From the beginning of the COVID pandemic starting two years ago, we have heard conflicting and often nonsensical recommendations from those charged with knowing better and leading the country through the biggest public health crisis that most of us have ever experienced.

From “15 days to slow the spread” to mask mandates changing as fast as the weather, reality and science was whatever those in power declared it to be on any given day. First, we were told that masks were worthless in stopping viruses. Shortly thereafter we were told to wear one, then two, then one, now back to none.

Masks are unnecessary in a crowded mall, restaurant, or BLM protest, but life-saving in an elementary school, airport, or airplane which is constantly recirculating and disinfecting the air. Similarly, the vaccines, we were told, would stop transmission and infection with COVID until we learned that they did neither, only reducing the severity of illness and risk of death.

In the U.K. for example, last month 80-90 percent of COVID deaths were among the vaccinated, although the “fact checkers” are eager to claim “misinterpretation” or “lack of context.” 

Nothing is permitted to interfere with the preferred narrative.

So, when are vaccinations no longer necessary? When has a country or region reached a sufficient level of herd immunity that life can return to some semblance of normal? Never mind the businesses, families, and lives destroyed by closures and mandates, whose only view of normal is in their rear-view mirrors. Life will never be normal again just as it isn’t for residents of a town devastated by a hurricane or tornado.

Several weeks ago, the New York Times asked: “Who should get a fourth Covid shot?” In other words, not one but two booster shots. The article acknowledges what many would agree with: “Several studies have found that while mRNA booster shots have been successful at preventing hospitalization and death, their effectiveness against infections is waning.”

Vaccine makers Pfizer and Moderna are all in for more boosters as more shots translate into more billions to the company and more C-Suite billionaires. Both vaccine makers have asked the FDA for emergency use authorization for second boosters, for adults age 65 years and older in the case of Pfizer and for all adults for Moderna. How soon until they are seeking authorization for a third or fourth booster? When does it all end?

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Who actually needs a booster injection, much less a second booster? Vaccine immunity rapidly diminishes, hence the push for boosters. Forbes notes: “More evidence has emerged that immunity to Covid-19 is quick to fade—in people of all ages, but more so for the old than the young.” A recently published British study, discovered that the prevalence of COVID antibodies across England dropped more than 26 percent in three months.

What’s missing from this discussion is the well-known concept of natural immunity, where exposure to an infectious agent causes the immune system of the affected individual to acquire both humoral and cellular immunity, which is often long lasting, perhaps an entire lifetime.

Individuals afflicted with the SARS infection in 2003 still have antibodies in their systems, now almost 20 years later. It’s safe to assume a comparable long-lasting immune response to those infected with COVID, as it is a similar virus. Acting FDA commissioner Dr Janet Woodcock says: “Most Americans will be exposed to the virus” with resulting natural immunity, which is why COVID will end as a pandemic, and become endemic like the seasonal flu.

Do these individuals need one, two, or more boosters on top of natural immunity? Do the benefits of boosters, on top of natural immunity, outweigh the risks of a vaccine-induced adverse event? Is this even being considered or discussed?

Natural immunity, acquired through a respiratory infection, also provides mucosal immunity. Vaccine immunity, the vaccine being administered into the body, results in blood circulating antibodies which are not triggered until someone has COVID infection within their body. Mucosal immunity can step in upon exposure to the virus, a first line of defense, preventing systemic infection.

Think of protecting a building on a large property. Blood-based immunity protects the building only, but mucosal immunity protects the property, stopping invaders long before they even reach the building.

I must add the standard and necessary disclaimer that I am not anti-vaccine, having been personally fully vaccinated. Nor am I offering medical advice, only an analysis of this recent news item. Any vaccine decisions should be between you and your physician based on a thoughtful analysis of risks and benefits, as is standard for any medical intervention.

As this paper in Clinical Microbiology and Infection explains: “The rationale for the early mucosal immune responses against SARS-CoV-2 starts with its entry and early replication in upper airway mucosal surfaces, especially the nasopharynx.” In other words, a robust first line of defense.

This means that vaccine protection kicks in once one is already infected, rather than stopping the virus in the respiratory tract, preventing it from entering the blood stream and causing infection. As the above mentioned article states, “According to a classic dogma, parenterally administered vaccines against mucosal pathogens induce primarily serum antibodies, but are poorly capable of generating protective mucosal immunity, at the pathogen entry site.”

Who should then receive a booster injection? Everyone or only those at higher risk of infection, hospitalization, and death, where the added protection outweighs the risk of a vaccine induced adverse event such as a blood clot or stroke.

As the NY Times article notes:

One reason older adults may benefit from an additional booster shot is because as the immune system ages, it tends to weaken and does not produce the same quantity or quality of antibodies as it did when it was younger. On top of that, older adults often have other medical conditions that take up the body’s attention, putting them at higher risk of severe disease.

In other words, protect the vulnerable, don't simply vaccinate everyone. Shingles and pneumococcus vaccines are available for older individuals but are not recommended for the young and healthy, including children, as their risk of infection is extremely low.

Otherwise, we are simply treating antibody levels, without providing much actual benefit to the vaccinated individual. A New England Journal of Medicine study looked at Israeli health care workers of all ages and found that both Pfizer’s and Moderna’s fourth shots bolstered antibody levels, though they were not very good at preventing infection. Are we treating a lab result or a person?

The blanket approach of vaccinating everyone, regardless of age and health status, is a one size fits all approach that runs contrary to modern medical care.  The FDA describes, “personalized medicine” as: “Decisions about who should get certain kinds of therapies or specific doses of a given therapy, or who should be monitored more carefully because they're predisposed to a particular safety issue.”

Why is COVID being treated differently? From the beginning, an alternative approach could have been to protect and isolate those at high risk, offering therapeutics, even if not validated by lengthy randomized prospective clinical trials, to others, allowing natural immunity to grow and eventually protect most of population.

This is how we approach other infectious diseases, yet with COVID the old rules went out the window, replaced by draconian lockdowns, business closures, and mandates. Now we are learning, as Johns Hopkins University researchers reported,

Lockdowns have had little to no public health effects, they have imposed enormous economic and social costs where they have been adopted. In consequence, lockdown policies are ill-founded and should be rejected as a pandemic policy instrument.

How soon until we learn the same about the endless stream of vaccine boosters, particularly for those at low-risk? The blatant disregard of past infectious disease policy suggests that these measures were more about control than actually protecting people, leaving a stain on those entrusted to protect our public health.

Brian C. Joondeph, M.D., is a fully vaccinated physician and writer. On Twitter as @retinaldoctor. And on Truth Social as @BrianJoondeph.