expert reaction to Barrington Declaration, an open letter arguing against lockdown policies and for ‘Focused Protection’
An open letter has been published, arguing against lockdown policies and for ‘Focused Protection’.
Dr Julian Tang, Honorary Associate Professor in Respiratory Sciences, University of Leicester, said:
“Having watched their video and read their Declaration, I can understand their concerns and their aims, but they are not very clear about how they will carry out their proposed ‘Focused Protection’.
“The interviewer gave a very simple example of a grandparent looking after a school-age child, highlighting one household member (the child) who would not be expected to suffer from COVID-19 much, who would attend a large gathering with other young people on a daily basis, but where the other household member (the grandparent) should be ‘protected’.
“But the reply from Dr. Jay Bhattacharya in the video was not really understandable and had no practical details of how this would be done.
“In fact, this ‘Focused Protection’ approach is used each year during our annual influenza season, where we vaccinate the vulnerable – elderly and those with comorbidities – including pregnancy:
https://www.nhs.uk/conditions/vaccinati ... a-vaccine/; and even primary school children who have contact with such vulnerable groups in an effort to further protect the vulnerable:
https://www.nhs.uk/conditions/vaccinati ... u-vaccine/
“And if this fails to prevent influenza infection of the vulnerable groups, we have antivirals like oseltamivir and zanamivir that we can give to anyone who has influenza or in whom we even just suspect influenza (as empirical therapy during the influenza season) to reduce the severity of their illness.
“But we don’t yet have these additional ‘tools’ (the vaccine and antivirals) for COVID-19, to assist with this ‘Focused Protection’ approach.
“A similar approach may also work for COVID-19 one day – indeed a similar vaccination strategy for COVID-19 to that of influenza (targeting the most vulnerable) has already been discussed in the UK:
https://www.gov.uk/government/publicati ... accination; but we don’t have a COVID-19 vaccine yet, nor a more general use antiviral treatment.
“So I appreciate and understand the concerns and the sentiment behind this declaration, and of course other diseases are important and need attention, but without these anti-COVID-19 ‘tools’, I cannot see how they will achieve this ‘Focused Protection’ for these vulnerable groups in any practical, reliable or safe way.”
Dr Rupert Beale, Group Leader, Cell Biology of Infection Laboratory, Francis Crick Institute, said:
“An effective response to the Covid pandemic requires multiple targeted interventions to reduce transmission, to develop better treatments and to protect vulnerable people. This declaration prioritises just one aspect of a sensible strategy – protecting the vulnerable – and suggests we can safely build up ‘herd immunity’ in the rest of the population. This is wishful thinking. It is not possible to fully identify vulnerable individuals, and it is not possible to fully isolate them. Furthermore, we know that immunity to coronaviruses wanes over time, and re-infection is possible – so lasting protection of vulnerable individuals by establishing ‘herd immunity’ is very unlikely to be achieved in the absence of a vaccine. Individual scientists may reasonably disagree about the relative merits of various interventions, but they must be honest about the feasibility of what they propose. This declaration is therefore not a helpful contribution to the debate.”
Dr Michael Head, Senior Research Fellow in Global Health, University of Southampton, said:
“The Barrington Declaration is based upon a false premise – that governments and the scientific community wish for extensive lockdowns to continue until a vaccine is available. Lockdowns are only ever used when transmission is high, and now that we have some knowledge about how best to handle new outbreaks, most national and subnational interventions are much ‘lighter’ than the full suppressions we have seen for example in the UK across the spring of 2020.
“Those behind the Barrington Declaration are advocates of herd immunity within a population. They state that “Those who are not vulnerable should immediately be allowed to resume life as normal”, with the idea being that somehow the vulnerable of society will be protected from ensuing transmission of a dangerous virus. It is a very bad idea. We saw that even with intensive lockdowns in place, there was a huge excess death toll, with the elderly bearing the brunt of that, and 20-30% of the UK population would be classed as vulnerable to a severe COVID-19 infection. Around 8% of the UK population has some level of immunity to this novel coronavirus, and that immunity will likely wane over time and be insufficient to prevent a second infection. A strategy for herd immunity would also promote further inequalities across society, for example across the Black, Asian and minority ethnic communities. The declaration also ignores the emerging burdens of ‘long COVID’. We know that many people, even younger populations who suffered from an initially mild illness, are suffering from longer-term consequences of a COVID-19 infection.
