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Natural immunity, vaccine mandates, and “following the science”

Summary:
In October 2020, three public health academics published the Great Barrington Declaration, which argued that policymakers should focus on protecting those most vulnerable to covid, while encouraging those at low risk of death or serious disease to resume normal activities.  This would result in a rapid spread of natural immunity through the population, hastening an end of the epidemic. I will discuss the Great Barrington Declaration – both its substance and what it teaches us about libertarianism – eventually.  But for now let’s catch up with Martin Kulldorff, one of the authors of the Great Barrington Declaration, and a professor at Harvard Medical School: How can hospitals best protect their patients from Covid disease? It is an enormously

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In October 2020, three public health academics published the Great Barrington Declaration, which argued that policymakers should focus on protecting those most vulnerable to covid, while encouraging those at low risk of death or serious disease to resume normal activities.  This would result in a rapid spread of natural immunity through the population, hastening an end of the epidemic.

I will discuss the Great Barrington Declaration – both its substance and what it teaches us about libertarianism – eventually.  But for now let’s catch up with Martin Kulldorff, one of the authors of the Great Barrington Declaration, and a professor at Harvard Medical School:

How can hospitals best protect their patients from Covid disease? It is an enormously important question, also relevant for nursing homes. There are some obvious standard solutions, such as separating Covid patients from other patients, minimizing staff rotation, and providing generous sick leave for staff with Covid-like symptoms. 

Absolutely.

Another goal should be to employ staff with the strongest possible immunity against Covid, as they are less likely to catch it and spread it to their patients. This means that hospitals and nursing homes should actively seek to hire staff that have natural immunity from prior Covid disease and use such staff for their most vulnerable patients. 

Eh.  This might well have made sense early in the epidemic, before vaccines, but with vaccines now widely available it seems like a lot of effort testing, hiring and training new employees, and reassigning or firing existing folks for possibly not much benefit.  Maybe we should concentrate on getting everyone vaccinated.

Hence, we are now seeing a fierce competition where hospitals and nursing homes are desperately trying to hire people with natural immunity. Wellactuallynot

Instead, hospitals are firing nurses and other staff with superior natural immunity while retaining those with weaker vaccine-induced immunity. By doing so, they are betraying their patients, increasing their risk for hospital-acquired infections. 

By pushing vaccine mandates, White House chief medical advisor Dr. Anthony Fauci is questioning the existence of natural immunity after Covid disease. In doing so, he is following the lead of CDC director Rochelle Walensky, who questioned natural immunity in a 2020 Memorandum published by The Lancet. By instituting vaccine mandates, university hospitals are now also questioning the existence of natural immunity after Covid disease. 

This is astonishing. . . .

This is astonishing . . . 

No one is questioning the existence of natural immunity.  Here is what the 2020 Memorandum cited by Kulldorff said about natural immunity:  “It is unclear how long protective immunity lasts, and, like other seasonal coronaviruses, SARS-CoV-2 is capable of re-infecting people who have already had the disease, but the frequency of re-infection is unknown.”  And remember, this Lancet Memorandum is from 2020.  Kulldorff is using a memo from 2020 that does not question the existence of natural immunity to suggest that people today are questioning the existence of natural immunity.

Of course, people may not believe in natural immunity even if they do not say this out loud.  Kulldorff seems to think that it only makes sense to support a vaccine mandate without an exception for people with natural immunity if natural immunity does not exist.  He then infers that mandate supporters do not believe in natural immunity. 

But, in fact, it might make sense to have a vaccine mandate that applies to all health care workers, even those with natural immunity.  There are two reasons for this.  First, it is administratively simpler to require everyone to get vaccinated then to set up a system with exemptions for people with prior infections.  Second, it seems reasonable to believe that people with natural and vaccine-induced immunity will be less likely to become infected than people with natural immunity alone.  This will protect patients directly, by keeping their caretakers from getting sick if they are exposed to covid, and indirectly by bringing down overall disease prevalence.

Of course, it is possible to argue that we should offer exemptions to vaccination requirements to people with natural immunity, to respect the wishes of those who are vaccine hesitant, to avoid having to fire people for noncompliance (although, contra Kulldorf, it does not seem like this will be a serious problem), to tamp down political polarization, or to free up vaccine supplies for people in poorer countries. 

We could have a reasonable discussion about this.  A reasonable discussion would ask questions like these:  How would exemptions be administered?  Do we have the capacity to do mass testing for antibodies?  If not, do we delay vaccine mandates until we ramp up anti-body testing?  Are positive PCR tests sufficient to establish natural immunity?  What about other tests?  How will we check to see if natural immunity is waning over time?  How many additional breakthrough infections will there be if we expand exemptions to cover natural immunity?  How many people will in fact quit their jobs without an exemption?  Etc.  In other words, we would do policy analysis.  But this is not what how Kulldorff rolls.

Finally, there’s this:

If university hospitals cannot get the medical evidence right on the basic science of immunity, how can we trust them with any other aspects of our health? 

What’s next? Universities questioning whether the earth is round or flat? That, at least, would do less harm.

Libertarians have been caterwauling about progressives and public health officials and political leaders who say they are “following the science” when in fact the science is not clear, or when policy choices are based not just on science, but on value judgments that can reasonably be questioned.  Fair enough, people do sometimes invoke the authority of “science” to justify decisions where the science is not clear or where decisions depend on contestable value judgments as well as science.  But here we see the opposite: 

an academic with a libertarian ax to grind falsely claiming the mantle of “science” to justify a debatable policy (whether exemptions to vaccine mandates make sense is a complicated moral and policy question, not “the basic science of immunity”), misrepresenting the facts (no reasonable people deny that natural immunity exists), and using this misrepresentation to deliberately undermine trust in public officials. 

That makes lots of sense, if you’re a libertarian and regard distrust in government as a good thing.  Of course, distrust in government threatens to destroy American democracy, but whatever.  At least no one with natural immunity will be forced to get vaccinated.  Whew.

Oh, and guess what?  Kulldorff’s essay was published at the Brownstone Institute, founded by Jeffrey Tucker, the libertarian pundit who sponsored the Great Barrington Declaration, spent a year ranting about lockdowns, and parlayed that “success” into funding for his new venture.  We’ve seen Tucker’s work before.  For libertarians, covid is the gift that keeps on giving.

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