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At the opening of a Twitter clip, an American flag-patterned caduceus rises. Beside it reads the name of the organization that posted the Tweet, America’s Frontline Doctors. A kindly-looking doctor in a white medical jacket appears. “Hey freedom lovers. A team of nine scientists from Harvard, Johns Hopkins, and other top universities just published paradigm-shifting research looking at the safety and efficacy of the Covid ‘vaccines,’” he says, putting vaccines in air quotes.
The doctor launches into a summary of the draft paper, titled “COVID-19 Vaccine Boosters for Young Adults: A Risk-Benefit Assessment and Five Ethical Arguments against Mandates at Universities.” He focuses on one surprising fact in the paper’s findings: Based on a risk-benefit assessment of existing global data, it would take vaccinating an estimated 22,000 to 30,000 previously uninfected adults aged 18 to 29 to prevent the hospitalization of just one student with Covid-19.
The summary is interspersed with reaction clips, including one from the kids’ TV show Gravity Falls. The doctor concludes: “So in other words, the shots are completely worthless.”
In fact, a final version of the paper published this December in the Journal of Medical Ethics finds that the number of young adults that need to get vaccinated in order to prevent one hospitalization is closer to a range of 31,000 to 42,000. Contrary to the intentions of the authors, the data now serves as material for conservative medical organizations like AFLDS skeptical of Covid-19 vaccine efficacy.
The doctor in the video — Peterson Pierre, a cosmetic dermatologist — is a spokesperson for AFLDS. Like him, most of the organization’s doctors have never treated Covid-19 patients, yet AFLDS has promoted hydroxychloroquine, an anti-malaria medication, as a cure for Covid-19, despite warnings from the WHO and FDA that it is not preventative against the virus. As of March, the video about the research paper has reached over 18,000 views on Twitter with hundreds of likes and retweets.
To the vaccine experts who authored the paper, these groups are peripheral but flagrantly misrepresent legitimate inquiries into vaccine safety and efficacy.
Salmaan A. Keshavjee, a board-certified internist and the director of Harvard Medical School’s Center for Global Health Delivery, co-authored the paper in question. He rejects the video’s interpretation of his work.
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“I am surprised by the fact that so many people, from what I’ve read on Twitter at least, read it to mean, ‘Don’t get vaccines,’” he says. “That’s a very selective reading of this data. I’m genuinely surprised.”
Throughout the Covid-19 pandemic, Keshavjee published scientific research articles studying the global response as well as authored editorials in non-scientific media outlets. Although he advocates passionately for vaccination, Keshavjee says that many on Twitter considered his study “ammo to these people that are saying not to get vaccines.”
Rather, he and his colleagues had published the paper with the intention to respond to a gap in government accountability. “It is arguably negligent that key institutions such as the CDC and FDA have not conducted a risk-benefit assessment either before or after recommending that all adults should receive a booster dose,” they write in the paper, after analyzing data from integrated health systems in Israel, as well as from CDC trials.
Given the urgency of vaccine rollout during the global pandemic, the FDA granted additional doses of the Covid-19 vaccine Emergency Use Authorization based on observational data rather than trial data. The paper claims that the CDC failed to update vaccine efficacy estimates to reflect the reality on the ground, since Americans already benefit from increasing natural immunity against the virus following infection, while the vaccine itself has become less effective as mutations arise.
However, the rapid mutation of the virus has led other medical researchers to question the efficacy of natural immunity, given that immunity inevitably wanes over time, often faster than inoculated immunity.
Bill Hanage, an associate professor of epidemiology and co-director of the Center for Communicable Disease Dynamics at Harvard’s School of Public Health, argues for the short-term value of receiving a Covid-19 vaccine. “It is not a permanently transmission-blocking vaccine,” he says. “But it does reduce the chances of getting infected and transmitting for a period of time after vaccination. And that’s not nothing.”
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Keshavjee believes Hanage misses the point of the paper. “We have to remember that this is not an analysis of having a seasonal vaccine,” Keshavjee wrote in an email. “The paper looks at the cost-benefit for males between the ages of 18-29. In that particular group, mandates do not make sense because the risk of an adverse event may outweigh the benefit.”
The authors of the paper further claim that the CDC failed to analyze booster efficacy for those with comorbidities and a history of prior infection, as well as failed to conduct substantial risk-benefit assessments among children and adolescents.
They estimate that mass-vaccinating college-aged students with the booster dose may inadvertently cause many to experience side effects, yet prevent too few hospitalizations to make a mandate a worthwhile pursuit.
