Are the unvaccinated still a danger to the rest of us?

For nearly two years, COVID-19 vaccine refusers have been the subject of earnest pleas and financial inducements, shame and truth campaigns on social media. They’ve missed weddings, birthday parties, concerts and even lost high-stakes athletic competitions. Until last month, they were barred from entering the United States and more than 100 other countries.

Now the unvaccinated are suddenly back in the mix. They dine in restaurants, rock out at music festivals and fill the stands at sports venues. They roam freely in places where they used to be avoided for fear they might trigger superspreader events.

It’s like they’re no longer dangerous to the rest of us. Or are you?

“The unvaccinated are clearly a threat to themselves,” said Dr. Jeffrey Shaman, an infectious disease specialist at Columbia University. As recently as August, their risk of dying from COVID-19 was six times higher than fully vaccinated people and eight times higher than vaccinated and boosted people, according to the Centers for Disease Control and Prevention.

But, Shaman conceded, “for the rest of us, the danger is a more contentious issue.”

Certainly, when officials imposed vaccination requirements, the unvaccinated seemed to pose demonstrable threats to their communities.

State and local politicians have been trying not only to quell the spread of the virus, but also to prevent their healthcare systems from being overwhelmed and disrupting care for everyone. The unvaccinated made these goals more difficult to achieve because they were more likely to become infected and, if they did, would require hospitalization.

US officials had long hoped to inoculate the American public into a state of “herd immunity” where so few people would be susceptible to the virus that the outbreak would simply erupt. This goal assumed a uniformly high uptake of vaccines across the country. It was also based on a vaccine that protects against reinfection, permanently.

But none of that happened. About 30% of Americans have yet to complete their first series of COVID-19 shots, including the 20% who haven’t even rolled up their sleeves. Meanwhile, the virus is evolving in ways that are undermining the protection of vaccines, making “breakthrough” infections more common.

The longer the pandemic drags on, the more complicated things become.

Whether those who remain unvaccinated are still driving the spread of the coronavirus depends in part on the immunity status of the US population. Almost three years into the pandemic, it’s a difficult map to draw – both because public immunity comes from multiple sources and because it’s ebbs and flows.

More than 200 million adults and nearly 25 million children ages 5 and older have completed a first batch of COVID-19 vaccines. In contrast to the Omicron variant, however, the mere “full vaccination” offers little more than a touch of protection against infection and disease.

For the 49% of “fully vaccinated” Americans who have received at least one booster dose, infection remains possible, but the likelihood of becoming seriously ill or dying from COVID-19 is greatly reduced.

And then there is the “natural immunity” gained through coronavirus infection. By February 2022, after the first wave of Omicron infections swept across the US, 58% of Americans were thought to have been infected at some point during the pandemic, giving them a modest level of protection. The ranks of those previously infected have certainly increased since then, thanks to the second Omicron wave in late spring and summer.

An unknown number of Americans have “hybrid immunity” to both an infection and a vaccine. Researchers believe that contracting the coronavirus after vaccination (though not so much the other way around) may provide enhanced protection against serious illness and death. But whether that’s the case — and by how much — can vary, depending on how long ago an infection occurred and what variant caused it.

In other words, Americans’ vulnerability ranges from unvaccinated and never infected to vaccinated, previously infected and fully boosted, with infinite gradations of protection in between.

A masked man, right, wearing glasses and gloves, inserts a needle into the arm of a masked woman

A woman receives a dose of COVID-19 vaccine at First African Methodist Episcopal Church in Los Angeles in January 2022.

(Francine Orr / Los Angeles Times)

Under such conditions, the role that the unvaccinated might play in seeding outbreaks will be different.

“It’s kind of a patchwork quilt,” said Harvard University epidemiologist Stephen Kissler. “It changes over time and it changes in space. So it’s hard to tell where any particular community is at any given time.”

The steady decline in immunity raises a daunting prospect: that over time, people still labeled as “fully vaccinated” will become indistinguishable from the unvaccinated unless they receive a booster shot. Until more Americans take up booster shots, the “undervaccinated” will steadily swell the ranks of the vulnerable.

Wherever they are, they will help keep the pandemic going.

The country’s top vaccines from Pfizer-BioNTech and Moderna do not create a force field around recipients that protects them from ever contracting the coronavirus. They also don’t stop a person with a breakthrough infection from spreading the virus to others.

However, the vaccines appear to reduce the amount of virus that a sick person sheds through coughing, sneezing, or simply speaking. This means that unvaccinated people are not only more likely to be infected, but also slightly more likely to transmit it to others.

It would be hard to argue that the coronavirus would simply go under if everyone was vaccinated. This pathogen has proven adept at finding ways to circumvent our vaccine protection and will likely remain present among us for generations to come, like influenza and HIV.

But the unvaccinated and under-vaccinated almost certainly play an outsized role in the ongoing success of the coronavirus, experts say. Exactly how much is difficult to say. Scientists can quantify transmission differences between vaccinated and unvaccinated in the laboratory. Applying these differences to the real world is much more difficult, especially in a population as immunologically diverse as Americans are today.

Finally, there is concern that unvaccinated and undervaccinated Americans could accelerate the emergence of new coronavirus variants, some of which are bound to be even more transmissible or better at evading existing COVID-19 vaccines and therapies. Either – or both – would trigger new waves of transmission and disease.

Although a theoretical possibility, the unvaccinated are not fertile breeding grounds for genetic variants. People with compromised immune systems are much more likely to develop the long-lasting bouts of COVID-19, which can produce new variants with worrying mutations, and most of them are vaccinated.

COVID-19 flare-ups encourage variant emergence. Due to the sheer number of those infected, an increase increases the number of times the virus is replicated and gives it more chances of mutating. If it leads to hospitalizations, it will entangle patients being treated for immune-compromising conditions like HIV, cancer and organ transplants.

And as the unvaccinated are joined by more under-vaccinated people, climbs become a more plausible prospect.

People routinely confuse their community’s immunity status with their own vulnerability, said Dr. Peter Hotez, co-director of the Center for Vaccine Development at Texas Children’s Hospital and dean of Baylor College of Medicine’s National School of Tropical Medicine. When fewer of their neighbors are getting sick and dying, and high vaccination rates have suppressed COVID-19, even the unvaccinated feel invulnerable.

“It could be a fatal mistake,” he warned. Are the unvaccinated still a danger to the rest of us?

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