Dr. Aaron Kheriaty, professor of psychiatry at the University of California, Irvine, felt he did not need to be vaccinated against COVID-19 because he had become ill from the disease by July 2020.
So in August, he sued to stop the university system’s vaccination mandate, saying “natural” immunity had given him and millions of other people better protection than any vaccine could.
A U.S. judge last week rejected Kheriaty’s request for an injunction against the university over its mandate, which went into effect Sept. 3.
While Kheriaty intends to pursue the case further, legal experts doubt that his and similar lawsuits filed around the United States will ultimately succeed.
That said, there is growing evidence that infection with SARS-CoV-2, the virus that causes COVID-19, is generally as effective as vaccination to stimulate your immune system to prevent the disease.
Yet U.S. federal officials have been reluctant to acknowledge any equivalence, citing the wide variation in COVID-19 patients’ immune response to infection.
Like many disputes during the COVID-19 pandemic, the uncertain value of a past infection has led to legal challenges, marketing opportunities, and political greatness, even as researchers quietly work in the background to sort out the facts.
For decades, doctors have used blood tests to determine if humans are protected against infectious diseases.
Pregnant women are tested for antibodies to rubella to ensure that their fetuses do not become infected with the rubella virus, which causes devastating birth defects.
Hospital staff are screened for measles and chickenpox antibodies to prevent the spread of these diseases.
However, immunity to COVID-19 seems more difficult to distinguish than immunity to these diseases.
We do not yet fully understand what the presence of antibodies tells us about immunity.
The US Food and Drug Administration has approved the use of COVID-19 antibody tests, which can cost around US $ 70 ($ A95), to detect previous infections.
Some tests can tell if the antibodies are from infections or vaccines. However, neither the FDA nor the Centers for Disease Control and Prevention recommend using the tests to assess whether you are actually immune to COVID-19.
For that, the tests are essentially useless because there is no agreement on the amount or types of antibodies that signal protection against the disease.
“We do not yet fully understand what the presence of antibodies tells us about immunity,” said Kelly Wroblewski, director of infectious diseases at the Association of Public Health Laboratories.
Similarly, experts disagree on how much protection an infection provides.
How does natural immunity compare to vaccination?
In the absence of security and as vaccination mandates are imposed in the United States, Australia and around the world, lawsuits seek to push the issue.
People who claim that vaccination mandates violate their civil rights claim that infection-acquired immunity protects them.
In Los Angeles, six police officers have sued the city, claiming they have natural immunity.
In August, law professor Todd Zywicki claimed that George Mason University’s vaccination mandate violated his constitutional rights as he has natural immunity. He cited a series of antibody tests and an immunologist’s statement that it was “medically unnecessary” for him to be vaccinated.
Zywicki dropped the lawsuit after the university granted him a medical exemption, which it claims was not related to the case.
Republican lawmakers have joined the crusade.
The GOP Doctors Caucus, made up of Republican doctors in Congress, has urged people to lure vaccination to seek antibody tests instead, which contradicts CDC and FDA recommendations.
In Kentucky, the state Senate passed a resolution granting them the same immunity status as those showing evidence of vaccination or positive antibody tests.
Hospitals were among the first institutions to impose vaccinations on their front-line workers because of the danger that they could spread the disease to vulnerable patients.
Few have offered exemptions to the previously infected. But there are exceptions.
Two hospital systems in Pennsylvania allow clinical staff to postpone vaccination for one year after testing positive for COVID-19.
Another in Michigan allows employees to opt out of vaccination if they show signs of infections and positive antibody tests in the previous three months.
In these cases, the systems indicated that they were eager to avoid staff shortages that could be due to the departure of vaccine-requiring nurses.
For Kheriaty, the question is simple.
“The research on natural immunity is pretty definitive now,” he told KHN.
“It’s better than immunity that vaccines provide.”
But such categorical statements are clearly not shared by most in the scientific community.
‘The research on natural immunity is pretty definitive now. It is better than immunity from vaccines. ‘
Dr Arthur Reingold, an epidemiologist at the University of California, Berkeley and Shane Crotty, a virologist at the respected La Jolla Institute for Immunology in San Diego, testified expertly in Kheriaty’s lawsuit, saying the extent of immunity to re-infection, especially to newer variants of COVID- 19, is unknown.
They noted that vaccination provides a huge boost to immunity for people who have been ill in the past.
Yet not all those who push to recognize past infection are vaccination critics or torchbearers of the anti-vaccine movement.
Dr. Jeffrey Klausner, a clinical professor of population and public health science at the University of Southern California, co-authored a recently published analysis that showed that infection generally protects for 10 months or more.
“From a public health perspective, it makes no sense to deny jobs and access and travel to people who have recovered from infection,” he said.
In his testimony against Kheriaty’s case of “natural” immunity, Crotty cited studies of the massive COVID-19 outbreak that swept through Manaus, Brazil, earlier this year, which involved the gamma variant of the virus.
One of the studies estimated, based on tests of blood donations, that three-quarters of the city’s population had already been infected before gamma arrived.
It suggested that previous infection may not protect against new variants.
But Klausner and others suspect that the frequency of previous infections presented in the study was a gross overestimation.
‘From a public health perspective, it makes no sense to deny jobs and access and travel to people who have recovered from infection.’
A large study in August from Israel, which showed better protection against infection than against vaccination, could help turn the tide against acceptance of previous infection, Klausner said.
“Everyone is just waiting for Fauci to say, ‘Past infection provides protection,'” he said.
Da Dr. Anthony Fauci, the top federal expert on infectious diseases, was asked in a CNN interview last month whether infected people were as protected as those who have been vaccinated, he revealed.
“There may be an argument,” as they are, he said.
Fauci did not immediately respond to a request for further comment from KHN.
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CDC spokeswoman Kristen Nordlund said in an email that “current evidence” shows great variation in antibody responses after COVID-19 infection.
“We hope to have some more information on the vaccine’s immunity to natural immunity in the coming weeks,” she said.
A “monumental effort” is underway to determine what level of antibodies are protective, said Dr. Robert Seder, Head of the Cellular Immunology Section at the National Institute of Allergy and Infectious Diseases.
Recent studies have taken a stab at a number.
Dr. George Siber, a consultant in the vaccine industry and co-author of one of the papers, said antibody tests will never give a yes-or-no answer about COVID-19 protection.
“But there are people who will not be vaccinated,” he said.
“Trying to predict who is at low risk is a worthy task.”