|Ahead of print publication
“The Great Barrington Declaration” and “The John Snow Memorandum”: Two parallel lines which are destined to meet
Department of Community Medicine, Dr. DY Patil Medical College, Hospital and Research Centre, Dr. DY Patil Vidyapeeth, Pune, Maharashtra, India
|Date of Submission||18-Oct-2020|
|Date of Decision||18-Oct-2020|
|Date of Acceptance||19-Oct-2020|
Department of Community Medicine, Dr. DY Patil Medical College, Hospital and Research Centre, Dr. DY Patil Vidyapeeth, Pune, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this URL:|
Banerjee A. “The Great Barrington Declaration” and “The John Snow Memorandum”: Two parallel lines which are destined to meet. Med J DY Patil Vidyapeeth [Epub ahead of print] [cited 2020 Dec 4]. Available from: https://www.mjdrdypv.org/preprintarticle.asp?id=300006
Few renowned scientists and epidemiologists recently put on record their dissent over the strategy adopted by almost all countries of the world for coping with the pandemic of COVID-19. They drafted the “The Great Barrington Declaration” which stresses on “Focused Protection.”
This strategy advocates protecting the vulnerable, i.e., the elderly and people with comorbidities who according to evidence are more likely to die from COVID-19 infection, while letting the young people lead a normal life with no restrictions. This would allow students to return to school and working people to resume normal work and earn livelihoods which have been adversely affected by restrictive COVID control measures.
The Great Barrington Declaration has been criticized by the mainstream medical community. An open letter published in The Lancet signed by 80 scientists declared the concept of “herd immunity” around which the Great Barrington Declaration purportedly revolves, a dangerous fallacy not supported by scientific evidence. The scientists criticizing the Great Barrington Declaration named their rebuttal “The John Snow Memorandum.” The strategy to control the pandemic according to them appears to be restrictive measures till a vaccine is available.
The letter criticizing the Great Barrington Declaration seems to have been written in a hurry without homework. For instance, it stresses the contagiousness of COVID-19 and its higher fatality rates compared to influenza virus. On the other hand, it glosses over the higher morbidity and mortality caused by influenza virus among children, compared to negligible fatality in this group due to COVID-19.
Further, the open letter states that the strategy of herd immunity outlined in the Great Barrington Declaration is not supported by scientific evidence. They conveniently overlook that there is no scientific evidence either for the efficacy of lockdown. They are silent over the immense collateral damages due to the draconian measures adopted by countries which violate the ethics of medical practice, i.e., “Do no Harm” implying that the cure should not be worse than the disease.
The uncertainties on both sides which are the hallmark of the newest science and the oldest art which is medicine seem to have escalated to a debating contest, unfortunately. Science should not get polarized like politics. Scientific temper calls for accommodating opposing views and exploring together in search of evidence. It should not degenerate into signature campaigns and open letters. In response to the book, “A Hundred Authors against Einstein,” Einstein had responded that if he were wrong, then one author would have been enough!
There is hope yet. These two parallel lines are destined to meet much short of infinity, driven by ground realities if not by evidence.
What are these ground realities? We need a vaccine which is safe and effective, which is by no means a certainty. Currently, more than 170 candidate vaccines are in the fray, but the vast majority of these are likely to fail. There is no guarantee that any COVID-19 vaccine will succeed, but the global approach is the best way to ensure accessibility.
Toward this end, the World Health Organization (WHO) together with GAVI, Gates Foundation, and other agencies is pooling scientific and financial resources among countries to ensure equitable distribution to countries once vaccines are licensed after meeting safety and efficacy standards.,
According to the consensus steered by the WHO with these agencies, after regulatory approval, vaccine doses will be allotted to countries at the rate proportional to their population size so as to cover 20% of the total population of a country in the initial rollout, setting aside 5% for outbreaks and refugees., No country will receive enough doses to vaccinate more than 20% of its population until all countries reach this level. With the availability of this 20% quota, all countries will have to prioritize the vaccine recipients. Naturally, the vulnerable in each country will be the elderly and people with comorbidities who will receive the vaccine first in addition to occupational high-risk groups such as health-care workers. This will leave out the young and children. In any case, it will take time to know the safety profile of vaccines in pediatric age group. Weighing the risk-to-harm ratio, young people and children would be the last priority, as evidence indicates that they have the least vulnerability from COVID-19 infection.
Hence, the way forward from the present zugzwang is the same both for the proponents of the Great Barrington Declaration and the John Snow Memorandum! The bottom line in both the strategies is protecting the vulnerable and letting the young and children go back to work and school, as even the critics will concede that workplaces and schools cannot be shut down indefinitely. The only difference is that the proponents of the Great Barrington Declaration advocate using presently available means of protecting the vulnerable, i.e., by self-isolation and hygiene, while the proponents of the John Snow Memorandum advocate vaccine which will be available in the uncertain future, for only the vulnerable 20% of the world population, willy-nilly driving “Focused Protection.”
These two parallel lines are likely to meet much ahead of infinity due to these ground realities! Let us hope when these lines meet, the world scientific community regains the objectivity which seems to have been lost in the anarchy let loose by the pandemic.
| References|| |
Alwan NA, Burgess RA, Ashworth S, Beale R, Bhadelia N, Bogaert D, et al
. Scientific consensus on the COVID-19 pandemic: We need to act now. Lancet. 2020;396(10260): e71–e72. doi: 10.1016/S0140-6736(20)32153-X.
Doyle JD, Campbell AP. Pediatric influenza and illness severity: What is known and what questions remain? Curr Opin Pediatr 2019;31:119-26.