Who should get the COVID-19 vaccine now and who should wait?

Dr. Marc Siegel, Opinion columnist
·4 min read

With the coronavirus pandemic showing no sign of slowing down, multiple mutations to its core proteins are inevitable, and those variants that lead to a more transmissible virus offer a survival advantage and will soon predominate. While there is nothing unusual about this when it comes to new viruses, it is more common the more widespread the virus — and it does lead to a race against time. But is there enough time to beat down this virus before a variant emerges and predominates that is resistant to the very vaccine intended to prevent it? And will this variant require re-engineering of the vaccines we do have?

The answers to these crucial questions remain unknown. In the meantime, we need to do everything we can to slow the spread by masking, distancing, limiting gatherings and travel, and vaccinating as many people as possible. Our vaccines (two approved so far in the United States) are a limited resource, and production, distribution and administration are clearly a huge priority that will need to involve hospitals, pharmacies, doctor’s offices and an unprecedented massive national vaccination program by the federal government.

Vaccinate senior citizens

Vaccinating everyone 65 and older will do a lot to take the burden off our hospitals and slow the death rate dramatically. One thing we can do to help in the fight is to remove from the target group, at least for the time being, those who have had COVID-19 and recovered from it — excluding those 75 and older, where immunity is less certain once a person has experienced COVID-19.

Moderna COVID-19 vaccine on Jan. 20, 2021, in Louisville, Kentucky.
Moderna COVID-19 vaccine on Jan. 20, 2021, in Louisville, Kentucky.

My parents are in their mid-90s and recovered from COVID-19 last spring. They received the first dose of the Pfizer vaccine in Florida this week, as Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, suggested to me they should during a recent radio interview on SiriusXM.

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But there is little reason to doubt that the virus itself provides extensive and durable immunity, especially in people younger than my parents, both because of the extremely low reinfection rate, as well as the emerging scientific literature suggesting that natural immunity after infection (neutralizing antibodies as well as T-cells) lasts for several months if not years.

Vaccines if you haven't had COVID

This means that most people who have recovered from COVID-19 should not be vaccinated right now. We must prioritize the vaccine for those who haven’t had it. Because the real number of cases could be two to three times what has been reported, I believe that all vaccination centers should be reviewing antibody tests before administering the vaccine. It is a simple blood test, and though not 100% accurate, it's certainly an indication of prior COVID-19. Patients with antibodies should not be at the front of the line to receive the scarce vaccine.

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When we give out vaccines, just as we must prioritize health care and other front-line workers because of contacts with possible coronavirus patients as well as those with preexisting conditions, including obesity and diabetes, at the same time we must put off vaccinating those who have already had COVID-19. By spring, we should hopefully have a more specific test to determine immunity.

Any such test would include a measurement of what are known as “neutralizing antibodies,” which bind to the spike protein of the virus and keep it from infecting your cells. With this and other tests, we will be able to determine with greater accuracy who needs the vaccine and who doesn’t, and how long any immunity you have will last.

Dr. Marc Siegel, a member of USA TODAY's Board of Contributors and a Fox News medical correspondent, is a professor of medicine and medical director of Doctor Radio at NYU Langone Health. His latest book, "COVID: the Politics of Fear and the Power of Science," was published last fall. Follow him on Twitter: @DrMarcSiegel

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This article originally appeared on USA TODAY: COVID-19 variants: Racing to beat resistance to existing vaccines