Will the government let the vaccine make any difference at all?

[Furtwangler]

Sorry for long post. It's great news that a Covid vaccine is in the pipeline, but aren’t we forgetting that there already exists a potent means of providing immunity against the disease - catching the disease itself? The government was, rightly, quickly discouraged from its initial ‘herd immunity’ plan, with ‘immunity certificates’ for survivors, but when they changed tack, they went to the opposite extreme and declared that those of us who'd had it were to be treated no differently from those who hadn't.

Consider this: if the Pfizer vaccine were to be given to health & social care workers tomorrow, we’d have 3 million people, 90% of whom would be protected against Covid for an unknown time period - and we don’t yet know if they wouldn’t transmit the disease, only that they wouldn’t suffer the symptoms - and 10% who wouldn't.

But we already have in the UK at least 6.5 million survivors of Covid-19 who, judging by the tiny numbers proven to have contracted Covid twice, are a lot better than 90% protected, and who, once they’ve had it, don’t seem to be still able to transmit the disease: how would the huge dip in Covid infection rates over the summer have been achieved if there'd been 6.5 million active infectors?

I look at it this way: if I were running a care home, I would be very interested indeed in which of my staff had had Covid. In fact, I’d pay for them all to have blood tests, so that I could deploy those with positive antibody tests to look after my most vulnerable clients. I know having had Covid doesn't make a person zero risk; but government and workplace regulations make no risk distinction at all between those who have had Covid and those who haven’t. My staff would all still be urged to use the NHS Covid app, and self-isolate on being notified, regardless of whether they have had Covid or not, on the basis that ‘it’s not known if having antibodies stops you getting the virus again’. No wonder there are compliance issues with track & trace.

So the advent of a large, Pfizer-vaccinated group of people should, under current health advice, make no difference whatsoever. They would, as a group, be LESS protected than the naturally immunised. The government has to not only deliver the vaccine; it's got to change its tune on what the immunised are allowed to do, and admit that they have been mismanaging that risk.

[Kazzyhoward]

There's no proof re immunity after having covid. Even if people don't get symptoms a second time, there's no proof they can't contract it, be asymptomatic, and pass it to others. We need to wait for the scientific and medical evidence before thinking that herd immunity is a viable option. But even then, it doesn't nothing for the vulnerable and elderly - they can't be "protected" forever.

[DougRossIsTheBoss]

Vaccine derived immunity and naturally derived immunity are not necessarily the same thing. Vaccine derived should be better as vaccines are specifically targeted to induce a big immune response and to evade viral defence mechanisms.
Therefore your premise is flawed and the argument doesn't stand.

Up to now we have not known enough about natural immunity. Does it work? If so for everyone or only some? How long does it last? We have been gathering data. Whilst we didn't exactly know then the safest thing to do was to carry on with the same measures for all.

[Furtwangler]

@Kazzyhoward No proof re immunity after having covid - but a whopping great indication. MRC Biostatistics Unit at Cambridge Uni estimated 6.5m Covid survivors in MAY. Since then, we've seen a huge dip in infections & deaths, which were down to single figures per day in August. So how was that happening if having Covid didn't confer immunity? My whole point is, there are no certainties in any of this, so we have to do rational risk assessments. And the government have simply said, "Because we can't say there's NO risk, we're not going to assess people who've had Covid as being at the SAME risk as everyone else. That doesn't make sense; it can't make much sense to anyone running a healthcare operation.

@DougRossIsTheBoss Vaccine derived should be better as vaccines are specifically targeted to induce a big immune response and to evade viral defence mechanisms - SHOULD be better, but in actuality AREN'T. The results so far show Pfizer's vaccine to be 90% effective. That means 10% ineffective. This doesn't make it unwelcome - far from it, it means we can give people a high degree of protection at no risk to their health, whereas getting natural immunity via catching Covid carries a risk of death, especially amongst the old and ill. But the fact remains, this is a lower degree of immunity than exists among Covid survivors. So, with respect, your assumption does not at all prove my premise wrong and my argument stands.

