How long does covid-19 immunity last?
BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1605 (Published 30 June 2021) Cite this as: BMJ 2021;373:n1605Read our latest coverage of the coronavirus pandemic
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Dear Editor
This article rightly asks a few key questions, which have been around ever since the vaccine mission was started and they were also asked on numerous occasions whether on the political, or medical or media or public platforms. But the reality is that, no one knows the correct answers that are also reflected in this article. This is simply because, it’s too early to know the lasting efficacy of the vaccine, as it has not been tested for long enough. The world will have to go a long way to get the right answers.
This is also one of the prime reasons why a large section of the population worldwide are not confident and willing to take the vaccine.
It’s indeed credible that the vaccines were introduced at rapid speed and now numerous vaccines are in the race for commercial success but the first few front runners, as we know Pfizer, Astra Z, Moderna, etc, have already been lucky to make the most impact. Yet, with numerous serious concerns and controversies as to their real benefits against serious adverse effects. These have been so widely publicised that the people are seriously alarmed and have developed anti vaccine sentiments for right reasons.
The fact is that, not only the world does not know how long the vaccine will last but also what the ultimate effects of the vaccine will be in 5 or 10 or 20 or more years later down the line. We have not got to that stage yet to advise people whether they will be safe with no long term adverse health effects - neuro-cerebro-myelo-cardio-gastro hepato-renal single or multi organ syndrome - as a result of vaccine or the Covid infection itself.
However, it is understandable why the Government and the responsible medical bodies want to push the vaccination programme as the main agenda as rescue mission with overwhelming optimism even when there is no long term safety or efficacy data available, as stated above.
It is therefore no wonder that there is a worldwide large population still very anxious, concerned and reluctant about taking covid vaccine. The general public may not always be ignorant or irresponsible and rather can be thoughtful and intelligent about their decisions. When I face questions from patients and public, such as – “can you confirm that the vaccine will definitely last to protect me and the others around me and that I will not catch the Covid infection and also not pass the same to others and I will have no adverse serious illness in 5 or 10 or more years time””?
I ask, is there any clinician or expert clinical academic or Prime Minister or chief medical adviser in the world who can answer YES to the above questions? If no one can, then world medical community must think.
People do not like indefinite unsubstantiated answers that they are used to hearing from all sources, be it in the news media or medical advisory lines or TV interviews, etc. They want definite answers that the world doesn’t know. So, how can you penalise them for asking genuine questions?
There is also scientific evidence against random vaccination, as one of the authors below has pointed out:
“”…the data suggest that people confirmed to have been infected with SARS-CoV-2 may not need vaccination, and definitely do not need vaccination in the short term””.
We know Covid-19 is not a deadly disease for everyone and it can safely be avoided if full and appropriate self care and protection is taken, and that is nothing but common sense care and treatment.
Indeed there was a spread of deadly consequences in the early stages and that happened more in the western countries than the rest of the world, except for a few odd exceptions, for some unknown reasons. But that is most likely due to lack of precautionary measures. Vaccines are therefore an additional precaution for those who are willing to take them but at the same time those who are reluctant should not be forced into it or penalised. This is simply because taking vaccine is not a full proof stop and there is no guarantee that vaccine will protect self and not pose any risk to others.
It also must be noted that Covid vaccine is contraindicated to many, such as with serious allergies, anaphylactic history, immune or coagulation compromise, etc.
What is most important is to build the knowledge, education and awareness among people to understand that an unvaccinated person has the same responsibility as a vaccinated person to care for each other. This should be the Government's main agenda to broadcast and for the medical authorities to make it clear to the public. There should not be any blame game that all health care staff must be vaccinated to protect patients. This is a baseless argument.
After all, covid-19 is a virus, and less virulent than many other viruses that we already know and it will stay there until it finishes its as many waves and turns and goes away on its own accord – we have to learn to live with it. Therefore for many, the best remedy and best medicines would be awareness, education, precaution and protection with moral and common sense.
