The mantra has reached crescendo proportions, “Get vaccinated, get vaccinated, get vaccinated!!!!”, and, for many, advice that should be followed. But is it good for all? Now, before being accused as being an “anti-vaxxer,” I’m not. At the same time, however, should it really be a “one size fits all” recommendation? So here is my perspective.
To my simplistic thinking here in the U.S. there are two segments of population as they pertain to the vaccine:
- Those vaccinated. I fall into this group as do my many family members and friends. From the CDC data from July 2021, approximately 69% of the adult population has been vaccinated, most fully, while others have received at least one shot (Pfizer or Moderna). Other sites (e.g. USA Facts, which accumulates data from 70 government sources) report the vaccination rate of the entire U.S. population as being lower. In the case of USA Facts the published rates are 57% of the population having had at least one dose of the vaccine while 50% of the population are fully vaccinated (data as of July 25, 2021). So next time you hear about an “x” vaccination rate ask yourself whether the rate refers to adults only or if it refers to the entire population. If the latter, then anticipate lower rates as children <12 years of age, comprising ~47 million individuals, are being included. I am confident the reader is aware that there is a raging debate regarding the advisability of vaccinating this group to begin with as there is good data showing that both the likelihood of infection is very low in this group as well as the likelihood of transmission to adults is also low.
- Those not vaccinated which, in light of the above figures, means 31% of the adult population or 43-50% to the entire population. I’ve had questions about the breakdown of this unvaccinated group because I suspect that, if the group is taken as a whole rather than component parts, it keeps the unvaccinated numbers high which are then alarmingly reported on whatever news outlet(s) you choose to get your information.
So what could make up the component parts of the unvaccinated group? For me this would include: a) kids <12 years of age if the vaccination rate is referring to the entire population, b) those with a true medical contraindication to the vaccine, c) those with moral objections to the vaccine (e.g. since there were cells used from aborted fetuses in developing the vaccine [esp. J&J] a number of Catholics refuse to get the vaccine), d) those who don’t believe any vaccine is worthwhile or safe, e) those who don’t trust the system and never will, f) those with misconceptions (e.g. microchips, risk of DNA alteration) or concerns (e.g. adverse affect on fertility) and, finally, g) those who have had Covid and either have questions about, or refuse to get, the vaccine. It is in this last group that I feel faces the vaccine conundrum. More about this momentarily.
Why get a vaccine? To build up immunity to an infectious process that could have significant consequences if infection occurs. So in the case of Covid, as with other viruses, immunity to the virus can develop because one becomes infected, recovers, and generates antibodies via a robust immune response to subsequent infection (natural immunity) or though vaccination. Natural immunity to Covid encompasses an individual’s immune response is to all components of the virus (capsid [think of it as the “shell” of the virus] as well as the spike [those projections sticking out of the capsid shown in multiple illustrations]). With vaccination alone the immune response is generated to the spike only which, as the data show, can still provide a very high level of protection. Antibodies to these components (anti-N, referring to the capsid; anti-S referring to the spike) can be measured and tracked (seroprevalence). “N” antibodies alone only develop through natural immunity while “S” antibodies are linked to the vaccines and natural immunity.
There is widespread agreement that individuals who become infected with Covid can be symptomatic or asymptomatic. In light of this there has been a persistent question as to what percent of the population, whether from symptomatic or asymptomatic infections, has recovered, and now has immunity to the virus? One attempt to generate data to answer this question has been through the Nationwide Commercial Laboratory Seroprevalence Survey. As of mid-May 2021, positive “N” seroprevalence rates (implying natural immunity) in the 50 States has ranged from 2.7% (HI) to 36.7% (OH) overall, with 25 states having rates <19%, 20 states 20-29%, and 5 states with rates >30%. The data, however, has been tempered by less than robust testing in some of the states. It was also not clear to me how the data breaks down between symptomatic/recovered and asymptomatic/recovered individuals. Overall, however, I think it is safe to say that there is a significant part of the population (depending on the State where they live) who has developed a natural immunity to the virus.
Now onto the conundrum. The conundrum faces those who have developed natural immunity (knowingly or unknowingly) to the Covid virus. Simply stated, it revolves around the question as to whether or not unvaccinated, but previously infected, individuals should get the vaccine. Those urging this subpopulation of individuals with natural immunity to Covid to get vaccinated do so for a variety of reasons some of which are: a) the duration of natural immunity is unknown, 2) potential side effects from getting the vaccine are uncommon (“rare” per CDC), and 3) it reduces the risk of reinfection. There are a few observations I would like to make.
