I had had 3 shots by the height of the pandemic. Desperate times justify desperate measures - even though there were evident problems with the vaccine from the begging, I took it and I'd take it again, back then. The risk of dying from COVID seemed far more likely than any vaccine side effect and I'd always take the risk - the risk that comes from being a guinea pig of an imperfect vaccine. But that was then. It was during a pandemic. It was an extraordinary situation of sanitary emergency. Now is another story. I never took any booster and never will. And it's not exactly because I'm a "vaccine skeptic" - I believed that, with all the pandemics data, the pharmaceuticals would naturally, up.next, improve vaccine safety and make better, safer, versions of it. But that didn't happen, some vaccines were removed from the market and had their license revoked in a few countries; other vaccines has their posology changed with no explanation, instead of two doses you took one, and so it goes. All without the due medical conferences presenting the due evidence. All without medical community debate - the debate was made on social networks. The current vaccine decisions are uneven and biased, based on political decisions to pleace online activist groups of all kinds and on pharmaceuticals interest. So no, I am not a vaccine skeptical, but I am skeptical that the groups who handle the issue are handling it properly. About my patients, most don't even ask my opinion about taking the jab or not. They say "...(all the advice they didn't follow), but the COVID vaccine, that is up to date!" - and they say that with confidence and pride, which is kind of scary (what kind of brainwash is going on here, right?). To those who ask my opinion, I reply that the vaccine was important during the pandemic, and now it's not worth the risk, so the patient should not take it. I finish saying I don't take it and I will not take it again..
I've been GP in the South of Brazil for 25 years now.
I am a strong advocate for vaccines (PhD in Immunology/Virology plus years of academic and clinical research). Since before the Covid vaccines were even ready for distribution, I advocated strongly for both RNA based vaccines when I saw the initial data (I never worked for any of the companies involved). And I read a lot of the literature, particularly from Shane Crotty and Alessandro Sette, who study T cells (see their Ann Rev Immunol 2023 paper). I’ve been telling my friends that their T cell immunity after vaccination will keep them from developing severe, life-threatening Covid. But T cell immunity is technically difficult to study, so current recommendations are based solely on antibody levels against the Covid spike proteins which don't say much about total immunity.
Now, like your patient, I am “elderly” (74) though active. I have had 7 doses of the Moderna vaccine through 2023. After each of the 6 boosters, I had the flu-like syndrome and felt really fatigued. I have had Covid twice (and who knows, maybe more times). I worry slightly about a low but real incidence of myocarditis and pericarditis, mostly in young men, but haven’t seen anything definitive about the effects in older individuals. I have concluded that my risk might be a higher WITH the next vaccine dose than without it - and I will forgo the latest update and consider a protein-based vaccine in a few months to years. (I do recall seeing some studies on T cells from SARS-Cov1 infected patients that persisted 17 years).
I do think it's time for a reconsideration of the CDC recommendations. I understand that Dr Paul Offit, a member of the FDA Advisory Committee, also decided to forgo more vaccines. Obviously, it will be difficult if not impossible to conduct a study that will show whether the updated vaccines have benefit. But maybe it's time to consider some hypothetical arguments like the simple one outlined above in making public health recommendations. After all, it is really hypothetical that the updated vaccine which generates a strong antibody response against a few new epitopes of new prominent variants will provide strong protection against all the new variants out there. That is all the current recommendations are based on anyway.
For most people the virus has always been a bad cold, this is the fundamental item to come to grips with. then and only then, can the remedy and risk/reward be sought
Every wave of COVID I’ve taken care of at least 1 immunosuppressed patient (including now) who takes me back to the early days of the pandemic where our ‘best efforts’ just don’t seem to be enough. This is the one group who I will twist their arm to get boosted bc natural immunity seems to wane. All anecdotal, wish there was better data to inform other vulnerable groups. FWIW Haven’t seen a healthy person < 90 yrs old hospitalized with COVID in 2-3 yrs, vaccinated or not.