Competing interests: No competing interests
Dear Editor
We were once told that the key to defeating Covid was getting the infection rate below 1, so it should be a surprise with 75 million vaccines administered to the UK population as of 23 June and rising [1] that the Chief Medical Officer, Chris Whitty, cannot envisage a return to normal life till at least next Spring [2].
I note that it was not me but a Public Health professor from Imperial College, Azeem Majeed, who raised the question whether this Gargantuan effort has reallly been effective [3,4]. If vaccinating everyone cannot return society to normal for the foreseeable future what we seem to have now is some very confused thinking indeed.
Of course, it was the former editor-in-chief of this journal, Richard Smith, who wrote last year [5]:
“Doctors have important roles to play in a pandemic—primarily in treating the sick and advising on prevention—but they cannot become rulers, and politicians cannot hide behind them. And we, the people, must never succumb to the idea that a world run by doctors would be a better world.”
We have on a collective level “succumbed”, manifestly we have a much worse world, and there is perhaps no clear direction but more tyranny.
[1] https://www.gov.uk/government/publications/coronavirus-covid-19-vaccine-...
[2] Connor Boyd, ‘Britain won't return to normal until at least next SPRING: Restrictions could be reimposed this winter, Chris Whitty warns’, Daily Mail 7 July 2021, https://www.dailymail.co.uk/news/article-9761529/Britain-wont-normal-spr...
[3] Azeem Majeed, ‘ Re: How long does covid-19 immunity last?’, 30 June 2021, https://www.bmj.com/content/373/bmj.n1605/rr
[4] John Stone. ‘ ‘ Re: How long does covid-19 immunity last?’, 1 July 2021, https://www.bmj.com/content/373/bmj.n1605/rr-0
[5] https://blogs.bmj.com/bmj/2020/08/11/richard-smith-the-faults-and-danger...
Competing interests: AgeofAutism.com, an on-line daily journal, concerns itself with the potential environmental sources for the proliferation of autism, neurological impairment, immune dysfunction and chronic disease. I receive no payment as UK Editor. I also moderate comments for the on-line journal ‘The Defender’ for which I am paid. I am also a member of the UK Medical Freedom Alliance
Dear Editor
There is a plethora of studies supporting the conclusion that natural immunity confers robust, durable, and high-level protection against COVID-19 (1-5). Yet some scientific journals, media and news outlets, and public policy messaging continue to cast doubt. That doubt has real-world consequences, particularly for resource limited countries. We would like to review available data.
Infection generates immunity. The “SIREN” study addressed the relationships between seropositivity in people with previous COVID-19 infection and subsequent risk of severe acute respiratory syndrome due to SARS-CoV-2 infection over the subsequent 7-12 months (1). Prior infection decreased risk of symptomatic re-infection by 93%. A large cohort study published looked at 3.2 million US patients and showed that the risk of infection was significantly lower (0.3%) in seropositive patients v/s those who are seronegative (3%) (2). Another recent article by Vitale et al suggest that natural immunity to SARS-CoV-2 is long lasting; reinfections are rare events and patients who have recovered from COVID-19 have a lower risk of reinfection (3). The data with respect to the protective impact of prior infection are being redundantly reinforced.
Perhaps even more important to the question of duration of immunity are studies that have demonstrated the presence of long-lived memory immune cells in those who have recovered from COVID-19 (4,5). This implies a prolonged (perhaps years) capacity to respond to new infection with new antibodies.
In contrast to this collective data demonstrating both adequate and long-lasting protection in those who have recovered from COVID-19, the duration of vaccine-induced immunity is not fully known. To date >10,000 breakthrough infections (2 weeks after completion of vaccination) have been reported by CDC in the US, with a mortality of ~2% (6).
