The Playground

    Shane, that dialog has two problems:


    (1) a fanatic advocate up against a "sees both sides" cautious scientist

    (2) Hill's real contribution is summarised


    Watch the video I posted for a much better contextually rooted, but similarly adversarial, mediated discussion. It is a lot more informative. Especially about Tess's chaarcter.


    You discover the quality of people's judgement when they are, in a non-confrontational way, pressed for answers to the difficult questions.


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    The clowns try even harder!


    THHuxleynew our top forum fascist denies evidence based medicine.


    Trials are just for marketing and early testing. As we know from VIOX and tons of other non working drugs RCT trials have a very limited value.


    The only thing that counts in medicine is evidence that it works, that it does no harm!


    Please stop this fascist ASAP!!!

    Be honest about politics


    For example, my politics tend towards social responsibility and regulations to help everyone do this: when the costs of an NPI are low I view the cost of "freedom" to say not wear masks as higher than the cost of having fewer NPIs for COVID. That is a political view, subjective, and personal.


    If, however, I then say: "the science is clear - wearing masks reduces COVID R by such a large factor that if everyone did it in public places no other measure would be needed". Then I would be pushing my mask-loving politics into the science and taking something uncertain and known not alone enough (the effectiveness of masks) and hyping it up. That is not a subjective political judgement, where my view is as good as anyone else's - that is a biased and provably inaccurate statement about science.


    So with ivermectin. The politics here is about the role of doctors and hospitals as gatekeepers of medical treatments. It is proper for somone to say:

    "Doctors and other so-called experts should not have power over individuals. Anyone should be free to have any medical treatment they wish, however good or bad, as long as they can pay for it".


    Going from that to saying "Ivermectin is known to be effective treating COVID so for doctors not to provide this is homicidal" is biased and provably inaccurate science.


    In these cases the bias often comes from mis-measuring uncertainty. Claiming something that is very uncertain is in fact certain, or vice versa.


    When discussing it people may fix on the fact at issue (e.g. is ivermectin positive or negative as a therapy for those with COVID) and avoid thinking about the level of uncertainty. For ivermectin, where you put the balance of evidence now is an issue, also the uncertainty of that evidence is an issue. Those who are sure ivermectin (overall) is highly effective tend to rate evidence from studies as not suffering from consistent bias. If that is true certainty can be found from amalgamating large numbers of studies.


    Anyway - I think it super-unhelpful for the interesting science on ivermectin to be caught up with the politics. I'm pretty neutral myself on whether anyone who wants it should be allowed to dose with ivermectin. There are arguments both way. I'm not neutral on the scientific misrepresentations of the pro-ivermectin crowd - which are a disgrace. They have also made it more difficult for those who might give ivermectin the benefit of the doubt (and not worry about being wrong).

    Quote from Wyttenbach

    THHuxleynew our top forum fascist denies evidence based medicine.

    I just want to say W really gives me too much credit!


    There are many other, more competent, fascists than me.


    At school I always leaned towards neo-Nazi memes and have often wished I could live in Austria or Italy where others admiring the old values (strong rule by a powerful leader, keeping minorities away from contaminating society, ignoring or torturing so-called "experts" when they refuse to cooperate, giving the liberals the literal kicking they deserve if they ever come out onto the streets) have a larger place in certain segments of society.


    I can look forward to a more solid place in the UK with the rise in right-wing populist groups. My heros, such a "no-vaccine Bolsonaro" will I'm sure win out eventually.

    I think you need a morality check Thomas, you promote a vaccine with known side effects and some deaths have been attributed to, yet with all the ivermectin used around the world no deaths reported. Something to think about when you are writing your views. While people die, Thomas twiddles his thumbs!

    Quote from Fm1

    I think you need a morality check Thomas, you promote a vaccine with known side effects and some deaths have been attributed to, yet with all the ivermectin used around the world no deaths reported. Something to think about when you are writing your views. While people die, Thomas twiddles his thumbs!

    My role here has not been twiddling my thumbs: and I've explained why I'm motivated to do what I do.


