If the Objective is Herd Immunity, on Whom Should it be Built?
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If the Objective is Herd Immunity, on Whom Should it be Built? Christian Gollier1 Accepted: 11 July 2020 / Published online: 11 August 2020 © Springer Nature B.V. 2020
Abstract Assuming that there is no other solution than herd immunity in front of the current pandemic, on which groups of citizens should we build this herd immunity? Given the fact that young people face a mortality rate which is at least a thousand times smaller than people aged 70 years and more, there is a simple rational to build it on these younger generations. The transfer of some mortality risk from the elderly to younger people raises difficult ethical issues. However, none of the familiar moral or operational guidelines (equality of rights, VSL, QALY, ...) that have been used in the Western world over the last century weights the value of young lives 1000 times or more than the lives of the elders. This suggests that Society could offer covid protection to the elders by recommending them to remain confined as long as this herd immunity has not been attained by the younger generations. This would be a potent demonstration of intergenerational solidarity towards the most vulnerable people in our community. The welfare gain of this age-specific deconfinement strategy is huge, as it can reduce the global death toll by more than 80% as compared to a strategy of non-targeted herd immunity. Keywords VSL · QALY · Covid · Pandemics · Herd immunity · Deconfinement
1 Introduction How should we win the war against the covid pandemic? In the absence of a treatment or a vaccine, there exists only two options. The first option is a long confinement of a large fraction of the population that would maintain the reproduction number R below unity for a very long period of time to obliterate the virus. The economic cost of this suppression strategy is now considered as unbearable in many countries (Miclo et al. 2020). The other option is to progressively build herd immunity by gradually exposing the population to the virus. Under this scenario, the containment is weakened to allow R to grow above 1, but not to far away from it to escape the risk of overwhelming hospitals. Whether this is obtained through fine tuning the intensity of the confinement in real time (Alvarez et al.
* Christian Gollier christian.gollier@tse‑fr.eu 1
Toulouse School of Economics, University of Toulouse-Capitole, Toulouse, France
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2020; Acemoglu et al. 2020; Pollinger 2020) or through a stop-and-go policy remains to be decided. In this paper, I suppose that herd immunity is the escape route from the pandemic. In the absence of a vaccine, attaining herd immunity requires exposing a fraction of the population to the virus, and to recognize that some people in this targeted population will die. Determining who should be exposed to the virus to attain the herd immunity is a crucial policy issue. Which criteria should be used to perform this task? Should we leave nature do its dismal work at random until natural immunity is obtained, or should
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