Herd Immunity, Deathmaking and the Limits to Growth

(In memory of David Brandon 1941 – 2001)

Today I was reading the comments after an article about Dominic Cummings, the adviser to British Prime Minister, Boris Johnston. One of the comments that caught my attention was an attack on Cummings for promoting “herd immunity”.

This came after I had had a disagreement with someone yesterday in which I was more or less accused of flirting with fascist ideas by seeing value in the concept of herd immunity.

For the record therefore here are two descriptions of “herd immunity” – one from Wikipedia and another from an article by Anthony Barnett. (Yes I know Wikipedia is not always reliable but for this purpose it will do ). I invite readers to compare the two descriptions of what is supposed to be the same idea.

The Medical concept (as described in Wikipedia)

Herd immunity (also called herd effect, community immunity, population immunity, or social immunity) is a form of indirect protection from infectious disease that occurs when a large percentage of a population has become immune to an infection, whether through vaccination or previous infections, thereby providing a measure of protection for individuals who are not immune. In a population in which a large proportion of individuals possess immunity, such people being unlikely to contribute to disease transmission, chains of infection are more likely to be disrupted, which either stops or slows the spread of disease.The greater the proportion of immune individuals in a community, the smaller the probability that non-immune individuals will come into contact with an infectious individual, helping to shield non-immune individuals from infection.

From an essay by Anthony Barnett:

“…… When policy towards the virus was debated in Downing Street at the “end of February” it seems the government embraced the existing epidemic planning whose results were so “terrifying” when war-gamed in the 2016 Exercise Cygnus they were never published. The strategy, as presented by the Prime Minister’s chief of staff Dominic Cummings, was summed up by a witness as, “Herd immunity, protect the economy and if that means some pensioners die, too bad”, according to the Sunday Times.

It is not hard to see the logic of this approach from a free-market perspective. The deaths would mostly be of the old and thus merely accelerate the termination of those of us who are anyway ‘a drain’ on social services. The less elderly victims tended to have underlying health issues, which would also eliminate costs for the NHS. A younger, fitter, cheaper population would be the outcome, preserving the economy from the punitive ‘panic’ measures of other countries. It’s an approach implicit in Johnson’s Greenwich speech about Britain transforming itself into Superman. But it was abandoned. Why?”

Now…You can make up your own mind but my reading of the first description is that it a concept from medicine about the protection of non immune people from infection. It is a way of keeping the vulnerable – like old people – safe.

In the second description the issue at stake is the health (competitiveness of the economy) where the health and well being of vulnerable non immune people is a matter of indifference – or, more precisely, it is even desirable that the non immune die because they are a burden on the economy.

The two concepts are 180 degrees different.

For me this illustrates a number of things about mainstream economics (neo liberal economics if you like). One of my favourite quotes is from Anais Nin – “We do not see things as they are, we see things as we are”. If you are a neo-liberal economist…or a politician influenced by neo liberal economics – then it seems that you are inclined to take a concept used to help protect vulnerable people – and give it a social darwinist interpretation – the survival of the fittest. Instead of being about protecting people it means “helping them die” in order to help the economy.

In practice, where there is no vaccination the only way that herd immunity is going to work is for a separation of those who are vulnerable from those who are not during the phase that the contagion starts to take hold, runs to a height and then subsides to the point where 70 to 80% of the population have been infected. But that depends on adequate testing to know when that is and adequate measures to separate the vulnerable from the general population. “Adequate measures” here means material and financial resources for front line workers – like personal protective equipment and procedures so that, for example, care workers in the residential sector for elderly and vulnerable people, do not bring infections from their lives at home into their lives at work. It means training for care workers of vulnerable people. It also means procedures so that the hospital sector does not send infected people back to the residential care sector – but keeps people who are ill and infectious separate from vulnerable groups. As one GP put it in the middle of April:

“in care homes we potentially had the perfect storm for the pandemic. They are full of elderly and infirm and highly vulnerable people. Environments where it is often impossible to isolate residents, and staff who have never been adequately trained in isolation measures. Equally, whilst relatives cannot visit hospitals, care homes have been continuing to allow them in.