    Everyone needs to review their own motivations and morality - it is what all the good religions promote, and what all good people do.


    It is also a good idea not to get into arguments with others about their religious beliefs or practices.


    Maybe I'd make an exception for Scientology - unconscionably still viewed as a religion in some countries. I'll argue against that any day.

    Quote from Fm1

    you promote a vaccine with known side effects and some deaths have been attributed to, yet with all the ivermectin used around the world no deaths reported


    I think that pretty much proves this point:


    Quote from THHuxleynew

    When discussing it people may fix on the fact at issue (e.g. is ivermectin positive or negative as a therapy for those with COVID) and avoid thinking about the level of uncertainty.

    Quote from THHuxleynew

    PS - if you wish to annoy me, you could refer to me by my middle name: Henry.

    Not trying to annoy you just trying to give you a little protective. The twiddling was in reference to rct. I promote vitamin D and feel everyone in the world would benefit from supplementation. The WHO has for over 20 years prior to the pandemic posted that vitamin D deficiency was a worldwide pandemic. You have done as much as you can to deflect from the studies I've posted on vitamin D and it's relationship with Covid and all auto immune disease. Any early treatment has been look at by you as inconclusive, it seems you deny the science more here than most. Have a nice day henry :thumbup:

    UK Scientists Emphasize Concern about Merck’s Molnupiravir


    UK Scientists Emphasize Concern about Merck’s Molnupiravir
    Although Merck’s antiviral targeting COVID-19 called molnupiravir has been authorized by Britain’s regulatory authority called the Medicines &
    trialsitenews.com



    Although Merck’s antiviral targeting COVID-19 called molnupiravir has been authorized by Britain’s regulatory authority called the Medicines & Healthcare products Regulatory Agency (MHRA), that doesn’t mean the novel drug doesn’t pose danger to some potential COVID-19 patients. The use of the drug needs to be closely monitored due to concerns associated with the potential to spur dangerous mutations, report scientists. TrialSite reported recently on the UK nationwide PANORAMIC study involving participants aged 50 and above who would be classified as at-risk: those subjects must have been infected with SARS-CoV-2 under five days. Several scientists went on the record expressing their concern about use of the drug while the producer, Merck, argues the calls are unfounded.


    The Study Drug

    TrialSite reported on the substantially degraded results of the study showing only a 30% rate of cutting hospitalization and death rates, based on adjusted statistics. Many scientists now raise the concern that the drug could become a genesis of new variants in weakened immune systems.


    Mechanics of Action

    The drug interferes with the ability of SARS-CoV-2 to replicate once it penetrates the cells. By introducing modifications to the SARS-CoV-2 genome, the Independent’s Samuel Lovett wrote that this could lead to a “build-up of copy errors that weaken the virus and prevent it from further replicating, allowing the body to clear it.”


    However, the journalist raises the specter of concern among scientists that a “fitter” version of SARS-CoV-2 can result from the ensuing mutation accumulation. These experts suspect that the risks are higher in immunosuppressed persons given they have a harder time fighting off infections.



    Expressed Concerns with Molnupiravir in the UK

    The Independent’s Lovett shared several concerns from a variety of experts in the UK. For example:


    University of Warwick Professor and virologist Lawrence Young went on the record that the “mutagenic effect” of the study drug continues to represent a “…concern.”

    While Emma Thomson, clinical professor of infectious diseases at the University of Glasgow in Scotland declared that those who are classified as “immunocompromised” should be administered “other therapies” in parallel “to avoid the generation of resistance.”

    Penny Ward, visiting professor in pharmaceutical medicine at King’s College London went on the record “The patient group that one would be most concerned about are immunosuppressed individuals, as viral clearance needs not only restrained viral replication but also an intact functioning immune system to clear the virus-infected cells.”

    A university of Leeds virologist, Dr. Stephen Griffin, further declared that it “may be wise to avoid treatment of long-term persistent [Covid] infections within immunocompromised individuals as changes may be more likely to become established.”

