Research suggests most people who recovered from covid-19 are immune for at least eight months. Yet epidemiologists are largely still urging this population to get the vaccine if it’s their turn in line. 

Official guidance says vaccines should be offered regardless of whether people were previously infected. 

That’s per the Centers for Disease Control and Prevention, which also says the vaccine is safe for people who have had a prior infection. Former CDC director Thomas Frieden said he’d advise most people to get the vaccine, even if they’ve had covid-19.

But Frieden added that he doesn’t think it’s wrong for someone in a low-risk group who’d already had the illness to defer if they thought someone else could use the dose. 

The limits on vaccine supply bolster the argument that recovered people should let others go first. 

As administration of the vaccine bottlenecks across the country, the pressure is on to get the shots in as many arms as quickly as possible. 

Researchers at the University of Colorado Boulder found that prioritizing people who don’t already have natural immunity could allow health officials to get more impact from limited supplies, especially in areas where many people have already been infected, according to a modeling study that has not been peer reviewed. 

The researchers found that you would need to vaccinate 1 in 5 elderly people in New York to bring death rates down by 73 percent. But you can get the same result vaccinating only 1 in 6 people if you prioritize people who don’t already have antibodies to the virus, according to Kate Bubar, a PhD student in applied mathematics and quantitative biology, who co-authored the study.

And although a previous covid-19 infection isn’t a guarantee of immunity, it’s pretty good protection on its own.Researchers have found that eight months after infection, about 90 percent of patients show lingering, stable immunity. 

Still, risk can vary from person to person.  

“If I were over 70 or otherwise ill, I would certainly take the vaccine even if I’d had [covid-19]. If I were 30 and healthy, I should not be getting it now (unless a health care worker), but if for some reason I did get offered it I would probably decline,” Marc Lipsitch, an infectious-disease specialist at the Harvard T.H. Chan School of Public Health, said in an email.  

Some epidemiologists worry about the logistics of trying to weed out people with natural immunity.

It could complicate the process as health providers are already struggling to get the vaccine distributed quickly. So far around 6.7 million people have been vaccinated, even though 22.1 million doses have been distributed, according to a Washington Post analysis.

Eleanor Murray, an assistant professor of epidemiology at Boston University School of Public Health, worried that trying to verify someone’s past illness would add bureaucratic hurdles. 

“Confirming whether or not someone has had COVID already adds an unnecessary layer of red tape onto vaccine prioritization. Given that the prioritization is designed to get vaccine first to those people who are most likely to get infected and/or get very sick from infection, it makes sense to reduce the barriers to vaccinating this group as much as possible,” Murray said. 

Murray also cautioned that we don’t know how long people’s natural immunity lasts and that it could vary from person to person. This uncertainty may be an added reason to encourage people to get the vaccine.

There’s also a risk that telling people who had covid-19 to hold off on getting the vaccine could end up feeding into anti-vaxxer narratives. Some experts are reluctant to discourage anyone from getting the vaccine if they are eligible, especially given that vaccine hesitancy is widespread. 

There’s already a problem with people being offered the vaccine but not getting it. 

In Santa Rosa County, Fla., only about 40 percent of emergency responders who are eligible to get the vaccine have gotten it or signed up to do so soon. In New York, where around 30 percent of health care workers have declined the vaccine, the state’s Gov. Andrew Cuomo (D) has threatened that anyone who skips a dose now won’t be eligible for a priority vaccine later. 

The low participation rate is concerning, especially at long-term care centers. 

But not everyone who turns down a vaccine is a hardcore anti-vaxxer, Frieden cautions. He says that there is a “movable middle” of people. They aren’t going to be camping out overnight to get an early vaccine, but they may be convincible if costs and other barriers are low. Frieden says it’s crucial to keep a door open for those people, for instance, seeing whether they might be willing to schedule a shot three weeks from now instead of immediately. 

The slow pace of vaccinations has sparked a heated debate over how to stretch supplies.

A vocal group of experts has pushed for officials to consider giving as many people as possible the first dose of the two-shot regimen, even if it means risking a delayed second dose. President-elect Joe Biden has announced his incoming administration will take this approach, sending all doses out the door as quickly as possible instead of holding half back. 

“The plan, announced Friday by the Biden transition team, pivots sharply from the Trump administration’s strategy of holding in reserve roughly half the doses to ensure sufficient supply for people to get a required second shot,” our colleagues reported.

But some epidemiologists, including Frieden, argue that distribution is a bigger problem than supply at this point. Although he said he supports releasing most vaccines, he worries that some of the debates about how to stretch supply are “distractions” from the real obstacles of administration, which he blames in part on a lack of a coordinated federal plan for getting shots into arms. 

“What Operation Warp Speed has generally done is said, ‘We’re responsible for getting the drugs to the states, and after that, it’s their problem,’ ” Frieden said. “That’s a way to facilitate finger pointing; that’s neither a plan nor a solution.”