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The science and politics of COVID natural immunity

A woman is instructed on how to swab her nose by a medical worker at a free COVID-19 testing site in July 2020 in Chelsea. (David Goldman/AP)
A woman is instructed on how to swab her nose by a medical worker at a free COVID-19 testing site in July 2020 in Chelsea. (David Goldman/AP)

If you get COVID and recover, can that protect you from severe illness or death, even if you catch COVID again?

More and more studies say yes — that natural immunity can be just as protective as vaccination.

“There’s quite sustained — like 88% — protection at ten months after infection against severe disease and death,” Dr. Chris Murray says.

But this pandemic is all about politics, and America’s broken politics meant that public health officials sidelined the impact of natural immunity.

“If you get to the point where you don’t trust the FDA or you don’t trust the CDC in this country, we’re in trouble,” Dr. Paul Offit says.

Today, On Point: Understanding the impact of COVID and natural immunity on this country’s health, and its politics.

Guests

Dr. Chris Murray, director of the Institute for Health Metrics and Evaluation at the University of Washington. Professor and chair of Health Metrics Sciences.

Dr. Paul Offit, director of the Vaccine Education Center and professor of pediatrics at Children’s Hospital of Philadelphia. Member of the FDA’s vaccine advisory committee. (@DrPaulOffit)

Also Featured

Dr. Jeffrey Klausner, professor of medicine, infectious disease, population and public health sciences at the Keck School of Medicine of the University of Southern California. (@drklausner)

Dr. Monica Gandhi, infectious disease physician and professor of medicine at University of California- San Francisco. (@MonicaGandhi9)

Transcript

MEGHNA CHAKRABARTI: October 2020. President Donald Trump after recovering from COVID-19.

DONALD TRUMP [Tape]: I went through it. Now they say I’m immune. 

CHAKRABARTI: June 2021 American Janine Younis on CNN.

JANINE YOUNIS [Tape]: I had COVID in February, so I have natural immunity. There’s no reason for me to get the vaccine. There’s no reason for me to take the vaccine doses from vulnerable people in this country or in other countries who need more than I do.

CHAKRABARTI: September 2021 President Joe Biden. The Delta Variant Surge.

JOE BIDEN [Tape]: This is a pandemic of the unvaccinated, and it’s caused by the fact that despite America having an unprecedented and successful vaccination program, despite the fact that for almost five months free vaccines have been available in 80,000 different locations, we still have nearly 80 million Americans who failed to get the shot.

CHAKRABARTI: Also, September 2021, Kentucky Senator, Republican Rand Paul versus Health and Human Services Secretary Xavier Becerra.

RAND PAUL: You’re not willing to consider natural immunity?

XAVIER BECERRA: Senator, our team has reviewed every study that’s out there on COVID, whether it’s from Israel, from the U.S. or wherever else. They have used the facts that have been provided through the rigorous research that’s been done to reach a conclusion. 660,000 Americans or more have died because of COVID. We’re trying to do everything we can to save as many as possible. We’re using the facts. We’re following the science and following the law.

PAUL: Nobody’s arguing the severity of this, but you are completely ignoring the science of natural immunity, says Fauci. Says the whole group.

CHAKRABARTI: November 2021 CDC director Dr. Rochelle Walensky.

ROCHELLE WALENSKY: The CDC continues to recommend that people who have been previously infected get their COVID-19 vaccine. We know in our vaccine studies, our vaccine effectiveness studies with date certain when people were vaccinated, and we can prospectively follow them through our effectiveness studies and our effectiveness cohorts. The data on the infection induced immunity, some of which you quoted, are murkier.

CHAKRABARTI: This is On Point. I’m Meghna Chakrabarti. Science is an exercise in expanding human knowledge by making sense of uncertainty. American politics is an exercise in eradicating uncertainty. So in this pandemic, when absolutist politics from both Republicans and Democrats met an evolving understanding of COVID and natural immunity, what the country was left with was a hot mess of botched leadership and public health communication.

Well, there will be another pandemic in the future.

So today we want to look back at the story of COVID and natural immunity. And what the story has to tell in order for us to understand how can we do better next time? Now, our exploration is inspired by a study just published in the British journal The Lancet. It’s a meta analysis that finds that natural immunity from prior COVID infection does provide protection for at least ten months against severe disease and death from reinfection.

