Should My Patient Get a 7th Covid Shot?

Confessions of a newly-turned COVID-vaccine skeptic

Evidence, trust, and clear-thinking are core beliefs here at Sensible Medicine.

What struck me most when I read this essay from electrophysiologist, Dr. Joseph Marine, was his change in attitude regarding the SARS-CoV-2 vaccine. There is much to learn from the public health handling of the pandemic. How the current leaders lost the confidence of respected doctors is surely one of the most important lessons for the new health team. JMM

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Joseph Marine, MD

Last week, I saw a 70+ year old patient in the office in follow-up after a catheter ablation procedure. He was doing well and as we were finishing the visit he asked me a question to which I did not know the answer. So I went on Twitter/X and asked a noted expert:

Dr. Hotez did not have time to answer me, so I am going to put the question to the readers of Sensible Medicine.¹ But first, some additional background.

I was first struck by the way the patient asked me. He told me that he followed me on X and was aware of my skeptical views of the covid boosters because of the lack of solid data behind their FDA approval and CDC recommendation.

He made a big point of this, looking me in the eye as he emphasized his need to know my honest opinion. I realized that he was conveying to me (a lowly cardiologist) that he trusted my judgment on this question more than other physicians or the CDC. Because of my skepticism, I had demonstrated to him that I was not delivering propaganda or acting as the agent of another entity; that I was only interested in his welfare. That interaction reaffirmed my thinking about public trust and how important it is that the medical profession remain free of the perception of undue corporate or government influence. Patients will not trust our recommendations otherwise.

I was not always skeptical of the covid vaccine. When the results of the pivotal trials were first published in the NEJM in the late fall of 2020, I was impressed and eager to see them deployed. I promoted them among my colleagues and professional society. When my health system established vaccine clinics for employees, I volunteered for several shifts and vaccinated about 200 of my colleagues – before I was vaccinated myself. I encouraged other doctors to do the same. When the shot became available for children, I (somewhat reluctantly) allowed my teenaged children to get it – in part because I thought it would exempt them from masking and test/trace/quarantine protocols at school (I was wrong about that). The second injection made my youngest son (15 years old at the time) quite ill – he took to bed for 3 days, and I think it was his worst childhood illness.

I started becoming more skeptical in the summer of 2021. Reports of vaccine myocarditis emerged, and the CDC seemed to downplay them, along with other reports of adverse effects. In July 2021 came the reports of covid outbreaks in highly vaccinated populations in Provincetown and San Francisco General Hospital. The CDC responded by telling everyone to mask up again. Despite the widely held perception that vaccines would stop spread of infection and mark return to “normal,” we were now told that they would just mitigate disease severity.

Then in September 2021 came President Biden’s infamous “our patience is wearing thin” speech and the announcement of federal vaccine mandates. This resulted in a sharp backlash and a torrent of anger and discrimination directed at the unvaccinated.

I had previously brought up vaccination with almost every patient in my clinic. After the mandates were announced, the subject became too toxic. I am still imprinted with the memory of one patient exploding in anger when I brought up the subject – I think for the last time. A justifiable skepticism also arose among the public – if the unvaccinated were really a threat to the vaccinated – then what is the point of the vaccine?

With the failure of the covid shots to produce durable sterilizing immunity came discussions among government health officials about more boosters and the idea of an annual booster shot, “like we do for the flu.”

Except that SARS-CoV2 mutates and evolves by a completely different mechanism and there was no evidence-base for the proposal. Nevertheless, the FDA and CDC pushed on with the idea and began approving and recommending boosters on the basis of little or no clinical evidence, antibody responses in a few mice, and the dubious concept of “immunobridging.”

The FDA apparently pushed out two of their top vaccine experts who declined to go along with the plan. I watched several of the FDA and CDC panel discussions for the booster approval/recommendations and was surprised by how lax the process seemed. Very little critical examination of the data, virtually no challenging questions were asked of the study sponsors, and decisions about age cutoffs and risk groups to cover seemed arbitrary and haphazard. It seemed like little more than a pro forma process designed to produce a pre-ordained outcome.

So now I am a covid-vaccine skeptic, and I have no evidence-based answer to give to my patients seeking my advice. I can tell them what the CDC recommends. I can tell them to ask their primary care physician. I can tell them that I am unlikely to ever get another one (I had 3 before getting omicron).

We need the new commissioner of the FDA and the director of the CDC to address this problem. They need to reform the FDA approval and CDC recommendation processes to increase their rigor and evidence requirements, decrease the conflicts of interest, and improve engagement of the public in the process if they want to restore public confidence in their decisions. If they do not, we are likely to see further erosion of confidence, not just in the covid vaccine, but the entire CDC childhood vaccine schedule.

Also, in a few years I am going to have patients who have had 10 covid shots and 5 covid infections asking me if they should get an 11^th shot, and I am still not going to know what to tell them.

Please let me know your thoughts in the comments. What should I tell my patient? What do you tell yours?

* Interestingly, 6 covid shots and 3 covid infections is the same tally for Dr. Fauci. I would have asked him, but unfortunately, he is not on Twitter.

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