1. Vaccine Passports ignore the naturally immune.
– Natural immunity is durable and long lasting as the NIH highlights while stating they hope that vaccine induced immunity will be similar. A pre-print out of Israel shows both natural and vaccine immunity to be strong with natural immunity being more protective.
– In fact the FDA will only collect blood from the previously naturally infected (not from the vaccinated) “to ensure that COVID-19 convalescent plasma collected from donors contains antibodies directly related to their immune responses to SARS-CoV2 infection…”
– The practice of requiring the previously infected to be vaccinated is inconsistent with past CDC policy as after the H1N1 flu the CDC stated: “If you have had 2009 H1N1 flu, as confirmed by an RT-PCR test, you should have some immunity against 2009 H1N1 flu and can choose not to get the 2009 H1N1 vaccine.”
– A recent study out of the Cleveland Clinic Health System found that “not one of the 1359 previously infected subjects who remained unvaccinated had a SARS-CoV-2 infection” and concluded that “individuals who have had SARS-CoV-2 infection are unlikely to benefit from COVID-19 vaccination.”
2. It is hard to tell who is naturally immune.
– An estimated 15% of all COVID-19 infections (17.5 million) are considered asymptomatic by the CDC. Antibody test can uncover some of these naturally immune, but not all. Many recovered individuals have robust anamnestic immune responses without detectable antibodies to viruses such as Hepatitis B and SARS-CoV-2 (for both memory B cells and memory T cells).
– Furthermore, these asymptomatic individuals were essentially immune without prior exposure to SARS-CoV-2. Our current understanding of the immune system does not fully understand this phenomenon hence it is impossible to determine which unexposed individuals have pre-existing immunity.
3. Do Vaccine Passports Keep Us Safer?
– The simple answer to this is marginally, if at all. Vinay Prasad, MD, MPH says it best in that “a vaccine passport results in a trade-off. It very modestly changes the risk to vaccinated individuals and those who do not have a vaccine option.” There are multiple reasons for this:
a. Protection: Those that are vaccinated are protected.
b. Prevalence: Prevalence of circulating virus needs to be included in any risk assessment. As the diagram below shows the cases of COVID-19 in the vaccinated dropped, but was that due to the vaccine or simply correlated with the overall drop of cases in the US?
c. Risk Reduction: When looking at risk it is important to examine both the relative risk reduction (RRR) and absolute risk reduction (ARR) as highlighted recently in the Lancet: “Ranking by reported efficacy gives RRR of 95% for the Pfizer, 94% for the Moderna, 90% for the Gamaleya, 67% for the J&J, and 67% for the AstraZeneca vaccines. However, RRR should be seen against the background risk of being infected and becoming ill with COVID-19, which varies between populations and over time. Although the RRR considers only participants who could benefit from the vaccine, the ARR, which is the difference between attack rates with and without a vaccine, considers the whole population. ARRs tend to be ignored because they give a much less impressive effect size than RRRs: 1.3% for the AstraZeneca, 1.2% for the Moderna, 1.2% for the J&J, 0.93% for the Gamaleya, and 0.84% for the Pfizer vaccines.
d. Asymptomatic Transmission: Although vaccines seem to reduce transmission, they do not eliminate it. Each vaccines varies in its ability to stop transmission. Will we provide one passport to all vaccine recipients even though they pose varying risk of transmission? Finally, healthy people carry many viruses and do not spread them, in the case of the flu asymptomatic carriage was as high as 35%.
4. Vaccine Passports segregate society.
A recent BJM opinion piece explained, “ultimately, we need to facilitate the economic growth of emerging economies to increase the health, wellbeing, and security of all. Vaccine passports interfere with that future as they create a structural barrier to sustainable development, benefiting only the few at the expense of so many.”
5. Vaccine Passports threaten privacy.
– The ACLU, while not opposed to vaccine passports in principal, has significant concerns with a digital vaccine passport system. They state it must be primarily paper-based with an optional digital component, decentralized and open source, not allow for tracking or the creation of new databases, and not encourage overuse, turning us into a checkpoint society.
6. Vaccine Passports raise legal and logistic issues.
– Stefan Baral (MD.MPH) of Public Health at Johns Hopkins detailed logistical concerns such as who will ask for it, how will they check it, where will this occur.