And that protection is equivalent or slightly better than two doses of an mRNA vaccine. Well, Dr. Chris Murray is director of the Institute for Health Metrics and Evaluation at the University of Washington. He’s also an author of the Lancet study, and he joins us from Shoreline, Washington. Dr. Murray, welcome.

CHRIS MURRAY: Happy to be here.

CHAKRABARTI: So tell us, first of all, how did you go about doing this meta-analysis about natural immunity? What does it entail?

MURRAY: We searched all the published literature for any study that was on natural immunity or immunity after infection. You know, any combination of descriptions like that. And we found all studies that had been published. We looked for studies that compared the immunity or the infection rates and the death rates and hospitalization rates in those that were infected, not vaccinated. Compared to those that were uninfected not vaccinated.

And we also looked at studies that included those who had been vaccinated and then been infected on top of vaccination and had statistically controlled for the vaccination. Put all those together and try to look at what sort of immunity as a function of time since infection that people got.

CHAKRABARTI: Okay. So then tell me, what do you think the most important aspects of the study’s findings are? I mentioned one of them, about the robust protection from natural immunity after, what, at least ten months? Tell me more.

MURRAY: So to make sense of all the noise that’s out there about, you know, vaccination and immunity after infection, you’ve got to distinguish between immunity that gives you protection from hospitalization and death. That’s the good news in this study, that at ten months you had 88% protection, versus immunity blocking you getting infected at all.

And for the latter, the immunity against being reinfected, it’s not as good. And so that tends to wane pretty quickly. And then when Omicron came along, it was much, much more reduced. But that’s true for vaccination, as well. So it’s super important to think of the two categories. Protection against severe outcomes and just can you stop transmission through, you know, immunity.

CHAKRABARTI: But as you pointed out, neither of them do that. Neither of them stop transmission.

MURRAY: Neither of them stop. I mean, they stop a little bit, but it wanes very quickly. And, you know, we have during the course of the pandemic, we’ve had to change our thinking that vaccination and natural infection is really not an infection control strategy. It’s a harm reduction strategy.

CHAKRABARTI: Well, so tell me more, or help me better understand, though, the finding that said that protection from natural immunity is equivalent or actually slightly better than two doses, specifically of the mRNA vaccine. I mean, did that part surprise you?

MURRAY: Well, not really. The fact that it was as good as or actually slightly better than vaccination is in keeping with what we would expect sort of immunologically. The surprise was the duration, that at ten months you still had 88% protection. So that’s really good news in a sense for us all.

CHAKRABARTI: Okay. And so and just remind me, how does that compare to people who maybe haven’t been infected, but have been vaccinated? Do they also have a similar length of durability?

MURRAY: They do. From what we can see on severe disease, it’s just slightly less.

CHAKRABARTI: Okay. But to your earlier point, natural immunity, though, it could provide robust protection. … You’re taking a risk, though, because you have to get infected in the first place.

MURRAY: Exactly. It’s the safest way to get immunity is, of course, through vaccination. You know, for somebody who look at what’s happened recently in China, even with Omicron, if you are uninfected, unvaccinated, the first time you get exposed, you’re at great risk, particularly if you’re over 65.

CHAKRABARTI: Okay. Now, I have to say, I’ve got foggy memory of all the things that have happened over the past three years. … Do you recall when some of the first studies about natural immunity and COVID came out?

MURRAY: You know, at IHME, we have been modeling the pandemic and, you know, at the peak of the pandemic, we were putting out new models every day and then every week. And so I tend to think of back when we needed to start to take this into account in our modeling. And that is, you know, even as early as when the new the first new variant started to show up, it became a real question mark in our minds.

And then when the studies came out in April, May of 2021, out of Israel, it became clear that post-vaccination immunity waned quickly and there were lots of studies on neutralizing antibodies, lab studies that suggested that natural immunity would also be waning at about the same rate. So we started to be pretty concerned about the speed for blocking transmission in the spring of 2021.

CHAKRABARTI: Okay. So this is really important, and I appreciate the clarification on the date. So you’re referencing again, just to remind folks this, in the spring of 2021, following the studies, for example, out of Israel, the first information about net COVID in natural immunity came out. So now I want to just get directly to the question of like, how was this evolving understanding used amongst public health and political leaders in this country at the time trying to grapple with the COVID pandemic?

So in the fall of 2021, November, specifically, then Senator Richard Burr, a Republican, questioned CDC director Dr. Rochelle Walensky about natural immunity during a Senate Health Committee hearing.

