Oct. 15, 2020 -- The Trump administration’s embrace of “herd immunity” to combat COVID-19 has drawn sharp rebukes from infectious disease experts who say millions of Americans could die.

In a call with reporters featuring two senior officials, the White House said it supports an Oct. 4 petition called The Great Barrington Declaration that argues authorities should allow the virus to spread freely among young, healthy Americans while protecting older and vulnerable people. Doing so, they said, would allow communities to establish herd immunity in lieu of a working vaccine.

The declaration also opposes lockdowns and argues that schools and businesses should reopen. While many of the declarations’ authors and supporters are unknown, more than 9,800 medical and public health scientists worldwide signed on to support it, according to its website. The New York Times reported that the document grew out of a meeting hosted by the American Institute for Economic Research, a libertarian-leaning research organization.

Its lead authors, the Times said, include Jay Bhattacharya, MD, an economist and medical professor at Stanford University, the academic home of Scott Atlas, MD, President Trump’s science adviser. Atlas has also publicly supported herd immunity.

The declaration’s signatories include Sunetra Gupta, PhD, and Gabriela Gomes, PhD, two scientists who say herd immunity can be achieved when 10% to 20% of a population has been infected with the virus.

“Current lockdown policies are producing devastating effects on short and long-term public health,” the declaration states. “The most compassionate approach that balances the risks and benefits of reaching herd immunity, is to allow those who are at minimal risk of death to live their lives normally to build up immunity to the virus through natural infection, while better protecting those who are at highest risk.”

Within hours of the White House call supporting the Barrington declaration, public health experts condemned the Trump administration’s embrace of the declaration and its approach.

“It’s a ghastly way” to combat the virus, said William Schaffner, MD, professor of infectious diseases at Vanderbilt University School of Medicine. “It’s Darwinian survival of the fittest.”

He estimated “2 to 6 million” Americans would die as a result of the approach that Great Barrington recommends. “It’s a back of the envelop calculation,” he said, “but it would be a very large number -- over 2 million.”

He added: “Nature is fierce, so no, we don’t want to do that -- just let the virus run through our population unimpeded. It will leave in its wake a huge amount of medical care and it would be terrible for people who will be in hospitals and in intensive care units and a lot of them will die -- not all of them elderly either.

“This is a terrible way to achieve herd immunity.”

Debate Comes Amid Surge

The escalating debate over herd immunity comes amid an expanding coronavirus outbreak at the White House that has grown to more than 20 people.

It also coincides with new projections that don’t support Trump’s pledge to have a COVID-19 vaccine ready by Nov. 3.

The concept of herd immunity comes from livestock farming and refers to the point at which a disease stops spreading because nearly everyone has gotten it, thereby providing immunity.

In June, researchers from the University of Nottingham and University of Stockholm wrote in an article in Science that herd immunity might be achieved when 43% of a population becomes immune to the coronavirus.

Both numbers suggest widespread infection with COVID-19 would put millions at risk because the virus has a death rate in the United States of 0.6%, according to the CDC. That is six times the mortality rate from the flu.

Joshua Michaud, PhD, associate director of Global Health Policy at the Kaiser Family Foundation, agreed that the approach would be “an extremely risky strategy [that] would almost guarantee very high levels of disease and many deaths, without assurance of much in the way of overall health or economic benefits.”

The main problem, he said, is that separating high-risk and low-risk individuals is not possible, especially considering that an estimated 93 million U.S. adults (37.6% of all adults) can be considered as being in the “high-risk” category.

“High-risk individuals live, work, and come into contact with low-risk individuals in the same communities, in the same households,” he noted. “How can these two groups actually be physically separated, as would seem to be necessary under the focused protection plan?”

In addition, it remains unclear whether infection with COVID-19 confers immunity from reinfection. There are several case reports of patients getting the virus twice.

“We can expect that more and more reinfections will occur over time as natural immunity wanes,” he said. “You may never be able to reach that magic 'herd immunity' threshold at all if people can be re-infected.”

For these reasons, he endorses most public health specialists’ views -- including those of many of Trump’s own coronavirus task force -- that the best way to combat and control coronavirus is through COVID-19 testing, contact tracing, isolation and quarantine, mask use, and social-distancing measures that reduce crowding.

“There are many examples of countries that have done just that, and have reaped economic and social benefits from that approach,” he said.

More Scientists Weigh In

Michaud and Schaffner’s sentiments were echoed by the authors of a letter published in The Lancet medical journal late yesterday.

The group of 80 researchers and epidemiologists warned that a “herd immunity” approach is “a dangerous fallacy unsupported by the scientific evidence.”

They state: “It is critical to act decisively and urgently. Effective measures that suppress and control transmission need to be implemented widely, and they must be supported by financial and social programs that encourage community responses and address the inequities that have been amplified by the pandemic.”

Some public restrictions will be needed in the short term, they said, to lower the spread of the virus and correct problems in pandemic response systems. That alone will prevent future lockdowns.

Doing this will “allow rapid detection of localized outbreaks and rapid response through efficient and comprehensive find, test, trace, isolate, and support systems so life can return to near-normal without the need for generalized restrictions. Protecting our economies is inextricably tied to controlling COVID-19. We must protect our workforce and avoid long-term uncertainty.”

And an alliance of 14 public health organizations, known as the Big Cities Health Coalition, released a statement calling the Barrington Declaration “a political statement” that is “NOT based in science” and would “haphazardly and unnecessarily sacrifice lives.”

The coalition added: “It ignores sound public health expertise. It preys on a frustrated populace. Instead of selling false hope that will predictably backfire, we must focus on how to manage this pandemic in a safe, responsible, and equitable way.”

“The idea that herd immunity will happen at 10 or 20 percent is just nonsense,” said Christopher J.L. Murray, MD, DPhil, director of the University of Washington’s Institute for Health Metrics and Evaluation, which produced the epidemic model frequently cited during White House news briefings as the epidemic hit hard in the spring.

WebMD Health News Medically Reviewed by Brunilda Nazario, MD

Sources

William Schaffner, MD, Vanderbilt University.

The Lancet: "Herd immunity approaches to COVID-19 control are a ‘dangerous fallacy’, say authors of open letter."

 The New York Times: " White House embraces a declaration from scientists that opposes lockdowns and relies on ‘herd immunity.’"

Joshua Michaud, PhD, associate director, Global Health Policy, Kaiser Family Foundation.

Great Barrington Declaration.

Center for Infectious Disease Research and Policy, University of Minnesota.

The White House: “Background Press Call on the Trump Administration's Strategy to Safely Reopen America. Will add press release transcript to documents.”

Science: "A mathematical model reveals the influence of population heterogeneity on herd immunity to SARS-CoV-2."

Medicalxpress.com: “Herd immunity threshold could be lower according to new study.”

Big Cities Health Coalition: “17 Public Health Organizations Condemn Herd Immunity Scheme for Controlling Spread of SARS-Cov-2.”

Christopher J.L. Murray, MD, DPhil, director, University of Washington Institute for Health Metrics and Evaluation.

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