Part I: From Chuck Craton's comment: “I've reviewed the information presented to ACIP and it appears boosters temporarily decrease risk of hospitalization and serious illness, but by 120-180 days, you're getting pretty close to baseline pre booster.”
. . .
The “waning” effectiveness of the Covid boosters appears to be just a statistical illusion created by not counting infections within a 7-14 day window after getting a booster shot. Professor Vinay Prasad wrote “Many observational studies of vaccine effectiveness exclude cases that occurred within 14 days of dose … Omitting these cases is irresponsible … this can make an inactive product— something totally useless— look like it works.” Norman Fenton has shown that “any claims of Covid-19 vaccine efficacy based on these studies are likely to be a statistical illusion.”
Part II: From Chuck Craton's comment: “I've reviewed the information presented to ACIP and it appears boosters temporarily decrease risk of hospitalization and serious illness, but by 120-180 days, you're getting pretty close to baseline pre booster.” … “for the interested:”
“Close to baseline”? VE turns negative! I watched that Oct 24th ACIP meeting and a couple members asked about the slides on p.25-26 of the above pdf showing negative VE for 18-64 YO against ED/UC & Hospitalization after 180 days; -19% & -35% relative VE (compared to those not getting a booster).
When asked for her interpretation, Link-Gelles replied” “To be clear, there is no biological plausibility for the vaccine increasing your risk of disease” Really? Immune imprinting and class switch toward non-infammatory spike-specific immunoglobulin G4 antibodies have been suggested as possible mechanisms. Or, negative effectiveness could simply reflect that immunity from a recent infection is better than immunity from a booster with a variant that is out-of-date by the time it gets into an arm.
Link-Gelles continued: “... if a surge occurred the month before a new vaccine is introduced, and the population has a high level of infection-induced immunity, then we are going to measure lower relative VE. … if we were able to stratify by recent prior infections, we would see higher VE. But, because prior infection is infrequently documented in medical records, it is not generally possible in well-powered studies.”
But, apparently Link-Gelles is unaware of the series of Covid VE studies conducted over the past four years by Dr. Shrestha at the Cleveland Clinic. His “well-powered studies” of health-care workers (with excellent infection and vaccination records) did “stratify by recent prior infections”.
He found “the more recent the last prior COVID-19 episode was the lower the risk of COVID-19" and "that the greater the number of vaccine doses previously received the higher the risk of COVID-19” and “being “up-to-date” on COVID-19 vaccination … was not associated with a lower risk of COVID-19" and “vaccine-induced immunity is weaker and less durable than natural immunity. So, although somewhat protective in the short term, vaccination may increase risk of future infection.”
"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 … It seemed like little more than a pro forma process designed to produce a pre-ordained outcome.”
. . .
I've also watched several VRBPAC & ACIP hearings on Covid vaccines over the past several years and my experience matches your own. Similarly, Dr, Vinay Prasad had a similar experience when he presented his 5-minute comment at last June's FDA VRPAC meeting: “As I listened to the meeting, I realized my comments would be in vain. The FDA had already collaborated with the other speakers … The entire room didn’t feel like an impartial trial, but a kangaroo court. The decision had been made, and this was an elaborate theater. I worry that the FDA is entirely beholden to the pharmaceutical industry” https://www.drvinayprasad.com/p/my-comments-at-fridays-fda-drug-advisory
Thank you for the excellent essay. About a year ago, I asked my functional and integrative medicine doctor a similar question. I said, “I’ve had four Covid shots, and I had Covid when I came back from France last September. I had four days of very mild cold symptoms and slightly elevated body temperatures. I’m 65, but I don’t think I fall into the ‘frail and elderly’ category. Is it still important to get yearly boosters?” She sheepishly replied, “Noooo?” Then she went on to carefully say, “Let’s put it this way: I personally am not getting anymore boosters until there’s good quality evidence that the benefits outweigh the harms.”
After 6 shots his IgG4 levels likely elevated and his T cell immunity against Covid suppressed. He is therefore dependent on regular boosters to produce short term antibody production and a degree of protection.