    The PANORAMIC Study

    TrialSite recently reported on the PANORAMIC study in the UK. Is molnupiravir a “game changer” or does it represent minimal clinical value with a potential for serious health risks? That is a question the University of Oxford and other centers seek to answer in this study.


    What about Pfizer’s PAXLOVID?

    Another antiviral for COVID-19 headed to regulatory review, the existing data thus far indicates the drug could be as high as 90% effective at reducing the risk of hospitalization and death among vulnerable COVID-19 patients. With a different mechanism of action, the drug doesn’t trigger mutations in the same manner as molnupiravir.


    Professors Young and Penny Ward point out that the Merck drug should be combined with PAXLOVID when immunosuppressed people are participating. These scholars suggest individuals infected with this at-risk cohort with COVID-19 should be given PAXLOVID as well “as this may reduce the emergence of [a] resistant virus.”


    Some have Little Concern

    Meanwhile, the Independent reports others, such as evolutionary genomics expert Aris Katzourakis, do not fret about the drug. But he does advise “monitoring chronically infected individuals, such as certain immunocompromised patients.


    Ward cannot be certain that the study drug, “may drive mutations,” however, according to the Independent, Ward is “unsure it would accelerate evolution in favor of new variants.”


    In the meantime, Merck declares any discussion of mutations associated with molnupiravir is “unfounded


    Scientists’ caution over use of new antiviral pill in immunosuppressed
    Concern that molnupiravir, set to be given to 5,000 Britons in coming weeks, could help drive emergence of new Covid variants
    www.independent.co.uk

    Quote from Fm1

    You have done as much as you can to deflect from the studies I've posted on vitamin D and it's relationship with Covid and all auto immune disease.

    No - I am not deflecting from them. I read them, and overall they don't seem convincing. Which means the data is uncertain. There could be some effect.


    That is the way it must be for any sort of vitamin supplementation. Unless an effect is very obvious (Vit D and rickets) you can't easily get evidence.


    Vitamin D correlates with: time in Sun, exercise, good diet - all things that correlate with higher incomes etc. Low Vit D (in blood) correlates with various illnesses. So distinguishing the benefit or risk of any Vit D supplementation is particularly difficult.


    I'm quite tactful - the most recent one showed a positive correlation between Vit D active component in blood and cancer... But those correlations mean very little whether positive or negative.

    40:years of uncertainty, how convenient.

    Introducing an International Treaty on Pandemics: Report on the WHA Special Session


    Introducing an International Treaty on Pandemics: Report on the WHA Special Session
    The World Health Assembly (WHA) convened a Special Session to decide if and how to develop an international agreement on pandemic preparedness and
    trialsitenews.com



    The World Health Assembly (WHA) convened a Special Session to decide if and how to develop an international agreement on pandemic preparedness and response. The Geneva meeting was only the second of its kind. TrialSite has previously reported on the silence of the World Health Organization (WHO) on the controversial topic of vaccine mandates, as well as ethical concerns related to global regulation.


    An assembly of member states, The WHA ultimately governs the WHO, and called the special session proposed at the 74th WHA event in May. Reserved for exceptional issues that require in-depth discussion, the only other WHA special session to date was a one-day event in November 2006 during which the director-general’s contract was approved. This second session was scheduled over three days from November 29, with provisions made for virtual attendance if necessary.


    Seeking Legal Binding of Nations?

    Ostensibly to improve overall pandemic response, the assembly considered the development of a “WHO convention, agreement or other international instrument on pandemic preparedness and response,” referred to in the documentation as the “new instrument,” with a view to initiating an intergovernmental process for drafting and negotiating this new instrument.


    Two main documents were provided for discussion in the meeting:



    The report of the working group on Strengthening WHO Preparedness and Response to Health Emergencies;

    A draft decision proposed by 43 individual nations in addition to the Member States of the African Group and Member States of the European Union.

    Is a new agreement on pandemic preparedness necessary?

    WHO calling for more global legal authority could raise an eyebrow, if not concern of critics from multiple directions and points of view? Concerns grows among some followers of the organization that it’s become beholden to industry money. On the other hand, what mechanism would be in place to supersede market forces to ensure equity among vaccine or therapy distribution?