It is not as if the warning signs were not there, flashing red.

What was the government’s strategy for dealing with nursing homes?  It has been, up until the last couple of days, to make things even worse. The instructions from the Dept of Health have been to send patients diagnosed with COVID out of hospital, and back into care homes, with instructions to “barrier nurse” them, a term for a set of stringent infection control techniques.  Care homes were informed that they could not refuse to take the residents back.

All of which means that the staff end up attempting to barrier nurse COVID positive patients with flimsy surgical masks, no eye protection, no gowns and gloves that, in my case, disintegrate rapidly and are almost completely useless. Until very re cently, nursing home staff, in many homes, were told not to wear masks, and this was true even when there were COVID positive patients in the home.

The focus, the entire focus, has been to clear patients out of hospitals, waiting for the deluge of patients. This has been so effective that, in my area of Cheshire, the local hospitals have never been so empty…… have also watched patients go down very rapidly and die. COVID is a strange disease that kills people in a way that I have never witnessed before. In some cases, very quickly. I have tried to suggest that hospitals are the best place to look after potentially infectious people, not care homes. No-one has been interested.”

What the lived experience shows is that, in order to turn the original medical meaning of herd immunity into a lethal neo-liberal interpretation in real life, it is necessary not to take adequate steps to isolate vulnerable people from the general population. In order to kill people in an outbreak like covid 19 you don’t provide adequate resources, don’t train staff and implement procedures to direct a growing tide of serious ill elderly and vulnerable people back into places where they can infect even more.

A Sort of Gresham’s Law of Ideas: Bad ideas drive out good ones…

To economists there is a famous “economic law” formulated several centuries ago called Gresham’s law – that “bad money drives out good”. This was in a time when money took the form of coins with a precious metal content (gold or silver). The name refers to Sir Thomas Gresham (1519-1579) who observed what happened when Henry VIII reduced the portion of the silver in the shilling replacing it with base metals.

As explained by Investopedia “People were aware of the change and began separating the English shilling coins based on their production dates to hoard the coins with more silver which, when melted down, were worth more than their face value. Gresham observed that the bad money was driving out the good money from circulation.”

An analogous process that I have noticed is of bad ideas driving out good ones – or perhaps vacuous rhetoric replacing real ideas.

This occurs because of power relationships in society. Given these power relationships – whatever you might want words to mean they will eventually come to mean whatever the powerful groups mean by them.

I noticed this when working in the mental health services in the 1980s and 1990s. In the 1980s an increasingly vocal group of mental health service users who were critical of the ideas and practices of medical psychiatry formed a movement raising fundamental questions about the mental health service “in which the customer is always wrong” . This movement saw mental health issues as connected to the disempowerment of mental patients – both outside and inside hospitals. In its original form individual and collective advocacy was seen as helping to correct a power imbalance between staff and psychiatric patients and inside society more generally. The word “empowerment” became an important concept and at its most advanced meant that the concerns of psychiatric services users would become the starting point for the provision of services and the kinds of treatment.

This matched the changing health service ideology because the idea of patients as “customers” was being promoted by Thatcherism. For a time the word “empowerment” became a buzz word used by all – including senior managers and renegade psychiatrists. However they meant something different by the word.

For many service users “empowerment” meant setting the agenda for the services up to and including ideas about how mental health issues were thought about and treated. However for staff and managers “empowerment” became a word meaning largely passive “representatives” sitting on committees whose agenda and business was decided by the usual managers and staff.

Words used by the environmental movement about environmental issues also changed their meaning over time – or lost any real impact. For example, “sustainability” – an idea adopted at the Rio Earth Summit at the beginning of the 1990s – was soon revealed to mean different things to different people.