ROCHELLE WALENSKY: The CDC continues to recommend that people who have been previously infected get their COVID-19 vaccine. We know in our vaccine studies, our vaccine effectiveness studies with date certain when people were vaccinated, and we can prospectively follow them through our effectiveness studies and our effectiveness cohorts.

The data on the infection induced immunity, some of which you quoted, are murkier. They rely on retrospective studies, observational studies and studies where we can’t do a prospective study. We are following these people. We are following people who’ve been previously infected in our infection cohorts. But the data and the science are harder.

CHAKRABARTI: There’s never 100% certainty with any study. But was this a mishap, a missed opportunity by CDC Director Walensky to say, hey, potentially natural immunity is another tool in our toolkit in fighting this pandemic?

MURRAY: Well, I think it’s interesting. And, you know, at the time we thought that that position from CDC was somewhat extreme in thinking that there wasn’t protection. I think that that if you look at the contrast to what the many governments in Europe at the time were saying, there was a pretty big difference, that most of the scientists in Europe advising governments were accepting past infection as is equivalent to vaccination in terms of people being able to go out, go to restaurants, etc.

And we weren’t in this country. And I think part of it is just sort of do you take a global lens at all the data, or do you strictly look at the data sets that you particularly had at CDC is probably part of it. I also think the motivation here was probably well-meaning, that CDC was worried that talking about natural immunity would distract people from getting vaccinated. And so that sort of fed into the situation.

KAMALA HARRIS: If the public health professionals, if Dr. Fauci, if the doctors tell us that we should take it, I’ll be the first in line to take it. Absolutely. But if Donald Trump tells us that we should take it, I’m not taking it.

DONALD TRUMP: And then we developed the vaccine. Three vaccines in three months, in nine months. And actually, I’ll tell you, it was three days less, three days less than nine months. And it’s great. And you know what? I believe totally in your freedoms. I do.

JOE BIDEN: No, I don’t think it should be mandatory. I wouldn’t demand it be mandatory, but I would do everything in my power. It’s like I don’t think masks have to be made mandatory nationwide. I’ll do everything in my power as president of the United States to encourage people to do the right thing, and when they do it, demonstrate that it matters.

CHAKRABARTI: Well, you just heard then vice presidential candidate Kamala Harris talking about a potential COVID vaccine at a debate in October 2020. President Donald Trump, eight months after leaving office in August 2021. And finally, President Joe Biden talking about not wanting to make vaccines mandatory in December of 2020, just prior to his inauguration.

But by July of 2021, President Biden had shifted course and announced a vaccine or test requirement for all federal workers. And by September of that year, the administration also moved to require all U.S. employers with 100 or more workers to implement a vaccine or test policy.

BIDEN: These pandemic politics are making people sick, causing unvaccinated people to die. We cannot allow these actions to stand in the way of protecting the large majority of Americans who have done their part. Want to get back to life as normal. We must increase vaccinations among the unvaccinated with new vaccination requirements.

CHAKRABARTI: So again, that was September of 2021. What role was the Biden administration thinking that natural immunity might play in the 2021 pandemic control efforts? Well, earlier that year, in February, CDC director Dr. Rochelle Walensky was interviewed by the Journal of the American Medical Association Network, and she said in February of 2021 that people who had natural immunity due to a prior COVID infection could wait to get vaccinated even if they were in the so-called early priority groups.

WALENSKY: There’s no reason to say you shouldn’t be vaccinated. I think we’re recommending to wait 30 days. The real issue here is we think your immunity is probably reasonably good, probably beyond those 30 days. And so if you looked at all the constrained resources in vaccine distribution right now, the most constrained one is we don’t have enough vaccine.

And so if you think that you might be protected for a little longer, then maybe you pass up your point in line and let somebody else take that space in the queue and get yours. You know, in March or April when we have a little bit more.

CHAKRABARTI: Once again, that was CDC director Dr. Rochelle Walensky in February of 2021. But by November of that year, as we mentioned earlier, the CDC director was saying, well, the science around natural immunity was murkier. So quite different than what she was saying in February.

Well, I’m joined today by Dr. Chris Murray. He’s director of the Institute for Health Metrics and Evaluation at the University of Washington. And joining us now is Dr. Paul Offit. He’s a member of the FDA’s Vaccine Advisory Committee and director of the Vaccine Education Center and professor of pediatrics at Children’s Hospital of Philadelphia. Dr. Offit, welcome to you.

