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There are debates around vaccine mandates that focus on individual liberties, federalism, and the political backlash around vaccination. I will leave those topics for others to debate. As a physician, I have medical concerns around the rigidity of the new vaccine mandates. Here is a list.
Mandates Ignore Natural Immunity
If you recovered from a COVID infection, you have natural immunity which is 27-times more effective than vaccinated immunity in preventing symptomatic COVID, according to a large Israeli study.
Public health officials have been hesitant to talk about this study for fear that people will choose to get the infection over vaccination.
I do not recommend actively or passively getting the infection over vaccination because getting the infection can result in a regrettable severe illness (many critically ill patients are asking for the vaccine in the hospital but by then it’s tragically too late). But for those who were truly sick from COVID, you can feel good about your immune protection.
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For those who want to further increase that level of protection, I recommend one dose of an mRNA vaccine which can slightly augment one’s immunity, as demonstrated in the same Israeli study.
The new vaccine mandates inexplicably ignore the overwhelming science on natural immunity, resulting in damaged credibility by public health officials and possibly subjecting those already immune to the side effects the second vaccine dose that they may not need.
Employers and schools requiring vaccination should recognize natural immunity if they want to be science-based. Unfortunately our public health officials have been dismissive of natural immunity after digging into their position on this issue early. Recognizing natural immunity would go a long way in restoring the public trust in the public health officials.
Mandates make it hard to space out doses to 3 months
In general with any vaccine in medicine, the longer the interval between doses, the stronger and more durable the immune protection. The original 3 and 4 week interval between doses for Pfizer and Moderna was an atypical regimen that was designed to finish the clinical trials quickly last year given the urgent need for a vaccine to come to market. It was a noble goal, but now it’s time to evolve our recommendation based on the new science.
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New studies show that spacing out the 1st and 2nd Pfizer or Oxford/AstraZeneca vaccines by 3 months result in better immunity.
In one of those studies, researchers at the University of Birmingham found that delaying the second Pfizer dose to 12 weeks after the first resulted in a 3.5-times greater antibody response in older people.
Hematologist Dr. Paul Moss, a co-author of the study, concluded that it’s a good idea to extend the time between the first and second doses of the vaccine. “An extended interval may help to sustain immunity against COVID-19 over the longer term and further improve the clinical efficacy of this powerful vaccine platform,” Moss wrote.
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I personally waited 3 months between my 1st and 2nd mRNA vaccine and recommend the same to others who have only received their 1st mRNA dose so far. Doing so may obviate the need for a booster given the growing recognition by researchers that the first 2 doses 3 or 4 weeks apart may functionally as a single primer dose. But unfortunately the new vaccine mandates will hinder your ability to use this data-driven approach because mandates will have short deadlines for meeting the 2-dose requirement with an mRNA vaccine.
Mandates are not flexible with children
The current adult dose and short interval between doses may be too high for children. It’s always concerned me that we give are giving the same vaccine dose and short interval between doses to a thin 12-year old girl that we give to an overweight 50-year old man.
In addition, If a child had COVID illness and recovered, I do not recommend vaccinating the child because of natural immunity. The exception is children who are immunosuppressed or have a special circumstance.
Vaccines do reduce hospitalizations among children by approximately 90 percent. That’s why I recommend vaccination of children without natural immunity. But not with the current regimen.
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The complication of heart inflammation after vaccination has been associated with the second dose in particular. These complications have not been adequately studied in my opinion.
For adolescents, I recommend they get a single mRNA vaccine dose for now until the heart complications are better understood. They may be avoidable.
One dose was 100 percent effective in an Israeli study of children 12-15 years of age, suggesting a strategy that can protect children from both COVID and the heart complications associated with the second dose.
Let’s come together
Vaccinate requirements that are flexible and consider natural immunity are reasonable for essential workers, such as health care workers and teachers. But we should allow people to tailor these recommendations with their physicians.
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President Biden has rallied around the term ‘a pandemic of the unvaccinated’ but the more precise term is ‘a pandemic of the non-immune.’
It’s those without any immunity who are the ones dying in U.S. hospitals right now and it’s that group where we should all come together to strongly encourage vaccination.
Author’s note: Comments above represent opinions and do not constitute medical advice. Consult with your physician to discuss any of these issues above before making a medical decision.