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Wednesday, July 15, 2020

Indian inflection of herd immunity’ has deep cultural roots

In its corona version, poor are infected in sufficient numbers to produce immunity which accrues to those who have done nothing to earn it.

Written by Alok Rai | Updated: June 15, 2020 9:22:56 am
India COVID-19 policy, COVID-19 pandemic, India corona cases, herd immunity, herd immunity meaning, herd immunity explained, Now, ‘herd immunity’ has something of the rhythm of nature about it — the happily grazing herd, living through the cycles of birth and death, and acquiring immunity along the way. (Illustration by C R Sasikumar)

My epidemiologist daughter is a public health professional. On what turned out to be the eve of the fourth lockdown, she asked me in some alarm as to what was up with India’s COVID-19 policy. The following is my attempt to grope my way towards an answer.

For countries around the world, there is a difficult choice to be made between two broad policy options: Containment, possibly via lockdown; or, alternatively, allowing the infection to spread, in the hope of achieving “herd immunity”. There are costs involved in both strategies. As for the lockdown, it imposes a severe economic cost — how severe, we will discover in the coming months and years. But the immediate costs are all too visible — not only in terms of lost jobs and closed businesses, but in India, in the form of homelessness and hunger, the searing torment of the epic caravans of workers who have been forced to become migrants. The ostensible “gain” in this lockdown strategy is slowing down the rate of spread of the infection so that “the health services are not overwhelmed”. (This is an Indian joke: There are no health services worth speaking about.) But the eventual goal, even in the lockdown strategy, is the controlled spread of the infection, until an adequate proportion of the population has been infected and, hopefully, become immune. Given this proportion — which varies from infection to infection so different bugs, different numbers — the infective virus is unable to find a sufficient number of hosts in whom to replicate itself, and the individual infection does not translate into an epidemic.

With a pure herd immunity strategy on the other hand, as in Sweden, there is no significant economic cost, but the infection spreads more rapidly, with a concomitant increase in mortality. Sweden’s public health professionals were confident about the ability of their public health system to handle the anticipated tide of infections. However, the virus has wreaked significant havoc in terms of mortality in the care homes for the elderly.

Anyway, back to India. While some of “us” have been locked down in relative comfort, cocooned discreetly in our “innocent” privilege, the most visible effect of the lockdown has been the crystallisation of vast mobs of hungry, desperate people who, under normal circumstances, work to keep the wheels of our “normal” life turning. They have been wrenched from their normal, gruelling lives, and forced onto the burning highways — or, indeed, onto the by-ways, walking along the railway tracks, because the police have forced them off the regular roads. Alternatively, they have been confined in “homes” that are, basically, detention facilities, in circumstances that render them rather more likely to both contract and communicate infection than they would have been under normal circumstances. So, we have some weird hybrid of lockdown, and accelerated infection, in the hope of producing herd immunity.

Now, “herd immunity” has something of the rhythm of nature about it — the happily grazing herd, living through the cycles of birth and death, and acquiring immunity along the way. But the term “herd immunity” is typically used in the context of immunity produced through vaccination, and not by letting an infection rip through a population — a mode of thinking more appropriate to our genocidal imagination. Still, what we have, whether in the milling crowds at railway stations and bus depots or in the trucks in which they are piled, desperate to get back “home”, is significantly different. These are hothouse situations — places of concentrated, intense infection. Then, ever so gradually, these people will melt away, or stumble, into the hinterland — except that the only gift which they are bringing from the metropolis this time is a “Chinese” virus. Of course, on the other side of these tides of infection — and, of course, mortality — there lies the desired heaven of herd immunity. Or so we hope.

However, there are a couple of things that have to be clarified before we start cheering. The first has to do with numbers. The proportion of a population that has to be immune, whether through vaccination or infection, for herd immunity to be possible varies from pathogen to pathogen. However, even a conservative (for COVID-19) estimate of 60 per cent, in a population of over 1.3 billion, adds up to a lot of human beings. And, again, even if the percentage of people who die as a consequence of infection is assumed to be a conservative 1 per cent, that still adds up to a lot of bodies — in fact, nearly 8 million. The actual numbers may well turn out to be much higher. But I have great confidence in the stoicism of the Indian middle-class, as evident in the ease with which they have accepted the suffering of their former servants, their maids and their handymen, the people who built their homes and serviced their vehicles. They will, I do believe, find the moral strength to bear up to the mortality of others, even in such numbers.

There is however one further, cruel, twist. The aforementioned middle classes — primarily Hindu savarna — are not notable for their affection for the “herd”, any herd. But the secret and, I fear illusory, hope nurturing in their breasts is that the herd out there — dying or not dying, that’s immaterial — will generate herd immunity which will, somehow, be transferred to them. This is, quite simply, false. Herd immunity is a statistical concept. It only means that, because a crucial proportion of the herd is immune, the pathogen cannot find sufficient hosts to produce an epidemic. But the biological immunity earned by the once-infected members of the herd — the maids and drivers — through the production of antibodies, this does not osmotically transfer to the bosses. Individual members of the herd — the properly savarna locked-down householders temporarily sharing “herd-hood” with the unfortunates out there in the slums and on the burning roads — do not become immune. They remain vulnerable.

This subtly Indian inflection of “herd immunity” has, I suggest, deep cultural roots. These roots go back deeper even than the insensitivities produced by inequality and the class divide. I suggest that this ties in with the brahminical tradition of transferred merit — this is the pandit who performs puja on your behalf, this is the lala who pays some tone-deaf kathavachak to regale the neighbourhood, and cleanse lalaji’s conscience. In the corona version of this tradition, the poor are infected, and either die — they are expendable anyway — or they become immune in sufficient numbers to produce that very Indian herd immunity which, mysteriously but also typically, accrues to those who have done nothing to earn it.

Vikram Patel, of Harvard’s School of Public Health, has described India’s erratic lockdown policy as “insane” — lockdown when infection levels are low, but in such a manner that produces intensified infection among the forcibly disrupted millions of informal workers. Then, when the infection has been properly incubated and intensified, through some combination of incompetence and callousness, allow these millions to be disseminated into the hitherto relatively uninfected hinterland. In this way, the actual policy, as enacted on the ground, maximises both the economic catastrophe, and the ferocity of the epidemic.

But, to return to my daughter’s original question: Whence this brilliant policy, this hybrid of lock-down and herd immunity, which gives us the worst of both options — economic disaster, and a rampaging epidemic? Could it be the civil (and uncivil) servants who are, we know, the fount of all wisdom? Or is it another masterstroke from the Master, Himself?

The writer taught in the department of English, Delhi University

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