PAUL OFFIT: Thank you.

CHAKRABARTI: Can you make sense or how did you make sense between what CDC and the Biden administration were saying between February and November when it came to natural immunity and COVID?

OFFIT: Well, you learn as you go. And I think at some level, decisions were based, as you can hear in Dr. Walensky’s statement, based on the vaccines that we had in February 2021 versus the vaccines that we had in November 2021, when we had much more that was available. So, I mean, the answer to the question, can infection induced immunity protect? Yes, although in defense of Dr. Walensky’s statement, it is to some extent variable. I think that when you’re infected and you have an asymptomatic infection or mildly symptomatic infection or a severe infection that may differ from 1 to 1 level of symptomatology to the next based on the amount of viral replication.

So the amount of immunity may to some extent be different. I mean, we’re now [for a] population, I think it’s likely that asymptomatic infection may not induce the sort of same level of immunity as a more moderate infection. That’s number one. Whereas when you get a vaccine, you’re given essentially a known dose of, if you will, SARS-CoV-2 spike protein. So both clearly protect. But I can see where Dr. Walensky would be a little hesitant initially in this pandemic when it wasn’t clear to what extent, say, a different level of natural infection induced immunity could protect.

CHAKRABARTI: But Dr. Offit, you heard Dr. Chris Murray point out accurately a few minutes ago in the show that Europe, for example, went a completely different way. And they had vaccine, so-called vaccine or COVID passports, but you could include, you know, prior infection and natural immunity on those COVID passports. And that the United States and maybe even Canada kind of were outliers in in this respect. And to paraphrase, you know, Dr. Murray didn’t really quite make sense about why that was happening. Do you have an explanation for that?

OFFIT: Well, so you had certainly in 2020, you had a virus that entered this country roughly in January 2020. And we had nothing. We didn’t have monoclonal, we didn’t have antivirals, we didn’t have vaccines, we had nothing. We had zero population immunity. We were a blank slate. And you’re watching hundreds of thousands of people die from this virus. Then you have a vaccine in December of 2020. And now you’re starting to give that vaccine. I can tell you at the Children’s hospital, Philadelphia, we mandated that vaccine because we take care of a vulnerable population of hospitalized children, many of whom can’t be vaccinated.

We did not consider your right to catch and transmit a potentially fatal infection. And we wanted to make sure that we knew that you were immune. And I think that when people said, well, they had been vaccinated and we had to trust that we did so it became, in many ways an administrative decision, more so than, say, a scientific decision.

CHAKRABARTI: Okay. Well, but to you know, to put it mildly, administrative decisions when taken to the level of, you know, the White House can turn into blanket decisions that don’t really, I think they may deny the nuance of what science is actually saying. I mean, Dr. Chris Murray, can you tell me what you thought about … it seemed as if natural immunity, the concept and the data around it were almost immediately politicized in real time as studies were coming out beginning again in the spring of 2021.

MURRAY: You know, I think that you can trace some of this issue back to the interpretation of the original vaccine trials, the original trials for the many vaccines for J&J and except for a small arm of the AstraZeneca vaccine, were designed to tell us about vaccine efficacy against symptomatic disease and severe disease or severe outcomes. They were not designed to tell us about blocking transmission or blocking infection. And yet once the trials were out, we had this fantastic tool to reduce the harm of the epidemic. But it was very quickly translated into here’s a strategy to, quote, get to herd immunity.

… At the time, the government thought 70% of adults, we questioned that number even back in February of 2021. But that aside, you know, we pivoted from trials that showed us this harm reduction tool to assuming that it would also work to block transmission. And then it became this sort of incredible drive to get enough people protected so we would stop the epidemic and protect others. But, you know, there was the problem that we really didn’t know if it blocks transmission and subsequently learned it’s not particularly effective at that.

CHAKRABARTI: Well, but so what you’re saying is we being leaders were making decisions based on data that we really didn’t know. I mean, that’s literally what you just said. So, I mean, if I may quote something that you told our producer in advance of this show, that the concept of natural immunity did become very politicized with no benefit to anybody. Is that a fair analysis? I mean, that’s what you told our producer.

MURRAY: Yeah, I think that’s true. I think, you know, there was no intent on anybody’s part to do harm. Of course, I think it was different people’s interpretation of what was best for the country. But it wasn’t necessarily, you know, straight from studies, for example, this infection control strategy of, you know, getting 70% of adults vaccinated at the time, that was the target. If you remember, you know, we were going to be COVID free by July 4th, 2021, you know, was well-intended. It just wasn’t particularly backed up by the trials telling us that it would block infection.

