The Dangerous Myth That 'Natural Immunity' Is Superior to Covid Vaccination

One particularly pernicious myth going around in the US is the notion that "natural immunity," gained from contracting Covid-19, the disease caused by the virus SARS-CoV-2, is preferable to getting vaccinated. One prominent politician, Sen. Rand Paul (R.-Ky.), has declared that he refuses to get vaccinated, because of his belief that he has "natural immunity" since he's "already had the disease" (Slate, 5/23/21).

Now, the Republican Party is officially embracing its position as the anti-vaccine political party, advocating what they call "natural immunity" as an alternative or substitute to getting vaccinated, as the Associated Press (11/21/21) reported:

Republicans fighting President Joe Biden's coronavirus vaccine mandates are wielding a new weapon against the White House rules: natural immunity.

They contend that people who have recovered from the virus have enough immunity and antibodies to not need Covid-19 vaccines, and the concept has been invoked by Republicans as a sort of stand-in for vaccines.

Florida wrote natural immunity into state law this week, as GOP lawmakers elsewhere are pushing similar measures to sidestep vaccine mandates. Lawsuits over the mandates have also begun leaning on the idea. Conservative federal lawmakers have implored regulators to consider it when formulating mandates.

"We're actually doing a science-based approach," declared Florida Gov. Ron DeSantis, as he signed a law hobbling vaccine mandates. "For example, we recognize people that have natural immunity."

'State of fear'

The most dangerous misconceptions to deal with here are that getting infected with Covid is superior to getting vaccinated, and framing the concept of "natural immunity" gained from previous infections as a contrast to vaccine-induced immunity.

Dr. Marty Makary, a surgeon at Johns Hopkins and editor of MedPage Today, has been given a large platform by corporate media, writing several op-eds extolling the powers of "natural immunity" as an argument against vaccine mandates, as well as against other public health measures, such as wearing masks, despite the wealth of evidence supporting the importance of masks in reducing transmission.

For the Wall Street Journal (6/8/21), in an op-ed headlined "The Power of Natural Immunity," he wrote:

What's the harm of underestimating or disregarding the protection afforded by natural immunity? It almost certainly cost American lives by misallocating vaccine doses earlier this year, and is still doing so in countries where Covid is prevalent and shots are scarce. It continues to delay full reopening and prolongs the state of fear that has many people wearing masks, even when there's no mandate, or reason, to do so.

Focusing on the encouragement of universal vaccination in wealthy nations is certainly a good way to distract from those nations' failure to deliver on their promises to provide vaccines to the Global South--and, perhaps more importantly, from the maintenance of patent protections that prevent developing nations from producing their own vaccines.

Makary's arguments also notably always seem to place blame for Covid shutdowns and deaths on pro-vax rather than anti-vax positions; in a similar Washington Post column (9/15/21), Makary blamed those unconvinced by "natural immunity" for "the loss of thousands of American lives." Makary makes no mention of the hundreds of thousands of deaths in the US since vaccines became widely available to all, the vast majority of which would have been prevented if not for the widespread anti-vax arguments fed by people like Makary. Nor does he acknowledge that the primary cause of delays to full reopening is not vaccine mandates but the continued resurgence of Covid waves driven by the huge reservoir of Americans that lack immunity because of their vaccine hesitancy.

But the most troubling part of this passage is its insistence that we are living in a "state of fear" rather than an ongoing pandemic, and that there is "no...reason" to take public health precautions.

Makary's June Journal article is especially fascinating, since he published another Journal op-ed in February (2/18/21) containing fantastical predictions that the US would achieve "herd immunity" by April, which is obviously wrong, since here we are in December, without herd immunity (as experts predicted at the time). The Journal could have chosen not to publish Makary again after his ridiculous prediction failed, but not only did it continue to give him a platform, it also allowed him to lie further by claiming the US had already achieved herd immunity in June:

With more than 8 in 10 adults protected from either contracting or transmitting the virus, it can't readily propagate by jumping around in the population. In public health, we call that herd immunity, defined broadly on the Johns Hopkins Covid information webpage as "when most of a population is immune." It's not eradication, but it's powerful.

