Health authorities will be making a grave mistake if they don’t distinguish between those who have recovered from COVID-19 and others who need urgent vaccination.
Since last March I have written a series of articles for The Geopolitics and elsewhere to argue for the creation of an immunity passport (1). The key point in my proposals is that we have to identify people who have recovered from COVID-19 and allow them to resume their normal activities without danger to society, in the knowledge that they have developed immunity which will prevent new infection for an extended period. Better still, a recovered person is no longer contagious, which can only help break the chain of contagion.
Recognizing the rationale behind the immunity passport will now have additional far-reaching implications because new evidence of lasting immunity for the recovered will help prioritise and rationalise COVID-19 vaccination targets.
Nine months ago, given the very recent arrival of COVID-19, it was still unclear whether acquired immunity would be lasting. That was why the World Health Organisation (WHO) advised against the creation of an immunity passport last April. It then said there was “no evidence that people who have recovered and have antibodies are protected from a second infection.”(2) Since then, the situation has fundamentally changed.
Rigorous scientific observations have shown that spontaneously acquired immunity after infection with COVID-19 lasts at least as long as the immunity generated by the best vaccines.
According to WHO statistics as of Jan. 12, more than 91 million people have been infected with symptoms since the start of the pandemic and more than 65 million have recovered (3).
Only a negligible number of these have relapsed or been reinfected. These extremely rare cases are the exceptions which prove the rule of real and lasting immunity. This means a rate of natural immunisation of virtually 100% over 12 months, compared with a rate of effectiveness of a maximum 95% for recently approved vaccines which have been tested for between three and six months.
Those who are recovered therefore have immunity at least equivalent to that from the new vaccines (4).
The number of recoveries is increasing virtually as fast as the number of people infected. COVID-19 generally lasts for only a few weeks and 98% of those infected survive. So the number of recoveries closely tracks the number of infections with a delay of just a few weeks.
In fact, the real number of global recoveries is significantly higher than official statistics because up to 70% of those infected have few or no symptoms: they have developed real immunity without even realising it.
Before any vaccinations, the proportion of the population with spontaneous immunity may be between 10 and 20% in the most-affected Western countries. Only serological tests carried out on representative samples of the population can accurately measure this beginning of collective immunity.
Advantages of natural immunity
Compared with immunity through vaccination such as developed by Pfizer/BioNTech or Moderna, the immunity acquired naturally by those who have been infected is more complete and reassuring as it guarantees an end to being contagious, the absence of undesirable secondary effects and a double immunity covering humoral immunity (production of antibodies) as well as cellular immunity (action of the lymphocytes T cells, or killer cells). A lot of research still needs to be done to measure all the effects of the new vaccines.
No point vaccinating the recovered
The conclusion is obvious: it’s pointless to vaccinate people who have had the illness. This is of capital importance at a moment when the quantities of available vaccines are well below needs, meaning a need for rationing for long months or even years for poor countries while there is a race against time to vaccinate the maximum number of people in minimum time.
Once we recognise that those who have been infected have identical or even stronger immunity than that obtained by vaccination, we have to systematically identify and register these formerly infected people and give them a special status. This status should be effectively the same as that of those who have been vaccinated as both groups are now immune.
Hungary, Iceland and Israel
Three countries recently took such decisions in December and January: Hungary, Iceland and Israel. These three countries have created an immunity passport (called a “green passport” in Israel) for those who have been vaccinated and those who have been ill and recovered (5).
Recovery can be confirmed either by a positive serological test showing the presence of antibodies (notably the IgG type), or by two virological tests in succession: a first positive test showing contamination by coronavirus, and, after a few weeks or months, a second negative test showing recovery. These protocols can be reinforced and fine-tuned as I have suggested in The Brussels Times (6).
By stating that “there is no need to systematically vaccinate those who have already been contaminated”, the French Haute Autorité de Santé (HAS) acknowledges that vaccination is pointless for those who have already been ill (7). This is the first step in the right direction, but the operational consequences of this fact must be fully taken into account. The tragedy is that vaccines are lacking for countless other people who are much more vulnerable, those who have not yet encountered coronavirus and so have no immunity.
