It would seem about the right time to see a pivot from up top. I don't know how others feel but without any sort of pivot and reassessment I don't know how much trust our institutions have left. People speak of Joe Rogan on Twitter like his podcast is fringe while in reality it is the modern day version of the Oprah show. By the numbers his audience is the mainstream.
You ok? You know this is where you're going to cross the line, right? Get ready for major mud slinging and push back. They're going to bring the kitchen sink, and everything you've throw down it, at you.
I think he knows that. He's already been dealing with threats for months. Thankfully, he's not alone. Those with the courage to speak up are increasing in numbers thanks to those not being cowards.
I feel this is happening, as well. I've seen many doctors tweet, guest appear on YouTube, or otherwise reverse opinions from earlier in the pandemic. The "consensus" was always an illusion, but it is clearly shattering to pieces every day, now.
He for sure is...I'm hoping he doesn't loose his job over his honesty and educating on truth. I think there is power in #s and always has been...I think he needs to gather more MDs & scientists he knows in CA and beyond...have a huge round table discussion of ALL of these items, CDC studies, booster, etc...maybe it will go viral...maybe media will catch on...maybe not but worth a try. Like more than Zdogg & Makary....more voices...Offit? Gruber? etc etc. How about MDs in DC...? The speak out needs to be in large #s.....not sure what the best route is but just some ideas. Capitol Hill?
Thank you as always for putting things in perspective! It’s been a LONG week here in LA County, CA! My teens’ high school is now treating my teens as “unvaccinated” because they have not been boosted. Both teens have gotten two doses of Pfizer and we are hesitant to boost our son because of the risk of myocarditis. However, because he isn’t boosted, he got placed on “modified quarantine” this past week - where he can go to all of his academic classes, masked, eat lunch with friends outside, unmasked, but was NOT allowed to go to varsity soccer practices, masked!? How does that make any logical sense? It is honestly infuriating!! He had to get two negative tests (one on the 5th and one yesterday, on the 8th) in order to be allowed to go to soccer Monday, and now needs to test every Monday in order to continue playing soccer, just like his unvaccinated teammates… it’s like they ignore the fact that he has two doses of mRNA vaccine in him and is protected from severe disease, and if they all wear masks (surgical or N95/KN95 now required), then shouldn’t they all be allowed to both go to their classes, AND return to their sports?! Especially since soccer is outside in the fresh air and all are masked?! I’m so perplexed by the lack of common sense that I’m beside myself…
Thank you so much - it seems like the world has lost it’s collective mind so we will all suffer the consequences unless the public health officials actually come to their senses and listen to the experts, like Dr. Prasad, Dr. Makary, Dr. Demania, Dr. Ghandi, Dr. Offit, and company…
I wouldn't say "the world" has lost its mind, just certain parts of it. (I'm in LA County as well, and I can say for certain that many areas even in LA County are not following these ridiculous mandates and guidelines. A trip down to OC restored my faith in humanity as well.)
Yes, you are right - and I completely agree & admit I was emotionally charged and overly annoyed when I typed out my initial rant. I, too, go down to OC on the weekends, and yes, they definitely help in restoring my faith in humanity down there - I just wish we could move down there…
Back in the summer of '20 I decided to go down to Seal Beach rather than Santa Monica. It was like a different world!
The pandemic--to be specific, LA's response to the pandemic--made me seriously consider leaving CA. It's not an easy decision to consider, but I'm thinking of OC or San Diego Counties as compromises. I'd still be closer to family and friends as well as the ocean, not to mention the comfort of living in a familiar area. CA used to be a great place to live back when there were competing political parties, but I fear with a super-majority of one party or another it's too easy to put in wacky policies.
YES!!! I completely 100% agree! I grew up in OC but moved to LA after getting married and now our family lives in LA County, where things are getting so bad… My parents still live in OC and we are down there most weekends, and would love to move down there, but everything is so expensive now - it feels like we are stuck where we are…
I follow breakthrough cases, excavating the data from the most obscure location on a DPH website. The dropping VE has been coming on since November. Even the most heavily vaccinated and boosted cities or states have breakthrough infections exceeding 50%.
