Is striving for herd immunity, regardless of the human "culling" that may be required, ethical?
Why not just let the virus “burn through” the population to shorten the time needed to acquire herd immunity? We would protect the vulnerable and elderly, of course. This way we would just get the virus over with.
An increasing number of voices propose that this is what societies have to do to move quickly beyond this pandemic. They point to the experience of Sweden to bolster their claims that this strategy would work. It would preserve both health and wealth.
Note that whether we adopt this pandemic strategy or not is not a scientific question – though science has to inform the intellect so that it can judge wisely – but an ethical and a political one. Therefore, we need to begin by clarifying the ethical principles that we will need to make this prudential judgment.
Which ethical and social principles would the Catholic moral tradition propose to guide us here? I think that there are at least two. Both of these moral principles are the foundational pillars for the pro-life worldview.
First, we are called to acknowledge and respect the intrinsic dignity of each and every human organism. Because of this dignity, every human organism is priceless. Every human organism is inestimable. We all have this “beyond-price” value/worth/status because every human organism is made in the image and likeness of God with an intellectual nature that allows us to know and to love.
Therefore the Down syndrome fetal human, the 90-year-old person with dementia living in a nursing home, and the 45-year old who is also the managing partner of the mid-town NY law firm all have equal value. They all have equal moral status. They are all created equal regardless of their social contribution, their social role, or their social success, or lack thereof. We have to try to protect them equally well during a pandemic.
Second, we are called to favor and to protect the poor and vulnerable. Recalling the story of the Last Judgment (Mt. 25:31-46), we are called to put the needs of the poor and vulnerable first. This is especially important to remember during this pandemic because it is the poor who are bearing the brunt of the loss of health and the loss of wealth caused by COVID-19.
There are two ways of allowing the pandemic to “burn through” the human population.
First, we could just allow the virus to run wild by forgoing all social distancing policies whatsoever. It would take several months to achieve herd immunity – 60% to 70% of the population would need to be infected given this virus’s reproduction rate – but the number of sick and dying patients in the short term would be prohibitive.
Our health care systems would be crushed. Our economies would also be decimated because people who feared for their lives and the lives of their loved ones would simply not go out of their homes. They would self-quarantine and put themselves into voluntary lockdown.
I believe that most reasonable people would not advocate this strategy, though it is troubling that there are those who are calling for a “culling” of the human herd.
Second, we could attempt to control the speed of viral spread with some social distancing policies while simultaneously trying to protect the vulnerable and elderly. This way, we would allow the virus to burn through the population over an extended period of many months.
In contrast to current practices, this strategy would actually not attempt to squash community spread. Rather, the goal would be to mitigate its effects on the health care system so that it would not be overwhelmed. Some pundits have opined that Sweden is pursuing precisely this strategy.
So let us look at Sweden’s numbers and compare them to those of her neighboring Scandinavian countries. The numbers listed on the Worldometer’s COVID tracker on May 2, 2020 are displayed in the table below.
Allowing for differences in how cases and deaths are counted, what stands out is not the differences in number of COVID-19 cases, since these are comparable once you take population size into account, but the differences in death rates. Sweden has about five times more deaths than its Scandinavian neighbors.
Moreover, news reports suggest that these deaths are primarily among the elderly and the immigrant populations in the country. These are the poor and vulnerable who should be preferentially protected by a community. Instead in Sweden, they have been preferentially targeted by the virus because of this pandemic control strategy.
The Swedish government has argued that their high death rate is a failure, not of their pandemic control strategy, but of their measures to protect their nursing homes. Though these measures may certainly be improved, I do not think that this explains everything. Sweden’s neighbors have adopted similarly strict measures to cordon off their nursing homes and their death rates are down. The high death rate can only happen when the virus is allowed to move freely from one nursing home to another. This is much easier when community spread is not being minimized vigorously.
One of the things that Singaporean public health authorities have been talking about recently is that they have discovered that the COVID-19 virus is smart and relentless. It keeps trying to find its way into vulnerable populations. And it will never give up! In their case, the virus was able to enter their vulnerable migrant worker population living in crowded dormitories. And it exploded.
Looking at Sweden, some have suggested that this difference in death rate is inconsequential because these are people who would have died anyway. They have proposed that the death rate in these Nordic countries will eventually even out because death rates will inevitably rise once the lockdowns in Sweden’s neighbors are slowly relaxed. A second or third or fourth pandemic wave will wash out those elderly and vulnerable who were saved during the first wave. Why not get it over with now?
This retort assumes that flattening the curve simply delays inevitable deaths so that the health care system will not be devastated. This is one reason. The other reason is that flattening the curve delays deaths in the hopes that some therapy or vaccine will be discovered to prevent them altogether.
As a past hospital chaplain, I know that many advanced cases of metastatic cancer are inevitably terminal. However, we work to delay death for two reasons. For a medical breakthrough. And for more time, which for most people, even dying people, is sweet and precious. We are doing the same for the elderly and vulnerable in this time of pandemic.
In the end, I cannot endorse a “burn through” strategy because it inevitably increases the number of deaths, especially of poor and vulnerable people, who may be spared when a therapy or vaccine arrives. Moreover, short of a lockdown, no government has discovered a way to adequately protect the elderly and those who are at risk from viral community spread.
For someone who is pro-life and who values the intrinsic dignity of the human person and the preferential option to protect the poor and vulnerable, this strategy of allowing the virus to spread through a population to achieve herd immunity would not be an ethical option.
Rather I believe that we should continue to mitigate community spread with social distancing practices that attempt to preserve the economy while minimizing death. And we especially cannot forget the poor!
But what about the large number of deaths that we can expect from an economic crash or depression? Should these deaths not also be considered here?
I did not count these deaths because these deaths are not there to be counted!
Though it is counter-intuitive, there is a lot of data that shows that death rates actually decrease during economic downturns. I am not an economist so I will rely on a write-up in the journal, Nature, which is one of the world’s foremost scientific publications. The article is titled, “How the Next Recession Could Save Lives” [Nature 565 (2019): 412-415].
In the report, the author makes several important points that I will highlight here for the purposes of this essay.
First, economic data from US history reveals that more people – babies included – died when the economy prospered. Death rates go down during economic downturns. Second, the gross death rate in the USA reached its lowest point in the historical record kept until that time, during the Great Depression.
Third, death rates in Europe dropped faster during the Great Recession in the late 2000s than before the crisis. Fourth, death rates dropped dramatically in Spain during the Great Recession where unemployment reached 20%.
In fact, because of this data, José Tapia Granados, a health economist at Drexel University calls the link between recessions and lowered death rates “almost as strong as the evidence that cigarette smoking is bad for health.”
The article acknowledges that it is not clear why recessions and depressions lower death rates. Nonetheless the contrary claim that economic downturns necessarily lead to higher death rates is not supported by the evidence from history.
In sum, it is clear that economic downturns lead to much suffering, both psychological and physiological, especially among the poor and marginalized. However, they do not trigger an increase in the number of deaths in society.
Therefore, if they do occur because of the social distancing measures in place in a community, they are an invitation to endure the difficulty and pain as a sacrifice needed to save the lives of the elderly and the vulnerable in time of pandemic.