Which is best, vaccine-induced immunity, “natural immunity,” or “super immunity” to COVID-19?

Over the last few weeks, I've noticed a resurgence of messaging that emphasizes natural immunity as being superior to vaccine-generated immunity, particularly for the more recent variant of SARS-CoV-2. Jeffrey Tucker wrote an article on the Brownstone Institute website asking if public health officials have finally admitted natural immunity. They don't want you to know about natural immunity, it's the way out of the epidemic. Fox News and the Wall Street Journal have both had stories about natural immunity, as well as other examples.

I want to make my position clear before I get to the science. The use of the word "natural" in the term "natural immunity" has made it very easy to argue against COVID. I have discussed before how scientists made a huge mistake in using the term "natural immunity", because it is an inherently misleading term. Post-infection immunity is the more appropriate term to describe vaccine-induced immunity, with the added advantage of not having to suffer through the disease and risk its potential complications. Natural immunity is often described as having quasi-magical properties, implying that it is lifelong, far better against everything, and even beneficial, with some even going so far to argue that. Even though children do have a lower risk of death from COVID-19, there are still death tolls that rebuke this argument every bit as much as the death toll in the US.

It's not just antivaxxers and antimaskers who have started promoting the natural immunity narrative. Doctors who should know better. Activists, pundits, and politicians are co-opting the term "natural immunity" in order to oppose vaccine and COVID-19 mandates.

Leaving aside my contention that natural immunity is a horrible term, what is the real situation? It is often complicated with such issues. The science is not consistent with the dominant narrative about natural immunity, so we cannot discuss this question without looking at it.

The Great Barrington Declaration

I debated about bringing up the Great Barrington Declaration, having done so just last week in the context of a study that tried to argue that the GBD was overwhelmed. The article is being used to cast opponents as un serious social media creatures. The media narrative on natural immunity and natural herd immunity has been dominated by the GBD, its authors, and its boosters.

The ideas behind the GBD were threefold, the first of which was published in October 2020, before safe and effective COVID-19 vaccines were available to the public anywhere except in clinical trials. Proponents of GBD seem to define it as any government public health edict closing businesses or placing restrictions on private individuals. Natural herd immunity is inevitable, and we should adopt a strategy with respect to COVID-19 and healthy. The authors and advocates of GBD have long had preferential access to the media and government. The recent release of a book by Scott Atlas, President Trump's COVID-19 advisor, confirmed this preferential access.

The day after the Augusr meeting, the President described his strategy: "sheltering those at highest risk, especially the elderly, while allowing lower risk Americans to safely return to work and to school…they have to get back to work."https://t.co/7sEZgoRzXP pic.twitter.com/zCoI3VgIB0

— Mallory Harris (@malar0ne) February 18, 2022

And it was ≈ a month after HHS Science Adviser Paul Alexander sent an email saying "open up and flood the zone and let the kids and young folk get infected…we want them infected."

He now writes for the Brownstone Institute, GBD's "spiritual child."https://t.co/2jdbdhrqmj

— Mallory Harris (@malar0ne) February 18, 2022

We also know that the GBD was propped up by right-wing corporate interests, including AIER, the libertarian thinktank that hosted the event where the documented was written.https://t.co/KyHp0C05P7

— Mallory Harris (@malar0ne) February 18, 2022

There were problems with the three ideas behind the GBD. It tended to exaggerate the harms of lockdowns and minimize the ability of them.

The assumption was that natural herd immunity was inevitable. To portray COVID-19 as a fatal disease, GBD had to bend over backwards to portray it as amild disease, by lowballing death estimates. Natural herd immunity requires that immunity be long-lived, if not life-long. Natural herd immunity will likely never be reached if immunity wanes too quickly in individuals or virus strains that can evade immunity from previous infections. I can only cite Omicron and the new Omicron subvariant BA.2 as evidence that this has been the case with COVID-19, but even 16 months ago given how the Omicron variant has led to a massive surge in reinfections. Even as long as a year ago, scientists were beginning to fear that herd immunity was out of reach because too high a percentage of the population would need to be immune.

The concept of focused protection in the GBD was not defined to the point of being meaningless. It ignored the enormous difficulty of protecting the large segment of the population that is at high risk of severe disease and death, including the elderly and those with chronic health conditions, while a respiratory virus is ripping through the young. It was a profoundly ableist and even the idea that young people should be allowed to be exposed to STDs to protect the vulnerable was a part of the idea. It was a fake proposal, made up by a right wing think tank, which was opposed to the restrictions.

It is worth reviewing recent evidence to evaluate the relative value of post-infection immunity because of the political use and misuse of it. It is worth doing so in the context of the Brownstone Institute's founder asking the question about natural immunity. Tucker references a recent CDC study to make his claim.

In late January, the CDC published a report that made what might have been regarded as a shocking claim. If you have had Covid, the CDC demonstrated in a chart, you gain robust immunity that is better than that of vaccination, especially concerning duration.

That should be nothing surprising. Brownstone has chronicled 150 studies making that point. What made this new chart different was that it came from the CDC, which has buried the point so deeply for so long as to amount to a near denial.

