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Published on: Apr 20, 2020
3 minute read
By: Dr Rajan Choudhary

Is Herd Immunity A Valid Strategy For COVID 19?

Yesterday we explained you what Herd Immunity means and how it works, today we will take the discussion further to determine whether it is effective and can be recommended in the current context.

COVID-19 currently does not have a cure or a vaccine. Lockdown is the only strategy that appears to be working. Could implementing policies that encourages herd immunity be used to accelerate immunity in the population without the need for a vaccine?

INFECTIVITY

For the strategy to work we need to know a few things about the virus. How infective is it? In one of our earliest blogs we discussed infectivity at length and determined that the R0 (infectivity) may be between 2 and 3. This means each person with the virus can infect around 2-3 people at a time. Whilst this is not as high as Mumps (10-12) it is much higher than the common flu. The higher the R0 the more people that need to be immunised before herd immunity is achieved. For COVID it is estimated that 70% of the population need to be infected.

This is based off our current testing. Due to shortages in testing kits, only testing those that have a high likelihood of being infected and poorly organised testing infrastructure in some countries, we are likely underestimating. The number of people infected may be much higher as we are missing those that are asymptomatic but still have the disease and are still passing the disease on.

MORTALITY

Secondly, we need to know the mortality from COVID-19. Early estimates of mortality were as high as 10%, as we had little data on how many people were truly infected, but as the number of infected cases rose, and testing amongst the infected and symptomatic population rose, a more accurate mortality has been found to be around 1%. There is a risk we may still be underestimating the true mortality, as some cities have noted a spike in cardiac deaths, and some evidence supports possible cardiac damage due to COVID. But from the data we have, we know its mortality is lower than MERS (34%) and SARS (10%) but more than influenza (0.1%).

estimates of the COVID-19 case fatality rate

Whilst we have some data on who is likely to suffer from severe COVID symptoms (elderly, immunocompromised, people with heart or lung problems) we still cannot accurately determine who will get severe COVID in the “low risk” population. Simply because someone is young and healthy does not mean they will not die from COVID.

LENGTH OF IMMUNITY

Third we need to know how long this immunity will last. Similar coronaviruses responsible for the common cold usually create immunity that lasts for a few months, which is why we often get the cold repeatedly. A virus is also very prone to mutations that can change the structure and functions of its proteins, proteins responsible for tagging, latching on to and entering cells. If the structure of these proteins changes enough, then our antibodies will not be able to bind on, and new types of antibodies will have to be made with a slightly different structure. This effectively means our bodies have to start from step 1 again to create immunity, and we have to make new vaccines. This mutation rate is why we have to make new vaccines every season for the flu.

LONG TERM COMPLICATIONS

Finally, we need to know if there are any long-term implications from a viral infection. Again, this is something we do not know yet, as the virus has only been around for a few months. There may be implications for the cardiovascular system, long term breathing problems or more. And even if the complication rate appears relatively low (say, 1%), if millions of people are allowed to get infected, by definitions thousands or tens of thousands of people will have these complications, complications that can lead to issues later in life or an early death.

CONCLUSION

So, is herd immunity a viable strategy for COVID? Without a safe vaccine the general consensus appears to be no.

We don’t know how infective the virus really is or how many people it has infected

A 1% death rate is still very high. This means for every 100 people to be infected; one will die. This would mean hundreds of thousands of people dead in a country with a population over 10 million. It is unacceptably high.

If the death rate is 1%, then hospitalisation rate is likely higher. Almost all countries do not have capacity to have 1% of the population in hospital. Overwhelming the healthcare system will lead to poorer care, and worse care for those who do not have COVID. Leading to more people coming to serious harm or dying as a result of poor healthcare, not because of COVID.

We don’t know the long-term effects of COVID. By purposefully infecting people instead of waiting for a vaccine we may be causing unnecessary damage to a person’s health that only becomes apparent later in life. But this is speculation as we do not currently know if COVID has long term effects,

We don’t know if all of the risks above will amount to anything. The immunity may not last long enough, leading to another spike in infections and mortality.

Mass vaccination appears to be the safest strategy. And though human clinical trials have started on a number of vaccines, we are still months away from deployment. Until then we should not come out of lockdown prematurely, not until we have received an unbiased assessment from public health officials that states it is safe.

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Lower Premiums for Health Score Achievers: How Preventive Wellness Rewards Healthy Choices

Healthcare costs are rising steadily across India, driven largely by lifestyle-related diseases and late-stage diagnosis. In response, organisations and insurers are shifting focus from reactive treatment to prevention. One of the most effective approaches emerging from this shift is offering lower premiums for health score achievers.

