,
        10
      ],
      "ve": 50,
      "ve_note": "vs symptomatic infection, wanes in months; protection vs severe disease holds up better",
      "burden_then": "pandemic phase: millions of deaths",
      "burden_now": "endemic; boosters chase variants the way flu shots chase drift",
      "pct_reduction": null,
      "note": "Started as a novel virus, settled into the flu template: fast-drifting target, animal reservoirs (deer, mink), infection- and vaccine-immunity that wanes against infection while holding against severe disease. Same group as flu, same endgame: none."
    },
    {
      "slug": "tuberculosis",
      "name": "Tuberculosis (BCG)",
      "group": "damage_control",
      "status": "vaccine-limited \u2014 the disease outclasses the tool",
      "contagious": true,
      "human_only": false,
      "blocks_transmission": false,
      "stable_target": true,
      "no_carrier": false,
      "r0": null,
      "ve": 40,
      "ve_note": "BCG: ~70% vs miliary/meningeal TB in infants; 0\u201380% vs adult pulmonary TB depending on setting",
      "burden_then": "the leading infectious killer for most of recorded history",
      "burden_now": "~1.25\u20131.5M deaths/yr \u2014 still the top infectious killer; ~1/4 of humanity latently infected",
      "pct_reduction": null,
      "note": "The mirror image of flu: the pathogen is stable, but the century-old vaccine is the weak link \u2014 real protection for infants against the worst forms, wildly variable protection for adults against the transmissible pulmonary form. In damage-control not because eradication is structurally impossible, but because the current tool can't do more."
    }
  ],
  "flu_ve_by_season": [
    {
      "season": "2009\u201310",
      "ve": 56
    },
    {
      "season": "2010\u201311",
      "ve": 60
    },
    {
      "season": "2011\u201312",
      "ve": 47
    },
    {
      "season": "2012\u201313",
      "ve": 49
    },
    {
      "season": "2013\u201314",
      "ve": 52
    },
    {
      "season": "2014\u201315",
      "ve": 19
    },
    {
      "season": "2015\u201316",
      "ve": 48
    },
    {
      "season": "2016\u201317",
      "ve": 40
    },
    {
      "season": "2017\u201318",
      "ve": 38
    },
    {
      "season": "2018\u201319",
      "ve": 29
    },
    {
      "season": "2019\u201320",
      "ve": 39
    },
    {
      "season": "2020\u201321",
      "ve": null
    },
    {
      "season": "2021\u201322",
      "ve": 36
    },
    {
      "season": "2022\u201323",
      "ve": 30
    },
    {
      "season": "2023\u201324",
      "ve": 44
    },
    {
      "season": "2024\u201325",
      "ve": 56
    },
    {
      "season": "2025\u201326",
      "ve": 36
    }
  ],
  "sources": [
    {
      "label": "Dowdle WR \u2014 The Principles of Disease Elimination and Eradication (CDC MMWR, 1999)",
      "url": "https://www.cdc.gov/mmwr/preview/mmwrhtml/su48a7.htm"
    },
    {
      "label": "Our World in Data \u2014 Eradication of Diseases (ITFDE eradicable list)",
      "url": "https://ourworldindata.org/eradication-of-diseases"
    },
    {
      "label": "Guerra et al. \u2014 The basic reproduction number (R0) of measles: a systematic review (Lancet Infectious Diseases, 2017)",
      "url": "https://pubmed.ncbi.nlm.nih.gov/28757186/"
    },
    {
      "label": "WHO \u2014 Measles fact sheet (2.6M pre-vaccine deaths/yr; 107k deaths 2023; 60M averted 2000\u20132023)",
      "url": "https://www.who.int/news-room/fact-sheets/detail/measles"
    },
    {
      "label": "CDC Pink Book, Chapter 21 \u2014 Tetanus (infectious but not contagious; CFR by vaccination status)",
      "url": "https://www.cdc.gov/pinkbook/hcp/table-of-contents/chapter-21-tetanus.html"
    },
    {
      "label": "Warfel et al. \u2014 Acellular pertussis vaccines protect against disease but fail to prevent infection and transmission in a nonhuman primate model (PNAS, 2014)",
      "url": "https://www.pnas.org/doi/10.1073/pnas.1314688110"
    },
    {
      "label": "CDC \u2014 Seasonal Flu Vaccine Effectiveness Studies (VE by season, 2009\u20132026)",
      "url": "https://www.cdc.gov/flu-vaccines-work/php/effectiveness-studies/index.html"
    },
    {
      "label": "WHO \u2014 Up to 650,000 people die of respiratory diseases linked to seasonal flu each year",
      "url": "https://www.who.int/news/item/13-12-2017-up-to-650-000-people-die-of-respiratory-diseases-linked-to-seasonal-flu-each-year"
    },
    {
      "label": "Falcaro et al. \u2014 HPV vaccination and cervical cancer incidence in England (Lancet); Lei et al., Sweden (NEJM 2020)",
      "url": "https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02178-4/fulltext"
    },
    {
      "label": "WHO \u2014 Global strategy to eliminate cervical cancer as a public health problem (<4 per 100,000)",
      "url": "https://www.who.int/initiatives/cervical-cancer-elimination-initiative"
    },
    {
      "label": "GPEI \u2014 polio endemic status Afghanistan + Pakistan; 350,000 cases in 1988 baseline",
      "url": "https://polioeradication.org/"
    },
    {
      "label": "NCBI/IOM \u2014 Polio vaccines: VAPP ~1 per 3.2M OPV doses (CDC 1975\u20131984)",
      "url": "https://www.ncbi.nlm.nih.gov/books/NBK236293/"
    },
    {
      "label": "Rotavirus vaccine intussusception risk 1\u20135 per 100,000 first doses (post-licensure surveillance)",
      "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC6970121/"
    },
    {
      "label": "Martinez et al. / Lancet Global Health \u2014 infant BCG protection incl. ~70% vs miliary/meningeal TB; variable adult pulmonary efficacy",
      "url": "https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(22)00283-2/fulltext"
    },
    {
      "label": "WHO \u2014 Global Tuberculosis Report (TB the leading infectious killer, ~1.25M+ deaths/yr)",
      "url": "https://www.who.int/teams/global-tuberculosis-programme/tb-reports"
    },
    {
      "label": "WHO \u2014 Rabies fact sheet (~59,000 deaths/yr; dog vaccination as the control strategy)",
      "url": "https://www.who.int/news-room/fact-sheets/detail/rabies"
    },
    {
      "label": "WHO \u2014 Tetanus fact sheet",
      "url": "https://www.who.int/news-room/fact-sheets/detail/tetanus"
    },
    {
      "label": "R0 compilation for common VPDs (mumps 4\u20137, polio 5\u20137, diphtheria 6\u20137, rubella 6\u20137, pertussis 12\u201317, varicella ~10\u201312)",
      "url": "https://transportgeography.org/contents/applications/transportation-pandemics/basic-reproduction-number-r0-of-major-infectious-diseases/"
    }
  ]
}