To vaccinate or not

The incidences are increasing and at the same time, at least for the first time, a phase-out of the measures is being discussed at the highest political level. A contradiction? No! Unfortunately, however, it is hardly possible to discuss questions about corona policy pragmatically and with an open mind. This is also due to the fact that there are many misunderstandings around vaccination and the resulting developments. Misunderstandings that are not only cultivated by vaccination critics, but also and above all by the faction of the "Lauterbach Ultras", the self-proclaimed "Team caution", without ulterior motives. However, if we cling to false narratives, we will never find a way out of the self-inflicted crisis.

Most of the misunderstandings of the proponents of measures stem from the time when the vaccines against the Sars-Cov2 virus were still in the earlier test phase and the experience gained with other vaccines was simply transferred to the corona vaccination. But even here they were purposeless optimists for no reason. For example, there are very few vaccines against diseases that (a) provide one hundred percent protection, (b) ensure true sterile immunity, i.e. ensure that vaccinated persons cannot pass the pathogen on to third parties, and (c) lead to lifelong protection. The complexity of this problem is shown by the example of the polio vaccination. In fact, the oral vaccine is one of the very few vaccines that can offer sterile immunity and thus lead to herd immunity and ultimately to the eradication of the disease. Unfortunately, in rare cases, the oral vaccination can lead to vaccine damage, which is why it has been replaced in Germany since 1998 by an inactivated polio vaccine, which does not guarantee sterile immunity.

So the expectations projected into the corona vaccines were unrealistic from the start. It was dreamed that a completely newly developed vaccine, which is also based on a completely newly developed technology, would have a performance spectrum that even traditional proven vaccines, which have been researched for decades, do not have. At the time, there was talk of vaccination as an act of solidarity, a targeted herd immunity, zero Covid and even the planned eradication of the Sars CoV2 virus - daydreams that never stood up to serious scrutiny. Above all, however, it is dramatic that these misunderstandings – which are actively cultivated by many media – still dominate the debate today and make it massively difficult to find a way out of the dilemma. It is time to address these misunderstandings.

Misconception 1: Vaccination protects against infection

Very few vaccinations provide one hundred percent protection against infection. This is no different with the vaccines against Covid 19 used today. Already in the approval studies, for example, the vaccine Comirnaty developed by Biontech was "only" able to demonstrate a protective effect of 95%. These vaccines were developed on the basis of the wild type of the virus isolated in Wuhan and in the later field studies, variant B.1 of the virus was dominant, which arose as a result of mutation of the wild type in northern Italy. However, when the vaccines came on the market, the "English variant" (beta) already dominated and since the summer of 2021, the "Indian variant" (delta) has also been dominant in Germany. However, today's vaccines are far less effective against the latter in particular. Recent studies from Scotland show the protective effect of the Biontech vaccine against asymptomatic disease with the Delta variant at 79%. The protective effect against a symptomatic disease is slightly higher at 83%.

So is the whole vaccination by the Delta variant pointless? No, because the vaccines offer quite decent protection against severe disease. The current data from Public Health England also show a protective effect of 96% for the delta variant of the Biontech vaccine against severe disease, i.e. diseases that require hospitalisation. Even the vaccine from AstraZeneca has a comparatively high value here, at 92%.

However, it is also the case that this protective effect apparently diminishes over time. Thus, protection against infection according to studies decreases six months after the second vaccination. The US health authority CDC now only assumes a protective effect i.h.v 66% in the USA and refers here to symptomatic courses. It is still unknown how high the protective effect against asymptomatic courses is including delta and the decreasing protective effect. If you put all the numbers in proportion, 50% could be a realistic value here.

However, this comparatively low value should not lead to panic, since it is ultimately only of interest in the context of the incidences. Asymptomatic disease is actually a paradox. Those who do not have symptoms, according to colloquial definition, are also not sick. However, it should also be clear that a protective effect of just 50% cannot guarantee that the disease can disappear through vaccination.

Misconception 2: Vaccinated can not infect anyone

If you really want to eradicate a virus, this is only possible if you have a vaccine in parallel to a very high vaccination rate, which ensures that the vaccinated person cannot pass the virus on to third parties. This was the case with the oral polio vaccine. However, this is not the case with the vaccination against Covid 19 and here the delta variant also has a significant influence.

In the meantime, the question is not whether vaccinated people can spread the virus, i.e. infect third parties, but whether there is a difference between vaccinated and unvaccinated people in this regard. Studies from the US state of Wisconsin showed that the viral load does not differ in vaccinated and unvaccinated people. This is also proven by further investigations by the US health authority CDC. However, it is still open whether the length of time that infected people can excrete this maximum viral load differs according to vaccination status. But even if this assumption could be proven, it would ultimately only mean that vaccinated people are just as contagious as unvaccinated people – but over a shorter period of time. This does not change the basic statement that vaccinated people can infect third parties.

