Vaccinating people who have had covid-19: why doesn’t natural immunity count in the US?


The question in the above headline comes from the title of the feature article in the September 13, 2021 issue of the British Medical Journal. The BMJ is a peer reviewed journal of the British Medical Association. It is one of the world’s oldest medical journals beginning its publication in 1840.


You have limited time, so I have summarized an otherwise long and comprehensive article. Some editorial comments are included.


The US CDC estimates that SARS-CoV-2 has infected more than 100 million Americans, and evidence is mounting that natural immunity is at least as protective as vaccination. Yet public health leadership says everyone needs the vaccine.


The substantial number of Covid infections, coupled with the increasing scientific evidence that natural immunity is durable, have led medical observers to ask why natural immunity didn’t seem to be factored into decisions about mandating vaccination.


“Natural immunity varies from person to person and experts do not yet know how long someone is protected” the CDC states on its website. This is a statement no longer consistent with the science.


Viruses and other infectious organisms have been around since long before humans walked the planet. Vaccines, on the other hand have not. The first was smallpox, invented in 1796. Without natural immunity, many past viral illness, hundreds and thousands of years ago, would have been extinction events.


Now, in Orwellian fashion, the only approved form of immunity is vaccine-induced, with no regard for natural immunity.


As breakthrough Covid infections in people fully vaccinated are increasing, data from Israel buttress natural immunity over vaccine immunity. Their studies show that “fully vaccinated” individuals are 27 times more likely to become Covid infected and symptomatic, and 7 times more likely to be hospitalized compared to those unvaccinated, but with natural immunity.


The Australian health minister announced at a recent press conference that 95% of the Covid patients in Victoria hospitals are vaccinated people. In the UK, 80% of those dying of Covid have been vaccinated. 60% of hospitalized Covid in Israel were fully vaccinated.


In Roseburg we are constantly reminded this is a pandemic of the unvaccinated. And it has been. That won’t last. We can look to Israel, Australia. the UK and other to see what will soon be here.


The Oregon Health Authority released this data October 14th. Note that although the vaccine is hoped to allow for less severe disease, the percent of total covid deaths among the vaccinated shows steady increase since March.

This data is not included to denigrate the vaccine but to recognize its limitation. Recent studies of the Pfizer’s Covid vaccine effectiveness against Covid infections fell from 88% during the first month to 47% after 5 months.


It has been shown viral loads are the same in Covid-19 delta variant infections, vaccinated vs. unvaccinated. If the vaccinated can equally catch and spread the virus, it raises reasonable questions.


One nurse asked, “Why do the protected need to be protected from the unprotected by forcing the unprotected to use the protection that did not protect the protected in the first place?”


Another observed, “this may be the first medical product in history whose failure is blamed on those who didn’t take it.”


Natural infection induced immunity is more durable.


The Cleveland Clinic studied its more than 50,000 employees. Not one of the over 1300 unvaccinated employees who had been previously infected tested positive during the five months of the study.


A recently published paper from China showed that antibodies can last more than a year post Covid infection. Another study published in Nature demonstrated that T cell immunity in patients recovering from 2003 SARS, which is similar to our current SARS-CoV-2 infections was still robust 17 years post infections.


Antonio Bertoletti, professor of infectious disease at Duke-NUS Medical School conducted research that compared the T cell response in people with symptomatic versus asymptomatic covid-19, Bertoletti’s team found them to be identical, suggesting that the severity of infection does not predict strength of resulting immunity and that people with asymptomatic infections “mount a highly functional virus specific cellular immune response.”


One of the largest studies of natural immunity was published was in Science in Feb 2021, which showed that, although antibodies decline over 8 months, memory B cells increased over time while memory CD8+ and CD4+ T cells maintained a steady presence.


Monica Gandhi, an infectious disease specialist at University of California San Francisco explained, “we’ve had a lot of really important studies that showed us that memory B cells and memory T cells form in response to natural infection.”


In the BMJ feature article, Gandhi included a list of some 20 references on natural immunity to Covid supporting the durability infection induced immunity. “I stopped adding papers last December because references were getting so long”, she stated.