Dear Vinay. The UC system is mandating the booster. My son can only go back to the Berkeley campus as a freshman if he complies. I am worried for his safety given the risk of myocarditis. Plus, now, they will be mostly virtual for the first 2 weeks. Could you send your thoughts on lack of efficiency and higher risk to the office of the President of the UC system, as well as to the UC Berkeley medical office, Dr Anna Harte and Guy Colette? My husband tired and got a curt response. So our voice won't matter. Th and ou for all that you do!
I would if it were me going to college, but my son is uncomfortable with the stigma associated with this stance, as a freshman trying to make new friends. Which I understand. Total catch 22. :(. We've written to them twice now, but they respond curtly saying they agree with the policy.
I'm not very sympathetic with people choosing fear of stigma over truth and principles, this is why our society has reached this place.
As a biologist, an atheist, raised in a traditional Roman Catholic environment, and rejected it, I've been facing down stigma my entire life (well since age 5, so over 50 years), and am not compelled by people who chose fear.
These vaccine mandates aren't stand alones. Westerners have been fully compliant with the lies since March 15, 2020. Each compliance led to the next.
Take this semester off, get your kid an internship which can lead into a summer job (practical experience and income), then transfer to a school in a free southern state in the Fall. Plenty of schools in SC, FL, TN, TX, etc. that remain committed to in-person instruction and resisting draconian policies.
We are also facing similar circumstances at the high school level. I, too, tried talking to the principal and vice principal and the school board, but because I am not an “expert” they do not listen to me. The district nurse actually had the audacity to hang up on me when I politely asked her if she could send me the guidance she is following, because I could not find it on the CDC website anywhere where it said that if teens are not boosted that they are to be treated as if they are unvaccinated.
Please read the research articles cited at "What every MD, immunologist, virologist and epidemiologist should know about vitamin D and the immune system" https://vitamindstopscovid.info/05-mds/ .
The immune system needs at least 50 ng/mL circulating 25-hydroxyvitamin D (25(OH)D for strong innate and adaptive responses, and to minimise the risk of hyper-inflammatory immune dysregulation. Without proper vitamin D3 supplementation - such as (70 kg 154 lb bodyweight) 0.125mg 5000 IU / day - most people's 25(OH)D levels are 5 to 25 ng/mL.
These mRNA and adenovirus vector COVID-19 "vaccines" have always been the 3rd best way of tackling the pandemic, after proper vitamin D3 supplementation and multiple early treatments, including melatonin, vitamin C, magnesium and ivermectin: https://c19early.com . For most people, the most urgently needed early treatment is boosting 25(OH)D ASAP.
The current vaccines make sense for those with obesity and other serious comorbidities even if their 25(OH)D levels are 50 ng/mL or more and if they have access to multiple early treatments. They have never been the best option for most people, and are now close to useless for reducing Omicron transmission. They provide significant benefits by way of protection from severe disease, but this is narrow and somewhat escaped by Omicron.
There's no reason not to vaccinate or boost - Omicron is upon us. There is no reason to vaccinate those who have already been infected and so have a much broader, stronger, longer lasting immunity - including mucosal immunity - than is possible with any number of vaccine injections.
Thank you for posting this and giving us evidence. This has seemed obvious and it's oddly reassuring to finally see it. I do wonder about two things.
One, you say this: "Boosting should happen in populations where it further reduces severe disease and death— aka older & vulnerable people." Are you saying that boosting for this population makes sense even though it only buys a little time with presumably accelerated waning of immunity in these populations? Why continue to recommend it for these groups? How does it further reduce severe disease/death?
And two, do we really even know if these vaccines hold up against severe illness and death? Or is it that almost all of the deaths occur is the very age group that all of us eventually die > 75 years old?