CHAKRABARTI: So this concept of intention, people having good intentions, but not necessarily having the data to back up their intentions, In my mind, that’s the definition of politics in a pandemic. Okay. So I want to dip more deeply. Understand, Dr. Offit, how some of the decision making went, particularly in the Biden administration. I want to lean on your experience as being a member of the FDA’s vaccine Advisory committee and also having been in the room in some very high-level meetings with health advisers in the administration. So back in January of 2022, Dr. Offit, you were on a podcast called The ZDoggMD Show. It’s a medical podcast hosted by Dr. Zubin Damania. And you described a meeting that you attended with some U.S. public health leaders.

CHAKRABARTI … When was this meeting that you talked about, when did it take place?

OFFIT: Sometime in 2021. I don’t remember exactly when, it was a nighttime meeting that I remember.

CHAKRABARTI: Okay. And then a Dr. Francis Collins from NIH was there. Dr. Anthony Fauci. There was surgeon general, Dr. Vivek Murthy, and Dr. Rochelle Walensky from CDC in this meeting.

OFFIT: Right.

CHAKRABARTI: And the discussion was whether or not the administration should include natural infection. And as you said in the in the clip, it should include natural infection. Should it count as a vaccine? Can you tell me more about the nature of the discussion was.

OFFIT: Well, some of the discussion, it was me and three other immunology virology types who commented on this. I think what that boiled down to is I don’t think anybody disagreed that natural infection offered some level of immunity. The question was really more an administrative or bureaucratic one. I mean, because what you were doing, you were trying to vaccinate a population that was generally under-vaccinated, you know, you had initially the uptake on the vaccine was excellent. When the vaccine started to roll out at the end of December 2020, uptake was excellent.

You know, 1.5 million people a day, 2 million people a day, 3 million people a day, 4 million people day. And then we hit a wall and we got to around 60% of the population being immunized. And there was a critical percentage of the population that simply chose not to get vaccinated. So the question is, you know, how to move forward on this. And I think that by putting the question of whether or not you’ve been naturally infected in there as a way of saying, okay, I’ve been naturally infected, you don’t have to get vaccinated. It puts a lot of trust in people saying that they have been naturally infected when you know, when you still had, you know, thousands of people dying every day.

I think it was really more of a adding another sort of bureaucratic hurdle to what everybody was trying to do, which was to get population immunity. I do want to point out one thing Dr. Murray said that I think is exactly right. He’s right when he says that the goal of this vaccine is to prevent serious illness, you know, the kind that causes hospitalizations or ICU admissions or death. Because there’s a short incubation period virus where like, you know, influenza or respiratory syncytial virus or rotavirus, you know, you’re not going to get longer protection against mild disease at all, although by being vaccinated, you do reduce your chance of getting infected and therefore do, to some extent, reduce your chance of spreading the virus. But it’s leaky.

CHAKRABARTI: But, Dr. Offit, I mean, one of the reasons I was so pleased that you could join us today is because you’re a longtime physician. You’re a member of the FDA’s Vaccine Advisory Committee. You definitely make science-based decisions. But there have been times in the past where your advice sort of differed from what I would say the administration’s advice was to the American people.

Because around the time of this meeting that we’re talking about, the question of can natural infection be used alongside vaccination, for vaccine mandate questions, we were talking about like college kids, should they be able to go to college if they have or haven’t been vaccinated? Should people be able to go to work? I keep hearing the defense of a bureaucratic decision. But I wondered, is this not a decision that kind of maybe blew up in the administration’s face by making people even more resistant to get vaccinated if it came off as an absolutist measure?

OFFIT: Well, if you’re talking about going back to college campuses or graduate school campuses, in the case of my future son in law, what I was against was I was against, at least by the end of 2021, the requirement of a third dose. Because at that point before, we had experienced Omicron, and it was still just Alpha and Delta. The two doses appeared to be highly effective at preventing severe illness. And even in people over 65, even in people who had multiple co-morbidities.

So I didn’t see frankly the need for a third dose, much less the requirement for a third dose. So when President Biden, for example, stood up in front of the American public on August 18th of 2021 and said, as of the week of September 20th, we are going to offer a booster dose for everybody over 60. And I didn’t agree with that because I didn’t think the data supported that.

