Coronavirus news & views

Tattoos and Vaccines: Muddled Thinking And A Good Idea

“Often wrong, never in doubt”  Anonymous

Muddled thinking. Despite reams of evidence to the contrary, including a recent Nobel Prize for the technology, vaccine fabulists, like RFK, Jr, , Robert De Niro, Jenny McCarthy, my own Senator Ron Johnson, and too many others continue to spread intentional disinformation about the safety and efficacy of the COVID mRNA vaccines. Despite these naysayers, mRNA vaccines are here to stay and new ones are being developed for many other maladies that have been hard to vaccinate for, like cancer, HIV, several animal diseases, etc.

I keep encountering people who belabor the same old disproven canards about millions of people falling dead from the vaccines, about the vaccines being “experimental,” and “gene therapy.” All this disinformation continues despite the fact that tens of billions of jabs have been given to 5.6 billion vax recipients around the world over the last 4+ years. At what point does  fact replace lie and truth supplant fable? The world’s entire medical establishment does not agree with these deceivers, yet they continue to sound the sham anti-vax alarm undaunted. I have pondered in these pages whether this willful dissemination of such disinformation that could affect peoples’ lives and health could be criminal. A case for this could be made.

The funny thing is that these alarmists are announcing the sky is falling over something well tested and vetted while ignoring another very common jab that many of them have likely have gotten without questioning, but that does have significant effects on one’s immune system: tattoos (see vocal anti-vaxer and celebrated tattoo artist, Kat Von D). When you stick hundreds of ink-filled needles into your skin, can it be good for you? Anti-vaxers worry about well tested and vetted vaccines, but never worry about tattoos. Why their selective outrage?

Much of tattooing remains mysterious: Scientists aren’t fully sure what makes certain tattoos fade fast, why others stick around when they’re supposed to disappear, or how they react to light. Given the fact that tat recipients are sitting for multiple injections of unknown substances into their bodies that last forever, tattooing would seem like a much better way than vaccines for someone like Bill Gates to poison us; or to use them for something sinister like mind control, or as a way to control the world population, as the vax chicken-littles often frett about with the mRNA vaccines. Why aren’t folks up in arms over this vast potential conspiracy? (Cynicism mine!)

What do tattoos do? The Atlantic recently ran an article about how tats mess with the immune system and a subsequent quick search found other concerning aspects about them. The practice involves poking dozens to thousands of holes into the middle layer of the skin, or dermis, and depositing different formulations of chemicals, or pigments, that permanently remain behind. Contrast that to the single shot of a typical vaccine that deposits into a muscle a single dose of an agent that has undergone extensive testing and approval for safety and that quickly is eliminated by the natural scavenger cells and processes of the body’s immune system so nothing remains soon after the shot is given. Both procedures irritate the immune system, but one is permanent, the other temporary.

When the hundreds of needle pricks deposit ink into the dermis for a tat, the immune system detects an assault on its body and jumps into action. The skin after all, is our immune system’s first barrier and it is well loaded with rapid-response defensive cells that lead the assault on the pigment intruder. This generally works well to heal wounds and clear infections, but the system breaks down trying to fight tat ink. The immune system simply cannot adequately clear that intruder. Rather, the pigments persist in the belly of the immune cells and skin cells, only to again be gobbled up when those cells die and disgorge their undigested contents. Then the process repeats, ad nauseam leaving a permanent stain in the skin.

Over time, the edges of tats fray and become fuzzy as ink particles are gradually shuttled away into the draining lymph nodes, which normally handle viruses, bacteria, fungi, etc. In the nodes, the immune system then revs up to recruit and deliver antibodies and T cells around the body to combat intruders that escape further into the interior. These nodes normally are pale white, but in tattooed people, they can be the color of the tattoo ink.

Thus not only is the skin tattooed, so are the lymph nodes!

It is not clear if all this misdirected immune response to tattoo ink throws the immune system off its game of surveillance against infectious pathogens. One study published last year found that tat ink can affect the function of immune cells. But, in another Australian study, tat ink was mixed with a vaccine in order to track the fate of the vaccine components after vaccination. There was no evidence of any untoward effect of the pigment on the vaccine itself. Other immunological differences between heavily tattooed and un-tattooed people have been noted but it remains unclear whether these are for the better or the worse. So, it remains uncertain whether tattoos are good or bad for one’s immune system.

However, tat ink can be harmful in other ways. The European Union banned certain pigments, that they believe are linked to bladder cancer. And a 2016 report from the Australian government found that >80% of black inks contained carcinogenic polycyclic aromatic hydrocarbons (PAHs). Other pigments may contain other harmful substances like barium, cadmium, lead, mercury, micro-plastics, etc. Then there always is the real risk of infection or allergic reaction when anything is injected into your body. Nice.