I was disappointed in your assessment of VAERS regarding deaths. We don't usually have to prove a connection when assessing adverse reactions with a new vaccine especially one rushed and based on new mRNA technology never before used. They removed the rotavirus vaccine RotaShield after a few dozen cases of intussusception but no deaths. There have been 21,000 deaths associated Covid vaccines reported so far. That's more than all other vaccines combined in 30 years. And when you combine that with the obvious poor efficacy of the vaccine it makes no sense to keep giving it until we sort this out. By the way why haven't we sorted it out? I haven't seen a single double blinded prospective study to assess deaths caused by the vaccine. This would be easy to do considering the available people who do and don't want to take the vaccine. The idea of throwing up our hands and saying we don't really know if these deaths are caused by the vaccine is bizarre. Statistical analysis would be simple to do. We could analyze these deaths that have occurred and find out what the cause of death was based on autopsy. I haven't heard any autopsies on any of them. I've had read stories of family members pushing for autopsies that have been refused. Its as if the goal is to minimize what VAERS is showing and not get to the bottom of whether the deaths were related to the vaccine. Please stop mentioning car accidents. It's a slap in the face of people who've lost loved ones possibly secondary to a vaccine being forced on them. It's not a thing. It's a talking point. VAERS is hard enough to navigate and filled on every page with threats of breaking federal law if you misreport. No one is dumb enough to put themselves through that after a car accident. Not the doctors who are primarily the ones who fill these out. But not the patients either who have had the wherewithal to complete one of those forms.
"Second, this argument would mean the state could tell people what to eat and how much to exercise, and how much to drink. Food, drink and obesity are drivers of hospitalizations. Instead, we have not accepted these infringements in the past. The justification for vaccine mandates is that it helps curb population spread. The latest vaccine effectiveness figures show that effect is now nearly gone, and transient at best. Ergo, the mandates are unjustified."
You are conflating the arguments for booster mandates (which are weak) and vaccine mandates (which are much stronger). The justification for the latter is not about spread or rates of mild symptomatic illness. It is that they preserve health system capacity and decrease collective social costs by significantly reducing rates of hospitalization and serious illness. One can disagree about the balance of trade-offs from those mandates (infringements on individual autonomy, backlash effects, etc.) but they deserve a more serious treatment than you give them here.
I can name you dozens of things people could/should do that would far more reduce the rates of hospitalization and serious illness. And none of them come with the unknowns and attendant issues of being untested (yes, the shots are untested until they have been in use for a decade like all other vaccines or purported vaccines [you cannot really be a vaccine if you are not sterilizing] like the EUA covid shot. Elderly people often get pneumonia and die...they always have. The average age of death from covid is still older than the life expectancy in this country.
I advise my patients over 65 to get the vaccine because it will mean they can eventually die of some other respiratory complication but at least this one can be deferred. There is little justification for anyone getting the shot below that age, and there are major contraindications below 40, especially in males. Clearly you have not examined the hospitalization rates by age or this would be clear to you. And the elderly population is mostly vaccinated and not subject to any of the mandates anyway...the only place they might be defensible (they are not, but you could at least make a case).
The media likes to trumpet the occasional young person who dies of COVID (most of whom have other comorbidities, but set that aside). Every year people of the same age die of the flu, other respiratory viruses, and sometimes for reasons not understood at all. None of those make the news, ever.
If you are interested in real hospital data, I suggest you will learn something from this current data: https://simulationcommander.substack.com/p/weekend-update-literally-updates. Any investigation will show that ICUs (forgetting a rare outlier hospital somewhere) have not been any more full than they are any other year. Hospitals depend on being full in the winter to make their budgets. Pediatric wards are full this year...with RSV, NOT covid.
Almost everything out there is misreported. The readers of this blog are generally pretty knowledgeable about the actual facts, not those promulgated by those with other agendas. There is plenty you can read to easily falsify the "we have to save the hospitals from overflowing" argument out there.
I agree with some of your points about individual risk-benefit analysis. Vaccine mortality benefits are definitely heavily concentrated in those >65 and those with underlying comorbidities. And there are plenty of other circulating respiratory viruses and opportunistic bacterial pneumonias that cause significant mortality and morbidity.
That said, any objective look at the data shows that SARS-Cov2 is much, much more serious than any other widely circulating respiratory infection. For example, in an unvaccinated population, it outstrips seasonal influenza's hospitalization and mortality #s by an order of magnitude in every age demographic except infants. Fortunately, unlike other causes of viral pneumonia, we have an incredibly effective vaccine against COVID-19 disease. So even if the benefits aren't as large for younger cohorts, they are still substantial. COVID-19 was a top 5 cause of death in people under 40 prior to the arrival of the vaccine. If we had a tool that could cut a major cause of death in any age group by 90%, we would deploy it without hesitation.
