Herd immunity for COVID-19
The Lancet; Spotlight|Online First
Published:November 24, 2020
DOI: https://doi.org/10.1016/S2213-2600(20)30555-5
In early October, 2020, three epidemiologists convened in Great Barrington, a small town in Massachusetts, USA. Jay Bhattacharya (Stanford University Medical School, Stanford, CA, USA), Sunetra Gupta (University of Oxford University, Oxford, UK) and Martin Kulldorff (Harvard University, Cambridge, MA, USA) were there to draft an argument for a new strategy to combat COVID-19. They called it the Great Barrington Declaration. It has since been endorsed by thousands of medical practitioners, researchers, and public health scientists.
“Current lockdown policies are producing devastating effects on short and long-term public health”, states the declaration. “Keeping the measures in place until a vaccine is available will cause irreparable damage, with the underprivileged disproportionately harmed...our goal should therefore be to minimize mortality and social harm until we reach herd immunity.” The authors recommended policymakers adopt an approach they termed “focused protection”. This entails easing restrictions on low-risk groups, with the intention of allowing them to establish immunity to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) through natural infection, while simultaneously stepping up the protection of high-risk groups. For example, governments could fund short sabbaticals for vulnerable workers in public-facing jobs and provide accommodation for individuals who cannot easily maintain isolation in their own home.
Within weeks, an opposing group of experts, also numbering in the thousands, had put their names to the John Snow Memorandum. The document, named after one of epidemiology's greatest historical figures, defended the restrictions to slow the spread of SARS-CoV-2 as “essential to reduce mortality, prevent health-care services from being overwhelmed, and buy time to set up pandemic response systems to suppress transmission”. It described focused protection as “a dangerous fallacy unsupported by scientific evidence” and warned that “uncontrolled transmission in younger people risks significant morbidity and mortality across the whole population”. The memorandum concluded by asserting that “controlling community spread of COVID-19 is the best way to protect our societies and economies until safe and effective vaccines and therapeutics arrive within the coming months”.
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