The Coming Crisis?
Q&A with Geert Vanden Bossche #4
If a vaccinated person acquires, and recovers from, a symptomatic SARS-CoV-2 variant infection (COVID), will this person now have "natural immunity" to the same degree as a recovered non-vaccinated person? Or will there still be some competition from the vaccinal antibodies? Many vaccinated people I know are becoming infected with moderate symptomatic disease and then recovering in 3-5 days.
This remains a difficult question. I am afraid, from an immunological viewpoint, breakthrough infections are a pain. As breakthrough infections accumulate, immune escape variants will only become more and more prevalent. This is because vaccines that cannot protect against mild or moderate disease allow vaccinees to shed virus while rapidly recalling and boosting their original vaccinal Abs (due to ‘antigenic sin’). The combination of mounting Ab titers and high viral load, within an increasing part of the vaccinated population experiencing breakthrough infections - only promotes further immune selection and dominant propagation of viral immune escape variants, which then, further improve on resisting vaccine-induced immune pressure of their infectiousness. It is, therefore, fair to assume that the recent emergence of Omicron resulted from large-scale breakthrough infections in a highly vaccinated population.
This is in sharp contrast to a situation where an unvaccinated individual contracts C19-disease. Unvaccinated individuals contract C-19 disease as a result of the virus breaking through their innate immune defense; in which case, viral transmission occurs well in advance of the appearance of a robust humoral response and, therefore, doesn’t cause immune pressure on viral infectiousness. De novo priming of anti-S Abs that are directed at the relevant circulating variant, prevents natural selection and adaptation of more infectious variants in the unvaccinated population.
Furthermore, vaccinal Abs continue to suppress innate immunity. This being said, it’s difficult to believe that recall of vaccinal Abs, in vaccinees who experience a breakthrough infection, would not accelerate the occurrence of viral resistance to the C-19 vaccines and not continue to further suppress the innate immunity of vaccinees. Recall of vaccinal Abs is inevitable given the dominant circulation of highly infectious strains. In other words, I fear that protection of vaccinees who recovered from C-19 disease and are re-exposed to the virus will be much less efficacious than the immune protection acquired by a nonvaccinated person who recovered from C-19 disease.
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