Every (immune) person counts, especially in developing countries

This article is part of the series — 2021: The Year of Vaccines.

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Governments around the world are closing in on a crucial turning point regarding the COVID-19 crisis. The long-hoped-for vaccines have arrived, and thanks to them, the two predominant goals behind many of the current lockdown restrictions—protecting the high-risk groups from infection and protecting the healthcare system from a collapse—are within reach. Once high-risk groups are vaccinated, many will be yearning to relax the burdensome restrictions still levied on society and the economy. However, it seems that numerous governments have revised their goals: They seem to aim for herd immunity through vaccination. This new goal is, if at all, attainable only with a significant delay unless governments acknowledge and use the natural immunity of the convalescent. The convalescent immunity is especially important for developing countries.

Convalescent immunity is relevant

Those who aim at reaching herd immunity must also acknowledge and make use of the natural immunity of convalescents as a resource, especially as it is (unfortunately) continuing to grow throughout the world.

A sensible vaccination strategy should seek to increase the total number of immune individuals as quickly as possible and with as little risk as possible. Such a strategy must always consider the shortage of vaccination capacity as well as the direct costs associated with vaccines. While these costs are comparatively marginal for most developed countries, they matter to a larger extent for developing countries where financial resources are far scarcer. To accelerate the process of reaching widespread immunity in the population, and to save valuable resources at the same time, those who have acquired natural immunity to COVID-19 already—because they went through infection and illness—should currently not be artificially immunised again through vaccination. This is even more relevant given the scarcity of vaccines the world is facing at the moment. Indeed, in Germany, the Vaccination Commission associated to the Robert Koch Institute (STIKO) suggests that persons who have undergone a laboratory-diagnostically confirmed infection with SARS-CoV-2 should not be vaccinated initially if vaccines are scarce. Those who are not taking advantage of the natural immunity are wasting valuable resources and are diverting vaccination capacities to those who are already endowed with (natural) immunity. The price they end up paying will stem from many unnecessary infections and, subsequently, deaths as well as prolonged restriction of freedoms for all.

A proliferating amount of studies published in leading journals show that those recovered from infection have robust and neutralising antibodies for, as of now, at least eight months (e.g., J.M. Dan et al. and A. Wajnberg et al. in Science). Recovery from infection protects similarly to highly effective vaccines. In contrast, little is known about the duration of immunity after vaccination. However, BioNTech CEO and Co-Founder Uğur Şahin believes that vaccination has a similar duration to naturally acquired immunity.

The number of naturally immune persons is already high and growing rapidly. It is commonly known that COVID-19 poses lower risks to people below the age of 50 than the elderly, and mild illness or even asymptomatic infections are particularly common among younger people. This is pivotal for many developing countries that tend to have young populations. For instance, about 95 percent of sub-Saharan countries are considered youthful, with at least half of the population younger than 25 years of age. Thus, natural immunity could be an immense resource, especially in developing countries, depending on the number of actual convalescents. Due to the high number of unreported cases in these regions, the extent of natural immunity needs to be estimated. Cases tend to be underestimated in antibody studies because some people who have recovered never developed antibodies—their immune system may have relied on cellular defense “only”. For India, some reports speculate that a substantial amount of the population has already acquired some level of natural immunity due to recovery from the virus. Even if such numbers were overestimated, the existing natural immunity in parts of the population in developed and, especially, in developing and emerging countries, is a non-negligible resource that must be sought, found, certified, and utilised.

Avoiding false premises

Governments that do not acknowledge and consider the naturally immune are left with dire alternatives. Those who exclusively rely on herd immunity through vaccination will have to continue to inefficiently impose harsh economic and personal restrictions on all people for many months, or even years, to come. However, with the duration of the restrictions, their costs grow, and their benefits decline. In addition, citizens’ willingness to vaccinate could wane. This is because the argument that vaccinating as many people as possible becomes less important once high-risk groups are vaccinated and subsequently protected. Moreover, vaccines have yet to be approved for children and adolescents, and the vaccination of these groups is still an issue to be discussed. A vaccination strategy that acknowledges and utilises convalescent’s natural immunity is getting more relevant by the week as the potential threshold for herd immunity is rising due to (potentially more infectious) virus mutations. The costs of relying on vaccination only while disregarding the resource of the naturally immune are proliferating by the day.

Taking secondary impacts of current proposals into account

As it stands, the problem of many developing countries with the pandemic may not be the number of infected people but weak health systems and the unintended secondary impacts of widespread lockdowns. A healthy population is a good with a high value, but a strong economy has systematically been closely linked to the health of its citizens and their life expectancy. General societal effects of lockdowns and recessions are vast, and they disproportionately affect society’s most vulnerable. Education systems have not been brought back to normal, which is likely to entail immense costs for society in the long-run, especially relevant in developing countries.

It is to be hoped that some governments will find the courage to acknowledge the risk as well as the opportunities at hand. What counts for the good of the population and the national economy is the vaccination of high-risk groups to restore the economy’s normal functioning and social life. This requires the recognition of natural immunity as part of the strategy to achieve herd immunity. The objection raised at the beginning of the pandemic—that recognition of natural immunity could lead to self-infection—is even less valid than before. The recognition of natural immunity would give people the best incentives to actively support and accelerate the government’s new sensible strategy and return to normal conditions.

• International Affairs
• Healthcare
• European Union
• India
• COVID Vaccine
• COVID19
• Herd Immunity

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