Furthermore, we know, thanks to extensive safety monitoring, that the only clinically significant adverse effects of the mRNA vaccines so far observed are concentrated in the population of men between the ages of 15-30. We also know vaccine side effects are almost exclusively concentrated in the short period of time after administration. So I feel pretty confident saying the benefits of vaccination vastly exceed the harms for everyone 30 and up.
As to your points about societal costs and hospital capacity - I think we are unlikely to have a productive dialogue if we are starting so far apart when it comes to the basic facts on the ground. I will simply say I place a lot more stock in the collective reporting of multiple hospital systems, local and state public health agencies, and the CDC than in a blog post that is cherry-picking data to fit its priors.
The mandate from my employer said nothing about reducing severe illness or hospitalizations/ preserving health system capacity. It was because the unvaccinated, despite having recovered from COVID were deemed to be unsafe to be around - pandemic of unvaccinated- "Given the dire statistics...we can no longer allow unvaccinated people back into the workplace until we better understand how they might interact with our customers and their vaccinated co-workers.".
The unfactual reasons above are what the government, and corporations, hospital systems still parrot today as the justification for across-the-board booster mandates- with no data/ no nuance.
Vinay did say that there is no argument that boosters should absolutely be targeted to the vulnerable/ elderly/ underlying health conditions
I agree that there are bad (or at least, more marginal) reasons for vaccine mandates, and they tend to get more play in the media because of the focus on transmission and spread. But the existence of worse arguments does not negate the reality of better ones.
Also, by pure libertarian logic, it's pretty reasonable for employers to respond to the pressures of the marketplace by enforcing vaccine mandates. At the end of the day, their job is to protect the bottom line. If they are going to lose employees and customers because of the perception they are not doing everything possible to maximize pandemic safety, then they have a fiduciary responsibility to implement vaccine requirements - even if the market pressures are based on weak data.
“It is that they preserve health system capacity and decrease collective social costs by significantly reducing rates of hospitalization and serious illness.”
What is the limiting principle with this rationale? Mandates for influenza vaccines? How about pneumococcal vaccines for the elderly? Mandatory suboxone therapy for opioid addicts? Or, reductio ad absurdum, mandatory gastric bypass surgery for those with a BMI over 40.
At least with those examples we have longitudinal safety data.
There is no single limiting principle. These types of public health decisions are based by weighing the expected social and individual benefits against individual costs. The other interventions you list are either much more costly to individuals (gastric bypass surgery) or offer less benefit to individuals (SARS-Cov2 is much deadlier than influenza and the vaccine is far more effective). The pneumococcal vaccine is a more interesting edge case, but on a societal level CAP hospitalizations are much less costly than COVID-19 hospitalizations.
And again, 'mandate' does not mean 'forcibly inject you.' It means 'assess a financial penalty on your taxes for incurring a higher expected healthcare utilization cost on society.'
And if your concern is longitudinal safety data, I'd be curious for you to outline the exact nature of novel adverse events you are expecting to emerge in the 12+ months after global distribution of the vaccines. We've already detected and characterized adverse effects (myocarditis) with a ~1:100,000 population level signal (obviously higher in the at-risk cohort). It is theoretically possible that late onset adverse effects could emerge...but they would be the first such late onset effects to ever be observed from a vaccination series, and I struggle to imagine a biologically plausible mechanism that could account for such an event. At some point, the tiny, tiny risks associated with the marginal uncertainty are outweighed by the known benefits - and the marginal uncertainty shrinks with every passing week.
It's also misleading to say that we have never had centralized, mandate-type efforts to control lifestyle-related cardiovascular disease. Soda taxes, mandating calorie listing, liquor licenses, indoor smoking bans, etc. It's true that have not had the state come door-to-door and gavage unwilling citizens with broccoli purees, but that's not what we'd be looking at with vaccine mandates either. Most likely it would be a financial penalty (similar to seat belt law violations) designed to offset the social costs of remaining unvaccinated.
