Does Botswana's Small And Mostly Youthful Population Present A Unique Chance To Try Herd Immunity In The Fight Against COVID-19?

Before he caught the virus himself and had to be hospitalized, British Prime Minister Boris Johnson had advocated for the UK to consider the of use herd immunity as a way to tackle the COVID-19 virus without putting the entire country under lockdown and the economy on a tailspin.

 To start with, here is how herd immunity works:

How herd immunity works

Herd immunity allows a contagious disease to be allowed to pass through a population without the need to vaccinate or immunize the entire population but rather reducing the probability of the contagious disease spreading to the most susceptible members of that population. In the above infographic, the first scenario shows a case when only a few members of the population get to be immunized against the disease. Obviously, if only a few people are vaccinated and unable to both contract and spread the disease whilst most are able to, the disease will spread rapidly to those who are healthy but not immunized, leading to an increase in the number of cases.

The second scenario is when most of the population is vaccinated against the contagious disease where in that case, chances of the disease being contracted to the most vulnerable group of the population—the unimmunized—are very low. The core idea behind the concept of herd immunity is simply to prevent the contagious disease being contracted by the most vulnerable members of the population and this is done by ensuring that chances of contracting the virus are extremely low among most of the healthy population.

When contemplating applying the concept of herd immunity to the context of the COVID-19 crisis, one obvious obstacle pops up—unlike the contagious disease in the infographic, Coronavirus does not have have a vaccine so no member of the population can be immunized against it. However, despite not having a vaccine yet, one unique characteristic of the Coronavirus makes herd immunity to still be somewhat of a possibility.

Cases of COVID-19 per 100k people

From the above infographic, it is clear that when it comes to contracting the virus, no age group, except maybe up to the teenagers, is safe. Rates of contraction amongst senior citizens are almost identical to those among middle-aged citizens and only slightly less than those of younger citizens. Alarming as that is, when one looks closely at the numbers, a pattern starts to emerge.

Numbers of hospitalizations due to COVID-19 to  per 100k people

The above infographic shows the number of people who had such severe symptoms from COVID-19 that they required hospitalization and eventually ventilators, beds in the ICU, etc. As aforementioned, a pattern becomes apparent. Unlike with the number of cases where the virus was almost not discriminatory, its severity is inclined more towards older generations while the numbers for working-age citizens, though still concerning, are much lower.

Number of deaths from COVID-19

This last infographic above now shows people who eventually succumb to COVID-19. It is clear as day that while most the working-age citizens eventually go on to make full recoveries from the virus, the senior citizens and a significant portion of the 45-64  are not so lucky.

It is obvious from the statistics that whilst older citizens with other chronic preexisting conditions are very much at risk of succumbing to the virus, the numbers amongst young and working-age citizens are very promising. Among that citizenry, COVID-19 kills way fewer people than even the common flu. Even if they do contract the virus, the worst they are going to get are mild symptoms and eventually a full recovery and have immunity to the virus as the body would now have developed antibodies for it like how it does with the common flu.

Those facts were the reason why Boris Johson and his government initially advocated for herd immunity or "letting the virus run its course" as he put it. The plan was to let younger citizens get the virus and eventually recover while isolating senior citizens with preexisting conditions to keep them away from contracting the virus. This would allow the working-age citizens to keep working and the economy to remain on its feet while senior citizens, who are mostly retirees, stay at home and pretty much await a vaccine. However, it did not work in the UK for several reasons, most of which can be attributed to the failure of the government to act on time. 

Coming to Botswana, looking at the details of how the Coronavirus operates, can herd immunity work? An argument for it can indeed be made. To start with, with roughly 2.3 million people as per 2017 estimates, Botswana has one of the smallest populations in Africa. Taking this into consideration, if the country was to decide to implement herd immunity, testing and isolating senior citizens, who make up only 5.33%(about 119 000 people) of the entire population might prove feasible with the necessary financial support.

With statistics available about the density and distribution of these senior citizens, arrangements can be made to set up isolation centers to cater specifically for these citizens whilst the rest of the population who are less susceptible to the virus are allowed to carry on with their normal every day lives. They would even be no need to isolate the entire senior citizenry because again according to statistics, the virus almost always severely affects those with preexisting conditions. 

Another reason why herd immunity should be considered as an option by the Botswana government is the fact that despite the country only recorded 13 positive cases and 1 death hitherto, these numbers may represent a highly deflated figure due to a low number of testing. Up to now, only 2527 tests have been performed all of which were individuals who had been previously quarantined. In short, the government is assuming that there are no cases of local transmissions that may have come either through border jumpers, those who arrived in the country before the lockdown, etc. 

This means that if there are indeed local carriers of the virus, they may be locked down with older members of their families and passing the virus to them. Wouldn't it make sense to assume the worst, that there may be local hosts, and remove our senior citizens from setups which might lead to them contracting the virus by either taking them to isolation centers if they cannot self isolate at home?

The impotence of the current lockdown is also another reason why a herd immunity strategy should be considered. Currently, the lockdown is doing more to spread the virus than actually do its mandated task of curbing it. Not only is the draconian and illogical permit system creating crowds at government offices but most people—including the legislators themselves—are simply not adhering to the regulations.

Several arguments can be made against the use of herd immunity including the 22% prevalence of HIV/AIDS among the youth in the country which might lead to younger citizens who are usually not severely affected by the virus being gravely affected why might lead to more people being hospitalized,  overwhelming the healthcare system. 

This argument and many others that have not been mentioned are valid and make the decision-making for healthcare professionals all the way more difficult. However, the fact remains that the current way of trying to contain the virus cannot be the only option because it is simply not effective. Not only is it detrimental in curbing the virus itself as stated with the aforementioned reasons but it is also economic suicide.

Herd immunity is not the perfect option but it is an option nonetheless. It is even much of a considerable option if you look at Botswana's circumstances. First and foremost, a lockdown has not and will not be as effective as it is in developed countries and secondly, because of a small and youthful population, the virus can be allowed to run its course without decimating most of the population, who are young and less susceptible to it. The country's small population also gives room for rapid and fast testing to be done so that those who are vulnerable can be identified and isolated in a relatively short period of time.

In Botswana's case, an argument for herd immunity is not even solely about having working-age people keeping the economy going. It is about admitting that copied and pasted ways from developed countries are simply ineffective in our context and hence a need for more options on the table. Even if an economic argument can be made against herd immunity like how operating isolation centers indefinitely is going to be costly, statistics show that an indefinite lockdown would have more far-reaching economic consequences than allowing working-age people to go back to work and students to go back to school.