Doctors who advise a healthy child to get a 2024 fall booster are committing malpractice

It's time to be honest; State medical boards in Florida and Texas should take note.

It’s easy to hide behind, “the experts said to do it.” You can point to Peter Marks at FDA or Mandy Cohen at CDC and say they told me to do it. But these people and these agencies have repeatedly displayed that they aren’t capable of good medical advice.

Peter Marks famously demoted Phil Krause at FDA to rush full biological licensing agreement (BLA) for covid vaccines so Biden could ram unethical mandates. Mandy Cohen supported the CDC policy of toddler masking, an illogical idea that punished young kids for no purpose.

Ultimately, however we all own our actions. If you are a doctor, you can’t blame others for the advice you give patients. You have to evaluate the evidence and do what you think is best.

This fall, the US is once again a major global outlier by recommending COVID19 boosters to little children, even those who have already and repeatedly had COVID19. In this essay I am going to argue not only that doctors should not advise parents to give their kids the booster, and not only that the FDA should not have approved it, and the CDC not recommended it: I am going to argue the strongest thesis of all: It is malpractice for a doctor to recommend the booster to children. Consider the case.

First, here is my UCSF colleague Eric Widera noting that the US is a global outlier in deciding to give an annual jab to kids, nearly all of whom have had COVID already.

Second, notably, the mRNA vaccine boosters target KP.2, but this strain is circulating less and less and we don’t know what the effect of the booster is on the strains likely to infect kids (and everyone) this fall.

Third, and this is the biggest point. If a doctor recommends that a healthy kids gets something, a doctor should have some confidence the benefit to the kid will outweigh the harms. That isn’t the case here.

We have no idea if the fall booster will further lower the risk of bad outcomes for kids because there is no randomized study and there will be no such study. Cohort observational literature is hopelessly confounded because parents who get the shot are different than those who don’t. Test negative case control literature is hopeless for many reasons (paper forthcoming), but also because the construct of what it means to seek the test may vary. Case control is biased because it is hard to find controls that are truly from the same underlying population.

At the same time, one of these days, a fall booster will have a serious safety signal. It is just a matter of time. All of the initial covid vaccines had safety signals more common than 1 in 100k in a subpopulation. VITT killed young women (1 in 50k), and myocarditis plagued young men (1 in 3k). Giving 18 year women J&J in the second half of 2021 or giving 16 year old men mRNA shots (anytime) was net harmful. The safety signal was > the absolute risk reduction for bad covid outcomes.

With healthy kids, the absolute risk of bad covid outcomes has bottomed out. During the peak pandemic it might have been somewhere between 1 in 500k or 2.5 million. Now it is even lower with prior immunity and a different strain. A new shot will one day have some side effect with a risk of 1 in 50 or 1 in 100 k. That risk will be greater than the potential benefit of boosting. It is just a matter of time.

The FDA and CDC has decided all of these numbers are small, and they are sure that no one will keep tally. But it is still a game of Russian Roulette. One of these years something bad will happen (as the construct changes and mimics other body epitopes). Its a gamble not worth taking.

In this setting, a wise doctor would advise parents of healthy kids NOT to get the fall booster. The potential harms are larger than the potential benefits. It doesn’t matter what Peter Marks and Mandy Cohen say— and after all, who are they? A random heme onc doctor from Brigham and a random doc who supported Obama. They are by no means the best scientists of their generation and their meager scholarship record prior to their government work confirms that.

Given these facts, a doctor who recommends a healthy kids get the vaccine is making a mistake. It is a mistake they could have tried to educate themselves on, and a clue would be that most of Europe is not making it. I think it rises to the level of malpractice because doctors should understand that you don’t mess with healthy people unless you have proven they have net benefit. While liberal states are unlikely to do anything, conservative states may be interested in regulating this.

What do you think? (Subscribe and leave a comment. Your subscriptions keep this substack going).