Ever since COVID-19 hit, I’ve been repeating the mantra, “Everything old is new again”. The reason is simple. Key to understanding a lot of the misinformation about COVID-19, its spread, and COVID-19 vaccines is an understanding that none of this misinformation is new. Rather, it’s the same misinformation that we at SBM have long been dealing with, just applied to the pandemic. Examples abound, including the minimization of the severity of COVID-19 that so much resembles how antivaxxers minimized the severity of the measles, misuse of the VAERS database to attribute harms to the COVID-19 vaccine that are very likely coincidental, false claims that COVID-19 vaccines cause infertility, and the appeal to “natural immunity” to the coronavirus and “natural herd immunity” as being inherently superior to vaccine-induced immunity or herd immunity from mass vaccination, which are denigrated as being somehow less than natural, artificial even—or even outright harmful. Never mind that achieving “natural herd immunity” requires that huge numbers of people be sickened and die of the disease, just as individual immunity from the disease requires the individual to be sickened and face the risk of severe disease and death.

Indeed, there is an eerie parallel between claims by Geert Vanden Bossche and Peter McCollough that COVID-19 mass vaccination is not just less effective but will lead to a “holocaust” and “depopulation” due to the emergence of ever more virulent COVID-19 “escape mutants” and the speculation by Andrew Wakefield pre-pandemic that the MMR vaccine will lead to a mass extinction due to the emergence of ever more virulent measles escape mutants.

Which brings me back to “natural immunity” and “purity.” Both are concepts embedded in alternative medicine, and an op-ed by Alan Levinovitz, an associate professor of religious studies at James Madison University and author of Natural: How Faith in Nature’s Goodness Leads to Harmful Fads, Unjust Laws, and Flawed Science, got me to thinking about them again in relation to COVID-19:

What began as a viral TikTok hashtag has infected every social media platform: Many of the proudly unvaccinated now identify themselves as #Pureblood.

Troubled observers have variously tied this term to the Harry Potter franchise (in which purebloods are Wizards untainted by muggle ancestry) and the eugenic Nazi fantasies of pure Aryan blood. But both comparisons miss the mark. The meaning of the hashtag is inseparable from vaccine refusers’ strong preference for “natural immunity,” a seemingly innocuous term that is actually a centerpiece of anti-vaccination ideology and ought to be abandoned immediately.

Although scientific authorities widely use “natural immunity” as a neutral description of immunity acquired through infection, it has different significance outside of medical journals. That’s because people often treat naturalness as synonymous with purity and goodness, even holiness. “God gave us a natural immunity,” said an announcer recently on Victory TV, a popular Christian network. “I personally choose God-given natural immunity over the new experimental vaccine for the safety and protection of myself and my family,” writes a chiropractor at Infinite Wellness Natural Healing Center. “How about you?”

I take a moment to observe right here that using the term “natural immunity”, as neutral as it sounds from a scientific perspective, was a huge mistake on the part of scientists for the reasons that Levinovitz describes above. Like the word “theory,” which in science implies a very high degree of certainty behind a proposition (e.g., theories of evolution and relativity) but in colloquial terms tends to connote any old wild guess, the term “natural” has very different connotations in the way most people who are not scientists use it.

Of course, vaccine-induced immunity is every bit as “natural” as immunity acquired after recovering from COVID-19, with the advantage that vaccine-induced immunity doesn’t require you to suffer through the disease and be at risk for the complications, long term disability, and death that it can cause. Otherwise, it uses the same “natural” processes that the wild-type virus does. As much as it perturbs me that this has to be explained again and again, boiling the concept of vaccination down to its essence, all a vaccine does is prime the immune system with a dead pathogen, a protein (or part of a protein from it), or a related but harmless pathogen so that the body can respond so much more quickly when the actual pathogen is actually encountered “in the wild”. The end result is to prevent you from becoming sick due to that pathogen. The best vaccines, of course, do more than that and prevent you from being infected at all (a phenomenon known as sterilizing immunity), but a good vaccine doesn’t have to induce sterilizing immunity or to be 100% effective at preventing transmission to accomplish a lot of very good things, again, not the least of which is preventing severe disease.

