LAST MONTH, in a commentary piece in CommonWealth, Tufts Medical Center physician and epidemiologist Shira Doron and Monica Gandhi, a professor medicine at the University of California – San Francisco, issued a call for a “campaign of honesty” when it comes to the state of knowledge around COVID vaccines, including making clear the uncertainty of whether all population groups should be getting follow-up booster shots.
A study published yesterday tries to shed more light on that issue – and its authors conclude that vaccine booster mandates for young people at universities, a policy most major universities in the Boston area have adopted, are likely causing net harm to young people.
In their earlier essay, Doron and Gandhi expressed concern that overall vaccination rates in the country remain too low, but said the public health messaging around vaccines has been poor, with some claims of vaccine benefits overstated beyond what evidence shows.
Appearing on the current episode of the Codcast, Doron expanded on their thinking. She said much has changed since the early days when vaccinations were highly protective against COVID infection and, therefore, transmission to others. Now, with the vast majority of young people having a prior COVID infection, and with vaccines effective against serious illness for higher risk individuals, but not very protective against infection, Doron said the picture has changed significantly. When it comes to booster shots, including the new bivalent vaccines, she said, “a transparent approach would be to say we’re not sure everyone would benefit.”
One particular concern has been the risk the vaccine carries of myocarditis, an inflammation of the heart muscle that has been seen in young people, particularly males, following vaccination. Doron said she agreed with the assessment of the Centers for Disease Control and Prevention early in the pandemic that “having a bad outcome from COVID in that age group is worse than the risk from that initial series of vaccinations.” Now, she said, it’s much less clear that the weight of the benefit-risk evidence favors vaccination in that population.
A paper published yesterday takes that point further, arguing that vaccine booster mandates for young people at colleges and universities are “likely to cause net expected harms to young healthy adults” and should be lifted. Researchers at the University of Oxford, as well as at other universities in the UK and North America, tapped available data sources on vaccinations and adverse events to evaluate the ethics of vaccine booster mandates for students at North American universities – an issue of obvious relevance to the college-rich Boston area.
In their paper, appearing in the Journal of Medical of Ethics, a publication of the British Medical Journal, the researchers estimated that to prevent one COVID-19 hospitalization over a six-month period, 31,207 to 42,836 young adults, aged 18–29, must receive a third mRNA vaccine. Moreover, for every COVID-19 hospitalization prevented, they estimated there are “at least 18.5 serious adverse events from mRNA vaccines,” including 1.5 to 4.6 cases of myocarditis in males, typically requiring hospitalization. They further estimated that preventing one COVID-19 hospitalization is associated with 1,430 to 4,626 cases of vaccine side-effects serious enough to interfere with daily activities, though typically not requiring hospitalization.
“Policymakers should repeal COVID-19 vaccine mandates for young adults immediately,” the researchers conclude.
Most Boston-area universities required students arriving on campuses this fall to have the two initial COVID vaccines plus at least one booster shot. Harvard is requiring students to get the newer, bivalent booster.
No immediate reply was received following requests for comment on the report from Harvard, Boston University, Northeastern University, and Tufts University, all of which have booster requirements for students.
Doron, the Tufts physician and epidemiologist, said the research published yesterday is exactly the kind of nuanced evaluation that’s needed. “An analysis of who stands to benefit from boosters, focusing on low-risk populations, is precisely what I wish CDC would provide so the public could see them as transparent and trustworthy. Other countries have made very different recommendations about boosters, based on age and risk factors, which tells me that the science is not fully settled on this.” Doron said the current CDC messaging “conveys a certainty that doesn’t exist and remains broad rather than targeted to those most at risk, diluting their effectiveness. The result, I believe, is the poor vaccine uptake we are seeing.”
On the Codcast released earlier this week, Doron said US officials seem to be favoring simplicity in their messaging, but at a cost that’s not being acknowledged. “You have to balance simplicity against transparency, and a complex message is really hard to put out there,” she said. “But the fact of the matter is that the science on this is really complex, and to try to oversimplify it comes at the expense of full transparency and honesty.”