Against this, spike protein is wholly bad and regular stimulation of its production likely harmful. As Omicron presently of low pathogenicity I would be against further vax.
Always a good plan to present facts as known for and against, provide reference material and let the patient decide.
As Dr. Prasad has written passionately and repeatedly about, this absence of data is a dereliction of duty by the FDA and NIH. With the amount of time and number of doses given thus far, there has been more than ample opportunity to have run clustered RCT to have hopefully shed some light on this.
I’m with you. I felt in looking at data internationally (the UK was especially effective, and made US data look like child’s play) that the vaccines were effective in reducing severe illness/mortality and spread up to and including delta variant. Once omicron became dominant, vaccines no longer prevented spread. I agree that mandates had no scientific substantiation beyond early/mid 2022 on that basis.
In my practice now, I tell pts who ask (usually on the older side as with most cardio practices) that the benefit is unknown and the risks are low. However, I don’t “recommend” things that are safe but useless, and I don’t make an exception for this.
If they ask “what have you done doc?”, I tell them I stopped after shot #4 in 2022, but I have no chronic illnesses and am not in any high risk group. And per my usual, I let them decide for themselves.
I had the first three Moderna shots in 2021, my husband three (or four) Pfizer shots, and my children three Pfizers. Unless something changes, we are done. Moderna two and three made me sicker than any illness I have ever had. I worry I made a mistake with my children, but we really believed in vaccines and masks and trying to be good humans. I feel like I was gullible in some regards. Our family physician does recommend boosters, and her office is not even keeping it is stock. Our pediatrician recommend it but did say it was a choice to abstain.
I do fear long covid. And repeat infections. Thus far, only my teen has had a confirmed case. And we test after known exposure and with any symptoms.
My wife and I work in healthcare and both chose 1 Johnson and Johnson vaccine in September of 2021. No boosters. Our booster was eventually getting very mild cases of Covid about 2 1/2 years in despite likely being exposed regularly. We rarely masked, ate real food, took immune support, exercised (even when we had covid), used sauna regularly, slept well, traveled, and carried on with our lives. Neither of us have ever had a flu shot nor had the flu that we know of. My last vaccine was a hep B vaccine 25 years ago. Turned 60 this year. My next vaccine will likely be a shingles vaccine at 65. We are both in the best metabolic health of our lives. I'm not 'anti vax'. I am very pro health and prevention. We've seen patients with 4 - 5 Covid shots who have still gotten covid several times. We see those with zero vaccines that have never had covid or just one case. The common denominator for mild disease? Good metabolic health, with or without a jab. Given the poor health of 90% of Americans, I can understand why some should get a Covid shot. I can also understand why some chose not to and others just one. What doesn't make sense is repeated boosters with no long term data. Risk stratification models were developed even prior to vaccines to identify those that are at higher risk of COVID-19 infection and severe illness with commonly used characteristics including vital signs, age, sex, comorbidities etc. but science and common sense gave way to fear and politics and the rest is history.
I agree that good metabolic health was a key covid survival factor. This was known in 2020. It is very unfortunate that the public health establishment did not include this in their public health messaging. An opportunity to improve the health of the public was lost.
My understanding (as a non-MD but someone who knows plenty of physicians and scientists at our local cancer center) is that the boosters are safe and somewhat effective in protection for a few months at least. For people with lipid intolerance, there is now the Novavax booster. I've only had COVID once; it was unpleasant and I hope to never get it again. My brother is convinced that he has long COVID brain fog from a previous infection. So I perceive non-negligible risks from actual infections (inflammation, long COVID), plus the downside of getting sick for a week, vs. negligible risks of boosters.
But what if the vax INCREASES the risk of getting Covid, not decreases it? (See the other comments). I also don't want to get long covid. That's why I stopped after the first vax when I learned how destructive it is.
I was wholeheartedly in favor of the original vaccine series. That was then, in late 2020, early 2021, when the virus was completely different. Now, Covid is a bad cold. I have not taken the umpteenth millionth booster. I have not done it for my kids, either.