[Furtwangler]

@Kazzyhoward Correction: the govt are saying, "Because we can't say there's NO risk, we're going to assess people who've had Covid as being at the SAME risk as everyone else." (deleted the word 'not')

[Covidfears]

I think you’ll find the dip is cases over the summer was mainly to do with the super long strict lockdown we had just come out of and schools were closed which was the big thing at keeping cases down. Then we opened everything up and here we are. Nothing to do with herd immunity as we are nowhere near that. Vaccine should get us there quicker and yes, we may need regular injections but so what?

To let everyone catch it to get here immunity at a rate the nhs could cope with would take probably 10 years or more

[PowerslidePanda]

Regardless of the risks to an individual - you can't create a 2-tiered society (i.e. those with some immunity (whatever the source) versus those without it - at least, not until everyone who wants a vaccine has the opportunity to get one. Otherwise people who are low risk will start trying to get infected on purpose, for the rights it confers them. So the government's only viable strategy is to vaccinate widely enough that the risks are low for everyone.

[Lemons1571]

You’re not factoring people’s behaviour into the plan. It would cause chaos. You’d get millions of people not isolating or social distancing on the basis of “I definitely had it in March so I’m not worried, well, I never got a test as they weren’t available but my cousins friends sisters dog works for the nhs and tested positive so I DEFINITELY had it”.

[Mummabeary]

@Furtwangler

I totally agree! It's a great point you make and I can't understand the government's attitude to risk in this respect either. They have snookered themselves a bit with this refusal to accept immunity in the population. There's an interesting interview with Tim Spector on unherd this week where he discusses the same and why he can't understand why everyone is refusing to address the fact there IS some immunity in the population.

[DougRossIsTheBoss]

You're comparing apples with pears
Pfizer know it's 90% because they studied it accurately.
You have no idea what immunity rates are in people naturally infected because accurate data do not exist.
You are making assumptions that because only a few people were known to have been reinfected it must be less than 10% but you don't know how many people had it in the first place, how many were reexposed such that they could have another infection or how many were reinfected but asymptomatic.
You certainly cannot say that the vaccine is less effective on what data we currently have. The only scientifically defensible position is that nobody knows.
The likelihood based on knowledge of other vaccines is that vaccine derived immunity will be better.

[Furtwangler]

I'm not advocating a herd immunity strategy. I'm not advocating a 2-tiered society. @PowerslidePanda I agree that the government must vaccinate as widely as possible but I don't see why that means they should ignore people's current immunity status until they do. My whole point is that, given the 90% effectiveness of the vaccine, vaccinated people might well be no more and no less protected against the virus than are people with natural immunity obtained from having had Covid. So the government will have to rethink its attitude to such people, or we might never see an end to this pandemic.

At the moment, when those of us who have had Covid say, "I've had the virus," we are told, by government and people on Mumsnet, "But you can't be sure that makes you safe."

After the vaccine rolls out, if our attitude to risk assessment remains what it is, that conversation will become "I've had the vaccine" > "But you can't be sure that makes you safe." How does that help bring the pandemic and its effects to an end?

[Furtwangler]

@DougRossIsTheBoss

science.sciencemag.org/content/370/6518/811

'The nature of acquired immune responses after natural infection varies substantially among pathogens. At one end of this immune spectrum, natural infection with measles or smallpox virus results in lifelong protection from the reacquisition and retransmission of secondary infections. Many other infections [e.g., influenza and respiratory syncytial virus (RSV)] confer imperfect or transient clinical and transmission-blocking immunity by either pathogen evolution or waning immunological memory. Finally, phenomena such as antibody-dependent enhancement (ADE) associated with prior natural infection [e.g., dengue] or a vaccine [e.g., RSV] could result in more clinically severe secondary infections. Furthermore, the immunity conferred by vaccines may not provide complete protection against reinfection and/or disease, and this protection may be inferior to that acquired after natural infection.'

