Dear Editor
After over three years of the first diagnosed ‘Case of COVID-19’ on the 17th November 2019 and the World grappling with the ‘COVID-19 Pandemic’ formally declared by the WHO on the 11th March 2020, the ‘Unfolding Uncertainties’ remain ‘Unending’. Increasingly by the day, more is known about the SARS-CoV-2, COVID-19 and ‘COVID-19 Pandemic’ BUT much more remains unknown with ‘Certainties’: The ‘Uncertainties’ are increasingly ‘Evolving’ and are ‘Unending’. These ‘Uncertainties’ relate to virtually every aspect of the SARS-CoV-2, COVID-19 and the ‘COVID-19 Pandemic’: They include, among several others, the Origin, Nomenclature and Taxonomy of the Disease and Aetiologic Agents (Variants/ Sub-variants), Susceptibility/ Vulnerability, Transmission Controversies, Changing Manifestations, Treatment, Outcomes and Prevention[1-14]. Several other ‘Unresolved Issues’ include, among others: ‘Response to Vaccines-Vaccination’, ‘Duration of induced Antibodies’, ‘Protection and Duration of Immunity following Vaccination’, ‘Mixed Vaccine Brands Issues’, ‘2nd Dose Uncertainties’, ‘Pervading Boosters Unfinished Matters’, ‘What Constitutes ‘Full Vaccination’ against ‘COVID-19’’[15,16].
Recent ‘Communications’[17,18] concerning ‘Hybrid Immunity’ is, therefore, quite intriguing and enlarges the ‘Pool’ of the ‘Uncertainties’ regarding SARS-CoV-2, COVID-19 and the ‘COVID-19 Pandemic’. The ‘Hybrid Immunity’ is defined to be ‘Immunity’ resulting from a ‘Mix’ of ‘SARS-CoV-2 Infection’ and ‘COVID-19 Vaccination’ in any ‘Order’ and provides a ‘Higher Protection’ against ‘Infection’ and ‘Reinfection’ than ‘Protection by either alone’[18] It is reported that, from the ‘Systematic Review and Meta-Regression’[17,18], the ‘Protection’ against ‘Infection’ from ‘Hybrid Immunity’ (Previous Infection and Subsequent Vaccination) drops to 41.8% after 12 months but ‘Protection’ against ‘Severe COVID-19’ and ‘Hospital Admissions’ remained high at 97.4%. Comparatively, the ‘Protection’ against ‘Reinfection’ from ‘Previous Infection alone’ drops to 24.7% but against ‘Severe Disease’ and ‘Hospital Admissions’ was fairly high at 74.6%. These data amplify the ‘Vaccination-Immunization-Protection Triad Transformation’ (VIP Triad Transformation) and the imperative to identify and uphold the ‘Determinants’ undergirding the ‘VIP Triad Transformation’. Ordinarily in ‘Vaccinology’, ‘Vaccination’ should offer ‘Protection’ against ‘Infection’. ‘Vaccination’ should not rely on ‘Infection’ for ‘Effective Protection’ against ‘Reinfection’. Is this a ‘New Normal’: The ‘Hallmark’ of the ‘COVID-19 Pandemic’?
This very brief ‘Communication’ seeks modestly to excite further ‘Conversation’ on the ‘Issue’ of ‘Hybrid Immunity’ and the ‘Value’ to be harnessed in the ‘Global Fight’ against the ‘COVID-19 Pandemic’.
