









































                                                                                                                         2021, Vol. 1 (S4) 15-16 
 https://doi.org/10.47488/dhrp.v1iS4.27 

  
 

http://dhrproceedings.org 15 © DHR Health Institute for Research and Development 
 

 

EDITORIAL 

Natural vs. Vaccine Mediated COVID-19 Immunity  
Scientific Justification to Mandate Vaccination of Recovered Healthcare 
Workers

 
To protect the vulnerable patients, many healthcare 
facilities (including DHR Health System) have 
mandated COVID-19 vaccination of its healthcare 
workers, vendors, contractors, students, residents, 
and fellows. This policy has been widely debated 
and it has been suggested that healthcare facilities 
should adopt a different policy for workers who 
have recovered from natural SARS-CoV-2 
infection and a waiver should be granted to them as 
far as COVID-19 vaccination mandates are 
concerned. It has been argued that individuals who 
have been previously infected with SARS-CoV-2 
virus have acquired immunity which should provide 
protection against re-infection and therefore they 
are at a lower risk for the patient. 

In the United States, over 40 million people have 
been infected with SARS-CoV-2 and over 378 
million doses of COVID-19 vaccines have already 
been administered (1). Some people with COVID-
19 have very mild symptoms and they may see 
natural infection as preferable to receiving the 
COVID-19 vaccine. Additionally, there are some 
people who are concerned that getting a COVID-19 
vaccine could make them sicker if they do 
ultimately get COVID-19. It is incontrovertible that 
getting infected with SARS-CoV-2 may offer some 
natural protection. Current evidence suggests that 
reinfection with the SARS-CoV-2 is uncommon in 
the 90 days after initial infection. However, it is 
unclear as to how long this protection lasts, and the 
risk of severe illness and death from COVID-19 far 
outweighs any benefits that are afforded by natural 
immunity (2).  It was therefore recommended that 
even people who have been previously infected 
with SARS-CoV-2 must consider getting 
vaccinated. 

In an independent study, sera obtained from 
recovered and naïve donors collected prior to, and 
following immunizations with existing mRNA 

vaccines, was tested to determine its neutralizing 
capacity against the wild-type and the SARS-CoV-
2 variant (3). Pre-vaccination sera from recovered 
donors neutralized the wild type but only 
intermittently neutralized the variant. On the 
contrary, a single dose of immunization boosted 
neutralizing titers against the receptor binding 
domain of both the variant and the wild type by up 
to 1000-fold. This study underscores the importance 
of vaccinating both uninfected and previously 
infected persons to elicit cross-variant neutralizing 
antibodies. 

The fact that vaccinated individuals are at reduced 
risk of infection as compared to patients who have 
recovered from SARS-CoV-2 infection was also 
confirmed by another case-control study (4).  
COVID-19 infections in Kentucky among people 
who were previously infected with SAR-CoV-2 
shows that unvaccinated individuals are more than 
twice as likely to be reinfected with COVID-19 than 
those who were fully vaccinated after initially 
contracting the virus. This data further indicates that 
COVID-19 vaccines offer better protection than 
natural immunity alone and that vaccines, even after 
prior infection, help prevent reinfections. 

The rapid spread of the Delta variant and the real 
potential for continued emergence of more 
transmissible and infectious SARS-CoV-2 
mutations because of hesitancy in getting 
vaccinated poses a serious national challenge which 
demands implementation of an urgent plan of 
action. Consequently, on Thursday, September 09, 
2021, the U.S., President issued a bold and 
aggressive plan entitled: PATH OUT OF THE 
PANDEMIC: PRESIDENT BIDEN’S COVID-19 
ACTION PLAN (5). This Plan has six distinct 
initiatives which, when successfully implemented 
would markedly reduce the risk associated with the 
spread of SARS-CoV-2 variants.  Under the 



DHRP, 2021, Vol. 1 (S4) 15-16  Editorial 

  
 

http://dhrproceedings.org 16 © DHR Health Institute for Research and Development 
    
 

initiative entitled “Vaccinating the Unvaccinated”, 
the following mandates were communicated: 

• Requiring all employers with 100+ 
employees to ensure their workers are 
vaccinated or tested weekly 

• Requiring vaccinations for all Federal 
workers and for millions of contractors that 
do business with the Federal government 

• Requiring COVID-19 vaccinations for over 
17 million health care workers at Medicare 
and Medicaid participating hospitals and 
other healthcare settings 

• Calling on large entertainment venues to 
require proof of vaccination or testing for 
entry 