Your confidence in the efficacy of vaccines sits oddly with the rest of your argument, which is essentially that we shouldn't go beyond the limits of the known facts. But it's ok if it supports your argument?

[Furtwangler]

@Mummabeary Thanks, I'll look that up! I'm as keen as anyone to see a vaccine rolled out and start to bring this awful business to a close. But anecdotally, I'm hearing people refusing to download the NHS app, and refusing to cooperate with track & trace, because they can't afford to take 2 weeks off work, and they don't see why they should if they've already tested positive.

@PowerslidePanda If recognising natural immunity confers the right to go to work, what's wrong with that? As distinct from being forced to stay off work when the risk of re-infection is very low. As I'm trying to say, the vaccine may not change anything if all it means is that a vaccinated person has a similarly low-but-non-zero risk of re-infection. If the government keeps the vaccinated in the same boat as the naturally immune, it will neutralise the benefit of the vaccine entirely. Something will have to change.

[PowerslidePanda]

I agree that the government must vaccinate as widely as possible but I don't see why that means they should ignore people's current immunity status until they do.

If recognising natural immunity confers the right to go to work, what's wrong with that?

Because it will incentive people to deliberately catch covid so that they become immune and can work! Until we begin to see the effects of herd immunity (which we're trying to achieve via a vaccine rather than by rates of infection), everyone needs to be in the same boat - regardless of whether they're individually immune through infection, through vaccination or not at all.

[DougRossIsTheBoss]

My confidence in vaccination is based on years of research into vaccines and all the research and development effort ongoing into this vaccine. I don't think that is misplaced.

You want to give equal status to naturally acquired immunity and my position is that we don't know enough about that to rely on it to the same degree. I don't see any inconsistency in that.

As you also point out natural infection confers a risk of severe illness that is not entirely predictable so we cannot have a strategy that relies on it in the same way as we can vaccination. We cannot give people an incentive to get infected by issuing immunity certificates because for some of them that will have serious consequences. Plus we have no idea how long that immunity might last or how good it is so we cannot encourage people to be complacent because they think they've had it.

In my experience loads of people who were convinced they'd had it then didn't have antibiodies when tested. Plus there's people insisting they had it in December in the U.K. without Far East contacts which is implausible. Confirmation bias is a big thing with humans.

[DougRossIsTheBoss]

Anyway the way the government is bigging up the vaccine they very obviously are not going to keep restrictions in place for vaccinated people.

We don't even have to wait for everyone to be vaccinated just enough people that it will reduce the potential for an epidemic.

[Furtwangler]

@Covidfears Yes of course the lockdown accounts for the big dip in numbers, but would it have been so effective if 10 percent of lockdowners were still transmitting the infection to their families? That seems really unlikely to me; it would surely have seriously undermined lockdown.

But how are you getting the idea that I'm advocating herd immunity? I mentioned it only to say that the government had abandoned it - a move I described as 'quite right' - and had gone to the opposite extreme, of treating natural immunity as completely worthless and untrustworthy. Where do I say, or imply, 'let everyone catch it'?

I'm trying to talk about these facts:

1. Despite the govt's best efforts, about 10 percent of us have caught Covid nevertheless.
2. Our naturally-acquired immunity - which I'm NOT claiming is total, OR that it relieves us from the responsibility to practise good hygiene, handwashing etc - is not allowed to make any difference whatsoever to what we're allowed to. And there's always been an argument to be had about that.

What's new is the promise of a vaccine. But if the vaccine offers the same, or worse protection than naturally-acquired immunity, we are going to have to revise our view on what those with partial immunity are allowed to do. Otherwise our vaccination programme will be a charade: we'll vaccinate millions, and then apply the same stringent judgement to them, and nothing changes.