This model aligns personal health responsibility with financial incentives, creating a win–win situation for individuals, employers and insurers.

What Is a Health Score?

A health score is a composite indicator that reflects an individual’s overall health status.

It typically considers:

preventive health checkup results
lifestyle habits such as physical activity and sleep
key biomarkers like blood sugar, cholesterol and blood pressure
body composition indicators

The focus is on risk reduction, not perfection.

Why Health Score–Based Premiums Are Gaining Importance

According to NITI Aayog and EY-FICCI reports, preventive healthcare can reduce long-term medical costs by up to 30–40 percent.

Health score–linked premiums:

reward proactive behaviour
reduce claim frequency
encourage early detection

This shifts healthcare from illness management to health preservation.

The Preventive Healthcare Gap in India

NFHS-5 and ICMR data show:

many chronic diseases remain undiagnosed until advanced stages
preventive screenings are underutilised
lifestyle risks are increasing among working adults

Health score incentives help close this gap.

How Lower Premiums Motivate Behaviour Change

Financial Incentives Drive Consistency

When healthy habits are rewarded financially, individuals are more likely to:

attend regular screenings
improve diet and activity
monitor health metrics

Behaviour change becomes sustainable.

Focus on Improvement, Not Punishment

Modern health score models emphasise:

gradual improvement
personalised targets
achievable milestones

This avoids discouragement and promotes inclusion.

Benefits for Individuals

Reduced Insurance Costs

Lower premiums directly reduce out-of-pocket insurance expenses.

Better Health Awareness

Tracking health scores increases understanding of:

personal risk factors
lifestyle impact
preventive actions

Knowledge leads to better choices.

Early Disease Detection

Regular monitoring identifies:

prediabetes
early hypertension
lipid abnormalities

Early intervention prevents complications.

Benefits for Employers

Lower Healthcare Claims

Preventive health programs reduce:

hospitalisations
long-term treatment costs

This improves corporate insurance sustainability.

Improved Productivity

Healthier employees experience:

fewer sick days
better energy levels
improved focus

Wellbeing translates to performance.

Stronger Wellness Culture

Reward-based programs signal genuine employer commitment to health.

Benefits for Insurers

Health score–based premiums help insurers:

manage risk more accurately
reduce high-cost claims
promote preventive engagement

This supports long-term viability of insurance models.

Role of Preventive Health Checkups

Preventive screenings form the backbone of health scoring.

They help track:

metabolic health
cardiovascular risk
nutritional deficiencies

NITI Aayog identifies screening as the most cost-effective health intervention.

Addressing Privacy and Fairness Concerns

Responsible programs ensure:

data confidentiality
voluntary participation
non-discriminatory design

Transparency builds trust and engagement.

Making Health Scores Inclusive

Inclusive programs:

adjust for age and baseline health
reward progress
offer support for high-risk individuals

Equity is essential for success.

Integration with Digital Health Platforms

Digital tools enable:

real-time health tracking
personalised insights
long-term trend monitoring

This improves engagement and accuracy.

Long-Term Impact on Public Health

Widespread adoption of health score incentives can:

reduce lifestyle disease burden
shift focus to prevention
improve population health outcomes

WHO supports incentive-based preventive health strategies globally.

Challenges and How to Overcome Them

Common challenges include:

low initial engagement
lack of awareness
resistance to change

Solutions involve education, simplicity and continuous support.

Why Lower Premiums Are More Effective Than Penalties

Positive reinforcement:

motivates sustained behaviour change
reduces anxiety
builds trust

Punitive models often discourage participation.

Future of Health Score–Linked Premiums in India

As digital health infrastructure expands, health score–based models are expected to:

become more personalised
integrate AI-driven insights
support nationwide preventive strategies

This marks a shift toward value-based healthcare.

Conclusion

Lower premiums for health score achievers represent a powerful shift toward preventive, value-driven healthcare. By rewarding healthy behaviours, early screening and consistent wellness practices, these programs benefit individuals, employers and insurers alike. Financial incentives aligned with health outcomes encourage long-term behaviour change, reduce disease burden and create a sustainable healthcare ecosystem. In a country facing rising lifestyle diseases, health score–linked premiums are not just an incentive—they are a strategic investment in healthier futures.

References

World Health Organization (WHO) – Preventive Healthcare and Incentive Models
Indian Council of Medical Research (ICMR) – Lifestyle Disease and Prevention
National Family Health Survey (NFHS-5) – Adult Health Indicators
NITI Aayog – Preventive Healthcare and Insurance Reform Reports
EY-FICCI – Corporate Wellness and Healthcare Cost Studies

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