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COVID-19 vaccine mandates should not discriminate against natural immunity, The unnaturalistic fallacy https://jme.bmj.com/content/48/6/371 COVID-19 vaccine requirements, debate, policies should have recognised proof of natural immunity, sufficient basis for exemption to vaccination requirements. Arguments Two implausible claims about natural immunity: Natural immunity is superior to ‘artificial’ immunity It is better to acquire immunity through natural infection Naturalistic fallacy (many things are natural, but not good) (A natural public health strategy, increased overall morbidity and mortality) We lack clear and convincing scientific evidence that vaccine-induced immunity has a significantly higher protective effect than natural immunity. Vaccine requirements represent a substantial infringement of individual liberty, and other significant costs Can only be justified if they are necessary for achieving a proportionate public health benefit. Without compelling evidence for the superiority of vaccine-induced immunity, it cannot be deemed necessary to require vaccination for those with natural immunity. ‘vaccine passports’ ‘health passes’ Rationale for vaccine mandates Preventing healthcare systems becoming overwhelmed, (staff and patients) Reducing community viral transmission Acquired immunity naturally, potentially equivalent to vaccination immunity This is the unnaturalistic fallacy as opposed to the naturalistic fallacy Natural immunity and vaccine-induced immunity, evidence Equivalency of Protection From Natural Immunity in COVID-19 Recovered Versus Fully Vaccinated Persons: A Systematic Review and Pooled Analysis https://www.cureus.com/articles/72074-e All of the included studies found at least statistical equivalence between the protection of full vaccination and natural immunity; and, three studies found superiority of natural immunity. NNT to prevent one annual case of infection in COVID-recovered patients 218 NNT COVID-naïve patients, 6.5 33.5-fold difference in benefit between the two populations our review demonstrates that natural immunity in COVID-recovered individuals is, at least, equivalent to the protection afforded by complete vaccination of COVID-naïve populations Vaccinations for recovered people, marginal on an absolute basis. Omicron in adults aged 65 or over minimal or no effect against mild disease with the Omicron variant from 20 weeks after the second dose of ChAdOx1-S or BNT162b2 data are beginning to emerge which suggest that the effect of the vaccines on transmission may diminish within a matter of months Immunological memory to SARS-CoV-2 assessed for up to 8 months after infection https://www.science.org/doi/abs/10.1126/science.abf4063 Immunological memory is the basis for durable protective immunity after infections or vaccinations. Substantial immune memory is generated after COVID-19, involving, memory B cells, antibodies, memory CD4+Tcells, memoryCD8+T cells. Circulating antibody titers were not predictive of T cell memory. Do not reflect the richness and durability of immune memory to SARS-CoV-2. Reinfection Rates Among Patients Who Previously Tested Positive for Coronavirus Disease 2019: A Retrospective Cohort Study https://academic.oup.com/cid/article/73/10/1882/6170939?login=true N = 150,325 patients 8,845 (5.9%) 141,480 (94.1%) Protection against reinfection, 81.8% Protection against symptomatic reinfection, 84.5% Risk of SARS-CoV-2 reinfection and COVID-19 hospitalisation in individuals with natural and hybrid immunity: a retrospective, total population cohort study in Sweden https://www.sciencedirect.com/science/article/pii/S1473309922001438 Cohort one, 2,039,106 Cohort two, 962,318 one dose Cohort three, 567,810 two doses 767 individuals with natural immunity needed to be vaccinated to prevent one reinfection Protection against the Omicron Variant from Previous SARS-CoV-2 Infection https://www.nejm.org/doi/full/10.1056/nejmc2200133 Protection from prior infection against severe outcomes from Omicron remained robust, 87.8% Reinfection often occurs with negligible symptoms and high Ct values, indicating reduced epidemiologic significance The case for natural immunity exemptions Vaccine requirements have significant costs Substantial infringement of individual liberty There are non-trivial risks associated with vaccination The Biopharmaceutical Industry Provides 75% Of The FDA's Drug Review Budget. Is This A Problem? https://www.forbes.com/sites/johnlamattina/2018/06/28/the-biopharmaceutical-industry-provides-75-of-the-fdas-drug-review-budget-is-this-a-problem/?sh=5dc27d7649ec