“The storyline is, ‘Are boosters equally effective in everybody?’ We should be answering that before we tell everyone to get it,” Keshavjee says. “And the corollary to equally effective is, ‘Are they equally safe in everybody?’”
Their paper asserts that university mandates may also harm young people that are hesitant to get vaccines. “Covid-19 booster mandates often involve a degree of coercion, including the threat of loss of access to education and free choice of occupation,” the researchers write.
Stephen M. Kissler, a postdoctoral research fellow at the School of Public Health’s Department of Immunology and Infectious Diseases, disagrees with the paper’s conclusions on a booster mandate in universities.
“There’s room for reasonable disagreement, but the evidence I’ve seen shows that mandating boosters for college students at this time of year is a good idea,” Kissler says, citing the benefits of immunizing college students in close contact.
“If you vaccinate in these months leading up to winter, you avoid transmission to university workers and staff members with higher risk of infection,” he says. “I don’t find any flaws with the analysis they conducted, except that it’s maybe a little too narrow in my mind in terms of what risks and benefits they consider.”
Keshavjee disagrees with this characterization of Covid-19 transmission in high-density environments, where the virus reproduces at a high rate. “Throughout the epidemic, COVID-19 has not demonstrated significant seasonality,” he wrote in an email. “And in situations of high density, one could imagine increased transmission. Unfortunately, in that setting the efficacy of a vaccine’s ability to stop transmission also goes down.”
The researchers still contend that university booster mandates are “highly problematic,” especially without a reliable method of recourse for vaccine-related injuries.
Without formal assessments of the risks and benefits of booster shots to young adults, the researchers argue, universities are creating vaccine policies based on insufficient data.
Keshavjee says that readily accessible medical information about the Covid-19 vaccines can reinforce public trust and equip people to engage with their own health decisions and protect their communities, rather than depend on mandates.
However, Kissler takes issue with the paper’s argument against booster mandates. “There is already so much evidence for the safety and efficacy of boosters, so it doesn’t seem like a strong basis for arguing against them being mandated,” he says, though he acknowledges the utility of researchers raising these questions for the public to grapple with.
Kevin Bardosh, a medical anthropologist and affiliate assistant professor at the University of Washington who is the lead author of the paper, claims that many media outlets have failed to meaningfully engage questions of vaccine mandate efficacy, which has exacerbated polarization to the extent that some Americans refuse to be vaccinated at all.
“Scientific institutions have shot themselves in the foot,” Bardosh says.
“Anti-vaccine organizations like AFLDS wield influence because they speak to Americans’ distrust not only in scientific institutions, but also in pharmaceutical companies,” Keshavjee says. “There is an ethical dilemma,” he says. “Is this driven by science? Or is this a desire for profit?”
Yet, Hanage believes that AFLDS discourages people from following the science. “Their messaging is scientifically unsupported. It flies in the face of our efforts to protect people, and to continuously get better at protecting people, by telling them things which are not supported by what we know now, and by sowing doubt, and by encouraging folks to do their own research, which means looking for blog posts, as opposed to having a serious conversation with their doctor about what is best for them.”
Peterson Pierre, the cosmetic dermatologist from the AFLDS Twitter clip, believes that he seeks the truth that other doctors omit. “The problem is this: authors want to publish scientific studies because it’s their job to do so but they also need to stick to the narrative because they want to keep their jobs,” he said in an emailed statement. “I don’t have those restrictions. I don’t play political games, and I don’t care what the narrative is, especially if it’s deceptive and harmful.”
“I am here to uphold the truth and do what is right and I have no conflict of interest. I have a clear conscience,” he added.
As for university booster mandates, Bardosh argues that a handful of American institutions are making impactful decisions for students’ lives based on a misinterpretation of scientific evidence.
“They have been much too quick to disregard the bodily autonomy and decision-making of their students. They have been much too quick to overstate the benefits of boosters and underplay their risks,” he wrote in an email. “Mandates are addictive. They create a culture of enforcement and coercion. They are hard to stop. But evidence does not support them.”
Hanage believes both the scientists and anti-vaccine groups bear the blame. “It is not clear to me what is a greater source of any such erosion: mandates themselves, or the noise that comes from people including scientists or doctors drawing attention to the mandates and complaining about them,” Hanage wrote in an email.
— Associate Magazine Editor Jade Lozada can be reached at jade.lozada@thecrimson.com.