I agree with you that the data are simply not there. It is becoming ridiculous. If someone who is immunocompromised, where Covid can kill, maybe. But for the general public, it is very hard to agree.
The first booster was really valuable for ages 55+. See our aeticle, Bernard Black, Vladimir Atanasov, Aharona Glatman-Freedman, Lital Keinan-Boker, Amnon Reichman, Lorenzo Franchi, John R. Meurer, Qian (Eric) Luo, David B. Thaw, and Ali Moghtaderi, COVID-19 Boosters: If The US Had Matched Israel’s Speed And Take-Up, An Estimated 29,000 US Lives Would Have Been Saved, 42(12) Health Affairs 1747-57 (2023) (http://ssrn.com/abstract=4634372)
And there is some Israeli evidence supporting a second booster for ages 60+, pre-Omicron.
I've seen no good evidence after that, and no good evidence in the Omicron period (some might exist and I missed it, to be sure)
But mortality below age 50 is negligible after initial vaccination. No evidence that booste helps.
So you can't be pro-COVID-vax, or anti-COVID-vax. Or even pro-booster or anti-booster. How many? For which ages? That's the nuance that we can't get from the CDC, or the available research studies.
Thank you for your comment and work in this field. More research and more nuance in CDC recommendations are exactly what is needed. In cardiology, and most other specialties, guidance is issued with different levels of recommendations (1, 2a, 2b, 3, etc) and levels of evidence (A, B, C). The CDC should adopt a similar policy.
I had had 3 shots by the height of the pandemic. Desperate times justify desperate measures - even though there were evident problems with the vaccine from the begging, I took it and I'd take it again, back then. The risk of dying from COVID seemed far more likely than any vaccine side effect and I'd always take the risk - the risk that comes from being a guinea pig of an imperfect vaccine. But that was then. It was during a pandemic. It was an extraordinary situation of sanitary emergency. Now is another story. I never took any booster and never will. And it's not exactly because I'm a "vaccine skeptic" - I believed that, with all the pandemics data, the pharmaceuticals would naturally, up.next, improve vaccine safety and make better, safer, versions of it. But that didn't happen, some vaccines were removed from the market and had their license revoked in a few countries; other vaccines has their posology changed with no explanation, instead of two doses you took one, and so it goes. All without the due medical conferences presenting the due evidence. All without medical community debate - the debate was made on social networks. The current vaccine decisions are uneven and biased, based on political decisions to pleace online activist groups of all kinds and on pharmaceuticals interest. So no, I am not a vaccine skeptical, but I am skeptical that the groups who handle the issue are handling it properly. About my patients, most don't even ask my opinion about taking the jab or not. They say "...(all the advice they didn't follow), but the COVID vaccine, that is up to date!" - and they say that with confidence and pride, which is kind of scary (what kind of brainwash is going on here, right?). To those who ask my opinion, I reply that the vaccine was important during the pandemic, and now it's not worth the risk, so the patient should not take it. I finish saying I don't take it and I will not take it again..
I've been GP in the South of Brazil for 25 years now.
I am a strong advocate for vaccines (PhD in Immunology/Virology plus years of academic and clinical research). Since before the Covid vaccines were even ready for distribution, I advocated strongly for both RNA based vaccines when I saw the initial data (I never worked for any of the companies involved). And I read a lot of the literature, particularly from Shane Crotty and Alessandro Sette, who study T cells (see their Ann Rev Immunol 2023 paper). I’ve been telling my friends that their T cell immunity after vaccination will keep them from developing severe, life-threatening Covid. But T cell immunity is technically difficult to study, so current recommendations are based solely on antibody levels against the Covid spike proteins which don't say much about total immunity.
