key: cord-0718935-7pu0l3ph
authors: Kampf, Günter
title: The epidemiological relevance of the COVID-19-vaccinated population is decreasing after booster vaccination, as shown by incidence rate ratios—author's reply
date: 2022-04-04
journal: Lancet Reg Health Eur
DOI: 10.1016/j.lanepe.2022.100376
sha: 37f2b50a9b95b4842266cfb3b20f0039e3393dbc
doc_id: 718935
cord_uid: 7pu0l3ph

nan

The epidemiological relevance of the COVID-19vaccinated population is decreasing after booster vaccination, as shown by incidence rate ratios-author's reply

University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, Greifswald 17475, Germany

With great interest I read the Correspondence by Bohnert et al. 1 in response to my letters where I described examples of public stigmatization against the COVID-19 unvaccinated population 2 and where I looked at the increasing epidemiological relevance of the vaccinated people as a possible source for transmission. 3 Bohnert et al. incorrectly state that I have failed to appreciate the true impact of vaccines on the burden of the COVID-19 pandemic. 1 I have, however, clearly acknowledged in one letter that the vaccinated have a lower risk for severe disease. 2 Booster vaccination does indeed reduce the risk for both symptomatic and severe COVID-19 as described by public health reports from many countries including Germany and England. Data from England showed a lower case rate per 100,000 persons in all age groups, amongst those who received at least three vaccine doses compared to the unvaccinated persons presenting to emergency care. 4 The situation, however, may be different when comparing all cases including the asymptomatic ones who could be possible sources of transmission. The rates of all COVID-19 cases per 100,000 were between 1.7 (1076.3 versus 629.7; age group: 80 or over) and 3.4 times higher (2760.2 versus 816.7; age group: 40 −49) among those who received at least three vaccine doses compared to the unvaccinated in all age groups of 18 years and older. 4 This provides further evidence that individuals who received at least three vaccine doses should also be considered as a possible and relevant source for transmission. That is why I emphasized that the vaccinated should not be ignored as a possible source of transmission which is currently even more relevant with a higher proportion of asymptomatic COVID-19 cases caused by the emerging omicron variant. 5 In my correspondence I described an increase of breakthrough infections in Germany among the COVID-19 vaccinated only among those of 60 years and older. 3 At the time of writing my previous Correspondence 3 the age group of 60 years and older was chosen because the proportion of fully vaccinated was higher in Germany (85%) compared to those between 18 and 59 years (73%), therefore it was considered to be the most suitable age group to describe any change of possible sources for transmission. It is correct that the proportion of breakthrough infections was lower in the middle age group but it was also simultaneously increasing from 8.2% (21st July 2021) to 37.5% (27th October 2021) which adds to the evidence that the epidemiolocal relevance of the vaccinated as possible sources for transmission was increasing at that time.

Bohnert et al. combine statements from two of my letters and imply that they belong together which is not the case. They claim that I wrote "many decision makers ignore the vaccinated as a possible transmission source" and that "this ignorance leads to inappropriate stigmatization of unvaccinated people". 1 This is, however, not correct. The stigmatization comes from public statements from selected politicians and scientists as clearly described in my Correspondence. 2 They state that I compared "science-based preventive measures" with "ideologies". 1 I used the term "stigmatizing", however, only in the context of public wordings from politicians ("pandemic of the unvaccinated") and scientists ("the unvaccinated threaten the vaccinated for COVID-19"). 2 According to the Cambridge Dictionary stigmatization is an "act of treating someone or something unfairly by publicly disapproving them". More such examples can be found. The president of the World Medical Association, Frank Ulrich Montgomery, said that "at the moment we are really experiencing a tyranny of the unvaccinated", 6 suggesting that the unvaccinated are tyrants. By using these words, the roles are clearly assigned for the public but only for one group. Although I realize that some colleagues have a different view on this, I still consider it to be a public and unfair disapproval of the unvaccinated as long as the partly vaccinated, fully vaccinated and those who received three or more vaccine doses continue to be a relevant part of the pandemic. 

GK has received honoraria from Sch€ ulke & Mayr, Germany, outside the submitted work. The views expressed here are those of the author and do not necessarily reflect those of the university he is affiliated with.

The epidemiological relevance of the COVID-19-vaccinated population is decreasing after booster vaccination, as shown by incidence rate ratios. Lancet Reg Heal Eur

COVID-19: stigmatising the unvaccinated is not justified

The epidemiological relevance of the COVID-19-vaccinated population is increasing

COVID-19 Vaccine Surveillance Report. Week 9. UK Health Security Agency

High rate of asymptomatic carriage associated with variant strain omicron

Tyrannei der Ungeimpften': Der Umgangston eskaliert