Why were there mostly negative outcomes? First, we know that any considered decision about adopting a viable proposal and monitoring its enactment on an ongoing basis requires valid information regarding who has been and has not been infected. There must be broad-based (if not universal) testing—and this testing was not widely or consistently available in the United States or in many other countries. The real challenge was even greater. There must also be contact tracing after testing has revealed a positive COVID-19 result. With whom has this person been in contact and have they yet been tested? This tracing was absent in most communities in the United States and elsewhere in the world. Without this tracing, the hit and miss of herd immunity would be completely untenable. Issues concerning the cost of tracking were prevalent. Concerns about confidentiality and the disruption of work forces were expressed. Perhaps of greatest importance was the psychological factor: a general fear of other people begins to emerge when tracing is implemented: “I don’t really want to know that other people might be infecting me!” Perhaps these diverse factors account for the absence of tracking—as does the politicization and polarization that accompanied virtually every aspect of the COVID-19 response in the United States (and many other countries).
We also know that herd immunization must include both the “artificial” immunity that comes from inoculations and the “natural” immunization that comes from being infected with and successfully recovering from a virus. Unfortunately, past history suggests that “medicine [inoculations] has actually played a surprisingly small role in the decline of most infectious diseases across time.” (Christakos, 2020, pp. 86-87). Socioeconomic improvements and public health policy measures have been much more important, as has the successful implementation of NPIs. Clearly, socioeconomic and pharmacological (immunization) factors must play a complementary role in addressing future pandemic virus challenges—and effective NPI policies must be engaged alongside these two factors. In its pure form, herd immunization will not work.