CHAKRABARTI: So let me just put it this way. When various members of the administration also often said, our decisions are based on following the science. When it came to what we know or knew about natural immunity and its protective aspects. Was the administration following the science around natural immunity?

OFFIT: Again, I think we were learning about what infection induced immunity was based on your level of infection and how long that that. And so I think we were learning as we went. And I think, you know, you have to make room for that.

CHAKRABARTI: I’m joined today by Dr. Paul Offit. He’s director of the Vaccine Education Center and professor of pediatrics at Children’s Hospital of Philadelphia. He’s also a member of the FDA’s Vaccine Advisory Committee. Now, Dr. Offit, I just want to play a little bit of tape here. This is Dr. Jeffrey Klausner, who says that COVID vaccination requirements sometimes put him in a tricky place. He’s a professor of medicine, infectious disease, population and public health at the Keck School of Medicine at the University of Southern California.

KLAUSNER: As a physician, I was dealing with patients who were saying, I’m going to be fired because I’ve recovered from infection, and I don’t want to get vaccinated. So I had to say, well, you are correct, and you don’t need to be vaccinated in terms of your personal health and protection against future disease. But you need to be vaccinated because that’s a requirement at your workplace.

CHAKRABARTI: Again, that’s Dr. Jeffrey Klausner at the University of Southern California. Now, Dr. Offit, I will stand by my assertion that I don’t think American politics, as it’s experienced or enacted now, can actually effectively use science in a broad-based public health decision making. I mean, we saw a form of absolutism in the Trump administration around COVID, and we also saw a form of sort of rigidity and absolutism from the Biden administration.

I mean, at the very, very top of the show, you heard me play a little bit of tape from then candidate Kamala Harris in a debate saying, you know, if Donald Trump told her to take a vaccine, she wouldn’t do it. But if other people did, she would. And I think we saw that same rigidity and lack of nimbleness, lack of trust in the American people through the Biden administration.

And so, once again, I just want to play something to you, Dr. Offit, that you had mentioned in that ZDoggMD podcast from January 2022 when you said that during the Trump administration, you could see political pressure very clearly being placed on the FDA regarding emergency use authorization for things like hydroxychloroquine. And then you go on to say, well, you also wondered if similar politics or political pressure was playing out under the Biden administration.

OFFIT: And I thought with the Biden administration, that would all go away, that we wouldn’t feel any sort of political pressure or decisions that were made by the CDC or the FDA. But and I hope I’m wrong, but I just feel like there is somewhat of that pressure. And so I hope I’m wrong, because these are institutions we have to trust. I mean, if you get to the point where you don’t trust the FDA or you don’t trust the CDC in this country, we’re in trouble.

CHAKRABARTI: Dr. Offit, again, that was January of 2022. I would love to give you a chance to elaborate on what was the pressure that you were talking about that you were seeing.

OFFIT: I think that there were three communications errors that were made during the Biden administration. The first is when in sort of July of 2021, there were thousands of men getting together to celebrate the Independence Day holiday there in Provincetown, Massachusetts. Most are vaccinated, but nonetheless, there’s an outbreak and 346 men get COVID. Four are hospitalized, which is a hospitalization rate of 1.2%, which is great. The vaccine working well, The rest had asymptomatic or mild infection. The CDC’s term for that, for those asymptomatic infections were breakthrough infections. Breakthrough is a bad word. It implies failure. Those were successes.

OFFIT: As Dr. Murray said, We had achieved what we wanted. We protected against severe disease. I think that the second communication error was one that we just mentioned, which is that I think when the Biden administration in August sort of said that we should have a booster vaccine for everybody over 16, when really up and through December of 2021, two doses was enough to protect all manner of co-morbidity and ages, I think that was a mistake. And then similarly, I think with the Bivalent vaccine, because I did vote against this back in June of 2022.

… I think, you know, the data there didn’t clearly support that the Bivalent vaccine was better than the Monovalent vaccine. And I felt that there was sort of a pressure at some level to do this because, you know, because the vaccine has been purchased. And I do want to make the point that it’s important to boost certain groups. The Bivalent vaccine was certainly no worse. … So people that need to be boosted should be boosted. But again, you felt that there was a certain pressure there that I had always hoped wouldn’t be there.

CHAKRABARTI: So you said regarding the Bivalent vaccine that there wasn’t necessarily data to say that it was more effective, but that the pressure was there.

