Achieving herd immunity against COVID-19 at the country level by the exit strategy of a phased lift of control

Sake J. de Vlas, Luc E. Coffeng*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

15 Citations (Scopus)


The COVID-19 pandemic has affected the entire world causing substantial numbers of cases and deaths in most countries. Many have implemented nationwide stringent control to avoid overburdening the health care system. This has paralyzed economic and social activities and may continue to do so until the large-scale availability of a vaccine. We propose an alternative exit strategy to develop herd immunity in a predictable and controllable way: a phased lift of control. This means that successive parts of the country (e.g. provinces) stop stringent control, and COVID-19-related IC admissions are distributed over the country as a whole. Importantly, vulnerable individuals need to be shielded until herd immunity has developed in their area. We explore the characteristics and duration of this strategy using a novel individual-based model for geographically stratified transmission of COVID-19 in a country. The model predicts that individuals will have to experience stringent control for about 14 months on average, but this duration may be almost halved by further developments (more IC beds, better treatments). Clearly, implementation of this strategy would have a profound impact on individuals and society, and should therefore be considered carefully by various other disciplines (e.g. health systems, ethics, economics) before actual implementation.

Original languageEnglish
Article number4445
JournalScientific Reports
Issue number1
Publication statusPublished - 24 Apr 2021

Bibliographical note

Funding Information:
The presented work was partly made possible by funding from ZonMw (, Grant 10430022010001). LEC further acknowledges funding from the Dutch Research Council (NWO, Grant 016. Veni.178.023).

Publisher Copyright:
© 2021, The Author(s).


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