THE POLITICS OF IMMUNITY
PART ONE: THE SCIENCE THAT PASSES US BY
If you research naturally acquired immunity to SARS-CoV-2 you can’t help but be struck by a conspicuous disparity in how the subject is approached depending on who is talking about it. It is like two parallel universes that stubbornly maintain distinct and competing narratives. One universe is of science-based research. The other is the universe of public messaging. The two rarely cross except on occasion. When they do, for a short time, it seems like a light has been turned on somewhere, illuminating a fascinating and meaningful space, but that light then dims again as the universes re-divide and go their separate ways once more.
In the scientific universe, the evidence is considerable and mounting that natural immunity from previous infection is at least as good if not superior than the immunity provided by vaccines, even against variants of concern. But you wouldn’t know it by watching the news.
Dr. Marty Makary, a professor at Johns Hopkins University School of Medicine elaborates : “…here we are now, over a year and a half into the clinical experience of observing patients who were infected, and natural immunity is effective and going strong. And that’s because with natural immunity, the body develops antibodies to the entire surface of the virus, not just a spike protein constructed from a vaccine.”
Initially, there were concerns that natural immunity would quickly fade, but more and more studies are revealing this not to be the case. Vaccines, however, have shown serious reductions in efficacy  after only a couple of months and, by some reports, even as little as a couple of weeks. 
A primary reason that naturally acquired immunity is showing such durability is because a person exposed to SARS-CoV-2 was exposed to the entire virus is a view shared by Matthew Memoli, director of the Laboratory of Infectious Diseases Clinical Studies at the NIH (National Institutes of Health)  While “vaccines are focused on only that tiny portion of immunity that can be induced” by the spike, he says. This broader exposure “would likely offer a broader based immunity” that is better at fighting off the variants.”
Studies that indicate natural immunity plays a significant role occasionally make it into online reports of major news outlets but rarely make headlines. And yet their sheer number and consistency raise serious questions about our current health strategies. They suggest that the CV19 recovered have little to gain from vaccination, and possibly some things to lose.
The emerging science supports the prioritization of vaccination for those who have not yet developed an immune response, particularly in less developed countries that are struggling to make their vaccination targets. Perhaps most of all, they suggest that the covid-recovered have an important role to play in our long-term efforts to keep the virus at bay in the wider community. Ultimately, they reveal that the policy of a “shot in every arm” is not based on the current science.
POLITICS FIRST, EVIDENCE SECOND
When we do hear about natural immunity outside of the research field, the language is largely shaded in political tones. Who is talking about it and the nature of their political affiliations is given more weight than the evidence itself. This was not always the case. At the start of the pandemic, even in the US, public officials recognized the potential role of natural immunity. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and Chief Medical Advisor to the President, was also in broad agreement. 
So what changed? In the scientific universe – nothing. The research continued and the studies kept coming, although it mostly remained shared between peers. But in the public space, radically dualistic politics began to divide people – and issues — into separate camps with their own armies of followers and their own credo. Group A was suspicious of government, medical agencies, and Big Pharma, they questioned certain public safety measures such as lockdowns, and was generally more afraid of the erosion of public liberty than the virus. Group B exhibited a high level of institutional trust, was willing to participate as a civic duty in all the health measures advised, and was generally more afraid of the virus than loss of civil liberties. In reality, these groups do not fall along sharply Republican and Democrat lines, and there are many sub-groups with less easily broad-brushed positions, but the media had little patience with such distinctions.
In this polarized space, while Republican politicians such as Kentucky senator and physician Rand Paul began to advocate for natural immunity in opposition to the government’s approach to the health crisis, Democrats recoiled from such associations practically by default. They became even more antagonistic when last October President Trump, never one to miss a bandwagon, tweeted that he was now “immune” to CV-19 (flagged by Twitter as “misleading and potentially harmful information”).
That same month saw the circulation of the Great Barrington declaration , which argued for replacing blanket lockdowns with measures to help protect the most vulnerable and build herd immunity through exposing the people least at risk. The declaration became a lightening rod for the debate on public health policy. Critics began referring to this strategy as “let it rip”, and natural immunity received another public shaming. If natural immunity had been a celebrity, its publicists would be starting to ignore their calls.
People began using language in entirely different ways. You had scientists using the term ‘herd immunity’ in a very positive sense, to mean the only way we would ever get ahead of the virus – either through vaccination or natural infection, and most likely a combination of the two. But in the public space, the term ‘herd immunity’ became saturated with a kind of recklessness or at least a contrarian position to lockdowns and mass vaccinations. While experts continued to calmly repeat to anyone who would listen that broad scale immunity to the virus was the only way to ultimately defeat it, politicians began to use this kind of language less and less. The UK government did a complete 180 after negative public reaction to the herd immunity concept back in March 2020, so much so that few can even remember it.
THE MEMORY HOLING OF NATURAL IMMUNITY
It was after the vaccine rollout that natural immunity was more or less cancelled in the public universe. Medical institutions went to the extreme of referring to natural immunity as a “myth”.
By May 2021, Fauci had changed his tune, and was now rhapsodizing that CV-19 vaccines were “better than nature.”  He was basing this assessment on studies that show increased antibody levels from previous infection plus vaccination, not vaccination or previous infection alone.
As time went on, and the vaccination program herd immunity, natural immunity, all began to smell suspiciously like the same thing; anti-vaxxers. Even though the mass vaccination programs are aimed at exactly the same target—herd immunity, it was as if herd immunity and vaccine immunity became two competing products like Pepsi and Coca Cola, and then one day Coca Cola mysteriously disappears from all the stores and everyone suddenly is acting as if only Pepsi had existed all along. Coca what?
Some observers began to accuse officials and the media of trying to ‘memory hole’ natural immunity. This is a reference to George Orwell’s dystopian novel, 1984, where a small chute that led to an incinerator was used to disappear information deemed embarrassing, inconvenient or subversive to the State. Since naturally acquired immunity to CV-19 was deemed an obstacle to universal vaccination mandates, officials chose to side-stepping the topic and the media chose to either ignore the evidence around it or to disparage those who tried to bring that evidence to public attention.
Even before Delta began circulating in the United States in March this year, studies were demonstrating how memory B cells and memory T cells form in response to CV-19 infection and how the adaptive immune system was producing antibodies perfectly capable of taking on the variants. A number of experts openly questioned why this wasn’t being taken into account in terms of government vaccine mandates. Freelance journalist, Jennifer Block, wrote an article that was published September 13 in the British Medical Journal called, Vaccinating People who have had covid-19: Why doesn’t natural immunity count in the US? The article is notable for its scope and international perspective, being one of the first and most comprehensive overviews of the studies and discussion of the topic. Block reports on experts who are questioning the science and ethics of treating the recovered as being ‘equally vulnerable to the virus—or as equally threatening to those vulnerable to covid-19—and to what extent politics has played a role.’ 
“Many of us were saying let’s use [the vaccine] to save lives, not to vaccinate people already immune,” Marty Makary, a professor of health policy and management at Johns Hopkins University told the British Medical Journal (BMJ).
RECOGNITION OF NATURAL IMMUNITY IN NATIONAL HEALTH POLICIES
Some countries do acknowledge a window for the immune protected before vaccine recommendations. In Israel it is three months before one mRNA vaccine dose for the previously infected and a “green pass” (vaccine passport) to those with a positive serological results regardless of vaccination status. 
Within the European Union, people are eligible for the health pass if they’ve had a positive covid test within the past six months, which also allows for a single dose of an mRNA vaccine.  Although some Scandinavian countries appear set to repeal health pass requirements for everything except international flights. In the UK, the NHS (National Health Service) covid pass is valid if you have a positive PCR test result within the past six months. 
Block notes that not having a national health pass actually makes it harder for the US to factor naturally acquired immunity into its public health measures. Members of the medical community like Jeffrey Klausner, clinical professor of preventive medicine at the University of Southern California and former Center for Disease Control (CDC) medical officer, have been speaking out in favour of giving those with prior infection the “same social status” as those vaccinated. Various proposals have been made for how this could happen, yet at least some of the resistance to this idea is because of the additional logistical complications it creates in the implementation of universal health measures.  As Alfred Sommer, dean emeritus of the Johns Hopkins Bloomberg School of Public Health bluntly puts it, “It’s a lot easier to just give them the damn vaccine.”
Some experts and medical professionals question if it is only an issue of logistics, however. As the BMJ article states; ‘a recognition of existing immunity would have fundamentally changed the target vaccination calculations and would also affect the calculations on boosters’.
“There’s a very clear message out there that ‘OK, well natural infection does cause immunity but it’s still better to get vaccinated,’ and that message is not based on data,” says Monica Gandhi, an infectious disease specialist at University of California San Francisco,. “There’s something political going on around that.”
SO WHAT IS THE EVIDENCE FOR THE STRENGTH AND LONGEVITY OF NATURALLY ACQUIRED IMMUNITY TO SARS-COV-2?
There are literally dozens of studies to date on the role of natural immunity and CV-19 from several countries, but let’s look at a sample from Israel and the United States. Since it was such an early adopter of vaccines and orchestrated such a fast and broad scale distribution, Israel has always been a few months ahead of Europe and the Americas. Their past is in a very real sense our present, and their present is fast becoming our future. The Israeli studies have also been some of the most substantive, with scientists having access to a national database that contains the covid medical data of the entire population.
COVID-19 IMMUNITY STUDIES OUT OF ISRAEL
Israel has been lauded with having pulled off one of the fastest and most efficient CV-19 vaccine programs in the world. Their campaign began as early as last December. They had 20% of the country single jabbed in only three weeks, and by March they had the highest global per capita vaccination, with 50% of the population having received both doses of the BioNTech/Pfizer.
In April this year, a three-month long nationwide study concluded that the vaccine provides slightly less protection than naturally acquired immunity. The evidence showed protection from vaccination was encouragingly high, at 92.8%. Protection from prior SARS-COV-2 infection, however, was 2% higher, at 94.8%. The researchers said that these results ‘question the need to vaccinate previously-infected individuals.’ 
Although this study suggested that natural immunity was more effective than vaccine immunity, the vaccine was still showing a high deal of protective strength. That was until the summer of 21, when data from several countries began to reveal an alarming rate of decline in vaccine generated immunity. Something had changed the game, and its name was Delta. The virus had mutated and was increasingly able to evade the vaccines that had been developed to block the original Wuhan strain. Immunity from previous infection, however, was discovered to remain comparatively more stable.
On July 23, the Israeli Health Ministry reported that another large study had found that a full course of the Pfizer-BioNTech vaccine, although 88% effective at preventing hospitalization, was only 40.5% effective at preventing symptomatic illness and only 39% effective at preventing infections. The Johnson & Johnson vaccine was found to be 33% effective against the Delta variant. Put another way, the Pfizer vaccine failed to prevent symptomatic illness 61% of the time and the J&J failed 67% of the time in preventing symptomatic CV-19 illness. This was a decrease in vaccine effectiveness by 25% in only a fortnight. 
Another Israeli study published in August demonstrated that people who had already contracted SARS-CoV-2 were much less likely to become infected with Delta, develop symptoms or being hospitalized compared to those never infected who had two doses of the Pfizer vaccine. Individuals who were both previously infected with SARS-CoV-2 and given a single dose of the vaccine gained additional protection against the Delta variant.
Science Insider reported that this study reveals the ‘power of the human immune system’. Charlotte Thålin, physician and immunology researcher at Stockholm’s Danderyd Hospital and the Karolinska Institute who studies the immune responses to SARS-CoV-2 called it, “a textbook example of how natural immunity is really better than vaccination.” 
COVID-19 IMMUNITY STUDIES OUT OF THE UNITED STATES
One of the earliest studies into SARS-CoV-2 post-infection immunity was funded by The National Institutes of Health (NIH) from La Jolla Institute for Immunology . It was the largest study at the time of all four major types of immune memory for viral infections: antibodies, memory B cells, and the two main types of memory T cells. It was published in January, right at the start of the national vaccination campaign.
Researchers discovered that ‘the immune systems of more than 95% of people who recovered from COVID-19 had durable memories of the virus up to eight months after infection.’ Although antibodies declined moderately after 8 months, memory B cells (the body’s antibody factories) actually increased over time. The researchers said that their results provided hope that the level of immunity developed by people who got the vaccines could be at least as good. An intriguing implication of this study was that antibody tests were not as predictive of T cell memory as previously thought and that ‘simple serological tests for SARS-CoV-2 antibodies do not reflect the richness and durability of immune memory to SARS-CoV-2’.
Scientists like Monica Gandhi have been trying to divert reporters away from their single-minded focus on antibodies as the ‘defining measure’ of immunity since the evidence indicates that declining antibodies does not mean that the immune response has declined, just as a high presence of antibodies doesn’t guarantee protection. Antibody levels naturally decline after the body has successfully fought off a pathogen, but immune memory remains through other cellular mechanisms. “It is accurate that your antibodies will go down” after natural infection, says Gandhi. If they didn’t, “our blood would be thick as molasses.” It is the T and B cells that seem to hold the key to long-term immune memory.
In May, researchers from Washington University School of Medicine, St Louis, observed that people who have recovered from mild cases of CV-19 are likely to have immunity for their lifetime. Lead researcher, Ali Ellebedy said that the media had misintepreted the data relating to decline in antibodies post-infection.
“It’s normal for antibody levels to go down after acute infection, but they don’t go down to zero; they plateau. Here, we found antibody-producing cells in people 11 months after first symptoms. These cells will live and produce antibodies for the rest of people’s lives. That’s strong evidence for long-lasting immunity.” 
THE SUMMER OF THE IMMUNIE SYSTEM
The summer of 2021 was notable for the extraordinary amount of research data and studies published on how the natural immune system responds to CV-19 infection. It was also when New York Times and The Washington Post both broke the story on a leaked Center for Disease Control (CDC) report  that had been presented on July 29th by Meredith McMorrow, the co-lead of the Vaccine Effectiveness Team Representing the EPI Task Force (expanded programme on immunization). The report contained some startling conclusions based on emerging evidence on the impact of the delta variant, and urged US officials to “acknowledge the war had changed.” Two of these conclusions stood out from the rest.
*Breakthrough infections could be just as transmissible as unvaccinated cases.
*There is no differences between vaccinated and unvaccinated people in terms of how much virus they harbour.
*Older vaccinated people are more at risk of hospitalization and death from CV-19than previously thought.
For reasons best known to itself, the New York Times ran a headline from the report’s least surprising (and least controversial) conclusion: that the Delta variant was more transmissible than chicken pox; a classic case of ‘burying the lead’ if ever there was one.
‘Individuals who have had SARS-COV-2 infection are unlikely to benefit from Covid-19 vaccination’ was the conclusion of a large study from Cleveland Clinic, Ohio, at the beginning of June. It showed significant protection among the those previously infected but unvaccinated against CV-19 infection. Not one of over 1300 unvaccinated employees who had been previously infected tested positive during the five months of the study.
June also saw the publication of a study from the National Institutes of Health Clinical Center in Maryland that concluded that “immunological memory is acquired in most individuals infected with SARS-CoV-2 and is sustained in a majority of patients for up to 11 months.”
In July, a comprehensive study from Emory University found durable immunity in the covid-recovered as well as cross immunity with SARS-CoV-1. Antibody responses of those with pre-infection were seen to decay at a slower rate than previously thought and the immune response actually increased with the severity of the disease as well as with each decade of age. Emory Vaccine Center director Rafi Ahmed, a lead author on the paper said that these results suggest that “patients are generating longer-lived plasma cells that can neutralize the SARS-CoV-2 spike protein.” 
On August 13, Science published a study suggesting that people who had contracted and recovered from the original Wuhan virus produce antibodies that are also potent against the highly transmissible variants such as Delta and Lambda. This study, out of the Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Maryland, showed that antibodies developed in response to currently available CV-19 vaccines had less efficiency in neutralizing novel variants of concern (VOCs). 
A study published August 16 in the journal Immunity,  concluded that natural immunity confers longer lasting and stronger protection against infection, symptomatic disease and hospitalization caused by the Delta variant of SARS-CoV-2, compared to vaccine-induced immunity.
There are many, many other studies from dozens of countries; far too many to mention here.
The ability of the immune system to adapt, learn, remember, and mount complex defenses and offensives against its attackers is a remarkable fact of biology. It is an extraordinary and dangerous hubris to suggest that our intellects are any match for its millions of years of evolutionary wisdom. Our bodies have developed immunity against numerous pathogens in the past such as measles, and those far more dangerous than SARS-CoV-2 such as smallpox with a whopping 30% infection mortality rate. We have developed natural immunity against SARS-CoV-1, SARS- CoV-2, and we will undoubtedly develop it against the next pathogen down the line. The human immune system does not give up its secrets easily. For all its terrible costs, CV-19 has presented scientists with a new opportunity to probe more of them.
Just as the virus is evolving, we also need to evolve as we enter the endemic phase of the virus. We need to evolve our ways of thinking about the problem we face, and how we can best come together and unite our strengths and capabilities. Immune responses have been found to be highly individual. Just as individual are how people respond to Covid, and also to the vaccines developed to protect us from it. Immunity testing will also need to develop far beyond simple calculations of antibody titers.
Complexity and public health policy are like oil and water, but it is perhaps time to begin to seriously consider imagining measures that are more targeted than the one size fits all versions that most countries have been applying to combat the virus.
We also need to change our language. And this might be the hardest of all to do. We have got used to mantras like ‘a pandemic of the unvaccinated.’ The science is showing us that talk of the vaccinated and the unvaccinated makes little sense in the context of immunity. “If we want to be scientific,” says Dr. Mart Makary, “we should talk about the immune and the non-immune.” Or perhaps ‘the naturally protected, the vaccine unprotected and the unprotected.’
But the change that will make the most difference of all is the end of the segregation of scientific and public discourse on matters that our governments find problematic. Scientists are not generally experienced in public policy and admittedly are short on answers in this domain, but denying the evidence in order to make the policy go down easier with the general public is not the way forward. It only creates more distrust of the very institutions that are asking people to put the health and lives of themselves and their loved ones so firmly in their hands.