Neo-liberal economics has proved to be a very corrosive concept system rendering the very idea of sustainability virtually meaningless – although nearly all politicians and businesses have used it for 30 years.

This became clear in debates between economists about the concept of “weak sustainability” and “strong sustainability” which were about how important is the damage done by pollution and the processes of depletion in view of the claimed ability to substitute “natural capital” with “human capital”. Later the main policy idea became “sustainable growth” which was a complete oxymoron. As an earlier economist, Kenneth Boulding had said, “Anyone who believes continual growth is possible on a finite planet is either a madman or an economist”.

Back to Herd Immunity…

It is no surprise therefore to find that medicine is another field where economic concepts and priority to “the economy” has turned the meaning of a key medical concept inside out.

The danger with something like this is that the next thing you know some medical institutions are bowing before the inversion of the meaning of their concept with health managers and staff keeping their heads down and going along with it – while other braver souls like Malcolm Kendrick feel that they must speak out. Even worse when careerists become willing and enthusiastic helpers and a bullying group-think drives out honest staff alarmed by what is happening. Just when you want hospitals to save people’s lives, you take steps to “flatten the curve” that keeps people out of hospital by sending them back to where they can infect others.

The context for this happening has been laid down by austerity policies hollowing out the UK National Health Service and the associated persecution of ill and disabled people who are dependent on welfare benefits. For example, early in 2019 it was revealed how more than 17,000 people had died while waiting to hear whether their claim for disability benefit had been successful. This is the context in which no serious attempt was made to think through and provide resources to protect the most vulnerable groups. It is a policy of which leads to vulnerable people going to early graves. It is a policy of “deathmaking”.


The Politics of Death

Back in 1972 when the original authors of Limits to Economic Growth ran their computer model and wrote it up the text that they published predicted not only rising pollution, depletion of resources and eventual falls in food and industrial production – they also predicted that people would be affected. The death rate would eventually start rising and the birth rate would start to fall. The population would start to fall. It was not only the economy that would be negatively impacted – so too would populations.

Proponents of “Degrowth” try, with good reason, to propose, design, develop positive ideas for “a prosperous way down” with positive ideas to improve the quality of life. A lot depends on whether the power relationships of society can be successfully challenged so that the way down is not one characterised by “disaster capitalism” but the burden and the losses are shared fairly. Instead of disaster capitalism we need forms of “disaster collectivism” .

Nevertheless we cannot avoid recognising that a major part of the problems that we will be wrestling with are connected to the end of life care of the baby boomer generation. The record so far as in this crisis is appalling and there is something profoundly inhumane about what has been happening. As a Swiss review of the deaths in care homes explains:

“Nursing homes play an absolutely key role in the current corona situation. In most Western countries, 30% to 70% of all deaths “related to Covid” occurred in nursing homes (in some regions even up to 90%). It is also known from northern Italy that the crisis there began with a panic-induced collapse of nursing care for the elderly.”

It is also wrong to reduce the problem to how many elderly and vulnerable people are dying – it is also a matter of the conditions in which they are living their last days and dying.

“A report from Germany vividly describes the extreme conditions under which hundreds of thousands of patients in care and nursing homes have had to live in recent weeks, often against their will. Many of the patients were barely allowed to leave their rooms, were no longer allowed to go out into the fresh air or receive visits from their relatives.”

“According to Helga Witt-Kronshage the worst thing is not at all the loneliness. It is not the ban on going into the garden where the sun is shining with the wheelchair. It is not the silence and not the empty corridors and not at all fear of the cursed epidemic. It’s the fact that no one asked her…. For the health of the next generations she will do everything that she can. But try to prolong her own life at the price of dying alone and not being able to hold the hand of her daughter? Why would she want that?”

This Politics has to be just – not only to the dying generation but also to the generations coming after

The politics of sustainability was supposed to be about inter-generational justice. It meant that we all had to think of ourselves as keeping the world in trust for future generations. There is therefore something that does not feel quite right about the inter-generational dimensions of covid 19.

