The incoherence and confusion with which the COVID-19 pandemic has been managed mean that chances to reduce its human and economic cost have been missed.
In an op-ed in The Brussels Times in November 2020, “COVID-19 immunity can help guide pandemic management,” I formulated proposals to better manage the world health crisis. The evidence of acquired immunity among those who have recovered from COVID-19 has since continued to increase, confirming the relevance of these ideas.
We can now be certain that acquired immunity lasts for at least 13 months, compared to 8 months in November, and the tiny incidence of reinfection shows that this immunity has every chance of lasting for even longer. Effectively, we cannot become ill with COVID-19 twice.
“The certainty of lasting immunity constitutes great progress in our knowledge of COVID-19 in pathological and epidemiological terms,” I wrote in November. “This improved knowledge should help us to better manage the crisis in its economic and social dimension as well as in terms of health.”
Yet many governments have not yet drawn the logical conclusions from our updated knowledge. They continue to attempt to manage the pandemic without distinguishing between immunological status.
France, where I live in exile from my native Cambodia, is a prime example. The government’s main mistake has been to treat everyone the same with uniform, national measures such as confinements.
Four categories of people
The population can be divided into four categories, according to their immunological status. The first group comprises people who have been neither infected nor vaccinated, which is still about 70% of the French population of 66 million. Then, there are those who are currently infected (8%), those who have been infected in the past and recovered (8%), and those who have been vaccinated (14% as of April 6).
Dividing the population by immunological status will be essential if we are to limit the economic costs of the pandemic. The authorities tend to simply disregard the five to six million French people who have had COVID-19, recovered and are now immune. Yet there exist simple, efficient methods to identify those who have had the illness, such as hospital statistics, and serological and virological tests. It is clear that natural immunity lasts for at least 13 months. This is already longer than the vaccines which have been developed to date, and for which regular booster shots are likely to be needed.
Unlike vaccines, natural immunity brings no risk of side effects. It is also 100% reliable, which no vaccine can claim. This should come as no surprise: the design and manufacture of a vaccine are simply an attempt to engineer a replica of natural immunity.
The French authorities are timidly starting to take account of the ever-growing section of the population with natural immunity. The Haute Autorité de Santé (HAS) said in December that “there is no reason to systematically vaccinate people who have already developed a symptomatic form of COVID-19.”
In February, the HAS said that only a single vaccine dose is needed for people who have already had COVID-19, rather than the two doses for everyone else. It’s crucial for France to follow this line of reasoning to its logical conclusion: a cured person is immune and safe, presenting no danger to people around them or to society at large.
Certificate of Vaccination
As the number of people who have been vaccinated continues to grow, the pressure on authorities to recognise their status through a “Certificate of Vaccination” will also increase. This will allow people to go about their normal business and travel without the restrictions applied to the rest of the population.
Why vaccinate people and then continue to restrict their activity, so worsening the damage to the economy? Pressure for an answer is likely to peak by the end of this year, by when at least 30% of the population in France and other European countries are likely to be fully vaccinated.
The idea of a passport or a certificate of vaccination has no connotations of segregation. The frontier between those who have and have not been vaccinated is not arbitrary: the priority has been to vaccinate the most vulnerable and the oldest first. Neither is the frontier fixed: the aim is to get people across the frontier as soon as possible.
The example of Israel
Given what we know about naturally acquired immunity the idea of a Certificate of Vaccination should be extended to those who have had COVID-19, in the form of a Certificate of Immunity. Such a document would be valid for both groups of people and would prove their status in a straightforward way.
This is the solution that Israelhas chosen with the recent adoption of a “Green Pass” which allows the holder to return to roughly normal life. The fact that Israel leads in Green Pass adoption is related to the unprecedented speed and efficiency of its vaccination campaign. A higher proportion of the population is vaccinated than anywhere in the world.
France and other countries have lagged behind in vaccination rates, and must follow Israel’s example in using immunity to find a path back to normal life.