    So, a working group reported on the benefits of an international agreement on pandemic preparedness, presenting this report at the Special Session of the WHA. In addition, the working group is also preparing a report related to proposed actions to improve the functioning of the International Health Regulations (IHR), in light of findings of an Independent Panel for Pandemic Preparedness and Response. This second report will be submitted to the Executive Board of the WHO at the 150th session on 24-29 January 2022.


    They were critical of the IHR, stating how it falls short in aspects of equity, “One Health,” information sharing, rapid response, financing, and compliance, amongst others. They indicated that current IHR systems could be strengthened in relation to certain aspects, like information sharing, but that other aspects may not fit under the IHR model and may be best addressed as part of a new legal instrument.


    One issue highlighted was compliance: while IHR is a legal treaty, compliance and accountability are not universal. There is a dispute resolution path provided in the IHR, yet not used. Thus, among other things, the group recommended strengthening compliance through incentives and assistance. However, they were undecided on whether this should remain part of the IHR treaty or form part of a new instrument.


    Noteworthy, this working group flagged a need for globally coordinated actions to prevent misinformation, disinformation, and stigmatization related to public health concerns. Would that lead to better, more objective information or even more censorship of any contrary or critical discussions as has been experienced during the pandemic?


    Equitable access to diagnostics, treatments, and vaccines was a highlighted benefit. The risks of pursuing a new instrument include the length of the process, the possibility of negotiating deadlock, and potential inefficiency at a time when resources are scarce.


    Should the decision be made to pursue a new instrument, rather than just strengthen the existing IHR, the form that the new instrument should take remained open. The group clarified the legal options, including agreements (opt-in), regulations (opt-out) and recommendations (non-binding). Of these, they suggested that an article 19 instrument, which is an opt-in agreement, would have the benefit of being legally binding on the states that chose opted in. However, there were concerns that an opt-in system may result in too few subscribers to have a meaningful impact.


    The group recommended that the Special Session be used to establish an inter-governmental negotiating body to develop the new instrument, clarify the procedures through which the draft will be developed, and support the working group in their endeavor to strengthen the WHO preparedness for response to health emergencies.


    The negotiator needs a new face

    The draft decision outlined that an intergovernmental negotiating body (INB) should be established to negotiate the new instrument. The INB would meet by March 1, 2022 at the latest, convened by the director-general. They would be tasked with developing a working draft; and by August 1, 2022, a final version. Progress reports would accompany the 76th WHA and its outcome at the 77th WHA.


    The draft decision was proposed by Albania, Argentina, Australia, Bangladesh, Brazil, Canada, Chile, Colombia, Costa Rica, Dominican Republic, Ecuador, Egypt, Fiji, Georgia, Iceland, India, Indonesia, Israel, Japan, Member States of the African Group, Member States of the European Union, Mexico, Monaco, Montenegro, Nepal, New Zealand, Norway, Pakistan, Panama, Paraguay, Peru, Republic of Korea, Republic of Moldova, Serbia, Singapore, Switzerland, Thailand, Trinidad and Tobago, Tunisia, Turkey, Ukraine, United Kingdom of Great Britain and Northern Ireland, United States of America, Uruguay, and Vanuatu.


    All together now – or not

    On November 29, the Special Session convened in Geneva, concluding on 1 December. Representatives from Member States offered opening remarks along with the European Council, the Coalition for Epidemic Preparedness and Innovations (CEPI), and the Global Outbreak Alert and Response Network (GOARN).


    The common theme in these addresses included the shortcomings in international cooperation highlighted by the pandemic. His Royal Highness Prince Salman bin Hamad Al Khalifa, the Crown Prince and prime minister of the Kingdom of Bahrain, said the pandemic had found us “without a global plan of action,” and that in the absence of standardized containment protocols, misinformation, and supply chain disruptions exacerbated the situation.


