Doctors Trashed Vaccines They Pushed For, Belittled Diseases They Fought

Having a rational and evidence-based discussion about vaccines is impossible if we refuse to acknowledge basic truths. Let's start with this one: every vaccine has side effects and some of them are worth it. It's true that no vaccine is 100% effective and has 100% tolerable side effects. But that doesn't mean we should ignore the evidence and let every disease we fear run rampant.

Today, I want to talk about COVID boosters. I'm not talking about infant doses or primary vaccination, but the booster shots that have been updated to target new variants. Many doctors argued that these modifications required a new randomized controlled trial (RCT) before they were given to anyone. An RCT is a study in which volunteers are randomly selected to receive the treatment or a placebo (an inactive pill). This is the gold standard for determining if a treatment works and is safe. Given the risks of COVID, conducting an RCT takes time and there are legitimate reasons for not doing them.

Two possible mistakesEvery day, doctors have to make decisions without the benefit of a large RCT to guide their every move. That's a normal part of medicine. Whenever I am conflicted about whether or not to start a treatment, I think about two possible mistakes I could make: I could give a patient a treatment they don't need or I could withhold a treatment they do need. I then try to gauge both how consequential and how probable each mistake might be. For someone with a potentially dangerous condition that has a safe treatment, it's better to overtreat several patients than to undertreat just one.

When the COVID vaccine was first rolled out, there was an RCT for the first booster, showing "95.3% efficacy against Covid-19 as compared with two doses," though this impressive result didn't stop some doctors from trashing this dose. As the pandemic progressed and knowledge accumulated, scientists reasonably concluded that it wasn't necessary to start over at step 1 and do an RCT for every tweak to the vaccine. RCTs are slow, the virus spreads quickly, and there's a real cost to waiting.

Of course, it wasn't totally absurd to believe that a vaccine that generated a strong immune response against SARS-CoV-2 would also protect against COVID itself. Other vaccines have been approved based on immunogenicity without controversy, and one meta-analysis from March 2023 found:

Predicted neutralising antibody titres are strongly correlated with observed vaccine effectiveness against symptomatic and severe COVID-19

Indeed, nearly 60 observational studies (see below) as well as several systematic reviews and meta-analyses have shown that boosters limit COVID's harms, though they are not a panacea and their benefit wanes quickly. Other studies have shown that boosters limit viral transmission.

Maybe it's true that every one of these studies is "plagued by confounding" and totally useless, as some doctors claim. Maybe it's just a statistical fluke that they all point in the same direction. If that's the case, millions of people got sore arms for no reason and a small number of young men got "mild" myocarditis. That's definitely not a good thing, but it's a drop in the bucket compared to COVID's toll.

But what if these studies were not entirely a statistical fluke? What if they were right, and the booster actually keeps some people alive and out of the hospital? It's not absurd to believe this, is it? Then, it would be a huge mistake to deprive someone of a booster dose they needed. Indeed one modeling study estimated:

That through June 2022, if the U.S. moved at a faster pace to approve it and get people boosted, an estimated 29,000 lives could have been saved.

Looking at all the evidence, I am confident that more people suffered grave injuries from missing a needed dose than from getting an unneeded dose. That's likely to be the case moving forward as well. COVID isn't going anywhere, and while deaths are much lower than before, over 1,000 Americans are still dying of COVID every week, and many more are being injured by it. It seems neither terrible nor scientifically implausible to try blunt COVID's harms with a periodic booster, even one that hasn't proven its value in a large and lengthy RCT.

Having a rational and evidence-based discussion about vaccines is impossible if we refuse to acknowledge basic truths. Every vaccine has side effects and some of them are worth it. Many doctors disagreed with this. They felt, unless every modification to the vaccine had proven its value via a massive RCT, then one could assume the vaccine did not work. These doctors could never show the vaccine was dangerous, especially for older people who needed it the most. It seems OK to get 217 vaccines.

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