COVID-19 Fact vs. Fiction: Which gives better protection -- a vaccine or natural immunity?

PITTSBURGH — With vaccine mandates taking effect at many businesses and some communities requiring proof of vaccination to go to concerts and even restaurants -- the debate over why natural immunity is being overlooked is heating up. Angie Moreschi of 11 Investigates examines what is going on in this Fact vs. Fiction report.

Debate over Natural Immunity:

Many employees who haven’t been vaccinated are facing an ultimatum -- get the shot or lose your job.  But whether it’s healthcare workers, airline employees, or any other profession, some who’ve already had COVID-19 say it’s not fair.

They are asking why the increasing number of vaccine mandates don’t give any consideration to natural immunity. Do they have a point?

We talked with Dr. Amesh Adalja, infectious disease expert and senior scholar at Johns Hopkins Center for Health Security, to better understand the debate.

Question 1: Is natural immunity being ignored when it comes to public policy?

Dr. Adalja: When it comes to public health policy, there’s often a tendency to use a one-size-fits-all solution, because it’s easier to implement.

Angie: Should natural immunity be given more consideration?

Dr. Adalja: I do believe when employers and organizations are thinking about vaccine requirements, that natural immunity is something that should be considered in a different category than someone who has no natural immunity and someone who is fully vaccinated.

So, Dr. Adalja says natural immunity is often ignored and should be given more consideration.

Question 2: Does natural immunity provide greater protection from COVID-19 than vaccination?

A handful of recent studies, including an Israeli study and Rockefeller University study, have found stronger and longer-lasting protection for people who have natural immunity.

Although another study released last week, done in conjunction with the CDC and researchers who’ve received funding from pharmaceutical companies, found “vaccine-induced immunity was more protective than infection-induced immunity against laboratory-confirmed COVID-19.”

The Israeli study, often cited by natural immunity advocates, indicates natural immunity can be powerful. It showed people who were vaccinated had a 13-times higher risk of getting infected than people who’ve already had COVID-19.

However, Dr. Adalja says that the study must be taken in context and could be skewed because of something called “survivorship bias.”

Dr. Adalja: If you’re looking at people with natural immunity, you’re only looking at people who survived COVID-19, not the ones who died. You shouldn’t look at that data and say -- ‘This is what happens if I get COVID. This is what happens if I get the vaccine,’ and compare those apples to apples. It’s not. It’s this is what happens if I get COVID and survive COVID-19. And that’s what’s called a ‘survivorship bias.’

So, Dr. Adalja says this answer to this is much more nuanced. Yes, you definitely get protection if you’ve had COVID-19, but more research is needed to determine how consistent it is among patients and how long-lasting it is.

Dr. Adalja: What we know about natural immunity is that it is a bit unpredictable. Some people have very high levels of antibodies. Some have low levels of antibodies. Some people’s antibodies wane faster; and we know that reinfections do occur, and those reinfections -- while they’re likely to be mild in someone with natural immunity -- could be contagious to others.

Question 3: Is getting COVID-19 better than getting the vaccine in order to get immunity?

Unequivocally, Dr. Adalja says the answer to this is “no.”

Dr. Adalja: The path to natural immunity is something that’s a bit of Russian Roulette because you might end up sick, you might end up hospitalized, you might end up with long-COVID, you might end up dead. The best way to protect yourself against COVID is to get your immunity through the vaccine.

Question 4:  Do people who’ve had COVID-19 need just one dose of the vaccine?

There’s been much debate over whether people who’ve had COVID-19 need just one dose of the Pfizer or Moderna mRNA vaccine for comparable protection to those who’ve been fully vaccinated. Some new studies are showing that could be the case, putting those individuals in a whole new category of ‘superhuman’ immunity.

Dr. Adalja: What the data shows is people with natural immunity, with just one dose of a vaccine, really go off the charts when it comes to immunity. People who have had natural immunity and get just one dose of the vaccine are probably the most immune people on the planet.

Dr. Adalja says for people who have natural immunity and don’t want to get fully vaccinated, he often recommends they get at least one dose of a vaccine for added protection.

Adalja also says he thinks it’s time for the CDC to consider updating its vaccine recommendation for people who’ve had COVID-19 to allow for just one shot. Countries like Israel and France already require just one dose.

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