There is, of course, a scientific debate going on right now about post-infection immunity versus vaccine-induced immunity in terms of strength and duration of immunity, but that’s not what the invocation of “natural immunity” by COVID-19 contrarians and antivaxxers is about. What they are about is to deny the efficacy of vaccines and assert the supposed superiority of “natural” post-infection immunity, frequently in the context of minimizing or denying the likelihood of severe disease and death due to the coronavirus. The answers are coming in, seemingly slowly, but remember that SARS-CoV-2, the coronavirus that causes COVID-19, only first reared its ugly head in China less than two years ago. That’s not a very long time at all to answer these questions. So it is not surprising that, thus far, the scientific literature is not entirely settled, which leads to people who want to believe that “natural immunity” is superior to be able to cherry pick articles to support their viewpoint. Oddly enough, Friday Daniel Lawrence Whitney, a.k.a. Larry the Cable Guy, did just that:

“Not settled,” however, does not mean that there is no scientific consensus or that it’s not strengthening.

Also:

In any event, as summarized here (although I really do wish that the doctors who had written this had used the term “post-infection immunity” rather than “natural immunity”), there are a number of issues with post-infection immunity that make vaccination, even after recovery from COVID-19, desirable, including that:

As for that Israeli study, which has been widely cited for its conclusion that those vaccinated with the Pfizer/BioNTech vaccine were 13-fold more likely to suffer COVID-19 infection from the Delta variant than those who have recovered from the disease, it has…problems. First, it’s on a preprint server and hasn’t been peer-reviewed yet, which should tell you that you should take it with even more of a grain of salt than you take any study. Second, one thing I noticed right off the bat is how its tables and charts only report odds ratios (that “13-fold” number). You have to dig into the text to see that the absolute numbers of infections were quite low (for example, only 19 reinfections in one group) and actually do the math yourself to figure out that the breakthrough infection rates after vaccination were low. For instance, in model #1, the breakthrough infection rate was 238/16,215, or 1.5%; in model #2, it was 640/46,035, or 1.4%. I found that omission very curious, as well as the framing that didn’t mention that this study actually showed that the Pfizer vaccine was quite effective. It also showed that those who had recovered from COVID-19 and were later vaccinated were much less likely to be diagnosed with COVID-19. In addition, as described in this presentation, this study appears to have suffered from significant selection bias based on how different the populations being studied were. It also suffered from survivorship bias.

The bottom line: Contrary to the narrative being pushed, for COVID-19 “natural immunity” is not superior to vaccine-induced immunity, which is less variable and more reliable. Even if it were, yet again, I must emphasize that vaccine-induced immunity has a key advantage over post-infection immunity. It doesn’t require you to suffer through the illness and face the risks of severe disease and death from the disease to acquire it.

"Natural" splendor:

“Natural” might be beautiful,” but in terms of immunity, it might not necessarily be better. (Hopetoun Falls, Australia. Photo by DAVID ILIFF. License: CC BY-SA 3.0.)

“Purity of essence”

Regular readers know that, from time to time, I like to invoke one of my favorite movies of all time, Dr. Stranglove, Or: How I Learned to Stop Worrying and Love the Bomb. Old fart that I am, I sometimes find myself explaining (with difficulty) to younger people with no memory of life during the Cold War what it was like to live during the Cold War and how we were really afraid that any day nuclear bombs might rain down on our cities. Even though some of that paranoia ramped up again in the 1980s, it was nothing like the level during the 1950s and early 1960s, when the movie was made.

