Are We In A "Pandemic of the Unvaccinated"?
“A pandemic of the unvaccinated” is a term that has come into vogue in certain circles. It is a politically powerful slogan, but it involves an irresponsible, careless, and socially divisive caricature of a very complex group containing sub-groups with dramatically divergent risks of being hospitalised with Covid-19. What is insinuated by those who glibly speak of a “pandemic of the unvaccinated” is that anyone who turns down a Covid vaccine is being a bad citizen by needlessly exacerbating a major public health problem. But that insinuation is not borne out by the available evidence.
Many ill-informed and divisive simplifications about unvaccinated people continue to get bandied around by politicians, journalists, and even some doctors and scientists. This fog of confusion is further exacerbated by the lack of transparency in the presentation of hospitalisation data. As anyone who has done any serious digging on these matters can attest, it is incredibly difficult, if not impossible, to find accurate, complete, and transparent data related to Covid hospitalisations and their vaccination status.
Here are five elementary questions that need to be answered if we are to understand whether it is true that anyone who does not vaccinate is thereby worsening the Covid crisis. Whether you are a budding investigative journalist, or just a concerned citizen who wants to pester your national or local health authorities with requests for information to shed some light on what is really going on, the following questions might be a good place to start. I have done a little digging for myself, in a mine of public data that is not exactly overflowing with transparency, and here is what I have found:
1. How are Covid hospitalisations distributed between completely unvaccinated patients and patients who have received one or more doses of a Covid vaccine?
This might seem like an obvious question, but it is actually quite difficult to get a straight answer to, since much of the official data counts recently vaccinated patients as “unvaccinated,” or else only compares data between completely unvaccinated and “fully vaccinated” or “double-dosed” patients (here is one clear example of a way of representing hospitalisation data that essentially ignores the contribution of partially vaccinated patients to hospitalisations; here is another).
But if, as some evidence suggests, the act of vaccinating is associated with increased chances of infection, especially in the two week period after the first dose, a period that is often categorised as “unvaccinated” or essentially ignored in the presentation of hospitalisation stats, then many hospitalisations potentially caused by the vaccine will not be visible to the public in the data presented in official reports.
Remarkably, based on a preliminary search of official government records in multiple jurisdictions, I could not find any hospitalisation data that included the percentage of Covid hospitalised that were simply un-jabbed versus jabbed. Whatever happened to data transparency? How hard could it be to include hospitalisation stats on those who had been jabbed yet not yet fully vaccinated? Why would that sort of basic information be omitted from official reports and tables?
2. How are all-cause hospitalisations distributed between completely unvaccinated patients and patients who have received one or more doses of a Covid vaccine?
Only by knowing the distribution of all-cause hospitalisations across jabbed and unjabbed persons can we properly detect whether, or to what extent, fluctuations in hospitalisations may or may not have been associated with different phases of the vaccination campaigns. For example, if vaccination causes a secondary harm such as a bloodclot or myocarditis and Covid-19 is not detected, this will not be reflected in the Covid hospitalisation data. I am not saying that vaccinations cause spikes in hospitalisations, just that it is very much in the public interest to have all of the relevant information on the table. Information on the precise vaccination status of all-cause hospitalisations does not appear to be in the public domain.
3. What is the medium to long-term impact of vaccinations on infections and hospitalisation rates?
Some people are still relying on data from relatively early on in the vaccination campaign, for example July and August 2021, to show that vaccinations reduce the rate of infection and hospitalisation. This biases results by taking data during a warmer period of the year which does not favour viral activity. In addition, evidence suggests that vaccine-induced immunity wanes substantially in a matter of months, even if its protection against severe disease subsists. So the only sensible way to measure the medium to long-term impact of vaccinations is to focus on hospitalisations and infections in the latter months of the vaccination campaign, especially as we head into the flu season - in this case, November and December 2021.
4. Among the unvaccinated, which age and health cohorts actually end up in hospital, and in which proportions?
This question is of critical importance for pinpointing which citizens are actually at moderate or high risk of hospitalisation from Covid-19. To say that “unvaccinated” citizens, taken as an undifferentiated group, are uniformly at risk or are all putting the hospital system under strain is simply false, since we know that several identifiable groups within the population of the unvaccinated are at low or very low risk of hospitalisation from Covid-19, and are not “filling up” our hospitals. Several such groups are worth mentioning:
(i) First, those who have already had Covid-19. Severe disease from reinfection is rare, and rates of illness and hospitalisation among the unvaccinated Covid-recovered are actually lower than among the vaccinated who have not been naturally exposed to the disease (as shown, for example, in this study).