REFERENCES
1. Godlee F. COVID-19: Weathering the storm. BMJ 2020; 368:m1199 of 26th March 2020
2. Eregie C.O. COVID-19 Pandemic: The difficult unresolved increasing challenges in weathering the storm. https://www.bmj.com/content/368/bmj.m1199/rr-10 of 31st March 2020
3. Eregie C.O. COVID-19 Pandemic: Still on the difficult unresolved increasing challenges in weathering the storm. https://www.bmj.com/content/368/bmj.m1199/rr-13 of 2nd April 2020
4. Kickbusch I, Leung GM, Bhutta ZA, Matsoso MP, Ihekweazu C, Abbasi K. Covid-19: how a virus is turning the world upside down. BMJ 2020; 369:m1336 of 3rd April 2020
5. Eregie C.O. COVID-19 Pandemic: Further perspectives on the difficult unresolved increasing challenges in weathering the storm. https://www.bmj.com/content/368/bmj.m1199/rr-16 of 5th April 2020
6. Eregie C.O. COVID-19 Pandemic: The daunting challenges of assuring sustainable benefits from weathering the storm. https://www.bmj.com/content/368/bmj.m1199/rr-14 of 8th April 2020
7. Eregie CO. COVID-19 Pandemic and the Value of Antibodies Testing: Still More Matters in the Works. https://www.bmj.com/content/370/bmj.m2655/rr-1 of 14th August 2020
8. Mahase E. Covid-19: Vaccine brands can be mixed in ‘extremely rare occasions’ says Public Health England. BMJ 2021; 372:n12
9. Eregie CO. COVID-19 Pandemic, beyond the ‘Vaccines Marathon Finish Line’ and ‘Post-Vaccine Approval Programmatic Haze’: The Evolving ‘2nd Dose Uncertainties’. https://www.bmj.com/content/372/bmj.n18/rr-12 of 24th January 2021
10. Eregie CO. COVID-19 Pandemic, beyond the ‘Vaccines Marathon Finish Line’ and ‘Post-Vaccines Approval Programmatic Haze’: The evolving ‘2nd Dose Uncertainties’; still more unfolding ‘Matters in the Work’. https://www.bmj.com/content/bmj.n18/rr-13 of 27th January 2021
11. Eregie CO. COVID-19 Pandemic, COVID-19 Vaccines and ‘2nd Dose Uncertainties’: Still unresolved evolving matters. https://www.bmj.com/content/372/bmj.n162/rr-3 of 8th February 2021
12. Eregie C.O. COVID-19 Pandemic, COVID-19 Vaccines and successful vaccination programmes: a further clarion call to observe research governance-related best practices and a critical look at preprints. https://www.bmj.com/content/376/bmj.o321/rr of 23rd February 2022
13. Eregie C.O. COVID-19 pandemic, Immunity and Infectivity: evolving facts support the imperative for sustained compliance with non-pharmaceutical interventions. https://www.bmj.com/content/378/bmj-2020-061402/rr-1 of 23rd July 2022
14. Eregie C.O. COVID-19 Pandemic and Rising COVID-19 Rates even among ‘Fully Vaccinated’ Persons: A Further Imperative for Emphasis on the Non-Pharmaceutical Interventions; ‘No One is Safe Until Everyone is Safe’. https://www.bmj.com/content/378/bmj.o1712/rr-1 of 11th August 2022
15. Eregie C.O. COVID-19 Pandemic, COVID-19 Vaccines and Boosters: More Unresolved Evolving Matters in the Works. https://www.bmj.com/content/375/bmj.n3011/rr of 17th December 2021
16. Eregie C.O. Covid-19 Pandemic, Reinfection, Reactivation and Covid-19 Rebound: Efficacy of Covid-19 Pharmaceutical and Non-Pharmaceutical Interventions; The Imperative to Guard Against Interventional Precocity in Downing Guards. https://www.bmj.com/content/377/bmj.o1365/rr of 15th June 2022
17. Bobrovitz N, Ware H, Ma X et al. Protective effectiveness of previous SARS-CoV-2 infection and hybrid immunity against the omicron variant and severe disease: a systematic review and meta-regression. Lancet Infect Dis 2023;18:S1473-3099(22)00801-5.doi:10.1016/S1473-3099(22)00801-5.
18. Torjesen I. Covid-19: Vaccination plus infection offers best protection, finds study led by WHO. BMJ 2023: 380:p171
Professor Charles Osayande Eregie,
MBBS, FWACP, FMCPaed, FRCPCH (UK), Cert. ORT (Oxford), MSc (Religious Education), FAMedS, FIPMD
Professor of Child Health and Neonatology, University of Benin, Benin City, Nigeria.
Consultant Paediatrician and Neonatologist, University of Benin Teaching Hospital, Benin City, Nigeria.
UNICEF-Trained BFHI Master Trainer,
ICDC-Trained in Code Implementation,
*Technical Expert/ Consultant on the FMOH-UNICEF-NAFDAC Code Implementation Project in Nigeria,
*No Competing Interests.
COVID-19 Pandemic, ‘Hybrid Immunity’ and protection against SARS-CoV-2 infection and reinfection: the ‘Uncertainties’ are unending