How should we use the collective data to prioritize vaccination? These new data support simple and logical concepts. The goal of vaccination is to generate memory cells that can recognize SARS-CoV-2 and rapidly generate neutralizing antibodies that either prevent or mitigate both infection and transmission. Those who have survived COVID-19 must almost by definition have mounted an effective immune response; it is not surprising that the evolving literature shows that prior infection decreases vulnerability. In our view, the data suggest that people confirmed to have been infected with SARS-CoV-2 may not need vaccination, and definitely do not need vaccination in the short term. Given the number of persons who have been infected, this simple approach could free up vaccine (estimated ~500 million doses) for the more vulnerable population around the globe where COVID is currently surging and could accelerate vaccine roll-out tremendously for those in need.(7) We should not be debating the implications of prior infection; we should be debating how to confirm prior infection.
References:
1. Hall VJ, Foulkes S, Charlett A et al. SARS-CoV-2 infection rates of antibody-positive compared with antibody-negative health-care workers in England: large, multicentre, prospective cohort study (SIREN). Lancet. 2021
2. Harvey RA, Rassen JA, Kabelac CA, et al. Association of SARS-CoV-2 Seropositive Antibody Test With Risk of Future Infection. JAMA Intern Med.
3. Vitale J, Mumoli N, Clerici P, et al. Assessment of SARS-CoV-2 Reinfection 1 Year After Primary Infection in a Population in Lombardy, Italy. JAMA Intern Med. Published online May 28, 2021.
4. Turner, J.S., Kim, W., Kalaidina, E. et al. SARS-CoV-2 infection induces long-lived bone marrow plasma cells in humans. Nature 2021
5. Wang, Z., Yang, X., Zhong, J. et al. Exposure to SARS-CoV-2 generates T-cell memory in the absence of a detectable viral infection. Nat Commun 12, 1724 (2021).
6. https://www.cdc.gov/mmwr/volumes/70/wr/mm7021e3.htm
7. Kuehn BM. High-Income Countries Have Secured the Bulk of COVID-19 Vaccines. JAMA. 2021;325(7):612
Competing interests: No competing interests
Dear Editor
I was concerned by Azeem Majeed’s letter [1,2]: it might seem a bit late to start assessing safety and efficacy after you have given these products to the greater part of the population - even that we might be seeking data that you would have supposed already collected.
In his cited article [2] he and his colleagues state that allergic reactions to the Pfizer Biontech were unexpected, but actually the concerns were already known [3]. Also the emergent clotting disorders associated with AZ vaccine they refer to [3] may not have taken into account known problems with adenoviruses [4].
I wonder whether we are really proceeding with due care?
[1] Azeem Majeed, ‘ Re: How long does covid-19 immunity last?’, 30 June 2021, https://www.bmj.com/content/373/bmj.n1605/rr
[2] Majeed A, Papaluca M, Molokhia M. Assessing the long-term safety and efficacy of COVID-19 vaccines. Journal of the Royal Society of Medicine. May 2021. doi:10.1177/01410768211013437
[3] John Stone, ‘ PEG in the Pfizer vaccine: not a good start’, 10 December 2021, https://www.bmj.com/content/371/bmj.m4654/rr-28
[4] John Stone, ‘ Re: Covid-19: Rare immune response may cause clots after AstraZeneca vaccine, say researchers’, 16 April 2021, https://www.bmj.com/content/373/bmj.n954/rapid-responses
Competing interests: AgeofAutism.com, an on-line daily journal, concerns itself with the potential environmental sources for the proliferation of autism, neurological impairment, immune dysfunction and chronic disease. I receive no payment as UK Editor. I also moderate comments for the on-line journal ‘The Defender’ for which I am paid. I am also a member of the UK Medical Freedom Alliance
Dear Editor,
Vaccines for COVID-19 were eagerly awaited; and their rapid development, testing, approval and implementation are a tremendous achievement by all: scientists, pharmaceutical companies, drugs regulators, politicians and healthcare professionals; and by the patients who have received them.[1] Early real-world data from vaccine recipients in England, Scotland and Israel show that vaccination provides a high level of protection from symptomatic COVID-19 infection and serious illness, along with a large reduction in the risk of hospital admissions and death.