For purposes of this blog, though, one character resonates: General Jack D. Ripper, the unhinged “purity”-obsessed commander of a bomber group who at the beginning of the movie launches an unauthorized bomber first strike against the Soviet Union that the leaders of the U.S. frantically spend the rest of the movie trying to stop before the planes reach their targets and the bombs start falling. (Ramping up the consequences even beyond that of a nuclear war, there was also a revelation about a Soviet “doomsday” weapon that would be exploded if even a single enemy nuclear bomb were to explode on Soviet territory and render the surface of the earth uninhabitable for decades.) Indeed, that’s likely why we’ve mentioned this character several times over the years. In fact, re-watching the movie in the age of COVID-19 and QAnon, I’m struck with how much Gen. Ripper would fit into today’s zeitgeist, with his fanatical emphasis on “purity of essence” and his antifluoridation views. (Although the movie does not mention vaccines, I have no doubt that Gen. Ripper was also antivaccine. It’s all of a piece.) In fact, the reason Gen. Ripper launches his bombers to carry out a first strike was so as not to allow, as he put it, “Communist infiltration, Communist indoctrination, Communist subversion, and the international Communist conspiracy to sap and impurify all of our precious bodily fluids” (around 1:10):

(I always wondered at how Gen. Ripper could smoke cigars and drink alcohol while being so obsessed with his “purity of essence,” but no one ever said people were consistent.)

In any event, elsewhere in the movie, in a discussion with his assistant, an RAF officer named Mandrake, Gen. Ripper details his obsession with his “purity of essence” and his determination to deny women his “essence” during “the act of love”, as he puts it. Unsurprisingly (for the time), Gen. Ripper believed that the fluoridation of water was the mechanism by which Communists were accomplishing this nefarious aim to “impurify” Americans’ “precious bodily fluids”, as he explains while US troops are attacking his base as part of the government’s effort to take over the base, locate the recall code, and thereby abort the first strike:

I love General Ripper’s first question, “Mandrake, have you ever seen a Commie drink a glass of water?”

As I’ve discussed in detail before, General Ripper’s fear of “contamination” (or, as he puts it, “impurification”) of his “precious bodily fluids”, his obsession with “purity of essence” (the very term playing a large role in the plot), and his conspiracy theory that “they” are out to contaminate that purity in order to conquer him and the US, remind me very much of how antivaxxers and COVID-19 deniers are discussing the pandemic and, of course, COVID-19 vaccines. What I haven’t discussed before (other than alluding to it) is how this all ties into the idea that “natural” (i.e., post-infection) immunity is superior to vaccine-induced (and therefore “artificial”) immunity. The idea of “purity” versus “contamination” lie at the heart of many alternative medicine beliefs, and it is those beliefs, which tend to be religious in nature, that pervade the discourse over “natural” versus vaccine-induced immunity to COVID-19. Moreover, such beliefs tend to victim shame as well given that, like so many alternative medicine beliefs, they suggest that if you only eat the right foods, do the right exercises, and use the right supplements, you can render yourself almost immune to disease. A long time ago, I discussed this in the context of Bill Maher’s claim that he would not catch influenza on a plane because of his superior immunity, which led Bob Costas to retort, “Oh, come on, Superman!” I also discussed it in terms of Del Bigtree’s horrendous victim shaming when he urged his viewers to “catch this cold” to contribute to “natural herd immunity” against COVID-19, while blaming people with chronic diseases influenced by lifestyle (such as obesity and type II diabetes) for having brought it on themselves.

My response to Del Bigtree is the same response I make to every antivaxxer who urges “natural herd immunity” to COVID-19: You first. Oddly enough, those advocating that the “healthy” be infected never seem to seek out the infection themselves.

Let’s go back to what now seems like ancient history, the year 2019. Truly, from the perspective of 2021, 2019 seems like another time, but even then the seeds of what we see now were fully germinated in the context of measles outbreaks that were occurring around the country because of low uptake of the measles-mumps-rubella (MMR) vaccine in some areas. Statements like this were not uncommon:

Yes, that’s Del Bigtree joining in to support the misinformation. Unsurprisingly, Darla Shine soon doubled down:

Although there was pushback:

And even more ludicrously:

Again, none of this is surprising. The appeal to “natural immunity” is a very old trope that is frequently combined with conspiracy theories about vaccine “profits”:

By early December 2019, just as the first large COVID-19 outbreak that led to the pandemic was picking up steam in Wuhan, China, antivaxxers were traveling to Samoa, where a huge measles outbreak had sickened over 4,000 children and killed 60, to spread their disinformation about the MMR vaccine. No less a luminary than Robert F. Kennedy, Jr. wrote a letter to Samoan Prime Minister Tuilaepa Aiono Sailele Malielegaoi touting “natural immunity” to measles due to maternal antibodies in breast milk, while blaming a “defective” vaccine and implying that it was actually the vaccine strain that had caused the outbreak. His evidence? He had none. He was just handwaving and JAQing off. Let’s take a trip down memory lane and briefly quote his RFK Jr.’s letter:

Media reports from Samoa suggest that the infection is targeting young infants who are not yet of age to receive the measles vaccine. If true, the culprit is most likely a vaccine that failed to produce antibodies in the vaccinated mothers sufficient to provide the infant with maternal immunity. Young infants contracting measles is a relatively new phenomena first recognized in the 1990’s. Prior to the development and widespread use of Merck’s measles, mumps and rubella (MMR) vaccine, mothers passed protection to their infants via passive immunity derived from the placenta and breast milk. In contrast, mothers vaccinated with a defective Merck vaccine provide inadequate passive immunity to their babies. Merck’s version of the MMR has created a crisis where infants under the age of one are now highly vulnerable to these infections. These young infants suffer a much higher morbidity and mortality compared to populations historically impacted by wild measles later in childhood.

As I pointed out, none of this is actually correct, and maternal IgG antibodies to measles fall to zero by 6-12 months of age, while the IgA antibodies in milk are not nearly as protective and wane even more rapidly. I’m not going to relitigate the relevant science here; my point in bringing this up is as an example of how antivaxxers blamed the lack of “natural immunity” in Samoan mothers who had been vaccinated with MMR for their babies dying of measles in the outbreaks from two years ago. I also pointed out that high vaccine uptake is the best way to protect infants like these, coupled with earlier vaccination during outbreaks. If herd immunity is high, faster waning of immunity due to maternal antibodies is then much less of a problem. If herd immunity is not high, than vaccinating earlier is a viable option to protect these infants. In his letter, RFK Jr. also lamented how vaccines might not result in lifelong immunity to measles, another way that “natural” immunity is supposedly superior. Of course, post-infection immunity to measles isn’t always lifelong, and even if it were, lifelong immunity can be maintained with booster shots, something that antivaxxers seem to consider anathema.

Perhaps the most striking example of how in the age of COVID-19 everything old is new again comes from reconsidering an argument that the godfather of the modern antivaccine movement, Andrew Wakefield, made about measles five years ago. In brief, he claimed that mortality from measles had been falling long before the vaccine because of “natural herd immunity” due, of course, to “natural” infection and that this was so much better than the herd immunity due to the MMR vaccine. You can tell from where RFK Jr. got his argument about the immunity in mothers due to vaccination being “inferior” to immunity due to “natural” infection, though, because Wakefield made the very same argument three years earlier:

Vaccinated mothers do not confer adequate passive immunity upon their infants (< 1 year of age). Infants are unable to generate an adequate immune response to measles vaccine and in the absence of passive maternal immunity, are unprotected during the first year, putting them at risk of serious measles infection.

You can also see a precursor of a COVID-19 era antivaccine claim back then, as Wakefield also said:

The increasing Herd Immunity associated with natural measles and the accompanying decrease in morbidity and mortality, has been interrupted by vaccination. This makes it difficult to predict how vaccinated populations might respond to, say, a new strain of measles virus that has escaped the ‘protection’ conferred by measles vaccine (escape mutant). Because that population is not immune to the escape mutant we risk high morbidity and mortality from measles once again.