OFFIT: Quite the opposite. I think the data was presented, suggested that it was unlikely to be more effective.

CHAKRABARTI: I want us to be clear on that. It was unlikely to be more effective, but the pressure was there because the booster had already been purchased.

OFFIT: You sort of felt that the train had left the station, I think was the sentiment.

CHAKRABARTI: So again, is that following the science? I mean I don’t understand. This doesn’t seem like it’s public health based. It’s not pressure coming from trying to do the bes for the public’s health.

OFFIT: Well, again, I would like to say that the Bivalent vaccine for certain high-risk groups, people who are elderly, people who have multiple co-morbidities, people who are immune compromised is a value. So it’s not nobody nobody’s getting hurt by that. I just think that we didn’t exactly follow the science. And I do think there was a certain political element to that. I think you’re right. I think, as John Barry said, when you mix politics with science, you get politics. And I think at some level that happened.

CHAKRABARTI: Do you know why, though? I’m asking you to read the minds of all of the heads of CDC, FDA. You know, I get it. It’s not necessarily fair, but I am putting particular scrutiny on the Biden administration because, you know, the most important leaders, health leaders in the administration were the ones who said over and over again they were going to follow the science.

OFFIT: I think the reason they were doing it is they thought they were doing the right thing. If you take the Bivalent vaccine as an example, you know, we were giving a vaccine from December of 2020 up until just recently that protected against the Wuhan one strain. That’s the strain that raised this ad in China and was really even the strain that left China. It’s been replaced by a number of variants.

OFFIT: So the thinking was, you know, why don’t we modify this vaccine so that we include circulating strains. And in the case of that June 2022 decision, those circulating strains were Omicron variants. And so certainly on the surface it made sense. It just didn’t work out that way. And so in a sense, we didn’t follow the science and it was no better. But again, I just want to point out it was no worse. And I do think people were trying to do the right thing. I don’t think there was anything nefarious here. As Dr. Murray said, I think people were trying to do the right thing. You could argue that it didn’t clearly follow the science.

CHAKRABARTI: Okay. So I take your point on that. But when it comes to trying to do the right thing, getting back to this question of how could the emerging science around natural immunity be used to greatest effectiveness in fighting the pandemic? It also seems to me, though, that the administration kind of didn’t really trust the American people to be able to handle communications that included nuance around natural immunity. I mean, the three examples that you gave were essentially communication problems. Did the administration not trust the American people enough to be able to understand what they were saying if they talked about natural immunity as well?

OFFIT: So I think part of it you have to think about the psychology of 2020. In 2020, we were a blank slate. People who were asymptomatically infected could spread the virus. So everyone was at risk, and everyone seemed to be a potential danger. And hundreds of thousands of people were dying and, you know, thousands of people were dying a day. I mean, that’s where we were in 2020. Your use of the term natural immunity is something you can notice that Dr. Murray and I have a little trouble saying.

We’ll say infection induced immunity or my particular phrase in 2020 is survivor induced immunity. I mean, we never say things like natural immunity from polio or natural immunity from smallpox, because if you were naturally immune to polio, you may have been paralyzed. Or smallpox, hopefully you survive. I just wish that we all should hire Mother Nature’s public relations team because the word natural has tremendous cachet that she has been trying to kill us ever since we crawled out of the ocean onto land. I mean, I think what happened was people were scared to death of this virus. And we knew that that the vaccine was our ticket out.

And I think that you’re right. I mean, you know, does natural infection afford a fairly high level of protection against severe disease? Of course it does. But I think at that time, you know, people were worried about just making sure people could be immune and making sure that they were immune. Because, you know, you can fake your PCR test if you want. I mean, you can buy positive PCR tests off the Internet. I think people were just what they wanted to make sure that people were getting immune given that how awful this virus was.

CHAKRABARTI: So, Dr. Offit, I do not take issue with anything that you just said. A completely hear you. And yeah, if we only had Mother Nature’s PR person. So I will change my language here and call it infection induced immunity. Point well taken there. But, you know, at the same time, I’ve returned to this question of politics in the United States. I keep coming back to the notion or the evidence that, again, European countries decide to go a different way when it comes to how they would use data around infection induced immunity in their pandemic control efforts.