I respect a lot of your work battling against marginal interventions with poor evidence bases (school closures, boosting low-risk individuals, cloth masks), but your recent string of Substack + Twitter posts about testing and vaccination mandates have lacked rigorous consideration of the stronger arguments at play.
They are the very definition of MARGINAL INTERVENTIONS. As Sweden has demonstrated, keeping MARGINAL INTERVENTIONS voluntary succeeds in many more ways than limitations on civil rights and racist policies.
The Swedish data is mixed, at best. And comparisons to a small, civically cohesive, wealthy Nordic country are just as spurious as when lockdown extremists compare the U.S. to New Zealand or Australia.
And why are they worse? Because they have little to No background immunitity yet, whereas other nations have developed significant population resilience. Everyone is going to get it and soon, some are just in denial.
Vinay: It is implicit in the title of your article ["Vaccine effectiveness (against infection not severe disease) goes down the drain"] that in the COVID context you equate the term "Infection" with *Having a Positive PCR Test Result* PERIOD. I do not disagree with that definition and I also have looked at the Kaiser paper, which you cited. In that elaborate test-negative case control study, it seems to me that their definition of "being a case" was *only* having a positive PCR test result, no matter the indication or circumstances for PCR test administration (obviously with some particular exclusion criteria applied, as was explicated by the authors).
Thank you for your summary and the courage to explain the conclusions. This won't end until people start saying No with conviction. Being informed with this data is essential to that goal.
It would seem about the right time to see a pivot from up top. I don't know how others feel but without any sort of pivot and reassessment I don't know how much trust our institutions have left. People speak of Joe Rogan on Twitter like his podcast is fringe while in reality it is the modern day version of the Oprah show. By the numbers his audience is the mainstream.
You ok? You know this is where you're going to cross the line, right? Get ready for major mud slinging and push back. They're going to bring the kitchen sink, and everything you've throw down it, at you.
I think he knows that. He's already been dealing with threats for months. Thankfully, he's not alone. Those with the courage to speak up are increasing in numbers thanks to those not being cowards.
I feel this is happening, as well. I've seen many doctors tweet, guest appear on YouTube, or otherwise reverse opinions from earlier in the pandemic. The "consensus" was always an illusion, but it is clearly shattering to pieces every day, now.
I think he is being honest and those of us who have been following the dropping VE data should speak up in support.
He for sure is...I'm hoping he doesn't loose his job over his honesty and educating on truth. I think there is power in #s and always has been...I think he needs to gather more MDs & scientists he knows in CA and beyond...have a huge round table discussion of ALL of these items, CDC studies, booster, etc...maybe it will go viral...maybe media will catch on...maybe not but worth a try. Like more than Zdogg & Makary....more voices...Offit? Gruber? etc etc. How about MDs in DC...? The speak out needs to be in large #s.....not sure what the best route is but just some ideas. Capitol Hill?
Thank you as always for putting things in perspective! It’s been a LONG week here in LA County, CA! My teens’ high school is now treating my teens as “unvaccinated” because they have not been boosted. Both teens have gotten two doses of Pfizer and we are hesitant to boost our son because of the risk of myocarditis. However, because he isn’t boosted, he got placed on “modified quarantine” this past week - where he can go to all of his academic classes, masked, eat lunch with friends outside, unmasked, but was NOT allowed to go to varsity soccer practices, masked!? How does that make any logical sense? It is honestly infuriating!! He had to get two negative tests (one on the 5th and one yesterday, on the 8th) in order to be allowed to go to soccer Monday, and now needs to test every Monday in order to continue playing soccer, just like his unvaccinated teammates… it’s like they ignore the fact that he has two doses of mRNA vaccine in him and is protected from severe disease, and if they all wear masks (surgical or N95/KN95 now required), then shouldn’t they all be allowed to both go to their classes, AND return to their sports?! Especially since soccer is outside in the fresh air and all are masked?! I’m so perplexed by the lack of common sense that I’m beside myself…
That’s so awful. I’m so sorry.