The UK: Half a Dose
In the UK, the lack of vaccines and the urgency of administering them are such that the authorities are seriously considering delaying a second dose, going against the protocol recommended by Pfizer/BioNTech. This approach rests on the fact that the first dose gives relatively satisfactory protection for a time, and that this time must be used to immediately administer the second dose to someone else who is more vulnerable. This will give a relative protection judged as satisfactory for a certain time. The aim is to protect more people as well as possible during a certain time, while awaiting the arrival of more vaccines allowing a second dose to be given (8).
COVAX can only cover 20% of poor countries’ populations
The WHO knows that COVAX, the globally-pooled vaccine procurement and distribution effort it leads to help poor countries face the pandemic, aims to secure vaccines for only 20% of the population in each participating country by the end of the year (9).
In such a dire situation, ignoring the immunological status of the millions of people who have recovered from COVID-19 and do not need to be vaccinated, would be a serious mistake.
A sure and rational approach
Natural immunity already acquired by many means that we need a sure and rational approach to manage the shortage of vaccines in this race against the clock to save lives.
Avoiding wasting vaccines on someone who is already immune means the dose can be used for someone else who is much more vulnerable and perhaps in danger of death.
The authorities must identify and register those who have recovered and have immunity – who are much greater in number than realised as their ranks grow as quickly as the number of people who are infected – to give them the same status as vaccinated people. People who have immunity either naturally or through vaccination will break the chain of transmissions and get the world back on its feet.
The conclusion of the proven lasting immunity for the recovered is clear: there is no need to vaccinate people who have already been contaminated by coronavirus.
This lesson applies in particular to poor countries in Africa and Asia which are still asking how they can find the financial and logistical means to vaccinate even a small part of their populations.
It is urgent for the World Health Organization to make operating recommendations on the basis of updated scientific knowledge so as to encourage national and local health authorities to make rational choices to preserve as many human lives as possible.
(1) First articles on the immunity passport
– The Geopolitics, 27 March 2020, “How to Prevent COVID-19 From Paralysing the World’s Economy”
– The Brussels Times, 12 April 2020, “Immunity Passports: A proposal to revive tourism, international trade and transport”
– Gavroche, 30 mai 2020, “ASIE – CORONAVIRUS: Le plaidoyer de Sam Rainsy pour le passeport immunitaire contre le Covid-19”
(2) World Health Organization, 24 April 2020, “Immunity passports” in the context of COVID-19
(4) Lasting immunity among those who have been ill
– MIT Technology Review, 06 January 2020, “Covid-19 immunity likely lasts for years”
– The New York Times, 27 November 2020, “Immunity to the Coronavirus May Last Years, New Data Hint”
– The Conversation, 25 November 2020, “New research suggests immunity to COVID is better than we first thought”
– The Scientist, 23 November 2020, “Immunity to SARS-CoV-2 Lasts at Least Six Months, Data Show”
– Reuters, 18 November 2020, “COVID-19 survivors may have long lasting immunity”
– The New York Times, 19 August 2020, “Your Coronavirus Antibodies Are Disappearing. Should You Care?
(5) Hungry, Iceland and Israel
– CNN Television, 06 December 2020, “These 2 countries (Hungary and Iceland) are embracing Covid-19 ‘immunity passports'”
– The Times of Israel, 04 January 2021, “Health Ministry says vaccinated, recovered to get ‘green passport’ for 6 months”
(6) The Brussels Times, 1er août 2020, “We need standardised Covid-19 certificates to prevent airline bankruptcies and revive international tourism”
(7) Le Figaro, 19 décembre 2020, “Covid-19 : il n’y a pas lieu de vacciner systématiquement les personnes déjà contaminées”
(9) World Health Organization, 18 December 2020, “COVAX Announces additional deals to access promising COVID-19 vaccine candidates”