The single most important objective of mass vaccination with Covid-19 vaccines was to achieve herd immunity! Meanwhile, health authorities and their advising ‘experts’ have acknowledged that herd immunity is no longer within reach. They now tend to blame a number of factors for not achieving this goal. Amongst those, they like to cite disappointing vaccine coverage rates, essentially in the younger age groups, and reduced efficacy of the current vaccines towards emerging viral variants. They claim that instead we’re now luckily heading towards a situation where the virus is becoming endemic and where vaccination will be key to ensure individual protection! Unless one is dealing with a pandemic or epidemic, only vulnerable people (the so-called ‘target population’) are getting vaccinated. As also younger people are now increasingly contracting Covid-19 disease, the need for all of us to get the shot remains unchanged and hence, mass vaccination campaigns are to be continued. That’s at least the narrative that is currently used to convince youngsters and children to take the shot too.
From a scientific viewpoint, the above interpretation of the current situation is beyond shortsighted and is lacking every piece of scientific evidence. First, the weak link between the (rising) number of cases and the (declining) hospitalization and mortality rates, as now observed in a number of countries with high vaccine coverage rates, is not reflecting a transitioning of the virus into an endemic phase. Endemicity is not possible without herd immunity and herd immunity is the last thing that the ongoing mass vaccination campaigns will be able to achieve (see below). The weak link is much more likely to result from the fact that in many cases the vaccines still provide protection against severe disease whereas the infection rate is now dramatically increasing due to enhanced circulation of more infectious variants that flourish on a background of increasing spike (S)-directed immune pressure exerted by the (massively vaccinated) population. As already mentioned in multiple previous contributions, increased infectivity rates in the population will make it more likely that younger age groups get re-exposed to the virus at a point in time where they have become vulnerable (i.e. during a temporary window of suppression of their innate antibodies by short-lived, immature S-specific antibodies). As the vast majority of individuals in the younger age groups have either not been vaccinated at all or only received a single shot of a 2-dose vaccine, the level of their functional (i.e., non-suppressed) innate antibodies (Abs) may still be high enough to prevent severe disease. I presume that this situation is going to change for the worse when i) the virus becomes resistant to the current vaccines (which genomic epidemiologists acknowledge is inevitably going to occur) and ii) the number of fully vaccinated youngsters is going to substantially increase. This is to say that the seemingly attenuated clinical symptoms are unlikely due to a shift of the pandemic towards endemicity or diminished virulence of circulating viral variants but merely reflect the impact of growing resistance of the virus to vaccinal Abs combined with a higher level of viral infectiousness. Growing resistance would still grant older age groups some remaining vaccine-mediated protection whereas younger age groups could still rely on some remaining innate immune protection. How otherwise could diminished hospitalization and mortality rates be reconciled with a steep incline in infection cases? This is certainly not a typical feature of a pandemic that is on the path of extinction!
It is, indeed, quite unbelievable that some advising experts pretend that although we won’t achieve herd immunity, we will still be able to exchange the pandemic for an endemic situation. When does that happen? The answer is: never. Neither disappointing vaccine coverage rates nor diminished virus neutralization rates should be blamed for failure of these vaccines to enable herd immunity. From their very first conceptualization, it should have been very clear that these ‘S-based’ Covid-19 vaccines are completely inadequate for generating herd immunity in a population, regardless of the magnitude of Ab titers induced or the rate of vaccine coverage. Why is this? Let’s first have a closer look at the definition of ‘herd immunity’. Herd immunity occurs when most of a population is immune to an infectious disease and thereby provides indirect protection to those who are not immune to the disease. Mechanistically, indirect protection is due to absence or strong reduction of infectious transmission by those who have been immunized (i.e., the majority of the population). So who concluded all of a sudden that herd immunity would only depend on antigen (Ag)-specific (in this case, ‘spike-specific’) humoral (Ab) responses and nonantigen-specific innate immunity (i.e., operated through several different immune stimulatory and modulatory cytokines and chemokines secreted by immunocompetent cells, including noncytotoxic Ag-specific T cells)? If this were the case, a natural pandemic could never irreversibly evolve into an endemic infectious situation. Here is why S-specific Abs and nonAg-specific innate immunity could never force the Sars-CoV-2 pandemic into endemicity, let alone eradicate Sars-CoV-2:
In the course of a natural pandemic, individuals who got asymptomatically infected or developed symptoms but recovered from the disease will be protected from productive re-infection by trained innate immunity or by acquired S-specific antibodies, respectively. The latter will be rapidly recalled upon re-exposure. Consequently,the vast majority of the population will be able to control the infection at the portal of entry upon re-exposure to the virus. This leads to rapid diminishment of viral transmission and provides the basis for growing herd immunity during a natural pandemic. Because of the rapid elimination of infected cells at the portal of entry, previously infected individuals will significantly reduce viral transmission in the host population. In the presence of declining S-specific Abs, the vast majority of individuals who are in good health may still be protected against productive infection as their trained innate Abs are thought to outcompete non-neutralizing anti-S antibodies. However, individuals who are immunologically