Vaccination Against COVID-19 Is Herd Immunity — But So Is “Curable” Spontaneous Spread.

“Herd Immunity” is a precise scientific term in Immunology — it is NOT a political term.

A few months ago, I wrote an article that has drawn fire from pseudo-experts and pundits who see scientific phrases only with a political lens.

You can read my article HERE.

The phrase I used in my opinion piece was “herd immunity” — but that phrase has been politicized and is now associated with donald trump and his dangerous posse of non-experts, who are methodically destroying everything that is exceptional about our beautiful country.

the physician, Scott Atlas, with no expertise in Infectious Disease or Immunology is now helping president trump blow smoke in the face of overwhelming scientific and clinical expertise from Drs. Fauci, Birx and Redfield. This physician is NOTHING more than a political pundit.

So, I’m writing this clarification for the superficial political pundits and non-experts who critiqued me and tried to box me in with the likes of the Hoover Institute’s, Dr. Scott Atlas — Mr. trump’s new “expert advisor” on the White House’s COVID-19 task-force.

Let me define the term herd immunity for those readers who do not fully know it.

The immunological concept of herd immunity refers to the epidemiological fact that: when a threshold number of individuals in any population are immune to an infectious pathogen, the population as a whole, and therefore individuals in that population, are protected from disease.

So, it is certainly a desirable outcome for Americans, and humanity on the whole, to achieve herd immunity to the SARS-CoV-2 virus, which causes COVID-19 disease.

But, how do we achieve such a state of herd immunity?

The answer is that we either: a) induce herd immunity medically, or b) allow it to evolve spontaneously.

Here, I want to clarify to the reader that when doctors vaccinate the population against any given infectious pathogen, they are in fact medically inducing herd immunity!

To vaccinate a population IS to medically induce herd immunity!

But what if a vaccine is not available or if it is not available to enough people?

Certainly, in the case of SARS-CoV-2 we do not yet have access to a proven, safe and effective vaccine — and even if the heroic efforts of Drs. Fauci, Birx, Redfield, Woodcock and other colleagues are successful in achieving an effective vaccine, it’s unclear if the entire population will have access to this new vaccine quickly enough.

Of course, our current COVID-19 vaccine deficit is also compounded by the fact that nearly half the population in the US is not educated enough about the benefits of vaccination, and is likely to refuse undergoing vaccination, even when it becomes available.

My previous article on herd immunity addressed just that question. That is, how do we achieve herd immunity without a safe, effective or sufficiently available vaccine, and where nearly 50% do not believe in vaccination, even if it were available?

The idea I presented previously was that spontaneous infection will also eventually achieve herd immunity in the population. In my prior article, I had reminded the reader of a time before the Chicken-pox vaccine when entire families would get together to have “Chick-pox parties”.

I wrote: “In fact, in the old days a lot of people used Herd Immunity to cure things like Chicken-pox. I remember vividly, when a kid in the family or neighborhood came down with chicken-pox, it was time for a “chicken-pox party”….Folks would get the kids together to pass it around and ‘get it over with’.”

My point in writing that article was NOT that we should have uncontrolled “COVID-parties” to achieve herd immunity in the case of SARS-CoV-2. In fact, to do so would be Extremely dangerous because: 1) SARS-CoV-2 is a non-endemic virus, so literally the entire population is susceptible to getting infected with it and 2) the risk of mortality from symptomatic COVID-19 disease is on the order 1–5% (perhaps even higher in the elderly).

With 330 million people in the US, that means letting the virus take its course spontaneously could cause between 3.3–16.5 million people to die, before the virus become endemic in 1–2 years. Our healthcare system and economy would simply not be able to tolerate that level of casualties in a short span of time.

My point in the prior article was that the only way we can achieve herd immunity in the absence of a widely administered COVID-19 vaccine is to block the SARS-CoV-2 virus’ “kill mechanism” first. Thus, my coinage of the #KillTheKillFirst hashtag.