Now, like your patient, I am “elderly” (74) though active. I have had 7 doses of the Moderna vaccine through 2023. After each of the 6 boosters, I had the flu-like syndrome and felt really fatigued. I have had Covid twice (and who knows, maybe more times). I worry slightly about a low but real incidence of myocarditis and pericarditis, mostly in young men, but haven’t seen anything definitive about the effects in older individuals. I have concluded that my risk might be a higher WITH the next vaccine dose than without it - and I will forgo the latest update and consider a protein-based vaccine in a few months to years. (I do recall seeing some studies on T cells from SARS-Cov1 infected patients that persisted 17 years).
I do think it's time for a reconsideration of the CDC recommendations. I understand that Dr Paul Offit, a member of the FDA Advisory Committee, also decided to forgo more vaccines. Obviously, it will be difficult if not impossible to conduct a study that will show whether the updated vaccines have benefit. But maybe it's time to consider some hypothetical arguments like the simple one outlined above in making public health recommendations. After all, it is really hypothetical that the updated vaccine which generates a strong antibody response against a few new epitopes of new prominent variants will provide strong protection against all the new variants out there. That is all the current recommendations are based on anyway.
I am still bothered that the most recent booster was approved under EUA (Emergency Use Authorization) even though the pandemic is long over.
For most people the virus has always been a bad cold, this is the fundamental item to come to grips with. then and only then, can the remedy and risk/reward be sought
Every wave of COVID I’ve taken care of at least 1 immunosuppressed patient (including now) who takes me back to the early days of the pandemic where our ‘best efforts’ just don’t seem to be enough. This is the one group who I will twist their arm to get boosted bc natural immunity seems to wane. All anecdotal, wish there was better data to inform other vulnerable groups. FWIW Haven’t seen a healthy person < 90 yrs old hospitalized with COVID in 2-3 yrs, vaccinated or not.
Part I: From Chuck Craton's comment: “I've reviewed the information presented to ACIP and it appears boosters temporarily decrease risk of hospitalization and serious illness, but by 120-180 days, you're getting pretty close to baseline pre booster.”
. . .
The “waning” effectiveness of the Covid boosters appears to be just a statistical illusion created by not counting infections within a 7-14 day window after getting a booster shot. Professor Vinay Prasad wrote “Many observational studies of vaccine effectiveness exclude cases that occurred within 14 days of dose … Omitting these cases is irresponsible … this can make an inactive product— something totally useless— look like it works.” Norman Fenton has shown that “any claims of Covid-19 vaccine efficacy based on these studies are likely to be a statistical illusion.”
https://www.drvinayprasad.com/p/observational-studies-of-covid-vaccine
Doshi paper https://pubmed.ncbi.nlm.nih.gov/36967517/
Fenton paper https://www.medrxiv.org/content/10.1101/2024.03.09.24304015v2.full
Part II: From Chuck Craton's comment: “I've reviewed the information presented to ACIP and it appears boosters temporarily decrease risk of hospitalization and serious illness, but by 120-180 days, you're getting pretty close to baseline pre booster.” … “for the interested:”
https://www.cdc.gov/acip/downloads/slides-2024-10-23-24/04-COVID-Link-Gelles-508.pdf
. . .
“Close to baseline”? VE turns negative! I watched that Oct 24th ACIP meeting and a couple members asked about the slides on p.25-26 of the above pdf showing negative VE for 18-64 YO against ED/UC & Hospitalization after 180 days; -19% & -35% relative VE (compared to those not getting a booster).
When asked for her interpretation, Link-Gelles replied” “To be clear, there is no biological plausibility for the vaccine increasing your risk of disease” Really? Immune imprinting and class switch toward non-infammatory spike-specific immunoglobulin G4 antibodies have been suggested as possible mechanisms. Or, negative effectiveness could simply reflect that immunity from a recent infection is better than immunity from a booster with a variant that is out-of-date by the time it gets into an arm.
Link-Gelles continued: “... if a surge occurred the month before a new vaccine is introduced, and the population has a high level of infection-induced immunity, then we are going to measure lower relative VE. … if we were able to stratify by recent prior infections, we would see higher VE. But, because prior infection is infrequently documented in medical records, it is not generally possible in well-powered studies.”