naïve or whose health state is debilitated will become susceptible to infection and disease. It is reasonable to assume that declining anti-S antibody titers in individuals with underlying health issues or otherwise immune suppressed may still enable S-specific Abs to outcompete innate, polyreactive IgMs. Similarly, the neutralizing capacity of anti-S antibodies may become suboptimal in individuals who become infected by a variant that is different from the one they previously recovered from. The occurrence of sub optimal neutralizing capacity likely explains how a limited ‘seasonal’ outbreak could be initiated on a background of herd immunity. In contrast, previously asymptomatically individuals who become re-infected in the absence of anti-S Abs will eliminate the virus regardless of the SARS-CoV-2 variant they become infected with. This is in sharp contrast to the immune response induced by vaccination of naïve individuals. Although suboptimal titers of functional vaccinal Abs cannot prevent viral infection and transmission, they may still protect vaccinees from contracting (severe) disease. However, as none of the current Covid-19 vaccines induces S-specific cytolytic T cells, vaccinees endowed with suboptimal S-specific Ab titers will no longer be able to abrogate viral transmission upon re-infection with Sars-CoV-2. In addition, mass vaccination campaigns conducted in the heat of the pandemic simultaneously allow large cohorts of subjects with suboptimal Ab titers (e.g., as occurring after the first dose or between the 1st and 2nd dose of a 2-shot vaccine) to become exposed to the virus. This enables naturally selected immune escape variants to evade vaccinal (S-directed) Abs. Conclusively, the transmission-blocking potential of the immune status conferred to the population by mass vaccination is spike Ab-dependent and substantially lower than that conferred to a population that becomes infected by Sars-CoV-2 during a natural pandemic. This is to say that in the course of mass vaccination campaigns large parts of the population are left with suboptimal / incomplete immunity (e.g., Ab titers too low, Abs not fully mature/ functional, no priming of Ag-specific cytolytic T cells) and can, therefore, not control viral transmission upon exposure to the virus.
This, together with the propensity of viral variants to propagate on a background of S-directed immune pressure, prevents ‘imperfect’ vaccines from establishing herd immunity when used in mass vaccination campaigns at the height of a pandemic. As a result, vaccinees are prone to breed naturally selected immune escape variants and serve as asymptomatic spreaders. This is exactly the opposite of what herd immunity is defined as! It is important to note that coronaviruses have evolved a broad spectrum of strategies to also evade nonAg-specific innate immune responses. S-directed immune escape can, therefore, not be compensated by nonAg-specific innate immunity, even if the latter originates – at least to some extent – from stimulation of S-specific T cells (see references 12, 13 in previous critical opinion article: ‘Why is the ongoing mass vaccination experiment driving a rapid evolutionary response of SARS-CoV-2?’).
Overall conclusion: From the very beginning of the mass vaccination program, it should have been clear that because of the intrinsic limitations of S-based Covid-19 vaccines and their deployment in mass vaccination campaigns in the midst of a pandemic, herd immunity was simply the last thing this mass vaccination program could possibly achieve and that moving this program forward would fulfill all the conditions for driving S-directed viral immune escape to eventually result in full resistance of Sars-CoV-2 to the Covid-19 vaccines. Boosting vaccinal Abs with 2nd generation vaccines is not going to solve the issue of immune escape, even if the immunization with ‘updated’ vaccines would be repeated by 6-month intervals. This is because 2nd generation vaccines will primarily recall S-specific Abs elicited by the first generation vaccines (due to ‘antigenic sin’) and not be effective against recombinations of Sars-CoV-2 variants, which are highly likely to occur as a result of co-infection, especially in the most vulnerable (see previous critical opinion article: ‘Why is the ongoing mass vaccination experiment driving a rapid evolutionary response of SARS-CoV-2?’).
The more rational way to control infectious viral transmission in a pandemic of an acute, self-limiting viral infection and to achieve herd immunity is to use live attenuated vaccines. An even more effective approach to immune intervention in a pandemic is to use vaccines capable of conferring sterilizing immunity as those will rapidly and dramatically reduce (asymptomatic!) viral transmission, thereby providing herd immunity at a low vaccine coverage rate and eventually enable virus eradication.
Geert Vanden Bossche received his DVM from the University of Ghent, Belgium, and his PhD degree in Virology from the University of Hohenheim, Germany. He held adjunct faculty appointments at universities in Belgium and Germany. After his career in Academia, Geert joined several vaccine companies (GSK Biologicals, Novartis Vaccines, Solvay Biologicals) to serve various roles in vaccine R&D as well as in late vaccine development.
Geert then moved on to join the Bill & Melinda Gates Foundation’s Global Health Discovery team in Seattle (USA) as Senior Program Officer; he then worked with the Global Alliance for Vaccines and Immunization (GAVI) in Geneva as Senior Ebola Program Manager. At GAVI he tracked efforts to develop an Ebola vaccine. He also represented GAVI in fora with other partners, including WHO, to review progress on the fight against Ebola and to build plans for global pandemic preparedness.
Back in 2015, Geert scrutinized and questioned the safety of the Ebola vaccine that was used in ring vaccination trials conducted by WHO in Guinea. His critical scientific analysis and report on the data published by WHO in the Lancet in 2015 was sent to all international health and regulatory authorities involved in the Ebola vaccination program. After working for GAVI, Geert joined the German Center for Infection Research in Cologne as Head of the Vaccine Development Office. He is at present primarily serving as a Biotech / Vaccine consultant while also conducting his own research on Natural Killer cell-based vaccines.