Since this declaration that "herd immunity" has already been achieved, there have been 17 million confirmed new infections in the United States--half again as many as had been recorded in the country in the previous 14 months of the pandemic--and more than 200,000 Covid deaths.

Misinterpreted study

In recent columns, Makary often touts as incontrovertible evidence an Israeli preprint (a study yet to be peer-reviewed) that made headlines (e.g., Science, 8/26/21) claiming infection-induced immunity offers more protection against the more transmissible Delta variant than two doses of the Pfizer vaccine. Bloomberg's "Previous Covid Prevents Delta Infection Better Than Pfizer Shot" (8/27/21) reported:

The largest real-world analysis comparing natural immunity--gained from an earlier infection--to the protection provided by one of the most potent vaccines currently in use showed that reinfections were much less common.... People given both doses of the Pfizer-BioNTech vaccine were almost six-fold more likely to contract a delta infection and seven-fold more likely to have symptomatic disease than those who recovered.

Some notable left-wing journalists have also cited the study as evidence that people and legislators should give more credence to "natural immunity," failing to note that the same study also wrote that "individuals who were previously infected with SARS-CoV-2 and given a single dose of the BNT162b2 vaccine gained additional protection against the Delta variant."

Dr. David Gorski, managing editor of Science Based Medicine (10/4/21), pointed out several other issues with the Israeli study's findings:

One thing I noticed right off the bat is how its tables and charts only report odds ratios.... You have to dig into the text to see that the absolute numbers of infections were quite low (for example, only 19 reinfections in one group) and actually do the math yourself to figure out that the breakthrough infection rates after vaccination were low.

I found that omission very curious, as well as the framing that didn't mention that this study actually showed that the Pfizer vaccine was quite effective.... In addition, as described in this presentation, this study appears to have suffered from significant selection bias, based on how different the populations being studied were. It also suffered from survivorship bias.

PolitiFact (9/1/21) noted that the Israeli study only tested one vaccine (Pfizer/BioNTech), and that gauging immunity by comparing Covid reinfection rates among the unvaccinated with breakthrough infections among the vaccinated "ignores the dangers of contracting Covid-19 in the first place, and the protections against severe illness that vaccines provide."

Perhaps more importantly, the Israeli study is only one, retrospective study, with plenty of others to contradict the idea that infection-based immunity is stronger than vaccination. For instance, a recent CDC study found that among hospitalized adults, vaccination offered about five times more protection than previously having had Covid (CDC, 11/5/21). The CDC's most recent overview (10/29/21) of scientific research cites a systematic review and meta-analysis of data and studies from the US/UK/Israel that found "no significant difference in the overall level of protection provided by infection as compared with protection provided by vaccination."

Although some vaccinated people experience breakthrough infections, and even death, despite being vaccinated, studies have shown that those who got Pfizer or Moderna vaccines have cases that are, on average, faster-resolving and less symptomatic than those who are unvaccinated, with less virus lingering (NEJM, 7/22/21).

The Atlantic's science reporter Katherine Wu (9/3/21) also noted:

When it comes to severe disease and death, though, vaccine effectiveness hasn't really budged at all: Immunized people seem to be thwarting the worst cases of Covid-19 just as well as they did when the shots debuted, often at rates well into the 90s. That's fantastic, considering that the FDA's original benchmark for vaccine success, announced in June 2020, was reducing the risk of disease or serious disease by 50% among people who get the shot.

Wu (9/16/21) also noted that "Several studies have shown that a decent percentage of infected people might not produce detectable levels of antibodies, for the simple reason that 'not all infections are the same,'" and that vaccines having standardized ingredients and dosage removes a lot of the ambiguity and uncertainty regarding how strong one's immunity will be.