“Independent SAGE are among the many scientists who have eloquently pointed out1 the many reasons why these initiatives are ultimately harmful and misleading as to the scientific evidence base. There are countries who are managing the pandemic relatively well, including South Korea and New Zealand, and their strategies do not include simply letting the virus run wild whilst hoping that the asthmatic community and the elderly can find somewhere to hide for 12 months. They have a proactive approach to ‘test and trace’ to reduce the impact of new outbreaks, and good public health messaging from the government to their populations. Ultimately, the Barrington Declaration is based on principles that are dangerous to national and global public health.
1 Independent SAGE report –
https://www.independentsage.org/a-delib ... -be-tried/
Dr Stephen Griffin, Associate Professor in the School of Medicine, University of Leeds, said:
“The Barrington Declaration, as per the recent letter to UK government CMOs, seeks to reduce the impact of interventions taken to combat the SARS-CoV2 pandemic upon healthcare systems and the most disadvantaged amongst our population. This is clearly a well-intentioned movement, and nobody can deny that COVID-19 has highlighted inequality and instability across a great many aspects of our society.
“Sadly, focusing on the pandemic rather than the cultures and environments in which it arose ignores long-standing issues in society that existed prior to, and likely long after the pandemic has passed. Moreover, the means by which the signatories propose to achieve their aim relies upon achieving so-called “herd immunity”, which at best is currently a theoretical concept for SARS-CoV2. By contrast, societal restrictions combined with effective rapid testing measures have effectively curtailed the spread of the virus in several countries.
“The signatories propose that members of the population deemed well enough to endure infection should be allowed to operate normally, enjoying full access to work, education, the arts, hospitality etc. By contrast, those deemed “vulnerable” to severe COVID-19 are to be somehow protected from the infection. This approach has profound ethical, logistical and scientific flaws:
“Ethically, history has taught us that the notion of segregating society, even perhaps with good initial intentions, usually ends in suffering. For want of a better term, the “vulnerable” amongst us come from all walks of life, have families and friends and deserve, fundamentally, to be treated equally amongst society. It is interesting to note that the signatories are not proposing that BAME or other COVID-susceptible groups be segregated along similar lines.
“Logistically, how on earth are we to both identify those at risk and effectively separate them from the rest of society? Basing risk primarily upon risk of death completely ignores the profound morbidity associated with the pandemic, including what we now term as “long COVID”, plus the criteria by which one or more risk factors might predispose towards severe disease remain both uncertain and incredibly diverse – we have only lived with this virus for ten months, we simply do not understand it well enough to attempt this with any surety.
“Scientifically, no evidence from our current understanding of this virus and how we respond to it in any way suggests that herd immunity would be achievable, even if a high proportion of the population were to become infected. We know that responses to natural infection wane, and that reinfection occurs and can have more severe consequences than the first. It is hoped that vaccines will provide superior responses, and indeed vaccination remains the only robust means of achieving herd immunity. Moreover, in the US, with its high end (albeit restrictive) healthcare system, over seven million confirmed infections have occurred to date, yet this represents only a small percentage of that population and no evidence of herd immunity is apparent despite over 200K deaths and untold morbidity. What then, might be the cost of attempting the strategy proposed in this document?
“We are all exhausted by the pandemic and are rightly angry at the notion of potentially enduring a second round of local and national lockdowns or other restrictions. However, we must not conflate the failures of certain governments to capitalise upon the sacrifices people make during lockdowns with these measures themselves being ineffective. Policies are enacted by those that govern, are multifactorial in nature, and so do not mean that contributing strategies are themselves flawed. However, the dangers of seizing upon dissatisfaction and political failings to support what amounts to little more than an ideology, runs the risk of inaction and an ensuing limbo of cyclical epidemic waves of infection for the foreseeable future.”
Dr Simon Clarke, Associate Professor of Cellular Microbiology at the University of Reading, said:
“There is no current evidence about COVID-19 to suggest that a long-term passive approach has any merit. Despite the huge advances in our understand of the coronavirus and resulting infection, we don’t know that herd immunity is even possible. Natural, lasting, protective immunity to the disease would be needed and we don’t know how effective or long-lasting people’s post-infection immunity will be. Just to find out whether this is possible, would be to consign a great many more thousands of people to their deaths, and many more would be left suffering from the effects of long covid, which even less is well understood.
“There is also the fact that we haven’t properly got to grips with how to shield vulnerable populations adequately and neither do we have the capacity in the UK to test for asymptomatic infections. Furthermore, we’re also still only scratching the surface of how the virus is transmitted.”
