Covid in media

Only vaccinate those at risk – not the young and healthy

Back in 2009, a full sixty percent of the Swedish population was vaccinated against the swine flu. Professor Hans Rosling called the pandemic a ”media hype” and immunologist Ann-Cathrin Engwall warned that mass vaccination could do more harm than good [1,2]. At least 350 Swedish children and young adults developed narcolepsy from the vaccine, Pandemrix, which contained new components that had not previously been used in this context [3].
A few years later, Sweden and Norway, which had both mass-vaccinated their populations against swine flu, ended up having more severe influenza seasons than other countries. This suggests that the protective effect offered by the vaccine was at best temporary, and resulted in these countries being hit harder when the swine flu virus subsequently developed into a seasonal virus [4]. Many of the vaccinated individuals did not develop a broader T-cell based immunity against viral proteins, which caused them to become more susceptible to viral variants. Are we about to make the same mistake again in 2021?

In over 85% of cases, covid-19 mortality is linked to one or more underlying diseases, and it primarily targets the very old [5]. In the group aged 90 to 99 years, 1 in 30 have died in the Swedish population. In the group aged 70 to 79 years, 1 in 420 have died. In the group aged 0 to 19 years, that number is 1 in 500,000 [6].
Known risk factors and the distinct age gradient should direct which countermeasures are used to fight the disease [7]. Mass vaccination of a young and healthy population is not medically justified but, on the contrary, is associated with some risks. The fatal coagulation disorders we have recently seen are just one example [8]. We should therefore only vaccinate those over the age of 65, as well as those with identified risk factors for death and serious illness upon infection. Individuals that have been infected and subsequently recovered from covid-19 have a natural immunity, and do not benefit from pre-vaccination.

For SARS-CoV-2, there are several pathways that contribute to the individual’s protection, e.g.

1. Innate defense mechanisms that respond to viral properties [9],
2. Acquired cross-immunity via previous infections with similar viruses [10],
3. Acquired immunity via covid-19 infection,
4. Acquired immunity via pre-vaccines.

As an example of innate defense mechanisms, an international study discovered that one in three Europeans likely carry a gene variant inherited from neanderthals, which helps them to break down the virus’s genome more effectively [9].
Previous infections with the common cold caused by other coronaviruses can also provide partial immune protection against SARS-CoV-2. One study showed that people who were infected with SARS in 2003 were immune to the new coronavirus seventeen years later. The countries affected by the MERS and SARS epidemics have experienced a less severe situation this time around, probably due to partial immunity in the population [10]. Overall, studies from around the world show that 25 to 50 percent of the global population has cross-immunity [11,12,13].

Researchers at the Karolinska Institute have shown that people without detectable antibodies and who have not experienced any symptoms can nevertheless have T-cell based immunity to the new coronavirus. The level of immunity to covid-19 in the population is therefore likely much greater than we have been able to measure so far [14]. Immunity after infection is unlikely to differ from other respiratory viruses, which means that re-infection is rare, and when it happens will usually only result in mild symptoms [15,16].
Epidemiologist John Ioannidis estimated that by February 2021, 19 to 25 percent of the world’s population have been infected [17]. Since no major lockdown was implemented in Sweden, in contrast to other countries, the proportion of infected and therefore immune individuals in our country is probably high.
The pre-vaccines are a new type of vaccine. The immune system is activated, and the vaccine effect is achieved only after our cells have taken up the vaccine template and produced and exposed the viral spike protein on their surfaces. More than one in three Swedes has now received at least one dose of pre-vaccine [18]. Individuals with risk factors are particularly well represented among those who have already been vaccinated. This means that the death rate from the virus is almost certainly going to be very low going forward.

Mass vaccination during an ongoing coronavirus pandemic outside of risk groups is, in our opinion, inappropriate and provides little benefit relative to the short- and long-term risks. The use of the pre-vaccines must be considered experimental, as the clinical trials have so far only released two months’ worth of follow-up data, and the trials still have more than a year left to run. This means that the spectrum of rare and delayed side effects is still not fully known, as exemplified by the recent attention surrounding lethal coagulation disorders.
Our wish is that decision makers more carefully weigh benefit versus possible risk based upon the known facts. We strongly suggest that only those over the age of 65 or those with risk factors be pre-vaccinated. Otherwise, we risk repeating the serious mistakes that were made in 2009, when we mass-vaccinated against the swine flu.

Sven Román MD, specialist in child and adolescent psychiatry
Nils Littorin MD PhD
Sebastian Rushworth MD
Ann-Cathrin Engwall PhD in molecular cell biology with focus on immunology
Ragnar Hultborn MD PhD, specialist in oncology, professor emeritus
Sture Blomberg MD, specialist in anesthesiology and intensive care, associate professor
Ralf Sundberg MD, specialist in surgery, associate professor
Lilian Weiss MD, specialist in surgery, associate professor
Susanna Hartmann-Petersen MD PhD, specialist in dermatology
Dinu Dusceac MD PhD, specialist in cardiology
Anna Maria Wiedemann MD PhD, specialist in family medicine
Boris Klanger MD, specialist in family medicine
Olga Lundberg MD, specialist in family medicine and rehab medicine
Ludwig Hellmundt MD, specialist in anesthesia and pain medicine
Robert Svartholm MD, specialist in family medicine
Hans Zingmark MD, specialist in internal medicine and pulmonology
Carina Ljungfelt MD, specialist in family medicine
Christina Malm MD, specialist in family medicine
Fritz Probst MD, specialist in family medicine
Kristian Holmberg MD, specialist in family medicine
Magnus Burling MD, specialist in family medicine
Nina Yderberg MD, specialist in pediatric psychiatry
Sven Meenen MD, specialist in family medicine
Margareta Andersson MD, specialist in occupational medicine
Maria Papadopoulou MD, specialist in ophthalmology
Ida Höglund MD, specialist in surgery
Hans Sjögren MD, specialist in anesthesiology and intensive care
André Marx MD