An Open Letter to Wellesley's President

Your Bivalent Booster Mandate For Students is Inappropriate

I’m pleased to share an open letter to Wellesley’s president by Dr. David McCune. His last post was about the Pfizer vaccine. If you agree, you can add your signature at the link below.

Vinay Prasad MD MPH

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Dear President Johnson,

Recently, a Wellesley College student reached out to me, as a physician, extremely troubled by her concerns at the University. After speaking with her and other physicians, I am moved to share with you that her case warrants your further, immediate attention. You may be familiar with this young woman, as she has written an anonymous opinion piece sharing her distress about Wellesley's vaccine mandate policy.

Something about this young woman’s situation troubled me; firstly, that she felt unable to freely express her views under her own name, despite Wellesley’s deep commitment to women’s empowerment and choice concerning healthcare. Equally important were her actual vaccine policy-based concerns. She told me she does not want people to think this is about her. "This is about the students whom I am concerned about who are being shamed into silence." Thus I am writing on her behalf, with the hope that you will listen to her and take her, and other students like her at Wellesley, seriously. 

As a physician, I focus on three points of fact concerning the mandate to which this woman, under Wellesley’s charge, must consent despite her fundamental opposition:

1. the scientific data itself behind the booster (which as a cardiologist and an epidemiologist is assuredly on your radar);

2. the notion of mandating healthcare; and

3. the inconsistency of coercing compliance with said mandate as compared with not only Wellesley’s values, but also with your own lifelong commitment to these, as evidenced by your extraordinary work with women’s equity in STEM and at the University as well. 

Wellesley’s current policy states that students are required to receive the bivalent booster by December 1, 2022. The provided rationale behind this is “to avoid an outbreak early in the spring semester.” Yet this goal is unsupported and unsubstantiated. No information about the new booster has been released by either the pharmaceutical companies or by the Food and Drug Administration. Worryingly, recent small studies of human antibody responses have been published as pre-prints, attracting global medical attention. These suggest the newly mandated bivalent vaccine may bias antibody responses toward older variants. Add to this the increasing evidence that the vaccine – whether the primary series or the booster – have limited ability to reduce transmission, and there is no valid case that Welleseley’s mandatory vaccination policy will prevent any spring outbreak (or reduce it in a meaningful way). While the booster may ultimately prove beneficial for some groups, there is no basis to the notion that it will achieve the stated goal of the policy.

If the objective of Wellesley’s policy has simply been misstated and is not, indeed, as a preventative against spring outbreaks (i.e. perhaps you are concerned for the health of individual students in high-risk categories?), that would be best to clarify to students and other stakeholders within the campus community because it is causing so much confusion and distress. Miscommunication has been thematic throughout the COVID pandemic response, at all levels, for thirty-one months and is no moral failing when navigating a novel virus with a new response. The CDC itself has repeatedly issued clarifications for misstatements. However, if this is indeed the rationale for the bivalent booster policy, it begs deep questions about what data Wellesley is using to consider either the vaccine or booster as staunching transmission of the SARS-CoV-2 virus to avoid outbreaks, which to date have shown themselves as at least moderately evasive.

As medical doctors, we also are both apprised of the risk of myocarditis in younger people, which is why Denmark and other European nations explicitly do not recommend the COVID booster for those under 50 years old. Recent studies from such broad-ranging nations as Thailand, the United Kingdom, and Switzerland confirm that injury to the heart muscle is detected in a substantially higher percentage of vaccine recipients than previously reported. While this damage is usually mild, very little is known about the long-term effects of these repeated cardiac insults. Younger individuals appear to be particularly prone to this side effect, while remaining at lowest risk from actual COVID infection. College students, with their low COVID risk profile and high vaccine complication rate, are at the top of the list of groups for whom we should pause to assess the potential harm we might cause with mandates for repeat vaccines. And for young women, there are understandable concerns about vaccine effects on the menstrual cycle, plus more mundane but common side effects such as fever and pain. Reasonable people may disagree about whether the benefits are worth these known risks. To be clear, I am by no means against vaccinations or suggesting that the COVID vaccine or booster is not a useful tool in the fight against COVID, but caution is warranted for one-size-fits-all mandates in a college-aged population.

This is precisely what this student, and others like her, are picking up on since the conversation surrounding COVID vaccination is part and parcel of the fabric of current American society. This is not the partisan-based or conspiratorial thinking that the media makes this out to be, to be blunt. Your student’s concerns are quite real, so real that without an assignment prompt or a grade, she sought out a venue, on her own, to publish her thoughts with the hopes that Wellesley would hear and respond to these by revisiting your bivalent booster policy. I cannot help but take seriously that she was too anxious to post her considerations under her own name, despite that she attends a college whose mission is to foster her growth as a woman and future leader, moreover under the leadership of one of the strongest female voices in America. When I shared this with female colleagues in medicine, many were struck by this point and asked me to kindly share this with you when I wrote. As such, hopefully you will read between the lines of the content to look at the context itself for the writing, which is troubling.

Which brings us to the ethics of Wellesley's policy: compelled healthcare should be an absolute last resort, as it violates women’s consent-based principles over their own bodies. I quote the American Medical Association Code of Medical Ethics regarding a person’s right to agree to medical care: 

“Informed consent to medical treatment is fundamental in both ethics and law. Patients have the right to receive information and ask questions about recommended treatments so that they can make well-considered decisions about care. Successful communication in the patient-physician relationship fosters trust and supports shared decision making.”

It is a well-established principle that there can be no free consent to medical care under conditions of coercion, and the seminal Belmont Report specifically mentions that populations with a power disparity have reduced capacity to freely agree to treatment. The threat to expel students, to expel women moreover, who do not accept the required bivalent booster belies any consent process. The prospect of losing the time and money invested in years of education, not to mention the psychological cost of this, and the outcome of this upon a human being’s hopes, dreams, and aspirations, is such a severe penalty that it constitutes de facto force. How else to explain student compliance with a vaccine booster policy that, when made voluntary, fewer than five percent of U.S. adults have accepted?

Finally, this policy is contrary to the values Wellesley espouses, which can only be a mistake. A mandated vaccination does not “value the equal dignity” of all students. Likewise, removing the opportunity for informed consent does not respect the “power and potential of our students and all members of our community to envision the world in which they want to live.” Finally, neglecting how a student could read about the risks and benefits of this treatment and reach her own conclusion denies the “transformative power of curiosity, learning, and teaching.”

I will leave you with the words from your current student, one of unfortunately many who are thinking similarly at Wellesley today. I ask that you have the empathy to see the world you have created through her eyes as she wonders: 

“What does it mean when a college tells its students that their bodies belong to the whims of bureaucrats rather than to themselves? It means that students are being groomed to believe that being an educated person means keeping one’s head down and submitting to every top-down order uncritically.”

Of course it is not your intention to foster this perception. Thankfully, it is not too late to reconsider the policy and make the bivalent booster optional, as was done recently by Bowdoin College and Wake Forest University. It is not too late to trust your students to make adult decisions about their healthcare. And it is not too late to teach an invaluable lesson, that there are times when, after due consideration, a reasonable person can admit to a mistake or an oversight and change their mind, whether based on data, messaging, changed understandings, or the simple value of empathy-driven, responsive leadership, befitting of Wellesley’s extraordinary legacy for women.

Respectfully,

David E. McCune, MD, MPH

Add your Signature to David’s Letter Here

https://docs.google.com/forms/d/e/1FAIpQLSfJaoC6CN0Pyiod5p-KEqmk1JIIVVDhgMF7PCD9lzhbQ4puXw/viewform?vc=0&c=0&w=1&flr=0