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A controversial proposal that promotes building herd immunity to COVID-19 through natural infection among populations with low mortality risk has been called “unethical,” impractical, and “dangerous.”
However, the three top scientists proposing it last week had a private audience with US Health and Human Services Secretary Alex Azar and Scott Atlas, MD, a top medical adviser to President Donald Trump. A growing list of online signers includes some high-profile physicians and scientists.
The original architects of the proposal, called the Great Barrington Declaration, are prominent names in the scientific community, including Martin Kulldorff, PhD, an epidemiologist at Harvard University, Sunetra Gupta, PhD, an epidemiologist at Oxford University in the United Kingdom, and Jay Bhattacharya, MD, PhD, a professor and public health policy expert in infectious diseases at Stanford University in California.
The organizers call their approach “Focused Protection,” which promotes isolating and increasing protection of groups who are most vulnerable to COVID-19 while avoiding lockdowns, letting the rest of the world go back to work, school, sports, and daily life activities while natural infection builds herd immunity.
“We know that vulnerability to death from COVID-19 is more than a thousand-fold higher in the old and infirm than the young,” the writers say.
Social distancing measures and quarantine restrictions, which have led to job and income loss, cause more harm than good, they say, citing lower child vaccination rates, fewer cancer screenings and the growing toll on mental health.
Letting the virus spread naturally will lead to herd immunity, they claim, with or without a vaccine.
Critics note that the proposal is short on specifics on how to separate vulnerable populations. They say the proposal seems to envision quick herd immunity without considering the “long-haulers,” or the people still feeling the effects of COVID-19 months after their infection.
Today, the Infectious Diseases Society of America (IDSA) and its HIV Medicine Association strongly denounced the declaration, “released without data or evidence, that states this crisis can be controlled in the absence of critical public health measures.”
IDSA President Thomas M. File Jr, MD, MSc, and HIVMA Chair Judith Feinberg, MD, said in the statement that herd immunity as an answer to the COVID-19 pandemic “is inappropriate, irresponsible, and ill-informed.”
“ ’Community immunity,’ or ‘herd immunity,’ a goal of vaccination campaigns, should never come at the cost of the planned exposure and infection of millions of additional people, as well as the severe illness and preventable deaths of hundreds of thousands of people,” they write.
Gregg Gonsalves, PhD, a global epidemiologist and assistant professor at Yale School of Public Health in New Haven, Connecticut, put his opposition bluntly: “This is a fringe component of epidemiology. This is not mainstream science. It’s dangerous,” he tweeted.
He said the declaration warns against something that is not currently endorsed: “full-scale lockdowns.”
“[N]o one likes lockdowns. No one thinks that they are without secondary harms. And most importantly, NO ONE is arguing for Wuhan-style full-scale lockdowns,” he tweeted.
He argues on Twitter that most elderly people do not live in nursing homes, but live with their families or alone. “How do you pull these older people to safety? What’s the plan?” he asks.
Additionally, the Centers for Disease Control and Prevention (CDC) has calculated that nearly half of people in the US have preexisting conditions that could put them at risk for severe COVID-19.
Gonsalves likens the proposal to “culling the herd of the sick and disabled. It’s grotesque,” he said.
Rupert Beale, PhD, who heads the cell biology of infection laboratory at the Francis Crick Institute in the United Kingdom, adds in an open letter from the Science Media Centre, “It is not possible to fully identify vulnerable individuals, and it is not possible to fully isolate them. Furthermore, we know that immunity to coronaviruses wanes over time, and re-infection is possible — so lasting protection of vulnerable individuals by establishing ‘herd immunity’ is very unlikely to be achieved in the absence of a vaccine.”
World Health Organization (WHO) Director General Tedros Adhanom Ghebreyesus called the proposal “unethical” at a press conference this week, according to multiple media reports.
“Allowing a dangerous virus that we don’t fully understand to run free is simply unethical,” he said. “It’s not an option.”
He pointed out that so far only about 10% of the population in most countries has been infected, according to blood tests for antibodies, so this approach to wide exposure would cause unnecessary infection and death.
“Herd immunity is achieved by protecting people from a virus, not by exposing them to it,” Tedros said. “Never in the history of public health has herd immunity been used as a strategy for responding to an outbreak, let alone a pandemic.”
David L. Katz, MD, MPH, president of the True Health Initiative and founding director of the Prevention Research Center at Yale University is among the cosigners of the declaration.
The proposal reflected opinions he stated in a New York Times piece in March.
“It’s been abundantly clear that the single greatest determinant of health outcomes is social determinants,” including food and financial security, and access to jobs, Katz told Medscape Medical News.
Desperation, unemployment, destitution, addiction, and hunger pose also pose a lethal threat to society, he argues.
Katz says his position from the beginning of the pandemic was, “Let’s lock down, let’s then get the data we need so we can risk-stratify the population and minimize total harm. Minimize total harm means protect people who can’t be exposed to the virus because they are likely to suffer an adverse outcome.”
At the same time, he said, policies should not overprotect young, healthy people.
“The adverse outcome rate in young, healthy people is a rounding error,” Katz said. “It’s a tiny fraction of a percent whereas in people with chronic illness over age 80, this is highly lethal threat.”
He says the declaration is not suggesting doing less all around, but to do more for the highly vulnerable.
What’s needed is much more protection in nursing homes and much less disruption around schools. Katz agrees with the proposal writers who say the damage from disruption to schools will reverberate long-term and the people most hurt will be the families with the fewest resources to learn from home.
He says using the logic that children shouldn’t be allowed to go to school because of the risk of the virus, “no kid should ever be allowed to go to college because of the risk of hazing and alcohol.”
Katz said about the public health experts who signed the declaration: “None of us is interested in the trade-off between lives and dollars — maybe there are economists who are. We’re just looking at the different ways the situation can cost lives.”
As to how to separate those who need the protection, he says policies are needed to establish risk tiers.
“The entire country would hear that when risk tiers interact, accommodation must be made for the highest-risk person in the group,” Katz said. “If kids interact with each other in schools without wearing masks, then if they interact with their grandparents, they need to distance and wear masks.”
He said herd immunity “is the only way pandemics end,” whether with a vaccine as a major contributor or through native infections or a combination of both.
“I would welcome a safe, effective, universally distributed vaccine,” Katz said. “I just wouldn’t recommend holding your breath until we have one.”
Marcia Frellick is a freelance journalist based in Chicago. She has previously written for the Chicago Tribune, Science News and Nurse.com and was an editor at the Chicago Sun-Times, the Cincinnati Enquirer, and the St. Cloud (Minnesota) Times. Follow her on Twitter at @mfrellick