US discord deepens over vaccines, immunity as coronavirus rebounds

Public skepticism about coronavirus vaccines and enthusiasm on the right for so-called herd immunity are colliding as the U.S. outbreak is worsening, developments that could dash hopes for containing COVID-19 in the months ahead.

Herd immunity aims instead to expose more people to the coronavirus, to build protection broadly in the population. It’s been roundly denounced by mainstream experts, who say it promises still more sickness and death. Still, the concept has surfaced in the White House, due to the increasing influence of Trump medical adviser Scott Atlas. It was backed this month by a group of academics in a treatise titled the “Great Barrington Declaration.”

Meanwhile, the predicted fall surge in infections is materializing, with new cases on the rise since early September, particularly in Midwestern states. The U.S. recorded about 69,500 new daily infections late last week, rivaling peak numbers over the summer, and nearly 60,000 additional cases Tuesday, according to Johns Hopkins University data compiled by Bloomberg.

Officially, about 220,000 Americans have died from the coronavirus. But the U.S. Centers for Disease Control and Prevention estimated Tuesday that the number of dead overall — from all causes — was about 300,000 higher than was expected in a typical year. Many are likely to have died from virus cases that went uncounted.

“On the optimistic side, we have vaccines and therapeutics that are on the horizon, like really close. And also on the optimistic side, we test much better now than we did five months ago and eight months ago,” said Howard Forman, director of the Yale School of Public Health’s health care management program. “On the pessimistic side, people have treated this as a political issue, not as a health issue. And I think that bodes very poorly.”

The latest COVID-19 surges are happening as the Nov. 3 U.S. election approaches, results of which are likely to be interpreted as a referendum on President Donald Trump’s handling of the coronavirus.

In lieu of a nationally focused response, Trump has pushed responsibility for everything from testing to securing protective equipment for medical providers to the states, resulting in chaos and intrastate competition. Meanwhile, he’s pushed for the availability of a vaccine by Election Day. The ambitious timeline was first characterized as unfeasible and now, because Pfizer Inc. won’t file for emergency authorization for its shot until late November, is outright impossible.

Trump’s aggressive promotion of a coming vaccine has stoked distrust among many in the U.S. Just half of Americans now say they would get a coronavirus vaccine, Gallup polling released last week found. Its surveys have registered a steady decline in willingness to take a vaccine since late July, with the most recent drop tied to diminishing support among Democrats.

And roughly 60% of adults said they were worried the U.S. Food and Drug Administration would rush a vaccine approval in the face of pressure from the Trump administration, a new Kaiser Family Foundation poll released Tuesday found.

Vaccination is one well-established path to herd immunity, or protection so developed that a disease can’t spread. But at a stone mansion in the Berkshires this month, academics convened by a free-market think tank had another route in mind.

In their “Great Barrington Declaration,” named for the Massachusetts town where they met, they advocated achieving protection by ending restrictions and increasing exposure among healthy people. They argued that children aren’t learning and other medical conditions are going untreated, that vulnerable people like the elderly and infirm can be initially shielded and later emerge.

The plan, which they toasted with champagne, focused a sentiment that’s persisted since the pandemic reached the U.S., often voiced by citizens who believe COVID-19 is milder than advertised. It’s also resonated with those who say public health measures, with their emphasis on shielding the group to protect individuals, impinge on individual freedoms.

Those opponents of masks and lockdowns are rallying behind the untested concept, though it alarms health officials and experts who point out that in gaining herd immunity, much of the herd must get sick. The idea of letting the virus run loose is surfacing not just in the White House but also state political races and in hard-hit communities like Orthodox Jewish neighborhoods.

On a conference call last week that the White House organized in an apparent effort to draw attention to the “Great Barrington” statement, two administration officials said it amounted to an endorsement of Trump’s policies. They insisted on speaking anonymously as a condition of reporters' participation in the call.

Trump adviser Atlas, a neuroradiologist affiliated with Stanford University’s conservative Hoover Institution who lacks an epidemiology background, said in a statement that the document emphasized protecting the vulnerable while reopening schools and society, and that “those specific policies are aligned with the president.” The Trump administration has sent thousands of rapid tests to nursing homes, while pushing for schools to reopen.

Atlas has repeatedly publicly said it’s preferable to expose young, healthy people to the virus, but has said he hasn’t ever encouraged Trump to adopt a herd immunity strategy specifically.

Mainstream public health leaders, meanwhile, have condemned herd immunity. World Health Organization Director-General Tedros Adhanom last week called the strategy “scientifically and ethically problematic,” and noted it has never before been used. A group of 80 scientists called herd immunity “a dangerous fallacy unsupported by scientific evidence” in an opinion piece published late Wednesday in the Lancet, a medical journal. A safer path to safety is by vaccination, they said.

Yet even an effort to gain herd immunity through immunization could be endangered by the politicization of vaccinations.

The World Health Organization, for instance, has estimated that achieving herd immunity will require 60% to 70% of the population either becoming infected or being vaccinated. But ultimately the efficacy of a vaccine will be a key factor too, especially if it confers protection that is only temporary, like a flu shot.

“The less it is effective, the more we need people to take it,” said Brian Castrucci, president and chief executive of the public health focused de Beaumont Foundation. “We just don’t know yet.”

Castrucci said that the U.S. has relied on successful vaccine development because of its “quick fix” culture. But the country can’t be assured immunizations will be the ultimate solution, and still needs an overarching strategy, he said.

“This is our national tragedy,” he said. “Our national disaster.”