Tattoo-like vaccines: a good idea. In a typical vaccine, the shot is delivered into an arm muscle where the immune system is not as robust as in the skin. The skin being a primary barrier to a hostile outside world is well stocked with an armament of immune sentry cells, muscles deeper in the arm not so much. But, there are enough immune cells in muscles to get the job done and develop protective immunity to antigens which the vax delivers. For an intramuscular vaccine delivered to an arm muscle, usually a comparatively large antigen dose is used and it takes a bit of time to get the immune system in gear. Mobile immune cell cops where the vaccine bolus is deposited gobble up the material like a squirrel shovels nuts in its mouth, and then head to nearby lymph nodes to “report” that an intruder was encountered. This gets the army of T and B lymphocytes ginned up and pumping out antibodies, other immune molecules and cytokines, and other cells to respond the intruder. You are then “immunized.” This also sometimes causes the temporary malaise associated with vaccines—mild fever, fatigue, flu-like symptoms and maybe arm pain. In rare cases, allergies happen, which is a rapidly arising, acute immune response to a component in the vaccine, such as chicken egg material found in many, but not all, flu vaccines. 

However, a few vaccines are actually given in the skin, more like tattoos are administered. Currently this route is used to vaccinate for small pox, TB, rabies, and more recently, mpox (formerly called monkey pox). Some studies, but not all, have shown that the intradermal (ID) vaccine route can outperform the intramuscular (IM) vax route. For this reason, other vaccines are now being developed to be given this way simply because the skin immune system is more robust and this might provide a more effective way to vaccinate, and it uses less vaccine material. This is called intradermal vaccination.

But intradermal (ID) vaccines are not that easy to administer. If not done properly and the vax material is injected too deep, which is easy to do, their efficacy can drop precipitously, just like Biden’s presidential chances plummeted after the disastrous debate. So, medical folk are actually looking at different vaccine technologies, including using tattoo machines to administer effective ID vaxes on a large scale across many clinics large and small. One technique using a DNA vaccine, called DNA tattooing has been tested in animal models and human trials and was inspired by traditional tattoo machines, which are pretty easy to use.

Bottom line: The way that vaccinologists have taken notice of tattoo technology to improve vaccine efficacy is intriguing. They have taken their science knowledge of skin immunology and realized that the pop culture tattoo fad just might improve vaccine technology and public health. That is very cool.

The sad irony is that many people who get tattooed are also vax deniers. Their cognitive dissonance is disturbing. Vax deniers loudly spread disinformation about vaccine dangers, then are completely sanguine about tattoos which inject strange chemicals into their bodies, some of which have been clearly proven to be unhealthy.

That selective outrage betrays the intellectual dishonesty and lack of curiosity of anti-vaccine dissemblers. Too bad we can't vaccinate against that.

Acknowledgment: I am indebted to Frank C. (no relation) for helping procure an article needed to write this blog post, which I had a very hard time accessing without paying a full subscription to the journal. Thanks Frank!

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Naturally Immune? You Still Better Get A Vaccine

Over 43 million Americans have reported cases of COVID-19. Many of them likely have some level of immunity that can be quite protective, even without vaccination. Even before vaccines were available, individuals who recovered from COVID-19 had detectable T-cell responses, and reinfections were rare, at least prior to the emergence of the more contagious Delta variant. This is what people refer to colloquially as “natural immunity,” to distinguish it from immunity conferred by vaccination. Some people claim that natural immunity is better and preferable to vaccine immunity and that a history of infection should count as much as being vaccinated when considering vaccine mandates. Is all this true? Well, like what we have seen and heard during the pandemic, a lot of truths have been spread, same with lies and disinformation. The story around natural immunity follows this pattern. Let me try to sort all this out here with a focus on whether previously infected people should consider getting vaccinated.

Natural infection can confer immunity to COVID. Like most viruses, previous infection with SARS-CoV-2 does confer immune protection against future re-exposure to the virus. Several peer-reviewed studies conducted in the early months of the pandemic, before vaccines were available, found that people previously infected were around 80% less likely to test positive for the virus during the next viral surge. These included studies of healthcare workers in the UK, the Danish population, and patients at the Cleveland Clinic, a large health system in Ohio and Florida.

Other data from the UK Office for National Statistics showed that between May and August 2021, a prior infection offered around the same level of protection against the Delta variant as vaccination. (Note that very recent and preliminary observations in South Africa suggest that infection with the new Omicron variant is high in people previously infected with other CoV-2 variants. However, since Omicron is so new and data on it are very sketchy at this time, this review will not further comment on this variant.)

A recent large Israeli study found that people who had been fully vaccinated with two Pfizer shots were 13 times more likely to later get infected with CoV-2 than those who had a prior infection. It also suggested that immunity from infection was longer lasting than that from vaccination. The study also showed that natural immunity plus the vaccine offered protection that was even stronger than either natural or vaccine immunity alone. This is one of the very few studies suggesting that natural immunity is better than vaccine immunity and has not been peer-reviewed. Furthermore, the subsequent rise of Delta since the end of this study confounds the issue a bit since Delta has been shown to be more infectious than the viruses the study subjects were exposed to. 