• Requiring employers to provide paid time 
off to get vaccinated 

 

While vaccinating recovered and naïve healthcare 
workers is essential, this mandate must be 
implemented ethically ensuring that healthcare 
workers fully understand both the empirical and 
moral rationale for the mandatory vaccination 
program. Simply imposing a mandate without 
laying the ethical groundwork is likely to result in 
measurable challenges. A prudently developed 
process must include educational and promotional 
campaigns to enhance healthcare worker’s 
knowledge and understanding of the complex and 
rapidly evolving science related to COVID-19. This 
may include organizing Townhall meetings with 
relevant experts in a forum that allows the 
healthcare workers to ask questions anonymously. 
Furthermore, this mandate must be anchored on the 
compelling patient safety concerns and an opt-out 
criteria based on legitimate and verifiable religious 
beliefs or medical condition should be made 
available to the healthcare workers.  To ensure its 
widespread acceptance, mandatory vaccination 
policies should be transparent and impartial 
ensuring that it is equally applicable to all members 
of the healthcare fraternity. Lastly, healthcare 
facilities should make every attempt to provide 
vaccinations that are free of charge and easily 
accessible.  

In conclusion we recommend that based on 
available scientific evidence, existing U.S. Centers 
for Disease Control & Prevention policies, and in 

the best interest of the patients, health care facilities 
are justified in requiring all its employees, vendors, 
contractors, and learners to be vaccinated even if 
they have recovered from previous infection with 
SARS-CoV-2. 

References  

1. Johns Hopkins Coronavirus Resource Center. COVID-19 
Dashboard. https://coronavirus.jhu.edu/map.html  (Accessed 
September 12, 2021; 22:19 hrs). 

2. Centers for Disease Control & Prevention. Answering Patients’ 
Questions About COVID-19 Vaccine and Vaccination. 
https://www.cdc.gov/vaccines/covid-19/hcp/answering-
questions.html   

3. Stamatatos L, Czartoski J, Wan YH, Homad LJ, Rubin V, 
Glantz H, Neradilek M, Seydoux E, Jennewein MF, MacCamy 
AJ, Feng J, Mize G, De Rosa SC, Finzi A, Lemos MP, Cohen 
KW, Moodie Z, McElrath MJ, McGuire AT. mRNA vaccination 
boosts cross-variant neutralizing antibodies elicited by SARS-
CoV-2 infection. Science. 2021 Mar 25: eabg9175. doi: 
10.1126/science. abg9175. Epub ahead of print. PMID: 
33766944; PMCID: PMC8139425. 

4. Cavanaugh AM, Spicer KB, Thoroughman D, Glick C, Winter 
K. Reduced risk of reinfection with SARS-CoV-2 after COVID-
19 vaccination – Kentucky, May – June 2021. MMWR Morb 
Mortal Wkly Rep 2021; 70: 1081-1083. 
https://www.cdc.gov/mmwr/volumes/70/wr/mm7032e1.htm?s
_cid=mm7032e1_w   

5. Path Out of the Pandemic: President Biden’s Covid-19 Action 
Plan. Sept. 09, 2021. https://www.whitehouse.gov/covidplan/   

 

Sohail Rao, MD, MA, DPhil 

Executive Vice President, DHR Health, 5501 S. McColl 
Road, Edinburg, Texas 

President & Chief Executive Officer, DHR Health 
Institute for Research & Development, 5323 S. McColl 
Road, Edinburg, Texas 

Corresponding author email: s.rao@dhr-rgv.com 

Disclosures: None 

ORCID: Sohail Rao: https://orcid.org/0000-0001-5027-
9992 

Manish Singh, MD, FACS 

Chief Executive Officer, DHR Health, 5501 S. McColl 
Road, Edinburg, Texas 

Disclosures: None 

ORCID: Manish Singh: https://orcid.org/0000-0003-
4146-3282  

https://coronavirus.jhu.edu/map.html
https://www.cdc.gov/vaccines/covid-19/hcp/answering-questions.html
https://www.cdc.gov/vaccines/covid-19/hcp/answering-questions.html
https://www.cdc.gov/mmwr/volumes/70/wr/mm7032e1.htm?s_cid=mm7032e1_w
https://www.cdc.gov/mmwr/volumes/70/wr/mm7032e1.htm?s_cid=mm7032e1_w
https://www.whitehouse.gov/covidplan/
https://orcid.org/0000-0001-5027-9992
https://orcid.org/0000-0001-5027-9992
https://orcid.org/0000-0003-4146-3282
https://orcid.org/0000-0003-4146-3282