As is well known, at this stage of this pandemic (May 2020) the younger you are the less the health risks seem to be. At the same time a lockdown policy has a number of consequences – which go beyond mere inconvenience and may impact the health of those who are stuck at home indoors. This will include negative impacts on the immune systems of those involved in the lockdown. These include lack of exercise and sunshine, lack of education and social interaction, and negative effects on the immune system of being kept separate from other people.

There is still a lot that is not known about covid 19 and that includes the degree of immunity people acquire when they have had the disease. However if young people have mostly mild or asymptomatic cases and have next to no chance of having serious illness or death when they are young it might even make sense for them as individuals to actually catch the illness if it subsequently turns out that people who recover are free of it from then onwards – especially when catching it at a later age would be a greater risk to them. (This remains to be seen).

Less speculative is that isolation imposed on people who are not in relationships can be very negative for mental and emotional health and is likely to increase suicide risk.

In addition the economic close downs and resulting impoverishment also have negative health consequences. An actuarial study in South Africa looked at the number of years of life for those at severe risk that a lockdown might save – and compared it to the years of life lost given what is known about the way that poverty is associated with shorter life expectancy. Life years lost were 29 times more than life years saved in conditions where a lockdown led to economic impoverishment. Does not this deathmaking raise issues of justice for younger people too?

The Economics of Deathmaking

Poverty and low life expectancy go together – A stark example is the life expectancy of homeless people in the UK. According to research carried out by the University of Sheffield the average life expectancy of homeless people is 47 compared to 77 for everyone else. The life expectancy for homeless women is even less – just 43 years. (Thanks to K F for suggesting this example )

Another example of deathmaking is the people burned to death in the Grenfell Tower disaster in Kensington in London. Residents had warned about the danger of fire years before but no one with the power to do anything about it gave a damn – their pleas for action “fell on deaf ears” . Adittya Chakraborty wrote in the Guardian “Over 170 years after Engels, Britain is still a country that murders its poor. The victims of Grenfell Tower didn’t just die. Austerity, outsourcing and deregulation killed them – just as Victorian Manchester killed the poor.”

The fact that people who are impoverished usually die younger is a theme that was explored by a German academic called Wolf Wolfensberger who worked on issues of rights for disabled people in the USA, Canada and elsewhere. He coined the term “deathmaking” (as a translation from the German “Totmachen” ) to describe the way that socially devalued people (like those with mental or physical disabilities) tended to die younger.

This was not because of their medical condition but because no one gives a damn about them and they do not get the treatment and care that they need to survive. For Wolfensberger the impoverished condition that many disabled people got into led to their early deaths for reasons that are not noticed by mainstream society nor by institutions which are supposedly there to support them.

In a 2009 interview on YouTube Wolfensberger gives an example of a socially devalued person who loses their dentures and is unable to get them replaced through the welfare system. As a result this person loses weight and becomes malnourished. This in turn leads to susceptibility to an infection and this leads to pneumonia. On the medical certificate the death appears to be the the result of a single problem like pneumonia. However, what is missing in this attribution is the story of events that led up to the death. What preceded the pneumonia? Why was the person malnourished? And so on. When you can tell the whole story then it becomes clear that the real cause of death is that no one gave a damn about them.

As it happens an elderly friend of my late mother lost his dentures in hospital. He took them out and placed them on the tray which his meal came on. When the tray was cleared away and swept into the trash his dentures were not noticed and went too. He never got them back nor did the hospital make any efforts to replace them. He too lost weight and wanted to die because he was so humiliated and distressed at being utterly unable to get the situation rectified. He did indeed die shortly afterwards. This is an example of death making.

I very much doubt that the death of my mother’s friend Charlie was correctly attributed because the medical system is run primarily for the benefit of the people who work in it, who manage it and for its suppliers – another point that Wolfensberger makes.

