Stanford professor suggests entrepreneurial approach to develop herd immunity against COVID-19; certified survivors can help those at risk out of lockdown

The emergence of a new cluster in South Korea has shown the world that just when one is thinking that the curve has flattened and people are getting on top of things, even one COVID-19 patient can turn the tables on all efforts and get an entire country back to square one.

Society is stuck between the frying pan and the fire, where on the one hand, locking everyone down will devastate the world economy, and on the other, getting people out of lockdown will be irresponsible. In this context, I reached out to Professor Emeritus of Decision Analysis at Stanford University, Professor Ronald A Howard, on what decision analysis thinking can offer.

Representational image.
Image by Christo Anestev from Pixabay.

Professor Howard was my PhD advisor at Stanford, and I have known him to think quite differently from the crowd. He suggested an idea that breaks the logjam and addresses prudential, legal and ethical concerns.

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His idea is the first to consider an entrepreneurial approach to a Controlled Voluntary Infection (CVI) strategy. It involves formation of special companies which offer, for a fee, the service of providing a COVID-19 infection in a certifiable manner, quarantining the individual and then certifying that they are now infection negative, and to whatever degree science can support, immune and non-lethal.

Early tests are showing that the number of people who are asymptomatic despite having contracted the virus is much larger than initially thought. That means one can hope that most people taking such a service will largely be spared of the severe symptoms. It is far safer to have COVID-19 alums around us than those who are asymptomatic and unknowingly infectious.

The customers for this company’s service will be those people who have weighed the tradeoffs and are willing to take the chance of adverse outcomes based on the data available, over losing their livelihood.

For such a programme to be ethical, the company would have to make full disclosure that going through a COVID-19 exposure will have the risk of severe infection and death, even if the individual going through it is young and is seemingly in good health. The service would include screening tests to rule out individuals with pre-existing conditions.

Those who go through this and come out certified can then participate in the society, both for their own economic benefit and the benefit of others. This would especially benefit those who are more vulnerable as they can now have certified, to the extent possible, non-lethal caretakers.

Those without the funds to be customers can be sponsored by prospective employers such as elders with money who need caretakers and find it much safer to employ certified individuals than asymptomatic carriers.

In this way, we can start to build herd immunity in a decentralised and scalable fashion. When enough herd immunity has come in, vulnerable people will be safer and will eventually be able to come out of the lockdown as well. The beauty of this idea is that it greatly reduces the pressure on the government. There is an economic benefit for all parties concerned, be it the company offering the service, or the individuals going through it.

But is it ethical for doctors who are presumably working for such companies to be exposing individuals to the virus? We note that ethics is about lying, stealing or harming others without their permission. Companies offering this service will need detailed disclaimers, just like any modern hospital would do before a procedure, explaining what their best data is so far and requiring the individual to acknowledge that they understand what they are getting into. Therefore, there is no lying or stealing. As for harm, since the doctor is acting as an educator and allowing the customer to make their own decision, there is no ethical violation.

This approach can be likened to an approximate social vaccine, which is what herd immunity provides us. An objection may be raised that we do not have enough data yet, and it would be unethical for policymakers to act on incomplete information.

There are two branches of statistics that are dueling about this. They are the Frequentists and Bayesians. Frequentists believe that probability can be derived only from frequencies found in data, and we can’t make decisions without data. Unfortunately, that insistence implies we have to wait for more people to die, and can only move science forward by counting more deaths. There is hardly anything more unethical than this.

The Bayesian school on the other hand recognises that probability is a state of information in our mind, and we can make rigorous decisions based on our best information in the absence of data.

The Indian government has already displayed courageous leadership in the absence of data by acting decisively to impose the lockdown and saving many precious lives. By quickly working out the parameters for the legal operation of such companies, along with probabilistic certification by the medical community, the Indian government will be able to align economic incentive with the well-being of the population and create a roadmap for moving from lockdown to reopening.

The author holds a PhD in Decision Analysis from Stanford University. The original interview may be accessed here.