But, apparently Link-Gelles is unaware of the series of Covid VE studies conducted over the past four years by Dr. Shrestha at the Cleveland Clinic. His “well-powered studies” of health-care workers (with excellent infection and vaccination records) did “stratify by recent prior infections”.
He found “the more recent the last prior COVID-19 episode was the lower the risk of COVID-19" and "that the greater the number of vaccine doses previously received the higher the risk of COVID-19” and “being “up-to-date” on COVID-19 vaccination … was not associated with a lower risk of COVID-19" and “vaccine-induced immunity is weaker and less durable than natural immunity. So, although somewhat protective in the short term, vaccination may increase risk of future infection.”
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0293449
https://academic.oup.com/ofid/article/10/6/ofad209/7131292
P.S. Further evidence of negative effectiveness can be found in the Supplementary Table https://stacks.cdc.gov/view/cdc/145937 for an infection VE study done by Link-Gelles https://www.cdc.gov/mmwr/volumes/73/wr/mm7304a2.htm Those with a bivalent booster did worse than those not "up-to-date."
"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 … It seemed like little more than a pro forma process designed to produce a pre-ordained outcome.”
. . .
I've also watched several VRBPAC & ACIP hearings on Covid vaccines over the past several years and my experience matches your own. Similarly, Dr, Vinay Prasad had a similar experience when he presented his 5-minute comment at last June's FDA VRPAC meeting: “As I listened to the meeting, I realized my comments would be in vain. The FDA had already collaborated with the other speakers … The entire room didn’t feel like an impartial trial, but a kangaroo court. The decision had been made, and this was an elaborate theater. I worry that the FDA is entirely beholden to the pharmaceutical industry” https://www.drvinayprasad.com/p/my-comments-at-fridays-fda-drug-advisory
Thank you for the excellent essay. About a year ago, I asked my functional and integrative medicine doctor a similar question. I said, “I’ve had four Covid shots, and I had Covid when I came back from France last September. I had four days of very mild cold symptoms and slightly elevated body temperatures. I’m 65, but I don’t think I fall into the ‘frail and elderly’ category. Is it still important to get yearly boosters?” She sheepishly replied, “Noooo?” Then she went on to carefully say, “Let’s put it this way: I personally am not getting anymore boosters until there’s good quality evidence that the benefits outweigh the harms.”
A very reasonable answer and approach!
After 6 shots his IgG4 levels likely elevated and his T cell immunity against Covid suppressed. He is therefore dependent on regular boosters to produce short term antibody production and a degree of protection.
Against this, spike protein is wholly bad and regular stimulation of its production likely harmful. As Omicron presently of low pathogenicity I would be against further vax.
Always a good plan to present facts as known for and against, provide reference material and let the patient decide.
As Dr. Prasad has written passionately and repeatedly about, this absence of data is a dereliction of duty by the FDA and NIH. With the amount of time and number of doses given thus far, there has been more than ample opportunity to have run clustered RCT to have hopefully shed some light on this.
I’m with you. I felt in looking at data internationally (the UK was especially effective, and made US data look like child’s play) that the vaccines were effective in reducing severe illness/mortality and spread up to and including delta variant. Once omicron became dominant, vaccines no longer prevented spread. I agree that mandates had no scientific substantiation beyond early/mid 2022 on that basis.
In my practice now, I tell pts who ask (usually on the older side as with most cardio practices) that the benefit is unknown and the risks are low. However, I don’t “recommend” things that are safe but useless, and I don’t make an exception for this.
If they ask “what have you done doc?”, I tell them I stopped after shot #4 in 2022, but I have no chronic illnesses and am not in any high risk group. And per my usual, I let them decide for themselves.
I had the first three Moderna shots in 2021, my husband three (or four) Pfizer shots, and my children three Pfizers. Unless something changes, we are done. Moderna two and three made me sicker than any illness I have ever had. I worry I made a mistake with my children, but we really believed in vaccines and masks and trying to be good humans. I feel like I was gullible in some regards. Our family physician does recommend boosters, and her office is not even keeping it is stock. Our pediatrician recommend it but did say it was a choice to abstain.