However, because these vaccines are new, we do not yet have information on how long the immunity generated by COVID-19 vaccines will last; or on how well they will protect against new variants of SARS-CoV-2. Longitudinal data on ‘vaccine failures’, or re-infections can help guide national policies on how frequently booster doses of vaccines are needed to maintain a good level of immunity in the population, and on whether vaccines need modification to provide protection against new variants of SARS-CoV-2.[2]
The UK is well-placed to collect these data and to secure its timely evaluation and integration with information provided by its strong life sciences research industry, to guide public health decision making. We also have a National Health Service that has developed computerised medical records for use in general practices on a population of around 67 million people. These electronic medical records provide longitudinal data on people’s health and medical experiences and can be used to estimate the longer-term efficacy of Covid-19 vaccines.[3] This will provide a valuable resource, not just for guiding public health policy in the UK, but also for global health.
References
1. Majeed, A, Molokhia, M. Vaccinating the UK against COVID-19. BMJ 2020; 371: m4654–m4654.
2. Majeed A, Papaluca M, Molokhia M. Assessing the long-term safety and efficacy of COVID-19 vaccines. Journal of the Royal Society of Medicine. May 2021. doi:10.1177/01410768211013437
3. Hodes S, Majeed A. Building a sustainable infrastructure for covid-19 vaccinations long term BMJ 2021; 373 :n1578 doi:10.1136/bmj.n1578
Competing interests: No competing interests
Israel: A cruel warning on how mass vaccination can go wrong
Dear Editor
Israel provided what seemed a bold and interesting response to the pandemic. The 'Israeli innovation' was a blanket vaccination campaign, based on the Pfizer jab. The approach has now been copied by other countries, such as Britain and France.
And this bulldozer of a policy has hit a reef - the Delta Variant.
Covid cases are accelerating in Israel. The new reaction is a partial lockdown, accompanied by the prospect of yet more booster shots.
Perhaps someone in the BMA should dare to be somewhat more honest about vaccines and variants. This BMJ article is rather too prone to describe the vaccine as all plain sailing with regard to variants. The Legacy Study, in two letters to the Lancet, is, however, more and more worried about those very troublesome Variants of Concern (1) (2),
Let's go back to May. The Lancet, then, pronounced on its front page 'that high vaccine uptake can meaningfully stem the pandemic' (3). But the Lancet in the accompanying comment piece did, if just bbriefly, bring up the issue of variants of concern. The Delta Varinant wasn't mentioned - but, of course, it didn't exist at that time.
Alas, as Harold Macmillan was prone to complain: 'Events, dear boy, events.'
I suppose that particular Lancet article currently has egg all over its face.
I would call myself very pro-vaccine. But vaccines should take many difficult lab years, not a few PR months, to create. The Covid vaccines are very much in the spotlight. If they become a shipwreck, fifty fathoms out of sight, the people against vaccines will unfortunately be able to gloat.
A vaccine is just one component of any tentative life-jacket in the Covid flood.
We are going to need, I am afraid, more basic measures such as masks, hand-washing, local lockdowns, and so on.
Maybe what we will ultimately require is closing the borders - everywhere. This is definitely illiberal and extreme. It smacks of xenophobia. It is a last resort. I have always called for open frontiers. However, I would add that I feel all countries should proceed to shut their frontiers. The principle would be similar to the problem of fire-fighting, where 'compartmentation' appears to break up the blaze into manageable chunks.
Not mass testing on its own, not mass vaccination on its own, not lockdown on its own, but a mixture of policies - that's the imaginative way forward we're just not getting.
References:
(1) Neutralising antibody activity against SARS-CoV-2 VOCs B.1.617.2 and B.1.351 by BNT162b2 vaccination. The Lancet. Vol 397 June 19, 2021. Pgs. 2331-2. David Bauer et al.
(2) AZD1222-induced neutralising antibody activity against SARS-CoV-2 Delta VOC. The Lancet. Vol 398 July 17, 2021. Pgs. 207-9. David Bauer et al.
(3) Covid-19 vaccine impact in Israel and a way out of the pandemic. The Lancet. Vol 397 May 15, 2021. Pgs. 1783-5. Eyal Lesham, Annelies Wilder- Smith.
Competing interests: No competing interests