With that in mind the attribution of death is one of those ways in which it is possible for health and care staff to conceal from themselves and from others what is actually happening.

Public health priorities are, or should be, informed by statistics of why people die – but in the United States 10% of people die because of medical errors according to research by John Hopkins University. This is the third highest cause of death yet there is not a high priority to do anything about this.

Why? Because the way of collecting national health statistics fails to classify medical errors separately on the death certificate in the USA. The way of classifying deaths is based on billing data in a privatised system. “The medical coding system was designed to maximize billing for physician services, not to collect national health statistics, as it is currently being used.”

(Mis) Attribution of death can hide many things. How very convenient it is for industrial polluters that covid 19 can be attributed to a virus from China rather than to local air pollution.

Deathmaking as Euthanasia

The words on this poster read in English: “60,000 Reichmarks is what it costs to support this person with a hereditary illness through his lifetime. Fellow Citizens this is your money too.”

In 1994 when I was working in the mental health services I attended a conference in Hamburg organised by the World Congress of Social Psychiatry. The conference had a theme – when medical services become toxic and start persecuting and killing their patients.

At this conference, decades after the Nazi era, German psychiatrists were revealing that the murders were organised by an earlier generation of mental health workers – many of whom continued practicing and even teaching after world war two. Here’s the beginning of an article about this policy:

“In October 1939, Adolf Hitler signed a decree that enabled Nazi Germany to forcefully euthanize patients who they deemed were “unworthy of life”.
After the war, the law was classified as Action T4. The name stands for Tiergartenstrasse 4, the infamous address of the Chancellery Department in Berlin, which employed physicians designated to conduct the euthanasia program.
The head of the Chancellery was Phillip Bouhler who worked together with the Fuhrer’s personal physician, Dr. Karl Brandt to carry out the program. Hitler’s eugenics policy promoted his interpretation of the Darwinist law of nature ― the survival of the fittest ― emphasized within the Nazi ideology…

The official duration of the program was from 1939 to 1941, but the Nazis continued with it throughout the war. The number of victims is hard to establish. In the two-year period, 70,273 people lost their lives and records exist to confirm this. Historians estimate that the total figure exceeded 200,000.”

Although the policy was probably at its most murderous in Germany other countries followed the same logic – Sweden, Switzerland and the USA also followed eugenic policies to sterilise groups of people who were socially devalued.

In conclusion – it is a mistake to assume that this story has a happy ending

The limits to economic growth is a big collective story but it has a personal dimension for each of us and that personal story will increasingly include impoverishment, physical and mental illness and death. It is important that we understand how impoverishment, illness and death work in a very unequal society so that we can try to set up mutual support arrangements as far as possible. Otherwise things are liable to be grim. There are no guarantees. The limits to economic growth have already been responded to by elites pushing through austerity policies that impoverish, make people homeless and ill. They are pushing many of us towards the slippery slopes down which we can slip into dynamics of deathmaking. It is a collective and individual saga for all of us not to let that happen.

Deathmaking does not just happen – it is the result of choices in government policy and institutional choices in health and welfare. It arises through the way institutions and their managers act – in this essay I have mentioned inequalities of power and influence for elderly and disabled people – but similar analyses could be made for minority ethnic groups, refugees, and other socially devalued groups who are considered expendable. It is a mistake to believe that institutions that appear to be there for our welfare can be trusted to look after our interests.
The “individualism” we are supposed to identify with is mythical – it is usually a narrative of the individual winning through against the odds. The odds against us are real enough – but winning against them is a fairy tale. The story we are supposed to identify with therefore does not really reflect the experience of a growing majority in which, past the limits to growth the management of life unravels and disintegrates.

