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posted on 2020-10-14 18:46:00 .
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On Monday, the White House hosted a pandemic-focused call for the press “on background”—intended to provide a window into the administration’s thinking but not to provide quotes that could be attributed to any government official. During the call, the unspecified White House officials touted a document supporting the idea of herd immunity as a plan to control the pandemic, saying it reflected the administration’s thinking.
The document, called the Great Barrington Declaration, was prepared by a libertarian think tank with the assistance of a handful of scientists who have been pushing the idea that COVID-19 isn’t much of a threat. And it has attracted enough attention that the World Health Organization decided to address it. The result severely undercut whatever the White House intended to accomplish.
“Never in the history of public health has herd immunity been used as a strategy for responding to an outbreak, let alone a pandemic,” the WHO’s Tedros Adhanom Ghebreyesus said. “It’s scientifically and ethically problematic.”
Not so Great Barrington
The document in question is called the Great Barrington Declaration, and it was organized under the auspices of the American Institute for Economic Research, a libertarian think tank with ties to the Koch network. The declaration itself was spearheaded by a group of scientists who have been pushing the idea that many countries are already near herd immunity and have been so since early in the pandemic. For example, a number of these researchers were involved in an antibody study of SARS-CoV-2 exposure that was torn apart by experts in the field. The document has attracted a large number of signatories. Some of them have actual expertise, but others—such as some homeopaths—only believe they have expertise, and many others are simply Internet vandals signing up with fake names.
Despite the poor reception of its research by the field, the group has been trying to get the attention of the Trump administration since early in the summer.
The declaration does what most advocates of herd immunity have done: play up the consequences of lockdowns while minimizing the consequences of the lethal pandemic. “Current lockdown policies are producing devastating effects on short- and long-term public health,” it says, before suggesting that most of these are caused by people forgoing normal medical care during the pandemic. How normal medical care could be provided during an unchecked pandemic was left as an exercise for the reader.
The researchers then go on to claim that “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.” The declaration’s version of compassion is then described as essentially ending any restrictions on high-risk activities—work, schools, concerts, sports, and more should resume for anyone who’s considered low risk.
The declaration even suggests higher-risk individuals might want to risk death for the benefit of society: “People who are more at risk may participate if they wish, while society as a whole enjoys the protection conferred upon the vulnerable by those who have built up herd immunity.”
In a word, no
The WHO’s Ghebreyesus is not impressed with the idea. “Herd immunity is achieved by protecting people from a virus, not by exposing them to it,” he said, indicating that vaccines are the only things that consistently provide that protection. And the problems with herd immunity through infection are enormous.
To begin with, in cases like polio and measles where we have achieved herd immunity, it required successful vaccination of 80 and 90 percent of a population, respectively. Right now, studies of most populations are indicating that “in most countries, less than 10 percent of the population have been infected by the COVID-19 virus.”
Added to that is the fact that we don’t understand how infection relates to immunity. There have been a (fortunately small) number of cases of second infections reported, and we don’t know why those occur. More generally, Ghebreyesus said, we don’t know how long immunity lasts or what explains the apparently variable responses to infection that have been seen when T cells or antibody production are examined. Without that knowledge, it’s difficult to determine whether infection can lead to herd immunity at all.
Ghebreyesus also reminded everyone that low risk does not mean no risk—people of all ages have died. And we’re just beginning to characterize the lingering symptoms of what is being termed “long COVID.” Given the fact that the virus wasn’t even infecting humans this time last year, it’s far too early to tell how long symptoms of COVID-19 persist and whether they are the consequence of relatively permanent tissue damage. Without that understanding, it’s difficult to determine whether any population is truly low risk.
All of that doesn’t even get into the issue of why herd immunity wasn’t considered an option in the first place. Unchecked infection of even the less-vulnerable population risks overtaxing the health care infrastructure, causing excess mortality from non-COVID-19 conditions and leading to the exact same loss of normal medical care that the Great Barrington declaration is complaining about.
Finally, Ghebreyesus reminded everyone that lockdowns were just one tool in a large arsenal of interventions that can be used to control the pandemic. While they might be required in cases where infection rates are climbing rapidly, things like contact tracing and mask use can help keep the pandemic in check in countries where infections remain relatively low—which he noted represent the majority of countries at the moment.
“Allowing a dangerous virus that we don’t fully understand to run free is simply unethical,” is how Ghebreyesus summed it up, later saying it “means allowing unnecessary infections, suffering, and death.”
WTF White House
So why in the world is the White House promoting a document with signatories that include “Dr. Johnny Bananas” and “Professor Notaf Uckingclue” instead of the WHO—or, for that matter, its own Centers for Disease Control, which has developed policy advice that focuses on limiting the spread of infection?
It’s difficult to know how this happened, given the anonymity granted to the people who were providing the background—The New York Times simply referred to them as two “senior administration officials.” But another reporter on the call noted that the administration’s health experts and its entire COVID task force weren’t participating. So this appears to represent an attempt by people within the White House to undercut their own health experts.
One obvious candidate for driving that effort is Scott Atlas, a neurologist who fancies himself an infectious disease expert and has previously gone on the record in promoting herd immunity. But Atlas has been advising the administration for months, and why his ideas would suddenly be openly embraced now is not clear.
It may ultimately be because Trump personally, and the administration more generally, has been undercutting health experts’ advice in various ways since the early days of the pandemic. The Great Barrington Declaration, despite its fringe ideas and the fact that it has the overwhelming support of Internet vandals, provides an opportunity to pretend that the administration’s response was a plan and not a combination of political posturing and the president’s complete lack of impulse control. The fact that nobody from the administration is willing to go on the record when endorsing this document suggests that most of them recognize doing so for what it is.
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