In the most recent review of the current scientific evidence by the CDC, they concluded that both fully vaccinated and those previously infected with the virus have a low risk of re-infection for at least six months, but that the two forms of immunity appear to have different strengths. Vaccination with mRNA vaccines produced higher concentrations of neutralizing antibodies—the type that prevent the virus from entering cells—than natural infection, although, over time, the antibody levels waned in both groups. However, long lasting immune memory conferred by natural infection appeared to be stronger than that conferred by vaccination.

Over time, immune B cells typically evolve to produce antibodies that better recognize an antigen, and an earlier study published in Nature found that antibodies produced by naturally immune memory B cells continued to evolve at least a year after infection. In contrast, antibodies produced by memory B cells in vaccinated people did not change much over time. This would suggest that over time, antibodies produced by natural immunity gain greater ability to respond to re-infection with the virus than antibodies produced by vaccination. One possible reason for this difference in the evolution of the anti-viral antibodies was that pieces of virus remain in the body for weeks after infection and continue to engage the immune cells, whereas vaccine lipid nanoparticles quickly fade away providing less immune stimulation. 

On the other hand, vaccine immunity might be better. So, as we have seen, a few reports suggest that natural immunity is superior to vaccine immunity. However, more studies suggest the opposite and even show that not everyone who catches COVID-19 will have effective immunity to re-infection. A CDC study reported that 36% of previously infected people did not form any antibodies against the virus. This is in stark contrast to antibody formation reported in 100% of people who received just one dose of an mRNA vaccine. Furthermore, the CDC reported in August that COVID survivors who went unvaxed were more than twice as likely as vaccinated people to get infected again contrasting with the Israeli study I mentioned earlier. Yet another CDC study looking at data from ~190 hospitals in nine states confirmed that unvaccinated people who survived an infection several months earlier were more than five times more likely to get COVID again than vaccinated people.

The reason that natural immunity might not always be effective is because the natural exposure to the virus is highly variable. People naturally infected are exposed to widely different doses of virus via different routes and possibly to different viral strains, all of which conspire to confer different degrees of protection. In contrast, vaccinated people receive standardized doses of the same viral antigen via the same route of exposure, making them more likely to develop a uniform degree of immunity. Researchers found that some people who had been infected had high antibody levels to the virus, while others had low levels, reflecting this variability in natural infection. This was substantiated by a new study from the University of Pittsburgh that also found that in many cases antibody levels from a prior infection are not high enough to protect people from getting sick again. Then, an Oxford study found that both long term T and B cell immune responses were highly variable in naturally immune people. The investigators took monthly samples of blood from infected subjects and measured their T and B cell responses over time. Interestingly, the variability in their responses was clearly identified as early as one-month post infection. Those with the weakest immunity at one month (25% of the subjects) had no detectable antibodies after six months. This contrasts to vaccine immunity, which does fade a bit over six months, but still remains consistently strong months after full vaccination. 

Finally, new evidence from an NIH-supported study from the Fred Hutchinson Cancer Research Center, Seattle showed that antibodies from vaccinated people better recognized the mutated spike proteins from viral variants than antibodies from naturally immune people who had not been vaccinated. In other words, vaccinated people seem better able to respond to mutated spike proteins present in new viral variants.

The bottom line. In sum, while natural immunity can be effective, most evidence shows that vaccines typically give rise to consistently better antibody and long term T and B cell responses.

Having made this point, it is important to further note that a combination of both types of immunity, or so-called hybrid immunity, appears to be stronger than either alone. Researchers found that vaccination of naturally infected people boosted antibody and memory B cells to levels higher than seen in those with just either type of immunity. People with prior COVID-19 who received even one vaccine dose had half the risk of a breakthrough infection than unvaccinated people with prior COVID-19. Another study from researchers at the Icahn School of Medicine in New York found that a single dose of either the Pfizer or Moderna vaccines produced more antibodies in people who had previously had COVID-19 than two vax doses did in those who had never encountered the virus. It also found that people with prior infection report more unpleasant, but not serious side effects from vaccination. Vaccinating previously infected people also elicits important cross-variant neutralizing antibodies that better protect them against the known viral variants. Hybrid immunity also appears to work in the other direction: A study of vaccinated people who were then infected during a July 4 holiday weekend outbreak on Cape Cod found that they produced higher levels of antibodies and T-cells directed against the virus. In sum, vaccination helps those with natural immunity (and everyone they interact with) and vice versa. 

For these reasons, the CDC now recommends that people who have had COVID-19 be vaccinated because the shots plus natural immunity have been shown to offer better protection than natural immunity alone.