I also did my best to articulate this point for the general public in a second article, which you can read HERE.

Still, I took a lot of fire from a few pseudo-experts, who simply are not in the habit of careful reading and are simply superficial political pundits with MDs.

To be crystal clear, I think the massive effort directed by the Department of Health and Human Services’ Operation Warp Speed to quickly develop a COVID-19 vaccine is commendable and radically unprecedented. And, without a question, an effective, widely available and generally used vaccine will save lives by medically inducing herd immunity to SARS-CoV-2.

But, in point of fact, I do think that the trump administration’s overt focus on developing a vaccine has come at the cost of ignoring the need for the second prong of our pandemic defense equation to be well-developed: that is, rapid identification of a therapy, or therapies, that could effectively block progression fo COVID-19 disease and kill the virus’ “kill mechanism”.

donald trump’s ridiculous obsession with Hydroxychloroquine blocked the rapid and scientifically rational deployment and testing of existing therapies for blockade of COVID-19 disease through FDA’s Emergency Use Authorization (EUA) pathway.

Of course, the president’s irrational and unscientific obsession with Hydroxychloroquine and the Dr. Fauci’s premature declaration of Remdesivir as THE Standard-of-Care for treatment of COVID-19 disease have made matters even worse. These two drugs are simply not allowing rapid testing of many other equally, if not scientifically more cogent, pharmacological agents as therapeutics against COVID-19 disease.

I know for a fact that, compared to vaccine development, the search for an effective drug to block COVID-19 disease progression has been a secondary priority for the trump administration — thanks in large part to trump’s grotesquely non-expert political interference, with the politics of Hydroxychloroquine serving as the distractor.

Back in April 2020, based on a concerted review of the emerging data about COVID-19 disease, I came to the prediction that blocking T-cell and Macrophage mediated inflammation could protect patients from severe illness and death. I came to this conclusion, because COVID-19 disease, especially in its severe forms, appeared to be acting like a hyper-inflammatory disease driven by overt T-cell and Macrophage activation.

At that time, I honed in on the drug cyclosporine as a potentially effective therapy, because, not only is it a clinically proven inhibitor of T-cell and Macrophage mediated inflammation, but it is also an inexpensive, relatively safe and generically available drug whose manufacturing could be upscaled rapidly — on a global level.

Cyclosporine is a fungus-derived drug that specifically inhibits replication of Coronaviruses and inhibits over-activation of T-cells and Macrophages.

You can read about my rationale for use of cyclosporine in COVID-19 disease HERE. Of course, several other physicians and immunologists have also expressed this opinion in opinion articles in various specialty journals.

So I began a campaign to convince our FDA regulators and public health experts to permit a limited Emergency Use Authorization (EUA) to deploy cyclosporine against COVID-19 disease. Ultimately, FDA rejected two of my back-to-back attempts at obtaining this EUA for use of cyclosporine.

You can read my rationale for obtaining this EUA for cyclosporine in an interview I did with DrugWatch. I also detailed my interactions with the FDA and others regarding this drug in a letter I wrote to the Chief Editor fo the Journal of the American Medical Association (JAMA), Dr. Howard Bauchner.

Additionally, I made a concerted, but unfruitful, effort to inform prominent members of the press about this drug’s potential as a therapeutic against COVID-19 — these included the senior editors of the Wall Street Journal and the Philadelphia Inquirer.

CBS News in Los Angeles covered the potential utility of cyclosporine for blockade of SARS-CoV-2 mediated hyperimflammation and cytokine storm syndrome.

As it became evident that inflammation and so-called “cytokine storm” syndromes are being triggered by SARS-CoV-2 in patients with severe COVID-19 disease, CBS news in Los Angeles did provide the public with an introduction to the concept I was proposing to our public health leaders: that cyclosporine could be a potentially effective drug for blockade of COVID-19 disease. You can view this news clip HERE.

