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The Great Barrington Declaration: A Few Words of Caution

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With the recently issued Great Barrington Declaration, the antilockdown movement has received a shot in the arm.

The proposal, introduced by three prominent epidemiologists and scientists at a summit sponsored by the American Institute for Economic Research, seems to offer a welcome alternative to current policies of blanket lockdowns.

The authors of the declaration recommend policies of “focused protection” and have already received the support of tens of thousands of public health professionals, medical practitioners, and members of the general public.

While I welcome the proposal as an excellent development and would view its adoption as a likely improvement over the current situation, I must nevertheless point out a few significant difficulties with this declaration.

Herd Immunity as a Policy Goal

To begin with, it should be clear that the proposal is a policy proposal. It offers general ideas about what the public health response to the pandemic should aim for and gives a few examples of the kinds of behavioral changes that should be implemented. Policy ideas are ideas that are ultimately imposed.

What are those ideas?

The authors state that the aim of the covid response should be to achieve herd immunity, which they define as “the point at which the rate of new infections is stable.”

While that definition is adequate, and while herd immunity may indeed be a real phenomenon that can take place under certain circumstances when populations are subjected to a contagious disease, it is important to recognize that herd immunity is not a concept that has any practical value for setting public health policy.

For one thing, there is no objective way to establish that herd immunity has been achieved, since a “stable” rate of new infection is a subjective notion. What is a stable or tolerable rate of infection for me may not be so for you.

Also, there is no guarantee that herd immunity can or will be achieved. If personal immunity to the virus wanes after a few months, it is at least conceivable that the population will always be subject to either outbreaks or waves of infection.

As a case in point, many places that were hit hard in the initial course of the pandemic are now seeing a resurgence of cases—albeit so far with less morbidity and much less lethality than the initial wave. Have they achieved herd immunity? Strictly speaking, they have not.

Another striking example in recent history is the case of Mongolia. Between 2011 and 2014, not a single case of measles was recorded in that nation, largely as a result of very high vaccination rates. Then, in 2015, a massive outbreak occurred which, over a span of sixteen months, affected more than fifty thousand individuals—mostly vulnerable children below the age of vaccination. The outbreak occurred despite Mongolia maintaining exemplary high rates of immunization. Did Mongolia have herd immunity on the eve of the outbreak? Evidently not, but how could one have known?

The point of contention is not that covid-19 will not wane in severity over time (it undoubtedly will), but that herd immunity is not empirically demonstrable outside of an experimental setting. Therefore, to set it up as a policy goal is to either give public health authorities carte blanche to decide if and when it has been reached or, if they prematurely declare that it has been reached, to risk giving hard lockdowners an excellent opportunity to claim the policy a failure and reimpose their harsh prescriptions.

Targeted Lockdowns?

The other major idea that the authors of the declaration propose is that to best achieve herd immunity public health policy should aim to protect the vulnerable.

But this is much easier said than done, since the more vulnerable live largely mixed in with the less vulnerable. Furthermore, vulnerability occurs on a gradient with no clear-cut definitions. Yes, age is a major risk factor, as are obesity and other comorbidities. But where does one draw the line? A policy of targeting the vulnerable necessarily imposes arbitrary divisions.

And a policy of “focused protection” may sound benign and appealing in theory, but the declaration is rather vague regarding how its proposal would look in practice. The authors list only a few examples of what the vulnerable “should” do (or not do) on their own, or what the less vulnerable “should” do (or not do) to the vulnerable, but they leave the question of implementation and enforcement aside. But, as I said earlier, policy is inevitably imposed—at least on some.

For example, the authors state that “nursing homes should acquire staff with acquired immunity.” Does that mean that current nonimmune staff should be let go? Also, “retired people should have their groceries delivered at home.” What if they refuse and wish to go to the market? Will they be prevented?

In informal interviews, the authors of the declaration have suggested that their shoulds and shouldn’ts could be optional (although one of them proposed that “teachers over 60 should work from home,” without clarifying if that would be a choice or a mandate). But “policy” and “optional” rarely mix, and focused protection, if it were to be adopted, would likely end up becoming a “targeted lockdown”—an improvement over the current situation, to be sure, but a lockdown nonetheless. Lockdowns are wrong in principle, whether targeted or full-scale.

Health Is Not a Common Good

Admittedly, given the present disastrous situation, the points I have just raised may seem fastidious or overly critical. “The perfect is the enemy of the good,” as the saying goes.

I also fully realize that the authors have manifested tremendous courage by openly defying many public health authorities and their ideological allies in academia, and have thus placed their careers and reputations at risk. I commend them heartily for doing so. In contrast to current policies, their proposal is a life-saving buoy, to be sure. Nevertheless, there is one more point that I insist on making, not so much to derail this effort, but to focus attention on a more fundamental issue.

The declaration states that it is the goal of policy “to minimize mortality.” But as commonplace an idea as that may be, it is a very mistaken one: state authorities should have no business saving individual lives, let alone promoting health.

An individual’s life and health are particular goods, not common goods. It is an obvious metaphysical truth that my health and my life can only be mine and are not shared in common with anyone, and certainly not with the political community at large. At its heart, “public health” is an oxymoron, since “the public,” as an abstraction, has no health to speak of. Only individuals are healthy or not.

That is not to say that it is not good for others, or for the country at large, that I, as an individual, remain alive and well rather than be sick or dead. But it is a major error to consider that the promotion of the common good means that the government must, via some kind of utilitarian reasoning, promote my health or “save my life” or the lives of other individual persons—even if it were actually capable of doing so—all the while balancing wider economic concerns.

By necessity, government intervention of that sort always comes with tradeoffs that pit the those benefiting from “lives saved” (if those can ever be identified) against those bearing the costs. That is not a promotion of the common good, which, by definition, must extend to all members of the political community (that’s what “common” means). Instead, the livelihood and health of individual persons should be promoted by other individuals and by communal, nonstate institutions naturally engaged in the division of labor, where tradeoffs can be freely and ethically evaluated and adjudicated.

The erroneous view that the promotion of the common good means a “fair” redistribution of a stock of material goods to benefit certain individuals at the expense of others has unfortunately been widely accepted since its first articulation at the beginning of the Enlightenment. It is a view that inevitably promotes the growth of state power, with ever-expanding government action justified in the name of a pseudo–common good.

The common good of the United States is in no way increased by my being alive nor is it diminished by my being dead, and likewise for every single one of my co-citizens. By implicitly stating otherwise, the Great Barrington Declaration perpetuates a pernicious and dangerous myth of modern political philosophy. If, under current circumstances, it may be wise to support the proposals it contains, let’s not lose sight of the bigger issue at play lest we quickly fall back into the same trap of utter dependence on the irrational diktats of the state.

[Also published at AlertandOriented.com.]

Author:

Michel Accad, MD

Michel Accad, MD, practices cardiology and internal medicine in San Francisco, offering individualized care in a free-market setting. His blog about health care and medicine is AlertandOriented.com. He also co-hosts the Accad And Koa Report podcast.

Note: The views expressed on Mises.org are not necessarily those of the Mises Institute.
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