Virologist Angela Rasmussen told me that there's debate over how many vaccine doses people who recovered from Covid need, because "more research" has been published about previously infected people who get one shot rather than two. The CDC currently recommends full vaccination for Covid survivors.

Immunity through mass death

There are effectively two strategies for achieving "herd immunity" (the threshold where a sufficient number of the population is inoculated against a disease such that widespread transmission is blocked): through mass vaccination, or through previous exposure to the virus. Vaccination seeks herd immunity without the massive human costs that come with letting the virus run its course, as seeking herd immunity through mass infection does.

This is evidenced by Sweden having up to 10 times as many Covid deaths compared to its neighbors in August, despite its being held up as a model by corporate media for its "herd immunity" approach of letting people get infected, which FAIR (4/30/20, 5/27/20) criticized at the time. Without the robust welfare state and national healthcare system of Sweden, it's no wonder the US's similar lack of public health measures has resulted in the most Covid deaths in the world; in the words of Trump science advisor Paul Alexander (Politico, 12/16/20), it would be "best to open up and...let the kids and young folk get infected" in order to get "natural immunity." Whether or not the Trump administration's pandemic response was motivated by the specific goal of immunity through mass infection, mass death was the result.

People should also not make the mistake of interpreting news about greater breakthrough infections as evidence that vaccines are failing. For example, when Singapore transitioned out of its zero-Covid strategy once 80% of its population was vaccinated, there was a predictable rise in Covid cases and breakthrough infections; however, the vast majority of the new cases aren't falling ill, due to their being vaccinated, and as the Atlantic's Wu (7/26/21) pointed out:

Breakthroughs, especially symptomatic ones, are still uncommon, as a proportion of immunized people. But by sheer number, "the more people get vaccinated, the more you will see these breakthrough infections," Juliet Morrison, a virologist at UC Riverside, told me. (Don't forget that a small fraction of millions of people is still a lot of people--and in communities where a majority of people are vaccinated, most of the positive tests could be for shot recipients.)

In one sense, whether infection-induced immunity or vaccine-induced immunity is better is not the most important question. For unvaccinated people who haven't had an infection, the question is whether one is better off getting vaccinated or getting Covid, and the data is clear that getting vaccinated is better.

As of December 16, there have been only nine confirmed deaths directly related to, or caused by, Covid vaccines (specifically the Johnson & Johnson vaccine), despite over 490 million vaccine doses being administered in the US, while over 800,000 people have died from Covid, out of over 50 million confirmed Covid cases in the US. Yet many believe they are better off taking their chances with getting Covid instead of getting vaccinated, when in reality, Covid infection is hundreds of thousands of times more dangerous than vaccination.

For the question of whether people who have had Covid should get vaccinated, that answer is also obvious. The current research shows that people with "hybrid immunity" (immunity from being vaccinated after having had Covid) often have even greater, "super" immunity than those who have only recovered from a previous infection (Nature, 10/14/21). Rasmussen told me that "vaccination is a more reliable way of inducing more consistent responses, which is why vaccination after infection seems to provide so much benefit."

A misleading contrast

However, it's important to stress that the very concept of "natural immunity" as a contrast to vaccine-induced immunity is a misleading one, as several medical and scientific experts have pointed out. Epidemiologist Michael Mina tweeted that he dislikes the term "natural immunity," because "there is no such thing as artificial immunity," as vaccines drive a "NATURAL immune response." The main question is whether one prefers to start building that immunity through a "safe vaccine" or a "risky infection."

Virologist Stuart Neil concurred, tweeting that the "only 'artificial' immunity is passive transfer of cells or serum. Vaccines stimulate your natural immune response without the need for a natural infection."

