As public health officials scramble to reach Canada’s remaining unvaccinated population, one potentially sizeable subgroup remains elusive: people who have decided against getting a shot because they’ve already contracted and recovered from COVID-19.
The advice from public health agencies is unequivocal: Eligible individuals who have tested positive for COVID-19 should get immunized because the experts still don’t know what level of protection a previous infection provides, particularly against emerging variants of the virus.
“Those who have previously tested positive for COVID-19 should still be vaccinated,” according to the latest information on Ottawa Public Health’s website. “There is no information that suggests that antibodies from a recent SARS-CoV-2 infection would interfere with vaccine efficacy.”
I’m going to wait until the vaccines are proven.– David Cohen
That echoes the current advice from both Canada’s National Advisory Committee on Immunization and the Centers for Disease Control and Prevention in the U.S.
“While you will receive some immunity from having a previous infection, it remains unclear the duration and breadth of that immunity,” said Dr. Kumanan Wilson, professor of medicine at the University of Ottawa and CEO of CanImmunize, an Ottawa-based technology company specializing in immunization software.
“It’s uncertain whether being exposed to a previous version or variant of the virus will protect you against new variants as strongly as a vaccine will.”
‘Saying no for now’
It’s precisely that uncertainty that’s keeping David Cohen, 45, from getting his jab.
“I’m not saying no to the vaccine in its entirety, I’m just saying no for now,” said Cohen, who lives in downtown Toronto with his wife and their two children, who are seven and 10.
The whole family tested positive for COVID-19 in October after Cohen’s wife, who works as an immigration consultant, contracted the illness at a federal detention facility.
This spring, Cohen, who runs his own research and development tax credit firm, underwent an antibody test that he says showed he was teeming with antibodies, the proteins produced by the human immune system in response to infection.
“The data that I have found shows that I don’t need a vaccine. If the data was saying OK, your antibodies are not sufficient, I would say OK, it’s not sufficient, I’m going to go get the vaccine,” he said.
Cohen doesn’t know for certain that he’s immune to COVID-19 — he just hasn’t been convinced that getting vaccinated will make him any more immune than natural infection.
“Licensed physicians are shooting from the hip, and that’s the problem: we don’t have enough data at all out there to prove any which way,” he said.
Cohen is quick to point out that he’s no anti-vaxxer — he said he and his family have been immunized against everything else.
But as the son of a nurse, he said he’s always been taught to wait until new treatments are proven.
“The vaccine is something that is a maybe at best,” he said. “I’m going to wait until the vaccines are proven.”
‘I’m seeking out the truth’
Carole Lutes, an Ottawa mother of four school-age children, has also decided to wait before getting her family vaccinated against COVID-19.
Lutes believes her entire family contracted the virus in the earliest days of the pandemic, but were unable to get tested. This past March, her husband became ill again and tested positive for COVID-19.
Like Cohen, Lutes is looking for stronger evidence that vaccinating her family will do more good than harm.
“We are not going to be hasty, and we’re waiting right now just to see,” said Lutes, 42. “I’m seeking out the truth. I do not want to make a mistake with my children, so I’m being really conservative, really hesitant.”
Lutes wants proof that the natural immunity her family has already built up needs an artificial boost, and insists her decision is entirely evidence-based.
“I’ve been called an anti-vaxxer before and it just hurts, because that’s just not the truth, and unfortunately we get put in the same boat,” Lutes said.
Science catching up
Wilson freely admits scientists don’t have all the answers yet.
“We’re learning a lot about immunology through this whole process,” he said. “What we are seeing … is that the vaccine response seems to provide a bit broader of an antibody response than natural infection, which is more targeted to the specific exposure that you had at the time.”
He points out that the evidence for vaccination stems from randomized control trials, whereas the evidence for natural immunity is based only on observational studies, “so there’s more uncertainty there.”
Still, he said he can understand why people who have had COVID-19 might consider themselves immune.
“That’s an understandable confusion on the part of the public,” he said. “I think it’s something that does require some education. This is pretty complicated stuff when you get into talking about broad-based versus specific antibody responses.”
In fact, Wilson said there is emerging evidence that those who have been infected with COVID-19 can boost their immunity further by getting vaccinated, and could actually hold an advantage over people who haven’t been infected.
“Early data is suggesting that if you’ve had a previous infection and get a vaccine, you get a particularly strong immune response,” he said.
As of Wednesday, Ottawa had 27,730 confirmed cases of COVID-19. Ottawa Public Health said it has no way of knowing how many of those people remain unvaccinated.