A recent New York Times article, "If You’ve Had Covid, Do You Need the Vaccine?" argues that vaccination is still the best choice after recovering from the disease. It mentions both of us, Mr. Isaac by name and Dr. Kheriaty by reference to a "psychiatrist," with a link to Kheriaty's lawsuit challenging the University of California’s mandate.
We argue, on the contrary, that the scientific evidence does not favor vaccination—nor warrant coercive mandates or restrictions—for those with natural (infection-induced) immunity. Furthermore, we affirm that all people should maintain the right to informed consent or refusal for COVID vaccines.
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Staff Sgt. Travis Snyder receives the first dose of the Pfizer COVID-19 vaccine given at Madigan Army Medical Center at Joint Base Lewis-McChord in Washington state, Dec. 16, 2020. (AP Photo/Ted S. Warren, File)
The natural immunity debate, to which Dr. Anthony Fauci recently said he has no firm answer, is not about whether people should try to acquire natural immunity by deliberately getting infected; nobody is suggesting this. It is about the level of immunity afforded to those who have already recovered from COVID (estimated at more than half of all Americans) compared to immunity from the vaccine.
Current mandates and restrictions that hinder Americans from working, getting back on campus, or being fully present with their teams, are arbitrarily discriminatory and are not reasonable conclusions of the data. For example, a person considered fully vaccinated with the Johnson & Johnson vaccine is, according to the data submitted to the FDA, 67 percent protected against infection; whereas studies of natural immunity consistently shows 99 percent protection against reinfection.
Why is the first group included, and the second group excluded from the workplace, travel, or other venues? That these policies ignore natural immunity already suggests an unscientific approach to their formation, as does the fact that COVID has a 99.998 percent survival rate for healthy people under 50.
Vaccine immunity against COVID infection begins to wane after four months (protection against severe symptoms fortunately does not decline as much). Unlike the polio vaccine, which remains over 99 percent effective for many years, a Mayo Clinic study showed that by July the efficacy of Moderna’s vaccine had dropped to 76 percent and Pfizer’s to 42 percent, which is consistent with Pfizer’s data showing a six percent efficacy decline every two months. By contrast, natural immunity has shown no signs of waning with time and new variants, with data going back to the beginning of the pandemic.
Much of the debate on natural immunity focuses on questions about antibody levels, but these are of variable clinical relevance: antibody levels do not necessarily correlate with long-term immunity. Circulating antibodies always drop over time, whether after infection or vaccination. Long-term immunity relies also on memory B-cells (which quickly ramp up antibody production when re-exposed to the virus) and T-cells. An available lab test measuring T-cells for COVID can establish prior infection even after antibodies decline. The clinically meaningful comparisons are not antibody tests but actual rates of infections, hospitalizations, and deaths. On all these measures, the evidence is now compelling that natural immunity is superior to vaccine immunity.
The largest study comparing the unvaccinated/naturally immune to the vaccinated found that vaccinated people were 6 to 13 times more likely to get infected, 27 times more likely to get symptomatic infections, and 8 times more likely to be hospitalized. These findings are not surprising, since infection with the virus allows our body to form an immune response to many parts (epitopes) on the virus, whereas the vaccines expose us only to one part, the spike protein. Data from Qatar found that only 0.02 percent of COVID recovered individuals experienced reinfection, with no waning over time, and with reinfections less severe than initial infections. Data from the U.K. during Delta likewise found a 0.025 percent reinfection rate in COVID recovered people, compared to a 23 percent breakthrough infection rate in vaccinated people over the same time period.
Registered nurse Carolyn Ruyle prepares a dose of a Pfizer COVID-19 vaccine at Lurie Children's Hospital in Chicago Nov. 5, 2021. (AP Photo/Nam Y. Huh)
The argument that "you might not benefit but should still get vaccinated for the sake of others" does not apply to COVID vaccines, because they do not prevent infection and transmission, but only lower the risk of severe symptoms. There are now countless documented cases of breakthrough infections in the vaccinated, and their likelihood of transmitting the virus is the same as the unvaccinated, as the Director of the CDC has acknowledged. By contrast, there is not a single reported case of someone with natural immunity getting a reinfection and transmitting the virus to others: we are the safest people to be around.
But perhaps vaccinating COVID-recovered individuals could still improve their immunity a bit more? The Israeli study mentioned above analyzed this question: the previously infected went from 99.74 percent immunity before vaccination to 99.86 percent after vaccination for the duration of the study. These differences are negligible and have no clinical relevance whatsoever. This miniscule difference included asymptomatic reinfections; numbers for symptomatic reinfections, hospitalizations, or deaths showed no improvement with vaccination.
Dr. Manjul Shukla transfers Pfizer COVID-19 vaccine into a syringe, Dec. 2, 2021, at a mobile vaccination clinic in Worcester, Massachusetts. (AP Photo/Steven Senne)
Vaccination always involves some risk of adverse events, however small—including known risks of myocarditis, which are higher for young men. Of relevance, several studies suggest COVID-recovered individuals are at elevated risk of vaccine adverse effects (as seen in studies here, here, here, and here, for example). According to U.K. data, for every 11 vaccinations, one person will have a clinically significant adverse reaction. Such risks are warranted only where there are meaningful clinical benefits. Based on Israel’s data, we would need to vaccinate 833 COVID-recovered people to prevent 1 asymptomatic reinfection, and we cannot even calculate the number to prevent 1 symptomatic infection because that showed no improvement. Thus, to prevent one case of asymptomatic reinfection, we would cause over 75 cases (833/11) of clinically significant adverse events. The number of people harmed to prevent one case of symptomatic reinfection would be much higher—too high to calculate with our current data.
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While we have no objections to COVID-recovered individuals freely choosing to get vaccinated, the risk/benefit tradeoff displays the need for policies and measures that respect the free choice of those who don’t. With full evaluation of COVID, its vaccines, and the scientific legitimacy of natural immunity, it is obvious these findings undermine the swift and blunt hammer of the vaccine mandate. They leave room for nuanced, scientific, and inclusive policies that better reflect the data.
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The same essential people who courageously worked on the frontlines defending us during COVID now face bullying from their peers and no support from the government of a country that was founded on freedom. We conclude that forced vaccinations are scientifically unjustifiable and—recalling the founding principles of our nation—contrary to our shared values as Americans. We can fight COVID and defend freedom simultaneously.
Aaron Kheriaty is a physician, a fellow at the Ethics and Public Policy Center, and chief of ethics at The Unity Project.
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