For more than a year I have been calling for the distinction between people who have not been in contact with COVID-19 and those who have acquired immunity through exposure to the illness, to be made explicit in the form of an “immunity passport”.
As I wrote in an opinion piece in The Brussels Times on April 10, 2021, the mistake has been to treat everyone in the same way, to put them in the same basket by subjecting them to the same national cycles of confinement (or lockdown), deconfinement and reconfinement. This lack of judgement has particularly serious consequences for vaccine policy.
Naturally acquired immunity now recognised
A year ago, with COVID-19 still a very new illness, it was not yet clear that immunity acquired by people who had been ill would be lasting. On April 24, 2020, the World Health Organization (WHO) cautioned against the creation of a “immunity passport” for those who had been ill because there was “no evidence that people who have recovered and have antibodies are protected from a second infection.”
In other words, there was no certainty that those who had been ill were really immune. The WHO based its judgement on the fact that not enough time had passed to be sure that the antibodies generated would last very long.
In short order, this initial WHO judgement was undermined by rigorous scientific observation. Expert analysis of tens of millions of real cases around the world showed that the immunity acquired naturally after contact with the coronavirus is just as real and lasts for at least as long as the immunity created by the best vaccines that have been developed.
In The Geopolitics on January 12, 2021, “The World Health Organization Must Revise Its Stance on Covid-19 Immunity Passports”, I called on the WHO to update its position on immunity passports on the basis of recent scientific observations.
The WHO waited until May 10 before very timidly rectifying its position on the immunity of the formerly ill. But the newly rectified WHO position remains at odds with that of the European Union, which, from July 1, will issue a “health pass” to those who are fully vaccinated, as well as those who have been ill. The two groups are considered to have the same degree of immunity against COVID-19.
Glass Half Empty – or Half Full ?
After an initial period of indecision, the pragmatic British approach to these questions has shown itself worthy of consideration.
The British very quickly understood the reality and importance of natural immunity through contamination – very often asymptomatic – by COVID-19. From April 2020, very early in the pandemic, the United Kingdom considered issuing an “immunity passport” to allow people to “leave the lockdown” as quickly as possible in complete safety.
Then, in January this year, the British logically started to debate whether people who had been ill and so acquired immunity should be vaccinated. The question arises in the context of serious shortages of vaccines which need to be optimally managed and targeted.
In France, the Haute Autorité de Santé (HAS) health authority says that “there is no need to systematically vaccinate people who have already been infected” and so recognises that vaccination for those who have been ill serves no purpose. But this recognition has not been put into practice. Finally, the HAS recommends a single dose of vaccine for those who have been ill, judging that this group already has at least the beginnings of immunity.
In vaccine administration and the prioritisation of targets, the British have made the best choices, even while not respecting to the letter the recommendation of the vaccine makers to keep the two doses relatively close together.
The overall population of a country facing the COVID-19 pandemic can be divided into four categories. The first group comprises people who have been neither infected nor vaccinated. Then, there are those who are currently infected, those who have been infected in the past and recovered, and those who have been vaccinated. This division was first made in the above-mentioned op-ed in The Brussels Times of April 10, 2021.
We can subdivide the vaccinated people into a further category made up of people who have been vaccinated with only the first dose while the protocol requires a set of two doses. These people can be considered “half-vaccinated” or “half-immunised”, which in itself represents another specific status requiring a specific treatment.
The British took account of this reality and deliberately decided, for almost all vaccination candidates, to delay the second dose. This approach is based on the fact that the first dose gives the start of immunity which is satisfactory at least for a certain time.
This period of respite, the British realised, could be used to give that person’s second dose to someone else more vulnerable. This second person would therefore also have a relative degree of protection judged sufficient for a certain time. Therefore it was possible to at least partially protect more people for a time while waiting for more vaccine doses to give the second shots.
The result is clear in terms of the number of daily deaths from COVID-19 which in the UK has fallen much faster than in France where the authorities did not adopt this pragmatic approach taking into account the degree of immunity from the first injection. Since April, the number of daily deaths from COVID-19 has dropped to virtually zero in the UK while it can still be between 200 and 300 in France.
Lesson for Poor Countries
The decline in deaths in Britain, of course, is not just because of spreading out the doses. The British government was also prepared to take a chance by pre-ordering vaccines under development, before they were proven to work, which the cautious, rule-bound French did not do. The result was that the French vaccination campaign was delayed by lack of doses.
In poor, very populous countries, distinguishing immunological status will save the greatest number of lives. In these Asian, African or Latin American countries there is the greatest shortage of vaccines and their usage must be optimised.
Those with naturally acquired immunity through contact with the illness are much greater in number than usually recognised. They can be easily identified through a positive polymerase chain reaction (PCR) test which is more than 15 days old, as for the European “health pass”. These people who have been ill must make way, at least temporarily, for other vaccination candidates who are more vulnerable as they have not yet been in contact with COVID-19.