(ii) Second, children and teenagers. They make up a very small percentage of Covid-19 hospitalisations. It is important to understand that Covid-19 risk is highly age stratified. For example, the risk Covid-19 poses to the life of the elderly varies a thousandfold or more from the risk to children (the estimated Infection Fatality Rate for over 80s in Spain, for example, is a thousand times greater than for 10-19 year-olds)
According to official official ONS (Office for National Statistics) data from the UK, in the week ending November 27th, the Covid hospitalisation rate for children between 5 and 14 was 1.27 per 100,000; whereas that rate was almost four times higher (4.14 per 100,000) for adults between 25 and 44 years old. This is raw data, which includes people hospitalised with other underlying conditions, so the numbers for healthy children and adults would be substantially lower.
(iii) Third, young adults under 45 in good health, without serious underlying medical conditions. According to official ONS data from the UK, adults between 25 and 44 years old were hospitalised in the week ending November 27th at a rate of 4.14 per 100,000, a rate that doubles for people 55-64, and quadruples for people 75-84. Again, this is raw data, which means the rate for people without underlying conditions would be substantially lower.
(iv) Fourth, people with no serious underlying health conditions have dramatically reduced chances of requiring hospitalisation from Covid-19. It is well known that Covid-19 risk is highly health stratified, even though this well known fact does not suit those who wish to lump all unvaccinated persons into the same basket.
A peer-reviewed study published on the website of the USA’s Center for Disease Control found that "among 4,899,447 hospitalized adults in PHD-SR, 540,667 (11.0%) were patients with COVID-19, of whom 94.9% had at least 1 underlying medical condition." Yes, you heard that right: 94.9% of Covid hospitalisations involved comorbidities or underlying conditions independent from Covid-19. If this study is accurate, then it is likely that Covid hospitalisations in general overwhelmingly involve at least one underlying medical condition independent from Covid-19 itself.
Unfortunately, publicly released data on Covid-related hospitalisations rarely indicates clearly what percentage of hospitalisations, whether jabbed or unjabbed, involve comorbidity or some underlying disease independent from the Covid infection. That information would give us a much fuller picture of who is and who is not at serious risk of Covid hospitalisation. In any case, the study I reference above suggests that even if vaccination reduces hospitalisation rates (which it may, in certain cohorts), this is very much a pandemic of the sick, not of the healthy and unvaccinated.
We can safely conclude from this risk breakdown above that (a) many unvaccinated persons are not at a high or even moderate risk of hospitalisation from Covid-19; and (b) that consequently, it is about as sensible to accuse “the unvaccinated” of perpetuating the pandemic, as to accuse “over 50s men” of perpetuating the pandemic. Whether someone has or has not received a Covid vaccine tells us very little useful information about their susceptibility to hospitalisation.
5. How successful are the Covid vaccines at preventing community transmission?
An advocate of universal vaccination might say, “OK, I admit that some people are at very low risk from Covid-19 and therefore may not personally need the vaccine. Nevertheless, by taking the vaccine, they are protecting others.” But this claim fails to grasp the fact that the protective effect of the vaccine is not removed because the vaccinated individual enters the company of an unvaccinated person.
Furthermore, the notion that my vaccine protects others - say, others who are highly vulnerable or unvaccinated - hangs on the efficacy of the vaccines at blocking transmission. Are the vaccines successfully blocking transmission?
The answer is, only to a limited degree, and certainly not to a degree one would consider as a “game changer” for viral spread. It was known from the very beginning that the Covid vaccines do not confer sterilising immunity, and it has since emerged that whatever added protection against infection they did confer dwindles rapidly within 4 to 6 months.
According to one Swedish study, described here, the relative protection against symptomatic infection dropped to 48% within 4 to 6 months. This is corroborated by recent PCR testing data from the UK Health Security Agency, showing that case rates recently detected among over-30s who are vaccinated are comparable to or higher than rates among their unvaccinated counterparts. Some of that data up to early December 2021 is presented in graphic form in this tweet.
To sum up, the suggestion or insinuation that anyone who turns down a vaccine can be indiscriminately accused of being “irresponsible” or increasing the strain on our hospitals sits rather uneasily with the actual characteristics of those individuals who get hospitalised with severe Covid-19 disease.
From a medical perspective, it makes no sense whatsoever to treat all segments of the unvaccinated population alike, since the unvaccinated population includes groups that are at low or very low risk of hospitalisation from Covid-19, such as those who have already acquired natural immunity through prior exposure to Covid-19, and those who are young and free from serious underlying health conditions like obesity, hypertension, immunodeficiency, and heart disease.
Nor does it make sense to accuse the unvaccinated of putting others’ lives at risk, since those who want protection are free to get vaccinated if they wish, and even if we are considering the potential for infecting highly vulnerable and/or unvaccinated people, the protection vaccines confer against infection dwindles rapidly over time.
Doctors, scientists, journalists, civil servants, government leaders, and ordinary citizens need to separate out the legitimate concerns of public health from the politics of lazy scapegoating and discrimination. It is high time we put crude stereotypes of the unvaccinated behind us, and attend to the real, empirically verified factors that put people at elevated risk of Covid hospitalisation, so that we can provide these people with all the support, protection, and treatments they need.
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