    Kassym-Jomart Tokayev, president of the Republic of Kazakhstan, pointed to “serious systemic inequalities at the global level.” This was echoed by Lionel Rouwen Aingimea, president of the Republic of Nauru, who stated that “it is clear that no-one is safe until we are all safe… ‘leaving no-one behind’ is a global responsibility.”


    The CEO of CEPI, Dr. Richard Hatchett, spoke of the unfolding situation regarding the Omicron variant as a direct result of vaccine inequity, stating that it “has fulfilled in a precise way the predictions of the scientists who warned that elevated transmission of the virus in areas with limited access to vaccines would speed its evolution.”


    Sebastián Piñera, president of Chile, agreed that the existing pandemic response system was “clearly insufficient,” and voiced his support for a legally-binding agreement, saying “non-binding instruments will only get us so far, and this is nowhere near far enough.”


    This was supported by Australia’s representative, who encouraged the implementation of a coherent, flexible and inclusive new instrument. The new instrument must have “real teeth” and strengthen global surveillance to reduce zoonotic disease risk.


    Calling for an End to “Discriminatory policies”

    In his opening remarks, Dr. Tedros Adhanom Ghebreyesus, director-general of the WHO, expressed his concern over the emergence of the Omicron variant, and emphasized the need to solve the vaccine crisis in order to end the pandemic. Clearly based on his words vaccination is the only way for the world to transcend the pandemic. He cited that more than 80% of the world’s vaccines have gone to G20 countries, with low-income countries receiving just 0.6%. He didn’t bother to note that some of the largest nations—many with sizeable economies—experience the largest numbers of deaths—USA for example has experienced more deaths due to COVID-19 than any other nation.


    He noted the lack of a “consistent and coherent global approach” which warrants a legally binding agreement. Referring to the role of the WHO’s Framework Convention on Tobacco Control in protecting people from exposure to tobacco smoke, he called for a “comprehensive, coordinated, effective” response to the threat of pandemics. He highlighted the need for better governance, better financing, better systems and tools, and a strengthened WHO.


    South Africa, where the new variant was identified, represented a group of southern African countries, including Botswana, Mozambique, Namibia, Zambia, and Zimbabwe. There was a call to lift discriminatory travel bans to southern Africa because of the Omicron variant, and that the COVID-19 response should be grounded on scientific evidence “following transparent reporting for collective action and solidarity to end the pandemic.” Botswana and Namibia supported South Africa and urged other countries to lift the “knee-jerk” travel bans to southern Africa.


    Representatives from the Central African Republic and Ghana strengthened this rhetoric, calling that unacceptable and discriminatory travel bans to seven African countries should be lifted.


    Tensions also appeared to be rising between Venezuela and the United States, with Venezuela calling out the US for subjecting it to “illegal, unilateral measures,” affecting the health of the Venezuelan population by prohibiting access to medication, health equipment, and COVID-19 vaccines.


    The United States responded to the allegations from Venezuela by saying “We regret that the Maduro regime has decided to use a multilateral forum to spread disinformation,” and that the US was providing humanitarian assistance, and the sale and export of food, agricultural commodities, and healthcare to Venezuela. In response, Venezuela concluded that they believe the US is acting illegally and the statements made by the US were repeating falsehoods.


    Equal Access

    A central topic which emerged repeatedly was the lack of access to vaccines in developing countries, while other countries were already providing booster shots to their populations. The Central African Republic is unable to reach vaccination targets due to lack of access to vaccines. The Gambia highlighted the 2% vaccination rate of most African countries, calling it “appalling.” This narrative was echoed by Tonga, Tanzania, Cyprus, Mexico, Madagascar, Brazil, Egypt, Ghana, Pakistan, and Barbados. The International Federation of Pharmaceutical Manufacturers Association acknowledged the need for equitable and fair distribution of pandemic products. Note mentioned by anyone was theunusually low total number of cases in sub-Saharan Africa except for pockets in South Africa and a couple other places.