Misconception 3: There may be herd immunity to Corona

Of course, if vaccination does not provide complete protection and vaccinated people can actively pass on the infection, then there can never be true herd immunity either. This is actually logical. Nevertheless, the entire debate on the part of the "caution team" is still directly or indirectly shaped by this very thought. If vaccinated people spread the virus to the same extent as unvaccinated people, any idea of herd protection or even herd immunity is simply paradoxical.

To illustrate this, a calculation example: Science currently assumes that the contagiousness, i.e. the contagiousness of the Sars-CoV2 virus through the delta mutation has increased by 50% and the vaccination protection is around 50%. So this is a zero-sum game in the end, which means no other than that the delta variant spreads just as quickly in a fully vaccinated population as the beta variant dominant last year in a fully unvaccinated population. Bye bye, herd protection.

Misconception 4: Only an almost complete vaccination rate allows an end to the measures

If there can be no herd immunity and no significant herd protection, it is also largely irrelevant to the question of the spread of the virus how many people are vaccinated. Neither a vaccination rate of 50%, 75% or even 100% would stop the virus. Only the (see above) still open question, whether vaccinated and unvaccinated are equally infectious, would have here a – albeit marginal – influence on the speed of distribution. Of course you can – if you really want to - spread through lockdowns etc. however, the issue of vaccination rates has little to do with it.

But at the latest here you have to remember what you are talking about at all. Because when it comes to the spread, it is only about the number of new infections and the resulting incidences. However, both are purely quantitative quantities that say nothing about the medical problem. This is where the vaccination rate makes a difference, as it significantly reduces the likelihood of severe disease.

Misconception 5: 3G or 2G would bring anything

If vaccinated and unvaccinated can be contagious, access restrictions á la 3G or even 2G do not make any sense. And this is not due to the unvaccinated, but to the vaccinated and the recovered. While unvaccinated people are not granted access at all with 2G and only with a negative corona test with 3G, both recovered and vaccinated people always have access with these models and do not have to be tested. Both groups can be infectious.

So if you want to actually reduce the incidences by means of access restrictions, you would have to willy-nilly move to a 1G model in which everyone – whether recovered, vaccinated or unvaccinated – only gets access if he can show a negative test. That would be consistent - from an epidemiological point of view and from the point of view of the critics of measures, this would make the madness of such restrictions generally visible. But since this would run counter to the politically intended vaccination campaign – why should a previously unvaccinated person be vaccinated if he has no visible advantage? of course, this will not happen and we will continue to slide into a kind of vaccination apartheid with 2G, in which we socially tolerate that a part of the population is harassed because of its vaccination status and its civil rights are curtailed.

Misconception 6: Vaccination is an act of solidarity

Those who get vaccinated today do not protect others, but themselves. Vaccination is not an act of solidarity, but a selfish act. Evaluations of Public Health England's large database show that vaccination figuratively reduces the individual risk of dying from Covid 19 to a level equivalent to around 30 years according to age prevalence. A vaccinated 80-year–old therefore has – with the same other risk factors - the same individual risk of dying from Covid 19 as an unvaccinated 50-year-old. It is not so easy to calculate what the benefit is when the relevant risk factors are present at the same time – but the data indicate that it is less.

Source: RT

The vaccination is – after weighing up the individual risks from the vaccine side effects – quite effective when it comes to the individual reduction of the risk from Covid 19. This is called self-protection. However, since vaccinated people spread the virus at best a little less than unvaccinated people, it is not an act of solidarity. No teenager needs to get vaccinated to protect grandma and grandpa. He can infect grandma and grandpa just as well despite vaccination. And if grandma and grandpa are vaccinated, they can just as easily infect their vaccinated or unvaccinated grandson. How to twist and turn it; everyone can infect everyone, vaccination plays a secondary role in this. This should actually make the debate about compulsory vaccination for employees of the health system superfluous. After all, the vaccinated nurse can infect her vaccinated and unvaccinated patients in the same way as her unvaccinated colleague.

Misconception 7: Hospitals are full of unvaccinated people

The data from Public Health England can be compared well with the clinical data from Germany and Israel. Recent figures from Israel show that the 17% of unvaccinated patients there account for 89% of ventilated patients in intensive care units and 60% of deaths. A clear age distribution can also be gleaned from the Israeli data.

Source: Haaretz

Despite the low vaccination rate, the figures from Germany are very similar. For example, in Germany in mid-September 89% of hospitalized corona patients were unvaccinated. However, the number of so–called vaccine breakthroughs – i.e. the severe course of the disease despite vaccination - increases significantly with age. Among those over 60, the proportion of vaccinated corona patients is almost 20%. But since this group also has the highest vaccination rate, this figure is by no means surprising. This proportion will increase significantly and soon there will be more vaccinated than unvaccinated people on the wards in Germany.

Even if we had a 100% vaccination rate, the hospitals would not be empty. However, then we would have a 100% share in the vaccine breakthroughs. The more vaccinated, the more vaccination breakthroughs there will be and the higher the relative proportion of vaccinated on the wards. However, here we are talking about relative, and not absolute figures.

