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Natural immunity to covid is powerful. Policymakers seem afraid to say so.
People making decisions about their health deserve honesty from their leaders.
President Biden visits the Viral Pathogenesis Laboratory at the National Institutes of Health in February, with Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, and NIH director Francis Collins listening. (Evan Vucci/AP)
By Marty Makary
Marty Makary is a professor at the Johns Hopkins School of Medicine and Bloomberg School of Public Health, editor-in-chief of Medpage Today, and author of “The Price We Pay: What Broke American Health Care — and How to Fix It."
September 14, 2021 at 3:45 p.m. EDT
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correction
A previous version of this article erroneously said Spectrum Health is in Detroit. It is in Grand Rapids, Mich. The article has been corrected.
It’s okay to have an incorrect scientific hypothesis. But when new data proves it wrong, you have to adapt. Unfortunately, many elected leaders and public health officials have held on far too long to the hypothesis that natural immunity offers unreliable protection against covid-19 — a contention that is being rapidly debunked by science.
More than 15 studies have demonstrated the
power of immunity acquired by previously having the virus. A 700,000-person
study from Israel two weeks ago found that those who had experienced prior infections
were 27 times less likely to get a second symptomatic covid infection than those who were vaccinated. This affirmed a June Cleveland Clinic
study of health-care workers (who are often exposed to the virus), in which none
who had previously tested positive for the
coronavirus got reinfected. The study authors concluded that “individuals who have had SARS-CoV-2 infection are unlikely to benefit from covid-19 vaccination.” And in May, a Washington University
study found that even a mild covid infection resulted in long-lasting immunity.
Coronavirus vaccines work. But this statistical illusion makes people think they don’t.
So, the emerging science suggests that natural immunity is as good as or better than vaccine-induced immunity. That’s why it’s so frustrating that the Biden administration has repeatedly argued that immunity conferred by vaccines is preferable to immunity caused by natural infection, as NIH director Francis Collins told Fox News host
told Bret Baier a few weeks ago. That rigid adherence to an outdated theory is also reflected in President Biden’s recent announcement that large companies must require their employees to get vaccinated or submit to regular testing, regardless of whether they previously had the virus.
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Downplaying the power of natural immunity has had deadly consequences. In January, February and March, we wasted scarce vaccine doses on millions of people who previously had covid. If we had asked Americans who were already protected by natural immunity to step aside in the vaccine line, tens of thousands of lives could have been saved. This is not just in hindsight is 20/20; many of us were vehemently arguing and
writing at the time for such a rationing strategy.
One reason public health officials may be afraid to acknowledge the effectiveness of natural immunity is that they fear it will lead some to choose getting the infection over vaccination. That’s a legitimate concern. But we can encourage all Americans to get vaccinated while still being honest about the data. In my clinical experience, I have found patients to be extremely forgiving with evolving data if you are honest and transparent with them. Yet, when asked the common question, “I’ve recovered from covid, is it absolutely essential that I get vaccinated?” many public health officials have put aside the data and responded with a synchronized “yes,” even as studies have shown that reinfections are rare and often asymptomatic or mild when they do occur.
The tide may finally be shifting, as pressure has grown on federal officials. Last week on CNN, Anthony S. Fauci, the nation’s top infectious-disease specialist, hinted that the government may be rethinking its stance on natural immunity,
saying, “I think that is something that we need to sit down and discuss seriously.” Some large medical centers, like Spectrum Health in Grand Rapids, Mich., have already announced they will recognize natural immunity for their vaccine requirements. Some Republican governors have picked up on public frustration over how the scientific guidance is inconsistent with the data, with Florida Gov. Ron DeSantis
accusing the Biden administration of “not following science” by crafting its vaccine mandate without taking into consideration “infection-conferred immunity.”
Booster shots won’t stop the delta variant. Here’s the math to prove it.
The current Centers for Disease Control and Prevention position about vaccinating children also dismisses the benefits of natural immunity. The
Los Angeles County School District recently mandated vaccines for students ages 12 and up who want to learn in person. But young people are less likely to suffer severe or
long-lasting symptoms from covid-19 than adults, and have experienced rare heart complications from the vaccines. In Israel, heart inflammation has been
observed in between 1 in 3,000 and 1 in 6,000 males age 16 to 24; the CDC has confirmed 854 reports nationally in people age 30 and younger who got the vaccine.
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A second dose of the two-shot mRNA vaccine like that produced by Pfizer and Moderna may not even be necessary in children who had covid.
Since February, Israel’s Health Ministry has been
recommending that anyone, adult or adolescent, who has recovered from covid-19 receive a only single mRNA vaccine dose, instead of two. Even though the risk of severe illness during a reinfection is exceedingly low, some data has demonstrated a slight benefit to one dose in this situation. Other countries use a similar approach. The United States could adopt this strategy now as a reasonable next step in transitioning from an overly rigid to a more flexible vaccine requirement policy. For comparison, the CDC has long recommended that kids do not get the chickenpox vaccine if they had chickenpox infection in the past.
The incorrect hypothesis that natural immunity is unreliable has resulted in the loss of thousands of American lives, avoidable vaccine complications, and damaged the credibility of public health officials. Given the recent mandate announcement by the White House, it would be good for our public health leaders to show humility by acknowledging that the hypothesis they repeatedly trumpeted was not only wrong, but it may be harmful. Let’s all come together around the mounting body of scientific literature and real-world clinical experience that is telling us not to require the full vaccine regimen in people who recovered from covid in the past. Public health officials changing their position on natural immunity, after so much hostility toward the idea, would go a long way in rebuilding the public trust.