So there: the CDC says it. So nonchalant! So uneventful!

If people had understood this two years ago, plus been made more completely aware of the dramatic risk gradient by age and health, lockdowns would have been completely untenable.

The society-wide mandates and lockdowns depended on keeping the public ignorant on settled points of cell biology and immunology, plus pressuring social media companies to censor anyone who didn’t fall in line. Here we are all this time later and the truth is coming out.

Had the knowledge of risk gradients and immunities been in the forefront of policy makers’ minds – instead of wild fear and obsequious deference to Fauci – we would have focused on protecting the vulnerable and otherwise allowed society to function normally so that the virus would become endemic. We would not only have saved thousands of lives; we could have avoided the vast economic, educational, cultural, and public-health wreckage all around us.

Those poor are advocates for natural herd immunity. Paul Alexander, the HHS science advisor who once wrote in an email that we want them, is a writer for Brownstone. It's a favorite tactic among antivaxxers who don't consider study quality, only quantity. Even though he didn't like what Fauci had to say, he blamed Anthony Fauci.

What about that study? The narrative lately seems to be a tale of a couple of recent studies, starting with the CDC study.

Did the CDC really say that “natural immunity” to COVID-19 is superior?

Tucker was taken by a video analysis written by Dr. Vinay Prasad, who was the author of the study that was published three weeks ago in Morbidity and Mortality Weekly Report. Dr. Prasad was contemptuous of those of us who took the time to refute quackery and antivaccine misinformation even before the Pandemic. He pivoted to becoming a rich source of misinformation, even describing public health interventions as potentially the first step on the road to fascist rule.

The entire claim is based on this graph.

A lot of work is done in this graph.

In order to assess what happened as the Delta wave became predominant, this figure represents data from California and New York, which account for 18% of the U.S. population.

Across the entire study period, persons with vaccine- and infection-derived immunity had much lower rates of hospitalization compared with those in unvaccinated persons. These results suggest that vaccination protects against COVID-19 and related hospitalization and that surviving a previous infection protects against a reinfection. Importantly, infection-derived protection was greater after the highly transmissible Delta variant became predominant, coinciding with early declining of vaccine-induced immunity in many persons (5). Similar data accounting for booster doses and as new variants, including Omicron, circulate will need to be assessed.

We have a snapshot of what happened as the Delta wave revved up but before Omicron crashed onto the scene, which led to different results than what was observed with the original COVID-19 strain, for which vaccine-induced immunity was more potent than post-infection immunity. Is this proof that natural immunity is superior? Not quite. The data doesn't come close to taking into account the effect of the Omicron variant and the increasing number of people receiving boosters. There are at least seven limitations that the CDC noted, among them no stratification of the analysis by time since vaccine receipt, misclassification of people with COVID-19 as having had vaccine, and unmeasured confounders.

Another analysis that tries to do that is not nearly as clear.

The data doesn't look as clean when presented this way.

That's why the CDC concluded.

Vaccination protected against COVID-19 and related hospitalization, and surviving a previous infection protected against a reinfection and related hospitalization during periods of predominantly Alpha and Delta variant transmission, before the emergence of Omicron; evidence suggests decreased protection from both vaccine- and infection-induced immunity against Omicron infections, although additional protection with widespread receipt of booster COVID-19 vaccine doses is expected. Initial infection among unvaccinated persons increases risk for serious illness, hospitalization, long-term sequelae, and death; by November 30, 2021, approximately 130,781 residents of California and New York had died from COVID-19. Thus, vaccination remains the safest and primary strategy to prevent SARS-CoV-2 infections, associated complications, and onward transmission. Primary COVID-19 vaccination, additional doses, and booster doses are recommended by CDC’s Advisory Committee on Immunization Practices to ensure that all eligible persons are up to date with COVID-19 vaccination, which provides the most robust protection against initial infection, severe illness, hospitalization, long-term sequelae, and death.

In this one study looking at the original COVID-19 strain and the Delta variant, post-infection immunity appears to be more robust, but with a lot of caveats.

The “natural immunity” wars continue

There are a number of other studies and they all say the same thing: post-infection immunity is better than post-vaccine immunity. One study that was published in the Journal of the American Medical Association was trumpeted last month. It was from Dr. Makary's group, which isn't a good sign. Get a load of its recruitment methods.

Healthy adults who reported no SARS-CoV-2 vaccination were recruited via 1 public Twitter post and 1 public Facebook advertisement between September 11, 2021, and October 8, 2021. Participants completed an online questionnaire about demographics, COVID-19 status, and mask use. Using weighted random sampling (relative weights based on the estimated unvaccinated US population by age, race and ethnicity, and education1), we created 3 equally sized sample groups among those who reported a test-confirmed COVID-19 infection (“COVID-confirmed”), believed they had COVID-19 but were never tested (“COVID-unconfirmed”), and did not believe they ever had COVID-19 and never tested positive (“no-COVID”). These groups were invited to undergo antibody testing at LabCorp facilities nationwide.

That is correct, you read that. There was no control group and recruitment was highly dubious. Yet he misrepresented his paper on social media.