Should people who've already had COVID go to the back of the line for the vaccine?

My first-blush reaction to that question is “no” because scientists don’t yet know for sure that recovery from the disease provides immunity. And even if it does, they don’t know how long that immunity might last.


But hold on. There have been around 14 million confirmed cases of the disease in the U.S. yet only a few reports of people being reinfected. If reinfection were common rather than an occasional fluke, we’d have many thousands more examples of it than the handful we actually have. Clearly some sort of immunity is being conferred by recovery.

And since we’re now almost nine months into this pandemic and reinfection remains rare, it seems like a pretty safe bet that immunity lasts at least nine months.

So what we could do, just to be on the safe side, is say that everyone who tested positive back in March should consider themselves vulnerable and get the vaccine immediately. Everyone who tested positive in April should consider themselves vulnerable as of January. Everyone who tested positive in May should consider themselves vulnerable as of February. Etc.

We could postpone millions of vaccinations that way with little ill effect, which means freeing up millions of doses of the vaccine for people who haven’t yet had COVID and are at real risk if they don’t gain immunity soon. Efficient distribution is important, and getting more important by the minute:

Doctors are already debating what people who’ve survived COVID should do:


Covid-19 reinfections are thought to be rare, but if natural antibody levels wane over time, it may be possible for a person to become infected more than once. Doctors and infectious disease experts agree that most people should get vaccinated, even if they may have natural protective immunity. In most survivors, a vaccine might even enhance immunity from the initial infections…

Although the Pfizer and Moderna vaccine trials didn’t recruit volunteers who were symptomatic or were known to have been previously infected, it’s believed that up to 10 percent of participants in the trials had had the virus, said Dr. Moncef Slaoui, the chief science adviser for Operation Warp Speed, the Trump administration’s $18 billion initiative to support the development of coronavirus vaccines. Those people either were asymptomatic or had such mild symptoms that they went undetected, he said.

“What we know is the vaccines are safe in these populations,” Slaoui said Wednesday at a news briefing about Operation Warp Speed. He added that more data are needed about how the vaccine works in people who had symptoms and were sick with Covid-19.

What’s tantalizing about the prospect of deprioritizing people who’ve already had COVID is that many, many more Americans than the 14 million we know about have had the disease. Last week the CDC estimated that for every confirmed case there are — wait for it — eight cases that go undetected. They estimated that 53 million Americans had been infected by the end of September. If the eight-to-one ratio is correct it would mean that right now the actual number of Americans who are immune, or on their way to immunity after they recover, is … 125 million, more than a third of the population. And given the gigantic number of new confirmed cases we’re seeing each day, that number will skyrocket by the time the vaccine is being administered in earnest next year. Assume 125,000 new confirmed infections each day for the next 45 days. Per the CDC’s ratio, that would mean 1.1 million actual infections each day, or another 50 million people(!!) by mid-January.


Half the U.S. population or more might have natural immunity by the time the vaccine program starts chugging — and yet it looks like we’re going to roll out the vaccine without regard to that fact. Many millions of people who are already immune will receive shots that could go to those who aren’t and who’ll otherwise get infected and die this winter.

Seems … inefficient, to put it mildly.

But what’s the alternative? Even if you told the 14 million people who tested positive to go to the back of the line (which would mean virtually the entire White House, by the way), we’ll still be dishing out tens of millions of doses of the vaccine to people who don’t actually need it in the first few months of America’s vaccination program. How do we identify the people who did in fact have COVID previously, have now recovered from it and enjoy immunity, but never took a test and got a positive result confirming that they had the virus? The only way I know of is an antibody test. But how do you run antibody tests on 100 million people or more in a short period?

Is there such a thing as a “rapid” antibody test? I.e. someone shows up to CVS to get the vaccine and first has to get a five-minute antibody check to see if they’re already immune? Administering the vaccine is an onerous enough process without layering on a massive testing regime to find out who’s had COVID and who hasn’t. Even if we did that, other hard questions would arise. What if someone takes an antibody test and the presence of antibodies is confirmed but the test shows a relatively low level? Do we let that guy get vaccinated ASAP or do we hold him back? What level of antibodies should be deemed too low?


The logistical hassle involved in identifying who’s naturally immune and who isn’t seems like it’s far more trouble than it’s worth … until you remember that potentially half the doses of this initially scarce vaccine could be wasted on people who won’t benefit from it and denied to people who will.

We should start thinking about this because, according to Politico’s tick-tock of when the vaccine will be available for different groups, the great bulk of us who aren’t essential workers or high priority due to health challenges might be waiting until April or May to get a crack at it. Five months. When you consider how many daily infections there are right now, you’re left to wonder whether we won’t all have had the disease and either recovered or died by then. I’m aiming to be one of three or four Americans who actually needs the shot in order to gain immunity from the virus come spring.

Here’s Scott Gottlieb yesterday on CNBC noting that, although full immunity requires two doses, some people will get a degree of immunity from the first shot. Between that and the fact that, uh, everyone’s getting infected right now, we should see some darned strong herd-immunity effects on the daily case counts in January. This virus is going to start running out of people to infect long before everyone’s gotten the shot in May or June.


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John Stossel 5:30 PM | July 13, 2024