A NIH funded study from La Jolla Institute for Immunology found “durable immune responses” in 95% of participants 8 months after infection.


It is important to understand that actual patient outcomes are much better predictors of protection than antibody titers.


Dr. Matthew Memoli, director of the Laboratory of Infectious Disease clinical studies at the NIH, warned against using antibody levels to predict level of protection. He pointed to real world data centering on outcomes.


He stated that while “vaccines are focused on only that tiny portion of immunity that can be induced” by the spike protein, exposure to the whole virus “would likely offer a broader based immunity” that would be more protective against variants.


Dr. Memoli finished, “Claiming as data (antibody levels to the spike) supporting that vaccines are better than natural immunity is shortsighted and demonstrates a lack of understanding of the complexity of immunity to respiratory viruses.”


Gandhi and others have also been urging attention away from antibody titers as the defining metric of immunity. ‘It is accurate that your antibodies will go down” after natural infection. That’s how the immune system works. If antibodies didn’t clear from our bloods stream after we recover from a respiratory infection, “our blood would be thick as molasses.”


Dr. Patrick Whelan, a pediatric rheumatologist at UCLA points out his sickest Covid 19 patients in intensive care, including children with multi-system inflammatory syndrome, have “had loads of antibodies…so the question is, why didn’t they protect them?”


Those policy makers advocating immunizations for all, independent of existing immunity, point to logistics. “It is a lot easier to put shot in arms than test people, than await results and then give people a choice.”


The politics of natural immunity have influenced policy. Rand Paul, Kentucky senator and physician has pushed the issue of natural immunity. When President Trump tweeted last October that his recovery form Covid 19 rendered him “immune”, Twitter labelled it “misleading and potentially harmful information”


Another polarizing factor was the Great Barrington declaration of Oct 2020 which argued for a less restrictive and more focused pandemic strategy that would help build herd immunity through natural infections in people at minimal risk.


The John Snow memorandum, written in response to Great Barrington, included the signature of Rochelle Walensky, who went on to head the CDC. That document stated “there is no evidence for lasting protective immunity to Covid following natural infection. This statement was based on a study of people who had recovered from covid-19 showing that blood antibody levels wane over time.


That Kentucky study that CDC officials used to justify vaccine mandates to include those with natural immunity, is based solely on the finding of decreasing antibody titers over time. It has been widely criticized because:


  1. This study’s findings were different from multiple other much larger studies in the US and around the world. It was an outlier.

  2. The sample size was very small. 246 patients in the study group, compared to the Cleveland Clinic 50,000 patient study.

  3. Conflict of interest was charged. The fact that the CDC funded the research, help conduct the research, and helped to author the publication, which then produced the results CDC wanted - and was used to support their existing stance in a politicized environment - was suspect.

  4. CDC used a PCR test. However, what constituted a positive case was different for vaxxed versus unvaxxed patients. Different thresholds of amplification for a positive result favored positive tests in unvaxxed (28 cycles in vaxed versus over 40 in unvaxxed).

  5. The CDC recently acknowledged PCR tests are inaccurate to distinguish between Covid and other influenza viruses.

  6. CDC conclusions were based solely on test results, not hospitalization or death rates.

Increasingly, the ethics of mandating the vaccine to those for whom it provides no benefit, while bringing a measure of risk, is questioned.


Dr. Christine Benn, vaccinologist and professor of global health at the University of Southern Denmark notes the real risk in vaccinating people who have had Covid 19 as doing more harm than good. A large study in the UK and another international study found that people with a history of Covid infection experienced a greater rate of side effects after vaccination.


Among 2000 people, those with a history of Covid were 56% more likely to experience a severe side effect that required hospital care.


Dr Whelan UCLA, stated the “sky high” antibodies after vaccination in people previously infected contributed to these side effect. Immune complexes are deposited in joints, meninges and kidneys creating injury.


Dr. Memoli explained “a lot of public health people have this notion that if the public is told there is the slightest bit of uncertainty about a vaccine, then they won’t get it.”


For Memoli, this reflects a bygone paternalism.


“I think it is much better to be clear and honest about what we do and don’t know, what the risks and benefits are, and allow people to make decisions for themselves.


Tim Powell MD

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