See the message? It’s that vaccinating will leave the population vulnerable to escape mutants. That’s a favorite antivaccine trope now used to argue against COVID-19 vaccination. Of course, I had the counterargument five years ago: Those who have “natural” post-infection immunity will also be vulnerable to escape mutants! Also, as must be repeated yet again, immunity from vaccination means not having to suffer through the disease itself to achieve immunity. As it turns out, this 2016 Wakefield argument was a precursor to an even more ludicrous argument in which he predicted that the MMR vaccine would lead to a “sixth mass extinction” (presumably of humans) due to the development of ever more virulent escape mutants. Other than some differences at the edges, at its core, Wakefield’s claim for the MMR and measles was identical to a claim made in a viral letter by COVID-19 crank Geert Vanden Bossche for the COVID-19 vaccine. The main difference is that Vanden Bossche claimed that a mass vaccination campaign during a pandemic is particularly dangerous, which made me wonder: When would be a better time to undertake a mass vaccination campaign than during a global pandemic that’s killed millions so far? Unsurprisingly, Vanden Bossche continues to fear monger about the emergence of “escape mutants” due to selection by COVID-19 vaccines, ignoring the observation from science that the richest source of new mutations is allowing the virus to spread and proliferate among the largest population possible.

It turns out, though, as Levinovitz points out, that the antivax appeal to “natural immunity” goes way, way back:

The language of naturalness short-circuits clear thinking about vaccines, substituting a theological binary — natural immunity vs. unnatural immunity — for empirical evidence. The standard vocabulary of medical science thus unwittingly undermines the very public health goals it is meant to serve by implicitly endorsing immunity that doesn’t come from vaccines.

None of this should be surprising, since we’ve known about the relationship between “pure blood,” naturalness and vaccine refusal for more than a century. The historian Nadja Durbach documented examples from Victorian anti-vaccination movements that would be right at home on TikTok: a father who feared his vaccinated baby had not a “drop of pure blood in its body”; an 1885 anti-vaccine banner that read “Pure blood and no adulteration”; and activists who asserted that vaccination was “pollution of our veins.”

For these Victorians, pure blood was “natural” and, by association, godly, because natural invoked the order ordained by God. The resulting ideology was, according to Durbach, a kind of “physical Puritanism” that granted vaccine resistance a divine mandate. Activists whipped up fear by describing vaccination as an “unnatural and dangerous” assault on the human body, unapproved by “Heaven’s will.”

Which brings us back to General Ripper:

The same associations remained powerful in the mid-20th century, when opponents of water fluoridation complained about unnatural adulteration of what should be pure. Their position — described by social scientists at the time as “naturalist syndrome” — was so mainstream that Stanley Kubrick skewered it in his classic “Dr. Strangelove,” wherein the lunatic Brig. Gen. Jack D. Ripper bemoans how fluoride corrupts the “pure blood of pure Americans.”

“Purity” vs. “contamination,” with disease and bad things caused by “contamination,” are at the root of much of alternative medicine and thus at the root of a lot of antivaccine sentiment. It’s at the root of the belief that “toxins” are the cause of disease and that “detoxification” is the cure. Before the pandemic, this belief manifested itself in many of the common antivaccine tropes involving “toxins” such as the false claim that vaccines are loaded with toxic chemicals, contain “fetal parts” or “fetal DNA,” and involve, as Bill Maher once put it, “injecting disease”, merely a different way of expressing the antivaccine trope that vaccines are “disease matter”. In the antivaccine world, as in the alternative medicine world, pharmaceutical products like vaccines are portrayed as “artificial” and “contamination” (of our precious bodily fluids) associated with decomposition, putrefaction, and impurity. Indeed, a decade before the pandemic, I encountered antivaxxers portraying vaccines as “transhumanism“. These same ideas from alternative medicine have manifested themselves during the pandemic in similar ways, with the added claims that mRNA vaccines somehow “alter your DNA,” thus by extension, presumably, “corrupting” your bodily essence, and, yes, “transhumanism” figures in this characterization too.

Never mind that:

Exactly.

