There are two things to understand about the “herd immunity” strategy the White House has reportedly “embraced” in the past month. The first is that the term, which originally referred to the protection a community gets from high vaccination rates, in this case is being used as shorthand for letting the coronavirus rampage through the nation until those who haven’t died have developed antibodies. The second is that health experts hate it.
World Health Organization Director-General Tedros Adhanom Ghebreyesus called the approach “simply unethical” earlier this month, and Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and a member of the White House coronavirus task force, has called it “ridiculous” and “total nonsense.” “It’s barbaric,” Dr. Gregg Gonsalves, an assistant professor in epidemiology at Yale School of Medicine, told me. “You’re going to let millions die for some notion of herd immunity?” It’s a particularly bad strategy with coronaviruses, he said. “Who knows how potent and how permanent antibodies are to the disease?”
Yet doctors worry that the White House is still officially or unofficially implementing this idea—particularly given statements like White House chief of staff Mark Meadows’s announcement on Sunday that “we are not going to control the pandemic.” And considering the time the medical community has spent saving lives and combating misinformation over the past year, the fact that this strategy is even being considered feels, to some, like a betrayal.
The “herd immunity” approach—also called “targeted protection”—would somehow focus on protecting those who are known to be vulnerable to the virus, like elderly people living in nursing homes, while encouraging everyone else to stop taking protective measures and succumb to the virus in order to achieve eventually some temporary form of immunity. “What we need to do is make sure that we have the proper mitigation factors, whether it’s therapies or vaccines or treatments to make sure that people don’t die from this,” Meadows added Sunday, without elaborating on how exactly a virus that’s so far killed some 225,000 in the country could magically be rendered nonfatal. It’s unclear how the vulnerable would be shielded from the less vulnerable. It’s also unclear who belongs in which group. Plus, no one even really knows how immunity to the virus works yet—whether it lasts a few months or a few years. Millions could die without communities ever reaching the goal of high levels of immunity.
Doctors, nurses, health specialists, first responders, food providers, and hospital cleaning staff have been working long hours, often without adequate protection from the virus, as cases across the country have mounted. By July, they were tired. Now they’re beyond weary. “For many, if not all, of us working in public health and health care, we are truly exhausted and frustrated,” Dr. Saskia Popescu, a hospital epidemiologist and infection preventionist, told me. “A push for herd immunity is not only dangerous and unethical but feels almost a slap in the face for those who have been working tirelessly to care for patients and provide public health resources.”
Not only is there no end in sight for health workers and experts working to address the virus; a strategy like this could result in a massive strain on an already overburdened health system. As cases have already begun resurging this fall, reaching a record high of 83,010 new cases on Friday, health workers are watching with dread. “This strategy could overwhelm hospitals and public health efforts like contact tracing,” Popescu said.
Without knowing more about how immunity to the virus works—and the potential long-term effects even of mild cases—it’s irresponsible to allow it to infect vast swaths of the country, experts say. “We are just barely starting to understand long-haulers,” Popescu said, “and the truth is that we’re barely 10 months into this pandemic, so it’s not just the immediate infection that could be life-threatening but also the longer implications that could be life-altering.” Long-term effects, in addition to the havoc they wreak on individuals’ lives, could place an additional strain on medical resources.
Here’s the original meaning of “herd immunity”: If enough people are vaccinated, it provides protection for others who are not able to be immunized, because the virus never really gains a toehold in the population—it’s never able to break through the wall of immunized people to be transmitted to the people without antibodies.
We have never reached herd immunity for a disease without a vaccine in the past; without one, cases rise and fall each year. It’s not clear how long natural immunity from being infected with the virus lasts. Right now, experts think it’s likely a few months. That means even if you survive the virus and have some immunity to it, you could be just as vulnerable—and maybe even more so, depending on how this virus works—in the future. Humans haven’t been around this virus long enough to know the answers to these questions yet.
“You’re essentially saying that we are going to commit ourselves to a substantial number of people becoming sick, potentially with long-term complications of the virus, and a lot of people dying unnecessarily because we’ve chosen not to do the hard work of controlling transmission in the community,” Dr. Rajeev Venkayya, president of the global vaccine business unit at Takeda Pharmaceutical Company, told me. “You could argue that it’s a distraction from the fact that we in the U.S. have been unable to control transmission of the virus, and so we would effectively be throwing up our hands and saying that we’re going to find a way to justify our failure.”
Even if the strategy were implemented, Venkayya said, “we don’t even know who the vulnerable are, because those who have preexisting conditions may not be aware of it.” And although adults 65 or older account for eight out of 10 confirmed Covid-19 deaths in the United States, leading the elderly to be dubbed an at-risk population, many young, healthy people experience long-term effects of the illness. People who have long been marginalized, including people of color, have experienced higher rates of contracting the virus because their communities have frequently been neglected and mistreated for generations. Will there be attempts to protect these communities if this strategy is adopted? If so, how? Will at-risk essential workers be paid to stay at home? Will nursing-home workers have access to universal sick leave? And how would we control people’s movements such that the less vulnerable, who are supposed to contract the disease, never interact with the vulnerable?
Instead of allowing the virus to circulate unfettered, experts say, we need to circulate more and better information on how to protect everyone. “We’ve had a whirlwind of nine months of misinformation about this,” Gonsalves said. “And we’re going to have to really play catch-up.” Many Americans still don’t know anyone who has died from the virus, he pointed out. “There’s a lot of inability for people to understand risk when it’s not right in front of them.” Leaders in other countries, such as New Zealand and European nations, have communicated much more clearly what the risks are—and how and why to avoid them. “We’re going to have a lot of work to do about rebuilding confidence, getting the facts out,” Gonsalves said.
It’s tiring, seemingly endless work. But health experts and medical workers would rather keep doing it than let the people they’re fighting to save sicken or die. And responding to this pandemic shouldn’t rest entirely on their shoulders. This virus isn’t giving up, experts say, and we can’t, either.