{"id":50685,"date":"2021-07-16T19:12:00","date_gmt":"2021-07-16T18:12:00","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=50685"},"modified":"2021-07-16T19:12:00","modified_gmt":"2021-07-16T18:12:00","slug":"kit-yates-how-can-we-reach-herd-immunity","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2021\/07\/16\/kit-yates-how-can-we-reach-herd-immunity\/","title":{"rendered":"Kit Yates: (How) can we reach herd immunity?"},"content":{"rendered":"<p><span style=\"font-weight: 400\">The term \u201cherd immunity\u201d first found its way into the UK\u2019s public consciousness very early on in the pandemic. The UK\u2019s chief scientific officer, Patrick Vallance, talked about allowing <\/span><a href=\"https:\/\/www.bbc.co.uk\/news\/uk-politics-54252272\"><span style=\"font-weight: 400\">\u201cenough of us who are going to get mild illness to become immune\u201d and building up \u201csome degree of herd immunity while protecting the most vulnerable&#8221;.<\/span><\/a><span style=\"font-weight: 400\"> What Vallance was referring to was herd immunity by natural infection. Without a vaccine this is the only way you can achieve herd immunity\u2014with the attendant illness and death that accompany these natural infections. The idea drew <\/span><a href=\"http:\/\/maths.qmul.ac.uk\/~vnicosia\/UK_scientists_statement_on_coronavirus_measures.pdf\"><span style=\"font-weight: 400\">concern from broad swathes of the scientific community<\/span><\/a><span style=\"font-weight: 400\"> and talk of herd immunity as a strategy was subsequently quashed by the government.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Despite the toxic connotations the phrase took on for many, herd immunity is an incredibly important concept. It suggests diseases can be eliminated without everyone having immunity. If you want to eliminate an established disease, then herd immunity is the way to do it. To achieve herd immunity, people can gain immunity in two different ways: through being infected and recovering with immunity, or through being vaccinated. For covid, <\/span><a href=\"https:\/\/directorsblog.nih.gov\/2021\/06\/22\/how-immunity-generated-from-covid-19-vaccines-differs-from-an-infection\/\"><span style=\"font-weight: 400\">the best way for people to get immunity is through vaccination<\/span><\/a><span style=\"font-weight: 400\">, <\/span><a href=\"https:\/\/sciencebasedmedicine.org\/covid-19-and-balancing-the-risks-the-vaccine-or-the-virus\/\"><span style=\"font-weight: 400\">even for younger age groups who are at a lower risk from severe complications due to covid<\/span><\/a><span style=\"font-weight: 400\">.<\/span><\/p>\n<p><span style=\"font-weight: 400\">When enough people have immunity to the currently circulating variant, the disease will start to decline. But how many people need to have immunity before the disease starts to die out? To calculate the so-called \u201cherd immunity threshold\u201d (HIT) we need to do some mathematical epidemiology.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">At the beginning of an epidemic when almost everyone is susceptible to the disease and there are no interventions in place to control it, simplistically speaking, the majority of the expected disease dynamics can be boiled down to a single number, <\/span><i><span style=\"font-weight: 400\">R<\/span><\/i><i><span style=\"font-weight: 400\"><sub>0<\/sub>\u2014<\/span><\/i><span style=\"font-weight: 400\">the basic reproduction number. This tells us how many people we expect each infected person to pass the disease onto during the course of their infectious period. This is a special case of the <\/span><i><span style=\"font-weight: 400\">R<\/span><\/i><span style=\"font-weight: 400\">-number we have become so familiar with from the news\u2014the zero-subscript indicating this is the value of <\/span><i><span style=\"font-weight: 400\">R<\/span><\/i><span style=\"font-weight: 400\"> at the <\/span><i><span style=\"font-weight: 400\">beginning<\/span><\/i><span style=\"font-weight: 400\"> of an epidemic with <\/span><i><span style=\"font-weight: 400\">zero<\/span><\/i><span style=\"font-weight: 400\"> interventions in place.<\/span><\/p>\n<p><span style=\"font-weight: 400\">If we can take measures to reduce <\/span><i><span style=\"font-weight: 400\">R<\/span><\/i><span style=\"font-weight: 400\"> so that it is below 1, then the disease will begin to die out. One way to do that is for people to gain immunity. The more people that have immunity, the fewer people each individual will be able to pass the disease onto. If <\/span><i><span style=\"font-weight: 400\">p<\/span><\/i><span style=\"font-weight: 400\"> is the proportion of the population that is immune (and <\/span><i><span style=\"font-weight: 400\">(1-p)<\/span><\/i><span style=\"font-weight: 400\">, therefore, the proportion not immune) then we can calculate the current reproduction number from the basic reproduction number as <\/span><i><span style=\"font-weight: 400\">R=R<\/span><\/i><i><span style=\"font-weight: 400\"><sub>0<\/sub><\/span><\/i><i><span style=\"font-weight: 400\">*(1-p)<\/span><\/i><span style=\"font-weight: 400\">. If a proportion <\/span><i><span style=\"font-weight: 400\">p=1-1\/R<\/span><\/i><i><span style=\"font-weight: 400\"><sub>0<\/sub><\/span><\/i><span style=\"font-weight: 400\"> of people are immune then