The consequences of the term “natural immunity”

The idea that “natural immunity” is somehow superior to immunity acquired through vaccines has real-world consequences, too, particularly when it is applied to the pandemic. First and foremost, this idea is used by advocates as an intentional argument to oppose vaccine mandates of any kind, as we’ve seen many times. The line of argument goes like this: People with previous COVID-19 infection should not be required to get the vaccine as a condition of their jobs, to enter public spaces, or for any other reason. Again, this ignores the science showing that post-infection immunity is far more variable and might not be as long lasting as vaccine-induced immunity, as well as the logistical problems of documenting who has and hasn’t had COVID-19 for the purposes of such mandates.

When it comes to the claimed superiority of “natural herd immunity” things get even more dangerous and potentially deadly. After all, “natural herd immunity” was the rationale behind the Great Barrington Declaration, a declaration promoted a year ago by the free market libertarian think tank the American Institute for Economic Research that advocated, in essence, letting COVID-19 rip through the “healthy” population in order to achieve “natural herd immunity,” while using “focused protection” to keep those most vulnerable to severe disease and death from COVID-19 safe. As I discussed when it was first published, the Great Barrington Declaration did not describe how the vulnerable could be protected when the coronavirus was spreading unchecked through the rest of the population (it couldn’t) and actually represented eugenics more than anything else, as well as a technique of a “magnified minority” that sought to make a very minority fringe opinion seem mainstream. It’s a technique that had been used by climate science deniers, HIV/AIDS denialists, and creationists before, but unfortunately, unlike the case for those science denialists, the Great Barrington Declaration was a raging success. For example, UK Prime Minister Boris Johnson and then-President Donald Trump eagerly embraced the principles and ideas of the declaration. More recently, Florida Governor Ron DeSantis appointed a signatory and apostle of the GBD Dr. Joseph Ladapo as Surgeon General and Secretary of the Florida Department of Health.

The religious idea of “purity” versus “contamination” (with sin or evil or whatever) that requires “purification” is a very old one. It’s at the root of damned near all alternative medicine and is never lurking far from antivaccine views. This concept goes hand-in-hand with the idea that “natural” means “virtuous” and is always better than the “unnatural”, such as those nasty pharmaceuticals and vaccines. (Never mind that immunity from vaccination is natural.) It’s also a profoundly harmful idea. It was harmful before the pandemic when cancer patients sought out “natural cures”—but cancer is natural!—and antivaxxers touted “natural immunity,” and, as Levinovitz points out, it’s even more harmful now:

Of course, natural does not mean good or safe. For most of human history, natural childbirth killed massive numbers of women, and still does in areas with limited access to unnatural hospitals. Natural selection worked its divinely mandated magic by killing off scores of infants. And acquiring “natural” immunity to the coronavirus means getting sick in the first place, an experience far riskier — for oneself, one’s loved ones and one’s community — than the “unnatural” vaccines developed to protect against it. But accustomed as we are to equating natural with good, it is easy to overlook the many ways it is not.

Indeed. “Nature” doesn’t care if you or I live or die. Cancer is entirely “natural”. So is COVID-19.

Truly, everything old is new again. One might even say that everything ancient (such as the belief that “natural” is always better) is new again, mainly because prepandemic most people had not been exposed to how quacks and antivaxxers had weaponized these ancient ideas against modern medicine in general and vaccines in particular. The optimist in me hopes that people, now exposed to the fallacy that “natural is better” will understand how it was always a fallacy, and not just about vaccines. In the meantime, henceforth I will no longer use the term “natural immunity” without qualification to describe post-infection immunity, because messaging matters.

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Posted by David Gorski

Dr. Gorski's full information can be found here, along with information for patients. David H. Gorski, MD, PhD, FACS is a surgical oncologist at the Barbara Ann Karmanos Cancer Institute specializing in breast cancer surgery, where he also serves as the American College of Surgeons Committee on Cancer Liaison Physician as well as an Associate Professor of Surgery and member of the faculty of the Graduate Program in Cancer Biology at Wayne State University. If you are a potential patient and found this page through a Google search, please check out Dr. Gorski's biographical information, disclaimers regarding his writings, and notice to patients here.