The debate that never should have started is over. Thankfully, one nation in the world recognized natural immunity to COVID-19 in their vaccine program and has the data to force the issue in other countries. All Israelis are required to enroll in one of four national health funds. Maccabi Healthcare Services (MHS) covers 26% of the population and maintains centralized electronic medical records, which researchers anonymized and analyzed.
Israel used the Pfizer/BioNTech vaccine exclusively in their national vaccination program. When it implemented a vaccine passport program, the previously infected were provided with a passport and excluded from the vaccination push. Later, these individuals were allowed to receive one dose of the vaccine if they chose to, but it was not required to maintain their passports.
The preprint study includes over 700,000 Israelis in a matched cohort methodology. It includes MHS members 16 years and older who were vaccinated or had a documented SARS-CoV-2 infection before February 28, 2021. It compared those who were vaccinated and never infected, the recovered, and those who opted to take the single vaccine dose. The rich data set includes vaccination with dates, diagnosed infections, symptom profiles, hospitalizations, and deaths. Researchers evaluated four outcomes: documented RT-PCR confirmed SARS-CoV-2 disease, COVID-19, COVID-19-related hospitalization, and death.
After adjusting for comorbidities, there was a 13-fold increased risk for a breakthrough infection following vaccination instead of reinfection after recovery. The vaccinated subjects had a 27-fold increased risk for symptomatic COVID-19 than the previously recovered. There were eight hospitalized patients among the vaccinated and one among the recovered cohort. Thankfully, there were no deaths.
When researchers compared the recovered with and without a single vaccine dose, the differences were slight. Out of 14,029 subjects, the unvaccinated experienced 37 positive tests while those with a single dose had 20. Symptomatic disease occurred in 16 patients who received a single dose and 23 of their unvaccinated counterpoints. The increased risk for those without the vaccine is less than one-fold. No one died of COVID-19.
With such a large study population, these findings should have immediate implications for public policy.
Any city, employer, or educational institution requiring individuals to get vaccinated should amend their policy immediately to allow for proof of infection or immunity as acceptable. Any institution with mask mandates that apply only to the unvaccinated must amend them to recognize recovered individuals. Employees, students, and residents should insist.
An antibody or T-detect test should suffice in place of a vaccine. A recent study estimates that roughly one-third of the U.S. population had COVID-19 by the end of 2020. Unfortunately, testing identified less than 25% of the cases. Since the federal government is encouraging these mandates, they should provide free immunity tests the same way they provide free vaccines.
The unqualified push to give all Americans a complete vaccine series and boosters must be amended. Recovered patients with natural immunity should work with their doctor to make the best personal health decision. These decisions should take into account what we know about other respiratory viruses and mitigating immunity. As Harvard associate professor of epidemiology Dr. Michael Mina said in a recent interview:
I’ve always said that we’re going to age out of this virus. People are going to keep getting exposed. And whether it’s to Delta or to a variant in five months from now, every time you or I or anyone else gets exposed — they’re really building up a decent cushion of immunity with each of those exposures… So it’s only a matter of time before we actually have not only vaccine-derived immunity but natural infection-derived immunity, too.
Mina’s comments echo the predictions a group of researchers who study human coronaviruses made earlier in the pandemic:
Our analysis of immunological and epidemiological data on endemic human coronaviruses (HCoVs) shows that infection-blocking immunity wanes rapidly, but disease-reducing immunity is long-lived. Our model, incorporating these components of immunity, recapitulates both the current severity of CoV-2 and the benign nature of HCoVs, suggesting that once the endemic phase is reached and primary exposure is in childhood, CoV-2 may be no more virulent than the common cold.
The hypothesis requiring evidence to the contrary should always have been that natural immunity would be strong and durable. Early in the pandemic, researchers detected reactive immunity to SARS-CoV-1 in survivors after 17 years. The viruses are first cousins. Add what we understand about other human coronaviruses and the assumption should always have been in favor of the immune system.
Israel always bet on natural immunity, and the latest study of their results is irrefutable proof their hypothesis was correct. Combined, recovered patients with or without a single dose have a vanishingly small (0.3%) risk of symptomatic infections. Researchers should perform additional studies of the vaccinated who suffered from symptomatic COVID-19 during the Delta wave. Boosters for these individuals may make very little sense.
It is long past time for our health bureaucracy to acknowledge natural immunity and focus prevention efforts on the most vulnerable, the elderly, the obese, and the otherwise immunocompromised. As Dr. Marty Makary said on Tucker Carlson Tonight on Friday, betting against natural immunity was a “bad hypothesis.” Americans should not continue to follow advice based on it.
WATCH Dr. Marty Makary’s full commentary on the Israeli study on natural immunity: