Vaccine holdouts with some immunity from a prior coronavirus infection find themselves in the muddled middle as the nation debates how far to go in mandating the shots, with some employers giving them a carve-out while blue states take a hard line, saying vaccinations are a better public health strategy.
Spectrum Health in Michigan is granting an exemption to employees who can show a positive antibody test within the past three months, while major health systems in eastern Pennsylvania said they will grant a yearlong reprieve from its vaccine rule to those who demonstrate natural immunity.
Tough mandates in places like Washington and New York states require workers to get the vaccine, flustering those who say they’re already producing antibodies.
Meanwhile, the Consumer Brands Association, a trade group representing 2.1 million workers, wants to know how President Biden’s push to require vaccination or weekly testing at large companies will be applied to workers with prior infections.
Firms are waiting for the Occupational Safety and Health Administration to shed light on the situation.
“How will the requirements address natural immunity? Will individuals that have contracted COVID-19 be required to be vaccinated or submit to testing requirements?” the association said this month in a letter to President Biden.
Favorable treatment is unlikely, since Dr. Anthony Fauci and other administration officials have repeatedly told persons with a previous infection to get the shots.
They point to a high-profile study out of Kentucky that found unvaccinated people with a previous infection are twice as likely to get reinfected as those who recovered and then got vaccinated. The officials also question the durability of naturally induced protection, even as they acknowledge that more research is needed.
“It is conceivable you got protected, but you may not be protected for an indefinite period of time,” Dr. Fauci, the director of the National Institute of Allergy and Infectious Diseases, told CNN this month. “I think that is something that we need to sit down and discuss seriously.”
The lack of formal deference to those who’ve recovered from COVID-19 and the fear of side effects from the vaccine is frustrating lawmakers like Sen. Ron Johnson, a Wisconsin Republican who recently told the National Institutes of Health that constituents want to see exemptions for the previously infected.
He cited studies from Israel and elsewhere that suggest infection-acquired immunity can be as robust as the response sparked by messenger-RNA vaccines in persons who never had the virus.
Nurses and other constituents are flooding his office with calls and emails, saying officials and companies pushing mandates “totally disregarded” those with natural immunity.
Scientists say some people who were previously infected might get a similar immune response as that afforded by vaccines, though individual experiences will differ based on things like genetics, the nuances of their immune systems and their experience with COVID-19.
They also call it more cumbersome and costly to rely on repeated lab tests to prove individual protection than a low-cost vaccine on the front end.
“It’s a fair statement that natural infection can produce substantial immunity but it’s much more variable than the vaccinations. You just don’t know what you’re going to get,” said Roger Shapiro, an associate professor of immunology and infectious diseases at the Harvard T.H. Chan School of Public Health.
“It is very complicated to try and have a public strategy that relies on people drawing blood and saying, ‘My COVID infection from two years ago still shows protection,’” he said.
He also said vaccines should also produce a consistent response from T cells in the body. While antibody levels may subside months after vaccination, these cells have long memories and are useful in recognizing and attacking new variants of the virus.
Natural infection also spurs a T-cell response but relying on infection as a strategy has a high human cost. History shows viruses can burn through a population in multiple waves before the collective immune response is able to push the pathogen into the background, making it a mild illness instead of a deadly one.
The Russian flu of 1890 killed about 1 million people out of a global population of about 1.5 billion in multiple waves before subsiding into a manageable problem. Recent research suggests a known coronavirus that causes common colds today might have been the culprit at the time.
Scientists say now that there are shots for the coronavirus at hand, the best way to see through waves of infection is through vaccination.
“Trying to get protected from COVID through natural infection is not protection, it’s getting infected. It’s completely nonsensical,” Dr. Shapiro said. “We certainly never would want to rely on something so risky for protection, when 1% to 2% of those under that strategy might die from trying to use it.”
When patients who’ve been previously infected ask Dr. Panagis Galiatsatos in Maryland whether they should get the vaccine, he tells them yes.
“The vaccines give us an exact outcome of antibodies,” said Dr. Galiatsatos, an assistant professor at Johns Hopkins School of Medicine in Baltimore. “There is data that supports those with the best immunity are those with natural [immunity] and vaccine.”
Still, plenty of people who have beaten the virus say they are ready to fight rules that force them to decide between getting vaccinated or losing their jobs.
George Mason University relented to one objector, law professor Todd Zywicki, who sued for an exemption from the school’s vaccine mandate.
He presented multiple antibody tests and statements from his doctor, who said the vaccine was medically unnecessary. The professor will hold office hours and in-person events so long as he maintains six feet of distance, and will be tested for the virus once a week.
New York state does not allow an exemption for previously infected workers subject to a vaccine mandate on health workers.
“While you may have some short-term antibody protection after recovering from COVID-19, we don’t know how long this protection will last,” the state’s website says.
Many health workers in the Empire State had until Monday to get their initial shot, meaning thousands of holdouts might get nudged from their jobs in the coming days.
“I’m young, I’m healthy, and I have no comorbidities. I had COVID already. So I don’t understand why I have to be forced to get a vaccine,” nurse Stephanie Defonte told Spectrum News NY1.
New York Gov. Kathy Hochul is not backing down from the mandate. She said the state might bring in the National Guard or declare a state of emergency that allows qualified health staff from other states and countries to fill gaps at medical centers that are weary from the long-running pandemic.
In Massachusetts, a police union is warning that dozens of state troopers plan to resign after a judge rejected its attempts to provide “reasonable alternatives” such as mask-wearing or regular testing to Republican Gov. Charlie Baker’s vaccine mandate.
Those seeking accommodations include troopers who have recovered from the virus, have antibody levels and don’t want the vaccine.
“It is unfortunate that the governor and his team have chosen to mandate one of the most stringent vaccine mandates in the country with no reasonable alternatives,” State Police Association of Massachusetts President Michael Cherven said.
Mr. Johnson called it “shocking” that the Biden administration is putting forth mandates and others cannot give a firmer answer on how natural immunity stacks up against vaccination.
“This administration clearly does not want the public to question whether natural immunity is more effective than vaccines,” the senator said. “As President Biden revealingly declared, the vaccine mandate ‘is not about freedom or personal choice.’ This administration’s decision to disregard the effectiveness of natural immunity and demand vaccination ignores current data and is an assault on all Americans’ civil liberties.”
Spectrum Health in Grand Rapids, Michigan, said the data supported an exemption for the previously infected if they can show a positive PCR or antigen test for the virus and the positive antibody test.
The system said workers who overcame the virus ought to get vaccinated, however.
“There is increasing evidence that natural infection affords protection from COVID-19 reinfection and severe symptoms for a period of time,” the system said. “Current studies are not clear on how long natural immunity protects from reinfection.”
St. Luke’s University Health Network in Pennsylvania is allowing employees to defer the vaccine for a year after the date they tested positive. The nearby Lehigh Valley Health Network also added the deferral option.
“Some of the evidence that came out recently from an Israeli study, as well as our own observation, is that if you have had a natural infection — we are talking about that this can be verified by a PCR — that it appears that the kind of immunity that you develop is actually either equal or superior to that than someone who might get two doses of an mRNA vaccine such as Pfizer or Moderna,” said Dr. Jeffrey Jahre of St. Luke’s told the WNEP-TV, the local ABC affiliate.
He said people should get the vaccine to maximize their protection and should not go out and catch the virus to achieve immunity.
“The important thing for everyone to know is to please get the vaccine,” he said. “Don’t rely on natural infection.”
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