We already have the bizarre spectacle of the Prime Minister of this country declaring that he's self-isolating for 14 days even though he's 'bursting with antibodies', because 'we have to stop the spread of this disease', but I don't give a damn about him. We'll have people turning up at care homes hoping that the nightmare is over, that their newly-vaccinated status will finally allow them to hold their relative's hand before they die, only to be told, sorry that changes nothing. We didn't let you in with natural immunity, the vaccine is no better so what makes you think we're going to let you in now?

I'm not at all advocating a herd immunity policy; I'm advocating that we do rational risk assessments that take into account the benefits of natural immunity. This government won't talk about immunity precisely because their initial let-it-happen herd immunity ideas were so awful; they've made the subject a toxic one. But they're going to have to talk about the benefits of partial immunity, because that's exactly what a vaccine will offer.

[frozendaisy]

If our PM had sacked Cummings when he went galavanting about in Spring, the country might, MIGHT, gave had some sympathy in that he might have been able to not self-isolate because he has antibodies AND like it or not he is the PM and there is a fuck of a lot to sort out right now.

But as has been proven the general population look for any excuse to do what they like so that option has been removed.

Yes a viable vaccine will change everything.

[Furtwangler]

@DougRossIsTheBoss Well, I reckon I'm pretty pro-science myself, but your confidence in science outstrips what the scientists themselves are saying. Good science is cautious, but you seem to have something more akin to faith. They're claiming 90 percent efficiency, no more, no less. That's partial immunity, just like most natural immunity.

The scientists have been the first to admit they don't even know whether their vaccine will prevent transmission, as distinct from preventing symptomatic disease, but that doesn't dent your faith even a bit. You can't base your argument against risk-assessing natural immunity rationally (THAT'S my argument, by the way) on 'we don't know how long it might last or how good it is' and then ignore the fact that the same is true of a vaccine. Science is a good thing, but blind faith in science is still blind.

...we cannot have a strategy that relies on [natural immunity] in the same way as we can vaccination. We cannot give people an incentive to get infected by issuing immunity certificates I'm not advocating that strategy. That's a jump you've made in your own mind. The government don't defend their immunity-is-irrelevant position by saying they're worried that waves of people will go around persuading Covid sufferers to cough into their eyes in order to gain the benefits natural immunity might bring; no, they claim that isolating even when you've previously tested positive is somehow supported by the science, and you're doing your national duty by helping prevent the spread of the virus, even though you're one of the least likely people in the country to spread it.

I'm NOT worried that, if natural immunity were to be rationally risk-assessed, waves of people would go around catching Covid deliberately. For most people, the benefits simply aren't worth the risk; they just do what they want to do anyway, usually by keeping as far out of the clutches of the track & trace system as they can. What, though, would you say to someone who deliberately caught the disease in order to be allowed to be at a loved one's bedside while they die? I'm not sure I could muster much criticism.

[Furtwangler]

@frozendaisy The Cummings fiasco really did torpedo any chance there was of keeping the majority of the country on board with a series of increasingly inconsistent rules and guidelines, didn't they? And for what? To retain the dubious advice of a man who holds most MPs and civil servants in contempt. Boris can pose as a man doing his national duty by self-isolating even though he's bursting with antibodies as much as he wants, but no-one will forget where the national interest stood when it conflicted with his desire to keep his arrogant friend in Downing St.

FWIW, I'm still largely sticking to the rules, in so far as I actually understand them, and they make any sort of sense. But I haven't downloaded the official Covid app, because I don't accept being told, potentially several times, to take two weeks off work even though I have natural immunity, when people who are so far uninfected are urged by the same govt to return to workplaces if they can't work from home. I don't claim that having had Covid makes me a zero risk, merely that it makes me a low risk.

[jasjas1973]

The govt cannot allow different rules for those with naturally acquired antibodies and those without, we simply do not know how long natural immunity lasts, as i understand, immunity levels vary greatly dependent on the severity of the initial exposure.