It disintegrates into sickness or the threat of sickness that cannot be easily avoided given constraining arrangements for everyday life. It is disintegrating because of unemployment. It is disintegrating because for many many people there is not enough income to pay the rent or mortgage. It is disintegrating into homelessness and food insecurity. It breaks down into a difficulty or impossibility of supporting children or vulnerable loved ones and dependents. It means getting by day to day by getting deeper in debt. It is an experience of persecution by official agencies that are supposed to be helping but are increasingly there as rackets to rip you off and whose planning and indifference can be lethal..It is an experience of the rich getting bailed out and everyone else getting ripped off. It is an experience, of the cops and the armed forces watching you and pushing you around, especially if you try and organise.

The people who govern us are barely aware of what is happening but have their most keen eye for their own interests of their crony networks. When the United Nations appointed someone to report on poverty in Britain the rapporteur, Philip Alston, found that ministers that he talked to were indifferent to widespread poverty and in denial about it. People like Cummings and Johnston set abstract goals that hope future historians will praise them for achieving – as Barnett puts it “Britain turning itself into Superman”. Their goals are vacuous but their chief attention is on their PR reputation.

Philosophers have mused about situations of deep crisis like this. We can kid ourselves that this is the deep crisis that we dreamed would happen and that we now have the answer ready. We can comfort ourselves with wishful thinking that the hideous situation we are all in is necessary to tip others into action that will set everything right. It’s all right, we can think, it is part of the drama on the road of progress.

But is a view like this far too complacent? The philosopher Adorno considered the philosophy of Hegel during World War Two and could see no guarantee that what was happening was a prelude to something that could be called progress.

Hegel had claimed that a reflective individual who surveys the course of history will be reconciled to tragedies when he understands their contribution to progress overall. Adorno was repulsed by this idea. He noted with indignation: “Millions of Jews have been murdered, and this is to be seen as an interlude and not as the catastrophe itself”

Are there more appropriate frames of mind to replace the complacency of the growth economy with its techno fix mentality? Might it be more appropriate to consider how, if we do not act in the right ways – and even if we do – we could slip into another “dark age”? If we want alternative historical metaphors for where we are we could imagine ourselves in the situation of indigenous communities when they first met the European adventurers at the beginning of centuries of colonialism. Unaware of how awful the path ahead would get.

Consider, for example, the Aboriginal people of Australia who, before the invaders, worked at most 3 hours a day in landscapes designed by themselves and managed with controlled burning. They lived in a sustainable ecological economy that had existed for thousands of years. They had a deep knowledge of how the ecological system worked and were a part of it.

Yet the English barbarians swept it all away not even noticing that how sophisticated and refined the society and economy was that they had encountered. The colonialists imagined that they were bringing “progress” to a primitive people. Now think of history from the point of view of the Aboriginal people – hunted down, robbed, murdered – and all in the name of what the invaders were certain was “progress” – and mostly still regard as progress even as Australia goes up in flames.

For many people recent world history is not one of “progress”. It is a history of impoverishment that has left their descendants dispossessed in favelas and slums. We call societies like Britain and the United States “advanced” and other societies “Emerging Markets”. Yet this is based on an arrogant assumption of what has happened in history and also a complacent assumption about what will happen from now on.

During World War Two another philosopher, Walter Benjamin, wrote about another way of interpreting the history of the world:

A Klee painting named “Angelus Novus” shows an angel looking as though he is about to move away from something he is fixedly contemplating. His eyes are staring, his mouth is open, his wings are spread. This is how one pictures the angel of history. His face is turned toward the past. Where we perceive a chain of events, he sees one single catastrophe which keeps piling wreckage upon wreckage and hurls it in front of his feet. The angel would like to stay, awaken the dead, and make whole what has been smashed. But a storm is blowing from Paradise; it has caught in his wings with such violence that the angel can no longer close them. This storm irresistibly propels him into the future to which his back is turned, while the pile of debris before him grows skyward. This storm is what we call progress.

(My source for this and the Adorno quote is Margaret Meek Lange: “Progress”, The Stanford Encyclopedia of Philosophy (Winter 2019 Edition)

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