    Ghana was among several countries to call out the inequities regarding access to other forms of medical assistance, as the bulk of medical countermeasures for COVID-19 has gone to “rich countries”. This statement was supported by representatives from Egypt, who highlighted the lack of data sharing between countries as well as the lack of “fair and equitable distribution of medicines, medical supplies, and vaccines among member states”. Tanzania stated that the inequities were “morally indefensible.”


    The issue of economic interests was raised by other participants as well. The representative of the Maldives brought up the issue of developments in the global public health sphere as a result of the pandemic that “involve non-state actors and business entities” that have an economic interest in the situation. Mexico echoed this concern, stating that it was necessary to protect the WHO from conflicts of interest “dominated by business interests and trade interests.” Has so-called regulatory capture gripped this global organization? Some believe so.


    Venezuela’s representatives hoped that a new instrument would contain provisions to promote the interest of public health above the pharmaceutical, insurance, and financial sectors. Hungary argued that vaccinations should be judged “solely and exclusively on a professional and scientific basis,” leaving political aspects aside.


    A united front

    While the proposed decision, which was made available at the start of the session, spoke of benefits in equity and enforcing compliance for member states, there wasn’t much more detail offered either in the documents or in the discussions.


    The issue of misinformation was raised both in the document and again in the organization’s address. The Republic of Moldova described it as an “avalanche of misinformation” and hoped that the new treaty would allow coordinated tackling of this issue. Slovakia agreed that misinformation undermines public health. It appears that one aim of the new legislation might be to provide a global approach to silencing voices that are not speaking in line with the health authorities.


    A comment made by the representative of the World Federation of Public Health Associations gave a further glimpse into the potential of this new global public health-focused legislation. They stated that the “new treaty will reaffirm the legitimacy of the WHO by enabling a comprehensive health surveillance system with independent verification of state reports.”


    Other countries tactfully expressed concern at the idea of a legally binding treaty that could over-rule or contradict their own state laws. Argentina, while supporting the idea of a new instrument, called on the process to be “transparent, inclusive and based on consensus,” respecting the sovereignty of member states.


    (Dis)agreements between Member States

    Whilst all speakers agreed the global response to the pandemic experienced shortfalls, their narratives were not aligned on overcoming that perceived problem.


    China supported amending the international health legal system with IHR at its core, stating that the “IHR remains and will remain the most critical legal document in global health governance for the present and future”. Representatives from Mexico and Cambodia supported China’s statements, saying that the IHR 2005 is the key international legal instrument for global health, and existing measures should be enhanced rather than to draft a duplicate “new” instrument.


    However, other countries supported the formation of a new, legally binding instrument. Bangladesh reiterated that the new instrument should be an effective tool that considers the transfer of intellectual property rights and technology, production of vaccines, and financing developing countries. If the instrument does not deliver on this, it will be “merely a political commitment, and not an effective tool,” they said.


    The decision to pursue a new instrument was passed without objection on the final day of the meeting.


    The final remarks during the Special Session were given by the director general. He called on member states to achieve the global targets of vaccinating 40% of the population of every country by the end of 2021, and 70% by mid-2022. He urged countries to share technology and know-how and to waive internal intellectual property rights. He concluded that countries that have made commitments to donate vaccines should make good on their promises.


    Final Thoughts

    There is no doubt that a coordinated approach to handling pandemics sounds good in theory. However, valid concerns are raised concerning the direction such a treaty might take. The funding links between commercial enterprises and the WHO raise questions over the independence of their recommendations. Focused on global distribution of new drugs, the discussions in this special session failed to touch on the ongoing assessment and potential withdrawal of those drugs when concerns arise. Instead, a universal approach to handling misinformation is proposed, without clarifying what is classified as misinformation.


    As of December 10, there are no resolutions published on the WHA Special Session site following the conclusion of the session. TrialSite will continue to report on any international discussions and the development of the new instrument as it unfolds


    WHASS2

    International Health Regulations (IHR) | Division of Global Health Protection | Global Health | CDC

    Allegations of Bill Gates and the WHO Influencing Vaccine-Only Protocols
    Many governments have drawn criticism for their delay in mobilizing resources or instituting preventive policies that would have minimized COVID-19
    trialsitenews.com

    Quote from zorud

    The mods should better stop people calling other members here fascicts from further posting. Just sayin...doesn't do good, even if it the playground....