A vaccine gives a more measured response.

This is where Bojo is being a clown by saying he has huge amounts of immunity/antibodies, he doesn't know any such thing - just being a chump Trump again.

[Furtwangler]

@PowerSlidePanda Funny, isn't it? 'You can't create a two-tiered society'. Our society is riven with unjustified tiers delivering wealth to a tiny minority, trapping millions in poverty or near-poverty, but we can't possibly allow those who have caught an infectious disease to gain any benefit whatsoever from the natural effects of their own immune system, even the right to return to work, in case someone else jumps on that small, risky bandwagon.

[Furtwangler]

@jasjas1973 Well, the antibody blood tests my family got do tell you how many antibodies you've got. My OH got it in March, the test was done in October and still showed high levels of IgG antibody. I appreciate that's not going to be everyone's situation. So we should be antibody (blood) testing at least as much as we are antigen (throat swab) testing, to discover people's levels of immunity. But we're not.

The government said back in the spring that antibody testing was 'unreliable'. It wasnt; only the home-test methods were unreliable (they still ordered millions). By which I mean, both finger-prick AND analyse at home. There were always lab tests which WERE accurate, it's just that they weren't on offer to most people. They are now, and I've paid £659 for five of them, check my privilege and my family's.

Now, I understand, reliable home analysis antibody tests are available. But still the govt talks and behaves as if antigen testing is the only game in town, and by far the most important tool in the fight against Covid.

Why? Because immunity is a danger word in government; it triggers alarm bells because they're desperate for us all to forget those early days when they talked about herd immunity so loosely. It was the wrong policy, but in fact it’s never been wrong to talk about immunity, it's what we're aiming at, after all. But our bodies' immune systems, with their pesky habit of developing high levels of protection for their owners, are an embarrassment and an irrelevance to this government.

Vaccines are not: the government can reap reputational rewards from them, by announcing, proudly, that they've just clinched an initial agreement to buy millions of doses. A vaccine programme is, of necessity, a government programme. Who defeated Covid? This government of campaign leaders and publicity experts will claim, we did. The nation, under our leadership.

Make no mistake, in Downing St there will have been grinding of teeth at the news that foreign vaccines look likely to be the first to be used, ahead of the home-grown contenders. That's not 'good optics'. It won't stop them trumpeting government support for their development, just as Trump is doing for the Moderna vaccine. Fair enough, let them trumpet. But this government's aversion to rationality over our natural immunity should not be so easily forgiven, because it served only the government's interests, not ours.

[Missmidden]

I agree with you entirely OP. There was a short statement released by SAGE last week (can’t find the link) which finally conceded that plateauing of cases might have something to do with growing levels of infection derived immunity- no shit Sherlock!! Unfortunately I haven’t seen it discussed in mainstream media much.

But you’re absolutely right- there will have to be a sea change in messaging when, miraculously, vaccine derived immunity is suddenly deemed to exist is a way that infection derived immunity apparently has not. Although, from some of the posters on this thread it seems they will be pushing at an open door- I am baffled!

[MereDintofPandiculation]

Since then, we've seen a huge dip in infections & deaths, which were down to single figures per day in August. So how was that happening if having Covid didn't confer immunity? And since August we've had a huge increase in infections, so if the dip was due to natural immunity, it suggests that the immunity lasts only a few months.

[jasjas1973]

@Furtwangler I do not doubt the political gaming in Downing street but every country in the world is banking on vaccines, inc countries that could work toward HI such as China or Russia.

With natural immunity, every generation has to catch CV, which is why we have vaccines for many other viral infections.

Also, around 25% of colds are caused by a coronavirus, yet immunity does not last long, just because you have high levels of AB after 7 months doesn't mean everyone else will.

I suspect the CV vaccine will be offered to the vulnerable and CV will eventually be treated as flu is now, with new variants of CV vaccine coming out every year, we'll need more hospital capacity though because CV is in addition to influenza.