In parallel, I was fully cognizant that the gold standard for determination of drug efficacy in treatment of any disease is the so-called Randomized Controlled Clinical Trial (RCT). So, I was honored that my good friends from four different major medical centers across the world, recognized the scientific and clinical rationale in my focus on cyclosporine. These colleagues all agreed to heed my call and set up RCTs for testing the safety and efficacy of cyclosporine for treatment of COVID-19 disease. These centers include two major academic medical centers in the US and two in the my parental country of origin, Iran, as follows:

  1. Hospital of the University of Pennsylvania, under leadership of Professor Carl H. June, in Philadelphia, PA. You may view that ongoing clinical trial HERE.
  2. Baylor College of Medicine, under leadership of Professor Bryan Burt, in Houston, TX. You may view that ongoing clinical trial HERE.
  3. Hamadan University of Medical Sciences, under leadership of Professors Keramat and Naghshehtabrizi, in Hamadan Province, Iran. You may view that ongoing clinical trial HERE.
  4. Masih Daneshvari Hospital, under leadership of Professor Seyed Hashemian, in Tehran, Iran. You may view that ongoing clinical trial HERE.

I was also happy to find out that colleagues in Spain were independently testing cyclosporine for treatment of COVID-19 disease, under leadership of Professor Pernaute. You may view the Spanish clinical trial HERE.

Of course, FDA did reject my concerted efforts to obtain an EUA for use of cyclosporine in COVID-19 patients. I believe that this was a federal regulatory error that was caused and potentiated by donald trump’s irrational abuse of the EUA mechanism to push use of Hydroxychloroquine. I detailed my experience with the rejected EUA application process for cyclosporine in an article I wrote for the online Magazine Physician Outlook. You can read that perspective HERE.

In the end, since I started advocating for deployment of cyclosporine, over 180,000 Americans have died of COVID-19. It is now clear that anti-inflammatory drugs are highly likely to block progression to severe COVID-19 disease, as the partial British success with the steroid Dexamethasone, has demonstrated as a proof-of-principle.

I know that it won’t be long, now, before we find out whether cyclosporine is effective at blocking progression of COVID-19 disease — from the RCTs led by my good friends and colleagues, listed above.

Of course, I sincerely look forward to the possibility of seeing and celebrating my colleagues’ success in treating COVID-19 disease with a drug I strongly believe has a very high likelihood of reducing the severity of COVID-19 disease and blocking mortality.

Finally, I want the reader to know that I wrote this article, here, for the public record — because a few superficial thinkers and armchair medical pundits are doing their best to lump me in with trump’s mindless “herd-immunity crowd”.

But nothing could be further from the truth.

In the end, I do think we will achieve herd immunity to SARS-CoV-2. That is the way immunology works on an individual and population level. We will, hopefully, achieve this state soon and primarily with a vaccine — but I also know that when we identify an effective enough drug (or drug combination) to block severe COVID-19 disease and deaths, in a vast majority of infected people, we can more comfortably allow spontaneous infections to take place in driving herd immunity home. This latter pathway to herd immunity, will be especially important in that subset of the population that, incorrectly, does not believe in vaccination.

My best guess is that within the next year, it’ll be a combination of a new vaccine and more a highly effective drug (or drug combination) that’ll relieve us from the clutches of this terrible plague we’ve come to know as COVID-19.

I do hope to see, ultimately, that cyclosporine plays a role in our success.

But either way, I believe that we will make it through this disaster.

In the meanwhile, let’s stay safe, socially distance, wear masks and protect the most vulnerable amongst us.

I ask that the reader please read my words carefully and not assume a superficial understanding or politically motivated to the topic on my part — as some have.

To be clear: Herd Immunity is NOT a political term. It is a scientific one that must be used precisely, in order to inform the public’s understanding of what it takes to defend against the present pandemic threat.

Hooman Noorchashm MD, PhD is a physician-scientist. He is an advocate for ethics, patient safety and women’s health. He and his 6 children live in Pennsylvania.