Vaccine holdouts with some immunity from prior coronavirus infections find themselves in the muddled middle as the nation debates how far to go in mandating the shots, with some employers giving them carve-outs and blue states taking hard lines.
Spectrum Health in Michigan is granting exemptions to employees who can show positive antibody tests within the past three months. Major health care systems in eastern Pennsylvania said they will grant yearlong reprieves from their vaccine rules to those who demonstrate natural immunity.
Strict mandates in Washington and New York states require workers to get vaccines, flustering those who say they are 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 Mr. Biden.
Favorable treatment is unlikely because Dr. Anthony Fauci and other administration officials have repeatedly told people with previous infections to get vaccines.
They point to a high-profile study out of Kentucky that found unvaccinated people with previous infections are twice as likely to be 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 have recovered from COVID-19 and fears of side effects from vaccines are frustrating some lawmakers. Sen. Ron Johnson, Wisconsin Republican, recently told the National Institutes of Health that constituents want exemptions for the previously infected.
He cited studies from Israel and elsewhere that suggest infection-acquired immunity can be as robust as those from messenger-RNA vaccines in people who never had COVID-19.
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 have been infected might get a similar immune response as that afforded by vaccines, though individual experiences differ based on factors such as genetics, the nuances of their immune systems and their COVID-19 illnesses.
They also say it’s 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 said vaccines should produce consistent responses from T cells in the body. Antibody levels may subside months after vaccination, he said, but T cells have long memories and are useful in recognizing and attacking new variants of the coronavirus.
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 populations in multiple waves before the collective immune response reduces the pathogen from a deadly illness into a mild 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 might have been the culprit at the time.
Scientists say the best way to stop 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 have been infected ask Dr. Panagis Galiatsatos in Maryland whether they should get a 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 as long as he maintains 6 feet of distance and will be tested for infection once a week.
New York state does not allow exemptions for previously infected health care workers subject to vaccine mandates.
“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 care workers in New York had until Monday to get their initial shots, meaning thousands of holdouts might be 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, a Democrat, 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 care staff from other states and countries to fill gaps at medical centers whose workers are weary from the pandemic.
Also Monday, a three-judge panel of the 2nd U.S. Circuit Court of Appeals in Manhattan lifted a lower-court judge’s block on a vaccine mandate covering all teachers and workers in the nation’s largest school district.
Mayor Bill de Blasio had announced in August that about 148,000 New York City public-schools employees would have to get at least a first dose of the COVID-19 vaccination by Sept. 27.
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 a vaccine mandate issued by Gov. Charlie Baker, a Republican.
Those seeking accommodations include troopers who have recovered from COVID-19, have antibody levels and don’t want a 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,” said Michael Cherven, president of the State Police Association of Massachusetts.
Mr. Johnson said it is “shocking” that the Biden administration is putting forth mandates and others cannot give firm answers 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 exemptions for the previously infected if they can show positive PCR or antigen tests for the coronavirus and positive antibody tests.
The system said workers who have recovered from COVID-19 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,” Dr. Jeffrey Jahre of St. Luke’s told WNEP-TV, the local ABC affiliate.
He said people should get the vaccine to maximize their protection and should not try to become infected to achieve immunity.
“The important thing for everyone to know is to please get the vaccine,” he said. “Don’t rely on natural infection.”