Misconception 8: Hospitals are full of vaccinated people

At this point, one has to clear up a misunderstanding that is very popular, especially on the part of the vaccination critics. There they like to refer to the high number of vaccine breakthroughs in order to prove that the vaccination is ultimately pointless and brings nothing. But even this is wrong.

If one estimates very pessimistically that vaccination only offers 50 percent protection against severe disease, the incidence according to Adam Riese could be twice as high in a fully vaccinated population to cause as many hospital admissions as in a completely unvaccinated population. This is a fact, but also a theory.

How high the protective effect is in the real world can be estimated approximately by the numbers from England and Wales. Since "Freedom Day", the number of new infections there has fluctuated between 20,000 and 50,000, which is on average quite comparable to the winter wave from November 2020 to February 2021. However, the number of hospital admissions, at an average of between 700 and 1,000 per day, is very clearly below the figures of the winter wave, in which between 3,000 and almost 5,000 patients were admitted to hospitals per day. From this, a protective effect of around 80% could be calculated.

A majority of UK Covid patients are double vaccinated, mind you. For example, in calendar weeks 34 to 37, "only" 228 unvaccinated patients in the 70-79 age group with Covid-19 disease were admitted to UK hospitals, compared to 1,297 fully vaccinated patients in the same period. In this age group, however, the vaccination rate is also around 95%. If one considers the new admissions not in absolute numbers, but in relation to the total population of the vaccinated and the unvaccinated, one comes to 28 vaccinated per 100,000 inhabitants and 92.3 unvaccinated per 100,000 inhabitants in this age group and thus a protective effect of around 70%.

An increase in the vaccination rate in the risk groups thus inevitably increases the proportion of vaccine breakthroughs and the rate of vaccinated in the hospitals (relative size), but also leads to the fact that overall significantly fewer people would have to be admitted to a hospital (absolute size). This finding is important when considering not the incidence, but the capacity of the health system as the most important indicator of the issue of measures. States such as Great Britain, Sweden or Denmark are doing just that and allegedly there is already a traffic light system in Germany, in which the numbers from the hospitals should be a relevant factor for the imposition or repeal of measures. However, you do not notice anything in this country. Different in the UK. There is currently a doubling of new infections to 100,000 per day as a kind of advance warning. The calculation: If this also doubles the hospital admissions to the maximum, the situation is still manageable. This is British pragmatism.

Misconception 9: Next spring the pandemic will be over

However, there is still alarmism in Germany. Currently, people swear by the "last corona winter". In the spring, everything should be over and you can return to normal. But how do you come up with such an argument? If the vaccinations do not have a significant effect on the infections, it is also completely irrelevant how many people are vaccinated. Corona will remain. And why should winter 2022 be so different from winter 2021? Or in other words: Why should politics declare Corona overcome in spring 2022 if nothing will change at all in the basic situation?

What is it all about? If the aim of the policy is to minimize the number of serious cases and deaths, the only meaningful indicator would be the vaccination rate within the high-risk group. Here, by lowering the individual risk of becoming seriously or fatally ill, one would indeed have a set screw that would produce visible results. If you reduce the individual risk of a 90-year-old (see above) to that of a 60-year-old by vaccination, this is already a house number. However, whether the already extremely low individual risk of a 40-year-old is reduced by vaccination to the hardly existing individual risk of a teenager is completely irrelevant for public health. The vaccination question is downright counterproductive for even younger age groups. For those under 30 years of age, a reduction in the individual risk is hardly possible anyway, but then the potential serious side effects are to be booked, which pose a danger especially for younger people.

Misunderstanding 10: The current corona policy is without alternative

So is the demand for an immediate end to the measures pragmatism or cynicism? After all, it is calculatingly accepted that there are more deaths in both the unvaccinated and the vaccinated due to significantly higher incidences. This is a social issue. Neither with the flu nor with things like multidrug-resistant germs is there a political consensus that the top priority is to save every single human life and to accept collateral damage. Otherwise, we would probably have to impose permanent measures from now on.

Corona has come to stay. The widespread misconceptions mentioned here are still the basis for the corona measures to be accepted by a larger part of the population - not as a permanent condition, but as temporary restrictions that stop again when a certain target value is reached, e.g. in the vaccination rate. However, if these misunderstandings are cleared up, it turns out that we actually only have two logical alternatives.

Interim solutions á la "in spring it's over" are not substantiated in terms of content and illogical. The one alternative is to go the Danish way and end the measures immediately. The other alternative is to make the state of emergency the norm and become a society that wears a mask and establishes vaccination apartheid. Do we really want that?

Note Jens Berger: In an earlier version, the sentence "But also 83% means that out of 1,000 people who come into contact with the virus, 170 still fall ill with symptoms" was in the article. This calculation is wrong, because the effectiveness in the studies was calculated differently.