Regarding duration of immunity–there are a growing number of studies showing that whether after Covid infection or vaccination the immune response is robust in most people. Ongoing studies also show that individuals with natural immunity still have immunity 12 months after infection while individuals who have been fully vaccinated have immunity at least to six months (discrepancy due to the fact that the virus has been around longer than the vaccines). It is unclear to me why those with natural immunity are being encouraged (and soon likely to be mandated) to get vaccinated. A few, of many, links: https://www.nih.gov/news-events/nih-research-matters/lasting-immunity-found-after-recovery-covid-19; https://www.nature.com/articles/s41590-02109233; https://clarion.causeaction.com/2021/07/28/johns-hopkins-physician-the-power-of-natural-covid-immunity/
Potential side effects–I agree statistically rare but tell that to the young adult, for example, who has developed myocarditis as a result of vaccination. Since it is understood in the scientific community that those in younger age groups (<40) often contract Covid but are asymptomatic, how clear is it that the vaccine is being given to someone in this age group with natural immunity especially when there has been concern expressed about the risk (regardless of age) of causing serious side effects? (Noorchashm, Hooman. “A Letter of Warning To FDA And Pfizer: On The Immunological Danger Of COVID-19 Vaccination In The Naturally Infected.”)
Reinfection–so reinfection in an individual who has received the vaccine is unfortunate but acceptable but not for one who has natural immunity?
I leave you with this final question and thought . Leaving aside the naysayers/doubters who will never be convinced, should unvaccinated individuals of any age group, but especially younger age groups, be given the opportunity to have Covid antibody titers checked periodically? If positive and high what is the advisability then of following (“natural history” in the science world) vs. forcing a needle into their arm at the risk of being considered a pariah otherwise? The science could be better. And, lest we forget, the vaccines are allowed to be administered under “emergency use authorization (EUA)” only (implying that the FDA isn’t totally comfortable with the safety and/or efficacy data). So, to me, those adults who have never been infected or are vaccine naive should strongly consider getting vaccinated especially if they have risk factors. Those who have developed natural immunity should have a choice.
Below are three links for additional review:
https://www.msn.com/en-us/news/politics/vaccines-benefit-those-who-have-had-covid-19-contrary-to-viral-posts/ar-BB1fZrwb
https://www.news-medical.net/news/20210608/No-point-vaccinating-those-whoe28099ve-had-COVID-19-Findings-of-Cleveland-Clinic-study.aspx
If You Had Covid, Do You Need the Vaccine?
If you wish to leave a comment, click on the particular blog title on the sidebar at www.docmentation.com. This will open up that topic again and at the bottom of the narrative there will be a comment section). Earlier blogs: Inaugural, Oscar, “That will be $108”, SODA POP, On the Evolution of the Medical Record, Housecall, The Four Reasons, Medicare and Medicaid, Responsibility, Decisions, Tales from the ER, Conversation, can be found with “search” or, for some, just scroll down the page.
Obviously, there is an increasing trust issue in this country with what to believe, given all the conflicting reports from supposedly pristine sources.
How do you choose which data to believe? Is it possible to source such immune from political persuasion?
Thanks for the article.
There are a variety of reasons leading to the erosion of trust. Implicit in trust is the concept of honesty, i.e. that those “pristine sources” speaking to you are being truthful in what is being told and, whether from the right or left, not spinning/politicizing information. In the “old days” pronouncements from “pristine sources” were taken as gospel since trust was high. But currently, because of that eroding trust, we are more likely to hear what we want to hear and, bolstered by social media and the internet, albeit each with its own potential misinformation and opinion, the honesty of those entities that used to be trusted entirely has been rightfully (in some case) questioned.
The populace has been whipsawed by widely varying information out of the CDC, e.g. masks no, masks yes, double/triple masks yes, masks no, masks yes. Why are deaths “from” Covid (where the infection leads to death) and deaths “with” Covid (where death is due to something other than the infection but the patient tested positive for the virus) lumped together? Why isn’t the CDC giving better guidance to those who have natural immunity? (see citation below which would help their cause). Why has science/scientists been more accepting of sloppy research–to maintain funding (NIH grants are big $$$) or to fit their particular narrative?
So who to believe? Ideally someone or some organization who can synthesize the legitimate data, both pro and con, and present it in an easy, understandable way such that people can make informed decisions. Honesty, truthfulness, consistency–anyone, anything in mind? Let me think about it…and, until I find that external “pristine source”, I’ll listen to both sides, solicit opinions, investigate when I need to, and become my own internal “pristine source.”
Wang, Z., Muecksch, F., Schaefer-Babajew, D. et al. Naturally enhanced neutralizing breadth against SARS-CoV-2 one year after infection. Nature 595, 426–431 (2021). https://doi.org/10.1038/s41586-021-03696-9