Vaccine vs. natural immunity: A debate driven by politics, not medicine

Everyone on the planet should know by now that SARS-COV-2 is a difficult virus to prevent and treat, that it causes a widespread inflammatory response that does more damage than the virus does directly.

We also know that the best tools we have to fight it are vaccines, synthetic antibodies and, now, the emerging antiviral drugs made by Merck and especially Pfizer, which stop the virus from reproducing before the dreaded inflammation occurs.

The Merck drug, Molnupiravir, feeds the virus a genetic (RNA) “meal” that essentially poisons it from reproducing, whereas the Pfizer drug, Paxlovid, employs an enzyme blocker known as a protease inhibitor, a kind of chemical that has dramatically fought another killer RNA virus, HIV AIDS. Paxlovid works by stopping the virus from cleaving protein precursors into new infectious particles that then jump to another cell. Exciting data just reviewed by Pfizer has determined that this drug, when given early in the disease course, reduces hospitalization by close to 90 percent compared to 50 percent for the Merck drug. One or both of them, combined with widespread rapid antigen testing to identify the infection early, could finally lead us out of the pandemic. They are likely to be given an Emergency Use Authorization by the FDA sometime over the next few weeks.  

And yet, despite the exciting emerging science and the sharpening indications for its use, the politics surrounding COVID continues to confuse us and obfuscate the truth. The new drugs are not intended to take the place of vaccines — in fact, they need to be combined with widespread vaccine use for the best public health outcome.

From a medical point of view, there is no real battle between vaccine-induced immunity versus natural immunity from infection, though some news reports and social media posts make it appear to be so. Both create a significant immune response, although neither appear to be durable, and they also augment each other. Arguing that one is better than the other is politics, not medicine. Better to recognize both as useful to prevent spread, especially as breakthrough infections are occurring at an increasing rate. 

The easily transmitted delta variant has raised the stakes of the battle while at the same time exposing the limitations of our weapons. In response, we create substantial new ones (anti-virals), and yet we continue to undermine our own efforts by doubting the latest science and insisting on our right to be non-compliant.

In the days of social media, everyone becomes a self-proclaimed expert, and rigidity and ridicule reign. Perhaps just as detrimental to our exit strategy, public health experts become celebrities and seem more interested in defending their positions publicly than in bending and reformulating with the emerging science.

Mandates create resistance, and this resistance becomes more important to some than the real question of whether the science works or not. This is particularly true when it comes to the vaccine. I know of one physician who had COVID twice and who took the first dose of the vaccine but was so certain she didn’t need the second dose (she was right) that she risked sacrificing her job rather than take the second shot. It was only when she realized that her response was to the arbitrary, unjust imposition of a blind authority, rather than to the risk of the shot itself, that she decided finally to take that second shot in order to keep working.

The pathway out of this pandemic requires all the tools of science, not politics — from vaccine to rapid tests to synthetic antibodies to the latest anti-viral drugs. The war between post-infectious immunity and vaccine-induced immunity, or the battle for the right not to wear a mask, or a superimposed political need to replace a high-tech preventive injection with a high-tech interventive pill, are all counterproductive. So, too, are superimposed, inflexible vaccine mandates that don’t take into account a negative test or a recent infection as equally effective tools for risk stratification. 

Political struggles are sucking up all the air that emerging clinical science needs to breathe. Our best path forward is to finally let the real science lead. 

Marc Siegel, M.D., is a professor of medicine and medical director of Doctor Radio at NYU Langone Health. He is a Fox News medical correspondent and author of the new book, “COVID; the Politics of Fear and the Power of Science.”