While India continues to remain locked down until at least May 3, the question that is inevitably appearing across the country is: what next? Economies around the globe are struggling to overcome the hurdles put forth by the COVID-19 outbreak, and India is no different. Consequently, several experts are suggesting the partial reopening of businesses to reduce the financial burden on India’s public reserves. Developing herd immunity is one of the suggestions that have been put forth in order to achieve this. However, is such a policy advisable?
Herd immunity is “when most of a population is immune to an infectious disease, this provides indirect protection — or herd immunity (also called herd protection) — to those who are not immune to the disease”. This technique was previously successful in containing infectious diseases like measles, mumps, polio, and chickenpox, wherein vaccines helped build herd immunity and eventually curb the outbreak. In the absence of a vaccine for COVID-19, this strategy implies allowing the younger population to resume working and develop herd immunity while maintaining physical distance from high-risk individuals, such as the elderly.
The herd immunity policy is suggested for poorer developing countries–including India–due to the logistic impracticalities of social distancing, insufficient healthcare facilities, and the economic toll caused by prolonged lockdowns in poorer countries. While Indian authorities have made no statement indicating the introduction of such a policy in India, their decision to restrict testing to only high-risk or critical patients allows the virus to spread while limiting healthcare to only those with severe symptoms. This may not be a direct implementation of the herd immunity approach. However, it is an inevitable consequence of limited testing.
Two European countries–Sweden and the United Kingdom–have experimented with this approach to contain the spread of COVID-19. British authorities initially remained adamant about the viability of their decision to allow the virus to spread through the younger population, arguing that it would allow them to develop a herd immunity and restrict the impact of the outbreak on the economy. However, after the increasing number of deaths caused by the overburdening of healthcare facilities across the country, and repeated warnings by scientists that this approach could lead to half a million deaths by August, the policy was rescinded, and a lockdown was imposed.
Sweden, on the other hand, continues to promote its decision to avoid a complete lockdown and rely on herd immunity to battle COVID-19. While businesses and markets continue to function, Swedes are practicing social distancing by voluntarily working from home and strictly practicing physical distancing in public areas. The chief epidemiologist at Sweden’s Public Health Agency, Dr. Anders Tegnell, said that the success of the policy is being proved by a “plateau in new cases” in parts of Stockholm. He said that despite an increase in testing, Stockholm is seeing a slow decline in the number of new cases. Nevertheless, the death rate in Sweden is much higher than in neighbouring countries. Dr. Tegnell justified this disparity by referring to the spread of the infection in elderly care homes, which allegedly caused an unexpected increase in the number of deaths. However, critics continue to question the adequacy of the measures adopted by Sweden and remain sceptical of its herd immunity approach.
As India sees an increase in the number of young asymptomatic patients, the viability of the herd immunity policy is being assessed. The discussion spread after Dr. Jayaprakash Muliyil, the Chairman of the Scientific Advisory Committee of the National Institute of Epidemiology, advocated it as the “only lasting solution” to the outbreak, arguing that the lockdown was the “easier choice”. While he admits that the nationwide restrictions have helped in spreading awareness and flattening the curve, he believes that the Indian economy will not be able to survive a prolonged lockdown, and thus advocates a herd immunity policy.
Dr. Muliyil argues that India’s “younger population,”–that is, individuals aged less than 60–will lead the success of such an approach. While countries like Germany, France, and the UK have an average age of 45, India’s is just 26.8. Hence, he recommended allowing the virus to navigate across the population, and allowing it to affect those under the age of 60–which comprises around 90% of the Indian population–on the assumption that COVID-19 only causes mild symptoms in that age group.
Another group of advocates for herd immunity in India is the team of researchers at Princeton University and the Centre for Disease Dynamic, Economics, and Policy. They believe that this strategy could work in India due to its disproportionately younger population, which enables fewer cases of hospitalisation and death. The team predicted that if the virus is unleashed in a controlled manner, 60% of the population could develop immunity by the end of November.
However, these suggestions are both incomplete and premature. Firstly, a “younger population” may not save India from UK-like consequences of the herd immunity policy. While trends in countries like Italy, Spain, and the US indicate that older people are more prone to severe symptoms of COVID-19, data in India shows otherwise. In India, the Ministry of Health and Family Welfare reported that 75% of the COVID-19 patients were aged 21 to 60 years. Out of these, 42% were aged 21 to 40 years. Even if the fatality rate amongst young Indians is proven to be lower, the rate of hospitalisation amongst the age group is higher than in countries like Italy, Spain, and the USA, with a comparatively higher number of patients winding up in ICUs. Further, younger Indians are also more prone to diseases like type-2 diabetes, high blood pressure, anaemia, and heart diseases, demonstrating their comparatively higher vulnerability to the coronavirus. Hence, allowing 60% of the population to be infected could risk overburdening India’s healthcare system.
Proposals to implement a herd immunity policy in India also fail to accommodate the country’s several unique social factors that could hamper the efficacy of such a strategy. For instance, unlike Sweden, which has an average household size of 2.2, the average household size in India is 4.9, with a significant number of young adults living with their family members aged over 60. The situation is even direr in slums and other crowded living spaces, where the high population densities are coupled with poor hygiene and sanitation standards. For example, Mumbai’s Dharavi, one of Asia’s largest slums, has a population density of over 270,000 people per square kilometre and a population of over one million. Hence, the suggestion of maintaining voluntary physical distance from the elderly is practically impossible to implement for the majority of India’s population.
More importantly, there is no evidence to prove that COVID-19 positive patients develop immunity to further infections after recovery. Like the flu, certain viruses mutate over time. Hence, antibodies from a previous infection may not provide life-long immunity. According to the Johns Hopkins Bloomberg School of Public Health, if the COVID-19 is similar to other coronaviruses, the developed immunity may last for months or years, but not for an individual’s lifetime.
Dr. Maria Vankhove, an infectious disease epidemiologist at the World Health Organisation, said that there is no scientific data to prove that those exposed to the virus are entirely immune to it following their recovery. The resurgence of COVID-19 amongst 91 released patients in South Korea supports this claim. Further, Wuhan’s Zhongnan Hospital reported that merely 2.4% of its employees and 2-3% of patients had developed antibodies against COVID-19. Wang Xinghuan, the head of the hospital, said that “[t]his is a long way from herd immunity”.
India is in dire need of a strategy to combat the potentially dire consequences of an extended coronavirus-induced lockdown. However, proposals to implement a herd immunity policy ignore the unique socioeconomic and cultural realities of Indian society that prevent or severely impede the success of such a strategy. In the absence of drastic measures to improve healthcare facilities and assure their ability to tackle an exponential rise in hospitalisations and critical care patients, implementation of a herd immunity policy could be catastrophic, and could cause several deaths, increased suffering, and an overwhelming burden on India’s healthcare system. Moreover, it may well cause India to reconsider the policy altogether, much like the UK, and extend the lockdown even further than originally envisaged or planned.
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Could Herd Immunity Be the Solution to India's Coronavirus Problem?
April 30, 2020