this takes us to <\/span><i><span style=\"font-weight: 400\">R=1<\/span><\/i><span style=\"font-weight: 400\">, the tipping point at which infection should start to decline. If, for example, the original covid variants circulating in the early stages of the pandemic had an <\/span><i><span style=\"font-weight: 400\">R<\/span><\/i><i><span style=\"font-weight: 400\"><sub>0<\/sub> <\/span><\/i><span style=\"font-weight: 400\">of 3, then at least two-thirds of the population would need to have perfect immunity to bring <\/span><i><span style=\"font-weight: 400\">R<\/span><\/i><span style=\"font-weight: 400\"> below 1. With <\/span><a href=\"https:\/\/science.sciencemag.org\/content\/372\/6538\/eabg3055\"><span style=\"font-weight: 400\">more transmissible variants<\/span><\/a><span style=\"font-weight: 400\"> such as delta, which <\/span><a href=\"https:\/\/www.nature.com\/articles\/d41586-021-01696-3\"><span style=\"font-weight: 400\">may have a basic reproduction number as high as 6<\/span><\/a><span style=\"font-weight: 400\">, this calculation suggests that the HIT might be as high as 83%.<\/span><\/p>\n<p><span style=\"font-weight: 400\">This is a very simplistic picture, but it can be useful for back of the envelope calculations. In reality many factors will influence the HIT. One consideration is the degree of immunity conferred. Vaccines, for example, are not 100% effective at stopping people from transmitting the virus. <\/span><a href=\"https:\/\/directorsblog.nih.gov\/2021\/06\/22\/how-immunity-generated-from-covid-19-vaccines-differs-from-an-infection\/\"><span style=\"font-weight: 400\">Immunity from natural infection is thought to be even worse<\/span><\/a><span style=\"font-weight: 400\">. This means the HIT will be higher than suggested by the na\u00efve calculation above. Even if vaccination reduces the degree of onwards transmission by as much as 85%, this would increase the HIT to 98%. The potential for immunity to wane also means we will need to up the numbers of people vaccinated and think about delivering booster vaccinations.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Another important factor is heterogeneity of the population\u2014understanding that not everyone mixes with everyone else equally. This is particularly important when we are vaccinating by age brackets. Immunity will not be spread evenly. Even if we reach a theoretical HIT through vaccination, if there are large demographics that are not immune then the disease can still spread freely in these groups. By not offering the vaccine to children, for example, we are providing a large reservoir of unprotected people in whom the virus can freely circulate.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Conceptualising herd immunity as \u201call or nothing\u201d is not particularly helpful. Generally as immunity builds up in the population it slows the spread. Even if we can\u2019t reach a level of immunity that will keep <\/span><i><span style=\"font-weight: 400\">R<\/span><\/i><span style=\"font-weight: 400\"> below one once all restrictions are relaxed (and certainly without vaccinating children it is unlikely we can reach the levels required), the more immunity we have the slower the spread will be, and the easier it will become to control covid though tested public health measures.<\/span><\/p>\n<p><span style=\"font-weight: 400\">The government\u2019s plan to relax almost all restrictions from 19<\/span> <span style=\"font-weight: 400\">July 2021 makes it clear that the UK\u2019s path towards herd immunity will, at least in part, be through natural infection with the consequences that entails. Recent spread has already seen <\/span><a href=\"https:\/\/www.theguardian.com\/world\/2021\/jul\/08\/nhs-hospitals-forced-to-cancel-operations-again-by-unfolding-third-wave\"><span style=\"font-weight: 400\">healthcare services struggle to cope under excess pressure<\/span><\/a><span style=\"font-weight: 400\"> and will lead to many avoidable deaths and long term illnesses. Currently, around 47% of the UK population are not yet fully vaccinated. Denying everyone in the country the best chance of being protected through vaccination and relying instead on \u201ccaution, vigilance, and personal responsibility\u201d to tackle an airborne and highly contagious infectious disease is an abdication of responsibility, which will involve exposing millions to the acute and long-term impacts of mass infection.<\/span><\/p>\n<p><em><strong>Kit Yates<\/strong>, senior lecturer, Department for Mathematical Sciences, University of Bath. <strong>Twitter<\/strong>:\u00a0<a href=\"https:\/\/twitter.com\/Kit_Yates_Maths?ref_src=twsrc%5Egoogle%7Ctwcamp%5Eserp%7Ctwgr%5Eauthor\">@Kit_yates_maths<\/a><\/em><\/p>\n<p><em><strong>Competing interests<\/strong>: KY is a member of Independent SAGE.