    Judging insults is like pornography; you know it when you see it, but everyone sees it differently. We grapple with this all the time when we get complaints.


    Roughly, if you say "Joe, you are a liar", we edit. If you say "Joe, that is a lie" we don't. Lots of gray areas in between those two, but we try and do the best we can.


    And our sensitivity to moderating varies also according to the topic, and thread. Here in the Playground, or anything Rossi, we tolerate more/moderate less than other threads.


    But if you are offended, feel free to make a complaint. We read and talk about each. If more than one person complains about the same thing, we generally take action.

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    Israeli National Study: Natural Immunity Durability Appears Superior to 2-Dose Vaccinated Durability, but Hybrid Immunity Trumps All


    Israeli National Study: Natural Immunity Durability Appears Superior to 2-Dose Vaccinated Durability, but Hybrid Immunity Trumps All
    A group of Israeli researchers from a handful of prominent academic medical centers, as well as the Ministry of Health, recently uploaded their study
    trialsitenews.com



    A group of Israeli researchers from a handful of prominent academic medical centers, as well as the Ministry of Health, recently uploaded their study results to the preprint server medRxiv. Analyzing the Israeli Ministry of Health national database, the investigators sought out to better understand the nature and extent of the “rapid decline in protection against SARS-CoV-2 after two doses of BNT162b” observed in several studies. Regarding the Pfizer-BioNTech COVID-19 mRNA-based vaccine, what are the levels of protection and actual extent of vaccine durability? Also, what about the extent of natural immunity—how long does this last? A fundamental question the Israeli researchers seek to answer centers on the durability of immunity from both COVID-19 vaccination compared to natural immunity and those considered with hybrid immunity. They find a dynamic, complex, and unfolding situation necessitating more data, but some preliminary conclusions are in reach. Some may surprise the world and probably won’t make it into the mainstream media at this point.


    The research team refers to “several studies” showcasing the “substantial natural immunity six and more months” after infection with SARS-CoV-2, while one study purports to measure the marked benefit of mRNA-based vaccination over natural immunity when it comes to hospitalization. But in both those who have been vaccinated and people who have been infected, both are afforded protection, and in both cases that protection wanes over time.


    Moreover, some studies point out the researchers show that so-called hybrid immunity, that is people who were both infected with SARS-CoV-2 and fully vaccinated, “elicits neutralizing antibodies at higher levels, that it is more broad-spectrum, and that it provides more protection against infection than immunity conferred by vaccination or infection alone.”


    TrialSite notes that this study has yet to be peer-reviewed, thus the data herein shouldn’t be cited as medical evidence. But the findings do merit discussion.



    The Study

    During this study period (August 1, 2021 to September 30, 2021) the investigators sought to capitalize on a national database (real world data) of 5.7 million people, probing the “Time course of natural immunity resulting from infection by estimating the rates of confirmed SARS-CoV-2 infection among previously infected, unvaccinated individuals, previously infected individuals who have also received the BNT162b2 vaccine, and vaccinated individuals without previous infection” based on a time lapse analysis associated with data since infection or vaccination. Of course, during this period, the delta variant was the dominant pathogen in circulation in Israel.


    The study team segmented the cohorts of this retrospective observational study to understand the association of time since infection or vaccination to the rate of verified SARS-CoV-2 infection. Additionally, the team investigates the rates of infection within and between groups seeking to find different protection levels among hybrid immunity relative to A) natural immunity or B) immunity conferred by vaccination.


    Study cohorts included:


    Recovered: Previously infected individuals 90 or more days after confirmed infection who had never been vaccinated.

    Recovered then Vaccinated: Previously infected individuals who later were 7 or more days after receiving a single vaccine dose.

    Vaccinated then Recovered: Individuals who had been vaccinated with one or two doses and were later infected.

