“Herd Immunity” as Indirect Genocide

While the topic of “herd immunity” first made its way into the COVID-19 news cycle back in March 2020 in the U.K., it has been gaining traction this month in the U.S. as conservative pundits and politicians abandon whatever hope they may have had of controlling the spread of the virus. The Economist asks, “Should COVID Be Left to Spread Among the Young and Healthy?” and in the journal Nature, scientists have explained “The False Promise of Herd Immunity for COVID-19.” What much discussion on this topic is missing, though, is a basic understanding of how infectious diseases respond to and in fact thrive amid socio-economic inequities. When you pair arguments for non-action with a model of the existing structure of our society, what you get is an argument for indirect genocide.

Public discourse generally assumes a biomedical perspective on COVID-19. We know that this is a virus, we know how viruses generally infect and impact human bodies, and we now know more about how this particular virus infects and impacts human bodies. The problem is, though, that the virus doesn’t just infect human bodies. It infects people. An analogy might be helpful here. A doctor can look at a human body like a car mechanic looks at a car. This may enable the mechanic to fix the car, but will often tell us very little that is helpful for preventing car accidents. To do that, we need to understand how drivers act and interact with one another and with the car, how roads and traffic signals are designed, et cetera. To deal with the five hundred car pile-up that is COVID-19, we need to include but move beyond biomedicine.

In its kinder, gentler form, the herd immunity argument–that young and healthy people should go back to work and should gain immunity through exposure to COVID-19–is rooted in a biomedical perspective on young healthy bodies. It assumes that young healthy people will be able to separate themselves from older and unhealthy people. What does this assumption take for granted? Among other things, wealth. It is mostly rich young healthy people who live apart from their parents, or who live in large enough homes to be able to avoid infecting unhealthy, older, and immuno-compromised individuals. And it is mostly rich people who work in jobs where they are able to to stay home if they are not a young healthy person. By and large, less wealthy persons are not able to approximate these ideals. They often live in multigenerational households, work in jobs where they have to be physically present and in contact with others, and are disproportionally burdened with health problems.

In our society, statistically speaking, wealth and Whiteness are correlated. While anyone might be rich, most rich people are White, and most rich people who are not White are in greater contact with friends and relatives who are not wealthy. So when a pundit or politician advocates for young healthy people to gain herd immunity, what they are advocating for is a world in which most White people are able to go back to work, or work remotely, while most Black people, Indigenous People, and People of Color must choose between having the money to feed their family and staying safe from COVID-19. In simple terms, this would lead to, and has already effectively begun, what can be described as indirect genocide.

There’s more to this story. I could describe the history of government actions and social policy that have led to racialized inequities, or the contemporary situation in which these inequities are reinforced and reproduced. Linked to many distinct levels of causality, the complexity of the problem is immense. However, I perhaps naively think that this knowledge–that the “herd immunity” policy would lead to more deaths among people who are not White–should be enough on its own to lead the vast majority of Americans to consider it to be immoral and indefensible.

COVID-19 Diary: The U.S.A. Goes All In On Techno-Optimism

Johns Hopkins COVID-19 Incedence Rate Map

Screenshot of COVID-19 Incidence Map on September 4, 2020

 

The USA has completely failed to control COVID-19. The many reasons for this failure have been well-documented, discussed, and argued over by a newly-emerging class of public/ global health pundits (I will not go into detail here). Whereas there was once discussion about which might be the best strategies for mitigating the impact of the virus, now there is only one strategy: a vaccine.

The White House and various state governors have certainly made many bad choices–and sometimes failed through inaction. However, as an anthropologist I’ve been trained to think about the place of individual actors in larger social and cultural contexts. It was not just bad actors that led us to this point. Our mainstream cultural frameworks for understanding health and medicine have also played a key role. Single-minded reliance on a vaccine was not inevitable, as success stories from around the world demonstrate (e.g. New Zealand, Taiwan). Rather, it is the shape of health discourses in the USA that predispose us to look for a technological fix (see also this piece by Martha Lincoln in Nature on COVID-19 responses and American exceptionalism).

Techno-Optimistic Stories

Over the past four years I have been studying global health discourses. In my research, I have noticed the pervasive use of what are called called “techno-optimistic” stories to generate interest in public/ global health interventions. “Techno-optimism” is about faith in technology–in this case biomedical technology–to provide simple answers to complex human problems. In the realm of global health, no organization epitomizes this approach better than the Bill and Melinda Gates Foundation. Their “data-driven” approach is in many respects laudable. Still, it is often linked with a narrow focus on drug treatments and vaccines, and their interventions rarely address what public health professionals call the “structural determinants of health”–the underlying socio-economic inequities that shape marginalized persons’ exposure to pathogens, access to care, and ability to make behavioral changes (see also Emily Yates-Doerr’s recent critique of the structural determinants concept).

Giving sick people pharmaceuticals seems cheaper and easier than addressing socio-economic inequities, at least in the short-term–though it does end up being more expensive in the long-term. In part, it seems easier because it allows people to avoid confronting the inequitable socio-economic and political structures that power our economy. Techno-optimism is just so much catchier and simpler than meaningful structural change.

Another Chance? Vaccine Delivery

Now we must wait for a vaccine, betting our economic and social wellbeing on its successful development by pharmaceutical companies and their university partners. This will solve everything, right?

Wrong. What will we do when that vaccine is created? the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices has been meeting to decide just that. When the vaccine becomes available (or if?), there will be limited quantities. We must decide as a society how to distribute the vaccine. Otherwise, the “market” will decide for us, meaning that the most wealthy and powerful will pay for earlier access. The CDC committee’s current discussions seem promising, suggesting that in addition to “front line” health care workers, the vaccine should be administered first to groups like essential workers, the elderly, and others who are disproportionately likely to get infected, and to get sick or die as a result of their infection.

While the CDC advisory group’s recommendations do make me hopeful, I am not confident that the U.S. health system is configured to make these recommendations a reality. So much of our system is tied to private insurance and corporate medicine. Unfortunately, it seems likely that wealthy people will be allowed to pay for access to the vaccine, and thereby bypass the clunky public health system that is disjointed and spread across federal, state, and local levels. I’m not certain what the public can do, except to keep public discourses focused on issues of equity and thereby expand our collective consciousness beyond the simplistic fixes offered by a narrowly-defined techno-optimism. So let’s do that.