I do fear long covid. And repeat infections. Thus far, only my teen has had a confirmed case. And we test after known exposure and with any symptoms.
My wife and I work in healthcare and both chose 1 Johnson and Johnson vaccine in September of 2021. No boosters. Our booster was eventually getting very mild cases of Covid about 2 1/2 years in despite likely being exposed regularly. We rarely masked, ate real food, took immune support, exercised (even when we had covid), used sauna regularly, slept well, traveled, and carried on with our lives. Neither of us have ever had a flu shot nor had the flu that we know of. My last vaccine was a hep B vaccine 25 years ago. Turned 60 this year. My next vaccine will likely be a shingles vaccine at 65. We are both in the best metabolic health of our lives. I'm not 'anti vax'. I am very pro health and prevention. We've seen patients with 4 - 5 Covid shots who have still gotten covid several times. We see those with zero vaccines that have never had covid or just one case. The common denominator for mild disease? Good metabolic health, with or without a jab. Given the poor health of 90% of Americans, I can understand why some should get a Covid shot. I can also understand why some chose not to and others just one. What doesn't make sense is repeated boosters with no long term data. Risk stratification models were developed even prior to vaccines to identify those that are at higher risk of COVID-19 infection and severe illness with commonly used characteristics including vital signs, age, sex, comorbidities etc. but science and common sense gave way to fear and politics and the rest is history.
I agree that good metabolic health was a key covid survival factor. This was known in 2020. It is very unfortunate that the public health establishment did not include this in their public health messaging. An opportunity to improve the health of the public was lost.
My understanding (as a non-MD but someone who knows plenty of physicians and scientists at our local cancer center) is that the boosters are safe and somewhat effective in protection for a few months at least. For people with lipid intolerance, there is now the Novavax booster. I've only had COVID once; it was unpleasant and I hope to never get it again. My brother is convinced that he has long COVID brain fog from a previous infection. So I perceive non-negligible risks from actual infections (inflammation, long COVID), plus the downside of getting sick for a week, vs. negligible risks of boosters.
But what if the vax INCREASES the risk of getting Covid, not decreases it? (See the other comments). I also don't want to get long covid. That's why I stopped after the first vax when I learned how destructive it is.
I was wholeheartedly in favor of the original vaccine series. That was then, in late 2020, early 2021, when the virus was completely different. Now, Covid is a bad cold. I have not taken the umpteenth millionth booster. I have not done it for my kids, either.
I agree with you that the data are simply not there. It is becoming ridiculous. If someone who is immunocompromised, where Covid can kill, maybe. But for the general public, it is very hard to agree.
I'd say the story is moe nuanced.
The first booster was really valuable for ages 55+. See our aeticle, Bernard Black, Vladimir Atanasov, Aharona Glatman-Freedman, Lital Keinan-Boker, Amnon Reichman, Lorenzo Franchi, John R. Meurer, Qian (Eric) Luo, David B. Thaw, and Ali Moghtaderi, COVID-19 Boosters: If The US Had Matched Israel’s Speed And Take-Up, An Estimated 29,000 US Lives Would Have Been Saved, 42(12) Health Affairs 1747-57 (2023) (http://ssrn.com/abstract=4634372)
And there is some Israeli evidence supporting a second booster for ages 60+, pre-Omicron.
I've seen no good evidence after that, and no good evidence in the Omicron period (some might exist and I missed it, to be sure)
But mortality below age 50 is negligible after initial vaccination. No evidence that booste helps.
So you can't be pro-COVID-vax, or anti-COVID-vax. Or even pro-booster or anti-booster. How many? For which ages? That's the nuance that we can't get from the CDC, or the available research studies.
Bernie Black
Thank you for your comment and work in this field. More research and more nuance in CDC recommendations are exactly what is needed. In cardiology, and most other specialties, guidance is issued with different levels of recommendations (1, 2a, 2b, 3, etc) and levels of evidence (A, B, C). The CDC should adopt a similar policy.