Gorski explained why contrasting infection-induced immunity and vaccine-induced immunity is a fundamental misunderstanding of what vaccines are and what they do:

As much as it perturbs me that this has to be explained again and again, boiling the concept of vaccination down to its essence, all a vaccine does is prime the immune system with a dead pathogen, a protein (or part of a protein from it), or a related but harmless pathogen so that the body can respond so much more quickly when the actual pathogen is actually encountered "in the wild." The end result is to prevent you from becoming sick due to that pathogen. The best vaccines, of course, do more than that and prevent you from being infected at all (a phenomenon known as sterilizing immunity), but a good vaccine doesn't have to induce sterilizing immunity or to be 100% effective at preventing transmission to accomplish a lot of very good things, again, not the least of which is preventing severe disease.

Some notable anti-vaxxers have taken their advocacy for "natural immunity" so far that they have even accidentally reproduced the rationale behind vaccines without realizing it:

Don't call it 'natural'

Twenty-four percent of white Protestants who identify as evangelical say they won't get vaccinated, compared to 6% of white Protestants who don't identify as evangelical or born again.

Alan Levinovitz (Washington Post, 9/29/21), a professor of religious studies at James Madison University and author of Natural: How Faith in Nature's Goodness Leads to Harmful Fads, Unjust Laws and Flawed Science, pointed out that many people "often treat naturalness as synonymous with purity and goodness, even holiness," and argued that alternatives like "virus-induced immunity" should be used in public messaging instead. Gorski endorses the term "post-infection immunity."

The mistaken belief in the superiority of "natural immunity" is one of the more commonly cited reasons why people hesitate to get vaccinated. Behavioral scientists have implored public health authorities to be "more aware of the psychology of citizen decision-making," and avoid contributing to the appeal-to-nature fallacy:

The power of this cognitive bias is so great that the average person is willing to pay a premium on foods and medicines referred to as natural. This has certainly spawned its fair share of shrewd marketing tactics aimed at unsuspecting consumers.... In our current Covid-19 predicament, the appeal-to-nature fallacy has an even darker side: It makes some people believe that they do not need vaccines. Why would they, if they can protect themselves the "natural way"?

Misleading contrast

Responsible outlets like Health Feedback (11/3/21) dedicated to combating popular but misleading scientific claims have run more accurate headlines, like "Infection-Induced Immunity Versus Vaccine-Induced Immunity: Weighing the Benefits and Risks." Yet reports in popular corporate outlets still often make the misleading contrast between "natural immunity" and vaccination-induced immunity (e.g., Yahoo, 11/14/21; Washington Post, 9/29/21).

Taking the appeal-to-nature fallacy to its most extreme and absurd conclusions, one might just as well argue that we should all intentionally try and give ourselves and everyone around us Covid, since there is an overwhelming and increasingly preponderant amount of evidence suggesting that the virus also emerged from nature (e.g., Wall Street Journal, 3/1/21; South China Morning Post, 9/20/21; Nature, 9/16/21; Cell, 8/18/21; Science, 11/18/21). This is exactly what Republicans like Rep. Matt Gaetz (R.-Fla.) propose when they attempt to make parody a reality by arguing: "The best vaccine we've found is mother nature's vaccine. It's contracting the virus." Yet, as Gorski noted, those who advocate for "natural immunity" strangely never seem to volunteer themselves to get Covid first.

There are many false or dubious sensationalist stories being promoted by corporate media and in online social media spaces, including progressive or left-wing ones.

Some of them include the debunked claim that the CDC director said that the vaccines were "failing," unsubstantiated claims that Pfizer "falsified" data for their clinical trials, misleading descriptions of the US's Covid vaccines as scientifically "experimental" with false claims of skipping animal trials and standard safety testing, or that vaccines don't help prevent infection and transmission of Covid at all (vaccines do, in fact, reduce infection and transmission, even if not entirely). With the newly detected Omicron variant spreading, it's especially important to dispel misleading or false information, and for all people to get as protected as possible--meaning vaccination and even boosters, as many experts are now advising (Atlantic, 12/8/21, 12/17/21; Stat, 10/21/21, 12/16/21).