And we just didn’t do that. So now, in the last few minutes, I want to talk about like, okay, what are the lessons that we can learn about infection induced immunity and COVID and politics in this country? Because, you know, we all want to just be as prepared as possible when the next pandemic comes along. So let me just go through a couple of thoughts here. First of all, at a Senate hearing in September of 2022, Senator Rand Paul questioned then chief White House medical adviser Dr. Anthony Fauci about … infection induced immunity. And Senator Paul accused Dr. Fauci of denying the basics of immunology, which Fauci pushed back and said that’s just not true.

ANTHONY FAUCI: I have never denied that there is importance of the protection following infection. However, as we have said many times and as has been validated by the authorization by the FDA through their committee and the recommendation by the CDC, through the committee that a vaccination following infection gives an added extra boost.

CHAKRABARTI: So we want to know if there was a more effective way that public health and political officials could have talked about natural infection induced immunity. So we asked Dr. Monica Gandhi that question. She’s an infectious disease physician and professor of medicine at the University of California, San Francisco.

MONICA GANDHI: I kind of go back to Nancy Reagan’s ‘Just say no’ about addiction management. I think that Americans are just more slogan based. And that’s not how immunity works or any of the COVID societal implications work. It takes a while to explain things.

CHAKRABARTI: Well, in August of 2022, after announcing his retirement, Dr. Anthony Fauci told MSNBC that he does hope that COVID taught public health officials some hard lessons on effective communication.

FAUCI: I mean, the things that we thought we knew in the beginning turned out as the months went by to not be the case, which really forced us to adapt and to change some of our policies and recommendations. That was interpreted by many as flip flopping or not really knowing what’s going on, when it really was the evolution of the science. So one of the lessons that I hope we learn is that we’ve got to be prepared. We’ve got to be able to respond, but we’ve also got to be flexible.

CHAKRABARTI: But we didn’t necessarily see that flexibility from the Biden administration. And Dr. Monica Gandhi says while she does not think that public health officials had any bad intentions, she also says that not being clearer an open about the science of natural or infection induced immunity and how it could inform pandemic response, that was a mistake. And she says that there’s was a way to talk about natural immunity, while also emphasizing how important vaccination was to ending the COVID pandemic.

GANDHI: We are in this modern, incredible, technologically advanced age that we would want people to avoid something that could make them ill, and we want people to get vaccinated. That was the way to say it, I think, on the news. But instead we say, ‘Kust say no’ where it might save lives. But in Europe, what they did was very different. Switzerland had what are called immunity passports. So you could go to a restaurant showing that you either had a natural infection or a vaccine. That would have probably been the better approach to just acknowledge immunity in any form.

CHAKRABARTI: Dr. Monica Gandhi at the University of California, San Francisco. So, Dr. Offit, what lessons do you think the public health community ought to learn when it comes to this story of infection induced immunity? And that would help us be better prepared or better manage the next pandemic.

OFFIT: I think we should trust the American public more to be able to understand more nuanced messages. So if you look at 2021, if you look at the papers that were published on natural infection versus vaccination in 2021, they were to some extent equivocal. There were some that showed natural people better, some that showed vaccination was better for a variety of reasons. So it was, as Dr. Walensky said in an earlier clip, it was a little murkier. And that’s true.

But so I think we should trust the American public to try and explain to nuance. And also, Dr. Fauci alluded to this. Make sure that when you make a recommendation, you say based on the information that we have now, that might change, because when it does change and it has changed over time, it looks like we don’t know what we’re talking about. See, that’s why you can’t trust them.

I mean, for example, when the vaccine came out in December 2020, 6 months later, it was still highly protective against severe disease, but it wasn’t highly protected against mildness, as you would have expected. Given the nature of this virus, a short incubation period of mucosal infection. But some people said, you know, I got this vaccine and now I have, you know, a two-day mild illness. You know, they lied to me.

And I think we should have made it very clear right from the beginning, this is not going to protect against fowl disease for very long. If this virus never created variants, if everyone in the world were vaccinated, this virus would still spread and still cause mild, as is true for another number of similar infections. … So I think we should have trusted the American people, to let them know that right away.

CHAKRABARTI: Do you think that American politics is capable of having that trust next time around?

OFFIT: I don’t know. I’m not a political pundit, but I think there are certainly examples of politicians who I think are very good at explaining things and trusting that the people that they’re talking to said that. So they do exist. They don’t seem to ever get on national television, but I know that they do exist. My friend is a congressman. So I think it’s possible. Yes.

This article was originally published on WBUR.org.

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