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>The term \u201cherd immunity\u201d first found its way into the UK\u2019s public consciousness very early on in the pandemic. The UK\u2019s chief scientific officer, Patrick Vallance, talked about allowing \u201cenough [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2021\/07\/16\/kit-yates-how-can-we-reach-herd-immunity\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":66,"featured_media":48372,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[223],"tags":[],"class_list":["post-50685","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-guest-bloggers"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Kit Yates: (How) can we reach herd immunity? - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2021\/07\/16\/kit-yates-how-can-we-reach-herd-immunity\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Kit Yates: (How) can we reach herd immunity? - The BMJ\" \/>\n<meta property=\"og:description\" content=\"The term \u201cherd immunity\u201d first found its way into the UK\u2019s public consciousness very early on in the pandemic. 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Today has been the first Saturday of high street shopping since non-essential retail stores across England were allowed to reopen last week, having been closed under the coronavirus lockdown for nearly three months. Yesterday, monthly retail sales data from the UK's Office for National Statistics (ONS) revealed the beginnings of a rebound during May, with a 12 percent recovery from record falls in April, but sales nonetheless remained 13 percent below February's pre-pandemic total. Retail sales figures for June, taking into account this month's reopening of the sector, will be published by the ONS on July 24. 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The UK\u2019s chief scientific officer, Patrick Vallance, talked about allowing \u201cenough [...]More...","og_url":"https:\/\/blogs.bmj.com\/bmj\/2021\/07\/16\/kit-yates-how-can-we-reach-herd-immunity\/","og_site_name":"The BMJ","article_publisher":"https:\/\/www.facebook.com\/bmjdotcom\/","article_published_time":"2021-07-16T18:12:00+00:00","og_image":[{"width":540,"height":350,"url":"https:\/\/blogs.bmj.com\/bmj\/files\/2020\/08\/population_england_london_PA-54240775.jpg","type":"image\/jpeg"}],"author":"julietwalker","twitter_card":"summary_large_image","twitter_creator":"@bmj_latest","twitter_site":"@bmj_latest","twitter_misc":{"Written by":"julietwalker","Est. reading time":"5 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/blogs.bmj.com\/bmj\/2021\/07\/16\/kit-yates-how-can-we-reach-herd-immunity\/#article","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2021\/07\/16\/kit-yates-how-can-we-reach-herd-immunity\/"},"author":{"name":"julietwalker","@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/person\/373707d32533c2cbca204980b8cd3493"},"headline":"Kit Yates: (How) can we reach herd immunity?","datePublished":"2021-07-16T18:12:00+00:00","mainEntityOfPage":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2021\/07\/16\/kit-yates-how-can-we-reach-herd-immunity\/"},"wordCount":980,"commentCount":0,"publisher":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#organization"},"image":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2021\/07\/16\/kit-yates-how-can-we-reach-herd-immunity\/#primaryimage"},"thumbnailUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2020\/08\/population_england_london_PA-54240775.jpg","articleSection":["Guest writers"],"inLanguage":"en-US","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/blogs.bmj.com\/bmj\/2021\/07\/16\/kit-yates-how-can-we-reach-herd-immunity\/#respond"]}]},{"@type":"WebPage","@id":"https:\/\/blogs.bmj.com\/bmj\/2021\/07\/16\/kit-yates-how-can-we-reach-herd-immunity\/","url":"https:\/\/blogs.bmj.com\/bmj\/2021\/07\/16\/kit-yates-how-can-we-reach-herd-immunity\/","name":"Kit Yates: (How) can we reach herd immunity? - The BMJ","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#website"},"primaryImageOfPage":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2021\/07\/16\/kit-yates-how-can-we-reach-herd-immunity\/#primaryimage"},"image":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2021\/07\/16\/kit-yates-how-can-we-reach-herd-immunity\/#primaryimage"},"thumbnailUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2020\/08\/population_england_london_PA-54240775.jpg","datePublished":"2021-07-16T18:12:00+00:00","breadcrumb":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2021\/07\/16\/kit-yates-how-can-we-reach-herd-immunity\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/blogs.bmj.com\/bmj\/2021\/07\/16\/kit-yates-how-can-we-reach-herd-immunity\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/blogs.bmj.com\/bmj\/2021\/07\/16\/kit-yates-how-can-we-reach-herd-immunity\/#primaryimage","url":"https:\/\/blogs.bmj.com\/bmj\/files\/2020\/08\/population_england_london_PA-54240775.jpg","contentUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2020\/08\/population_england_london_PA-54240775.jpg","width":540,"height":350,"caption":"Saturday afternoon shoppers, some wearing face masks, walk along along Oxford Street in London, England, on June 20, 2020. Today has been the first Saturday of high street shopping since non-essential retail stores across England were allowed to reopen last week, having been closed under the coronavirus lockdown for nearly three months. Yesterday, monthly retail sales data from the UK's Office for National Statistics (ONS) revealed the beginnings of a rebound during May, with a 12 percent recovery from record falls in April, but sales nonetheless remained 13 percent below February's pre-pandemic total. Retail sales figures for June, taking into account this month's reopening of the sector, will be published by the ONS on July 24. 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