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October 28, 2020

We, the undersigned students of Harvard Medical School, the Harvard School of Dental Medicine, and Harvard T.H. Chan School of Public Health, strongly condemn the actions of Dr. Martin Kulldorff in proposing what he and colleagues have termed “focused protection” as a response to COVID-19. This proposal calls for those with less likelihood of death to go about their lives as they would have prior to the pandemic as the population reaches herd immunity. As of October 25, 2020 the COVID-19 Pandemic has infected 43 million people and caused 1.15 million deaths. For herd immunity to be achieved, a significant portion of the population must be infected with the virus and develop immunity. This approach would result in millions of needless deaths, with particular concentration in low-resource communities and among black and brown people as has been the case thus far. The human cost of reaching herd immunity before the development of an established and accessible vaccine or treatment makes it an immoral strategy, causing suffering for the masses which far outweighs any societal benefits.

Beyond the pure immorality of this declaration, this strategy operates on an exceptional amount of assumption and speculation. The concept of “focused protection” relies heavily on a rather arbitrary line that divides high-risk populations from low-risk populations. Taking the explicitly stated metric of age as an example, this means that younger family members, who may be physically attending school, must stay away from their older family members until herd immunity is reached. This measure both assumes that the 20% of Americans who live in multigenerational homes will have the means and the willingness to adhere to these standards and equates low-risk with invulnerability. Although a less common occurrence, young people can and already have lost their lives to COVID-19. To dispose of precautions for this population is to offer them as a sacrifice for the sake of opening bars and businesses. In all of these cases, minority populations carry most of the burden of suffering—Black, Brown, and Asian families live in multigenerational homes at higher rates than White populations, while the majority of children and teens that have died from the virus are Black, Hispanic, or both.

But age is just one of the risk factors of COVID-19. Vulnerability to this virus is complicated and cannot be simplified into the binary that this strategy proposes. Among the underlying conditions that increase risk as noted by the CDC are cancer and heart disease, two conditions that frequently go undiagnosed and can be asymptomatic for long periods of time. Under focused protection, people affected by these conditions who may not be experiencing symptoms will fall squarely outside of the range of prevention measures, leaving them completely open to serious illness. These people cannot become sacrifices in our country’s attempts to combat the pandemic.

The reality of the situation is that the very principle of herd immunity Dr. Kulldorff and company are promising is questionable at best. With each passing month, we continue to learn more about this virus and make adjustments based on this new information. Focused protection does not allow for this, but rather operates on assumed constants—that people who contract the virus become immune and that the immunity is permanent. Without those assumptions, the plan to achieve herd immunity via focused protection collapses. However, we have already seen that immunity following infection is variable, with many recovered patients showing a significant decrease in immunity only a month following recovery. We have also seen that it is possible for people to become reinfected following their initial infection. Under these conditions, focused protection may create a perpetual cycle of infection and re-infection that lasts until a reliable vaccine is made widely available.

It is for these reasons that we condemn the idea of focused protection as a means to achieve herd immunity; we condemn the needless death and suffering that this strategy would cause;  and we condemn this departure from the standard of doing no harm, taught by the Hippocratic Oath, the Belmont Report, and the central tenets of all health professions. We, as a society, can and must do better.