    Vaccinated: Individuals seven days or more after receiving the second dose, and who had not been infected before the start of the study period.

    Booster: Individuals who received a third (booster) dose 12 or more days previously and had not been infected before the start of the study period.

    Discussion of Findings

    The authors report that this is the first such study to “Comprehensively quantify the waning of natural and hybrid immunity at the national level in a real-world setting.”


    The study team finds that in the recovered cohort, vaccinated cohort, and the hybrid immunity cohorts “clear evidence of waning immunity.” They note this pattern cuts across all age groups. Of note, the Israeli team declared, “The adjusted rates of confirmed infection for the recovered sub-cohorts were lower than those of vaccinated sub-cohorts when comparing sub-cohorts with similar time from immunity-conferring event.”


    Moreover, protection within the vaccinated cohort can be restored via the booster (3rd dose). They further find, concurring with other studies, that hybrid immunity is superior to those who were never infected yet received two doses of the Pfizer-BioNTech vaccine (e.g., the Vaccinated cohort). They also found that adding a dose to a previously infected person or conversely to a doubly vaccinated person (i.e., booster dose) “restores the protection to the level in the early months following recovery or vaccination.” Timing of that vaccination matters regarding levels of protection. Unfortunately, the study team lacked sufficient data to investigate the influence of time between infection and vaccination on level of protection and durability.



    Some key points that probably won’t make it to mainstream media:


    Natural Immunity Superior to Double Vaxxed 3 to 8 Months Out

    The Israeli study team reports that like an Israeli HMO study, “previously infected individuals with or without one vaccination dose have better protection than uninfected double-vaccinated individuals 3 to 8 months after the last immunity-conferring event.”


    Natural Immunity Superior 3 to 6 Months Out?

    Additionally, analysis of hospitalized patients, while not enough for a complete analysis, does diverge from previous reports that imply vaccinated persons were afforded greater protection than natural immunity 3 to 6 months after the immunity-conferring event.


    Limitations

    The study data doesn’t address Omicron variant


    Study not yet peer-reviewed—shouldn’t be cited as evidence

    Observational study—subject to confounding bias, etc.

    Results are sensitive to detection bias because of different tendencies to perform PCR testing in study cohorts

    While testing rate differences among and between cohorts are observed their overall magnitude is relatively small

    Recovered Cohort level of protection may be slightly overestimated as PCR testing often lower in this cohort

    ·

    Potential to misclassify cohort


    Conclusion

    Across study cohorts protection against SARS-CoV-2 wanes over time after so-called immunity-conferring events. It’s important from a public health policy perspective to better understand how much effectiveness wanes over time across the varying cohorts.


    They conclude that when it comes to Delta, the dominant variant during the study period, effectiveness wanes over time in the case of both vaccinated and previously infected [natural immunity] people over time. While an additional dose does add protection the investigators do not know for how long. Moreover, it’s still not known what the optimal timing of such dose is—this requires additional study.


    Lead Research/Investigator

    Yair Goldberg, Israel Ministry of Health, Technion Institute

    Micha Mandel, The Hebrew University of Jerusalem

    Yinon M. Bar-On, Weizmann Institute of Science, Department of Plant and Environmental Sciences

    Omri Bodenheimer, Israel Ministry of Health

    Laurence Freedman, Sheba Medical Center, The Gertner Institute for Epidemiology & Health Policy, Bio-Statistical and Bio-Mathematical Unit

    Nachman Ash, Israel Ministry of Health

    Sharon Alroy-Preis, Israel Ministry of Health

    Amit Huppert, Sheba Medical Center, The Gertner Institute for Epidemiology & Health Policy, Bio-Statistical and Bio-Mathematical Unit; Tel Aviv University, Sackler Faculty of Medicine

    Ron Milo, Weizmann Institute of Science, Department of Plant and Environmental Sciences


    Protection and waning of natural and hybrid COVID-19 immunity
    BACKGROUND Infection with SARS-CoV-2 provides substantial natural immunity against reinfection. Recent studies have shown strong waning of the immunity…
    www.medrxiv.org

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