Prof James Naismith FRS FRSE FMedSci, Director of the Rosalind Franklin Institute, and University of Oxford, said:
“The main signatories include many accomplished scientists and I read it with interest. I will not be signing it however.
“At one level this declaration is a statement of a series of scientific truths and as such is non-controversial. The declaration identifies the elderly and vulnerable to be at far far greater risk from covid-19 than the bulk of the population, an established fact. I do not think anyone disagrees that the disruption to education, social life and the economy have been very hard to bear and that they particularly disadvantage the young, the group least likely to suffer serious ill effects from covid-19.
“The declaration is correct, that once herd immunity is reached in the non-elderly population this will protect the elderly by greatly reducing the general viral spread. A vaccine would be a short cut.
“The authors have neglected to point out that our ability to treat covid19 is greatly improving due to scientific and medical breakthroughs, a point that strengthens arguments for their policy by reducing the toll of the virus.
“That said, the declaration omits some rather critical scientific information that would help better inform policy makers. It would help to consider the following points:
“We do not know yet how long immunity will last, so achieving herd immunity may not be simple. We do not have herd immunity to the common cold despite many of us having one or more each year. It would have helped had the leading scientists who signed this declaration estimated achievability of herd immunity with different immune response decays.
“The desired range for herd immunity is not stated nor how far away we are from it, thus no estimate of the number of deaths or the life changing complications that will result in the lower vulnerability group is made. Whilst these numbers are much lower than in the elderly, they are not zero. I suspect the public would like to know this.
“A working description of vulnerability is not given, the Goldacre paper in Nature assigned probabilities, what is the personal score threshold being advocated?
“From a public health point of view, it would have been useful to estimate the gains with different assumptions of the timing of the arrival of the vaccine.
“With respect to the UK, there are a limited number of critical care beds. Is there an estimate of the risk of overwhelming the NHS and ending up with triage (thus rising fatalities)?
“I agree wholeheartedly that protecting the most vulnerable will reduce deaths. We knew this by April and to my knowledge everyone advocates this. However, the continuing number of deaths in the USA and the rise in infections in the UK amongst this very group seen in ONS surveys would indicate this is hard to achieve. The declaration thus risks the same error we have seen with the UK’s track trace and isolate scheme – one can promise a scheme that is very easy to describe but is hard to deliver. Whilst actual implementation maybe beyond the expertise of the signatories, when scientists offer advice in a public forum it would help if they could be clear with the public about the risks of failure or error. The declaration is silent about what happens if we resume normal life (the easy bit) and fail, for whatever reason, to protect the vulnerable (the hard part). Further, the declaration is silent as to what success in shielding looks like? 100 % protection is impossible to achieve. How many deaths and how many life changing events will result if we are 80% or 60% successful? A more cautious policy might be government demonstrating that it can shield the old and vulnerable under current restrictions, as measured by the infection prevalence in this age group. These data would give a best case estimate of the toll of the policy. With this information we could move to resume normal life in stages fully aware of the consequences whilst continuing to monitor viral spread in the elderly.
“It is absolutely proper that scientists offer their best advice to government, especially perhaps, when that advice differs from the mainstream, as this does. In this pandemic, which has been such a disaster, it is clear that there have been many mistakes by medics, scientists and politicians. Humility and willingness to consider alternatives are hallmarks of good science.
“I would support the signatories giving their full consideration to all the scientific issues surrounding their prescription so that they might give more actionable policy advice.”
Prof Jeremy Rossman, Honorary Senior Lecturer in Virology, University of Kent, said:
“The actions taken to control COVID-19 have clearly had significant physical and mental health impacts across the population, often with the most disadvantaged suffering these consequences most acutely. The Great Barrington Declaration attempts to alleviate these impacts by promoting herd immunity and the protection of vulnerable populations. Unfortunately, this declaration ignores three critical aspects that could result in significant impacts to health and lives. First, we still do not know if herd immunity is possible to achieve. Herd immunity relies on lasting immunological protection from coronavirus re-infection; however, we have heard many recent cases of re-infection occurring and some research suggests protective antibody responses may decay rapidly. Second, the declaration focuses only on the risk of death from COVID-19 but ignores the growing awareness of long-COVID, that many healthy young adults with ‘mild’ COVID-19 infections are experiencing protracted symptoms and long-term disability. Third, countries that have forgone lockdown restrictions in favour of personal responsibility and focused protection of the elderly, such as Sweden, were not able to successfully protect the vulnerable population. While there is clearly a need to support and ease the physical and mental health burdens many are suffering under, the proposed declaration is both unlikely to succeed and puts the long-term health of many at risk.”