Thank you so much - it seems like the world has lost it’s collective mind so we will all suffer the consequences unless the public health officials actually come to their senses and listen to the experts, like Dr. Prasad, Dr. Makary, Dr. Demania, Dr. Ghandi, Dr. Offit, and company…
I wouldn't say "the world" has lost its mind, just certain parts of it. (I'm in LA County as well, and I can say for certain that many areas even in LA County are not following these ridiculous mandates and guidelines. A trip down to OC restored my faith in humanity as well.)
Yes, you are right - and I completely agree & admit I was emotionally charged and overly annoyed when I typed out my initial rant. I, too, go down to OC on the weekends, and yes, they definitely help in restoring my faith in humanity down there - I just wish we could move down there…
Back in the summer of '20 I decided to go down to Seal Beach rather than Santa Monica. It was like a different world!
The pandemic--to be specific, LA's response to the pandemic--made me seriously consider leaving CA. It's not an easy decision to consider, but I'm thinking of OC or San Diego Counties as compromises. I'd still be closer to family and friends as well as the ocean, not to mention the comfort of living in a familiar area. CA used to be a great place to live back when there were competing political parties, but I fear with a super-majority of one party or another it's too easy to put in wacky policies.
YES!!! I completely 100% agree! I grew up in OC but moved to LA after getting married and now our family lives in LA County, where things are getting so bad… My parents still live in OC and we are down there most weekends, and would love to move down there, but everything is so expensive now - it feels like we are stuck where we are…
I follow breakthrough cases, excavating the data from the most obscure location on a DPH website. The dropping VE has been coming on since November. Even the most heavily vaccinated and boosted cities or states have breakthrough infections exceeding 50%.
Dear Vinay. The UC system is mandating the booster. My son can only go back to the Berkeley campus as a freshman if he complies. I am worried for his safety given the risk of myocarditis. Plus, now, they will be mostly virtual for the first 2 weeks. Could you send your thoughts on lack of efficiency and higher risk to the office of the President of the UC system, as well as to the UC Berkeley medical office, Dr Anna Harte and Guy Colette? My husband tired and got a curt response. So our voice won't matter. Th and ou for all that you do!
You must stand, and refuse to comply. This NEVER ends unless people stop complying.
I would if it were me going to college, but my son is uncomfortable with the stigma associated with this stance, as a freshman trying to make new friends. Which I understand. Total catch 22. :(. We've written to them twice now, but they respond curtly saying they agree with the policy.
I'm not very sympathetic with people choosing fear of stigma over truth and principles, this is why our society has reached this place.
As a biologist, an atheist, raised in a traditional Roman Catholic environment, and rejected it, I've been facing down stigma my entire life (well since age 5, so over 50 years), and am not compelled by people who chose fear.
These vaccine mandates aren't stand alones. Westerners have been fully compliant with the lies since March 15, 2020. Each compliance led to the next.
Take this semester off, get your kid an internship which can lead into a summer job (practical experience and income), then transfer to a school in a free southern state in the Fall. Plenty of schools in SC, FL, TN, TX, etc. that remain committed to in-person instruction and resisting draconian policies.
We are also facing similar circumstances at the high school level. I, too, tried talking to the principal and vice principal and the school board, but because I am not an “expert” they do not listen to me. The district nurse actually had the audacity to hang up on me when I politely asked her if she could send me the guidance she is following, because I could not find it on the CDC website anywhere where it said that if teens are not boosted that they are to be treated as if they are unvaccinated.
We are facing the same thing with our son returning to Boston College. I haven't gotten any response from them yet.
Sorry for typos, I mean thank you for all that you do!
Dear Dr Prasad,
Please read the research articles cited at "What every MD, immunologist, virologist and epidemiologist should know about vitamin D and the immune system" https://vitamindstopscovid.info/05-mds/ .
The immune system needs at least 50 ng/mL circulating 25-hydroxyvitamin D (25(OH)D for strong innate and adaptive responses, and to minimise the risk of hyper-inflammatory immune dysregulation. Without proper vitamin D3 supplementation - such as (70 kg 154 lb bodyweight) 0.125mg 5000 IU / day - most people's 25(OH)D levels are 5 to 25 ng/mL.
For rapid boosting of 25(OH) in 4 hours or ~~4 days, please see: and https://nutritionmatters.substack.com/p/calcifediol-25-hydroxyvitamin-d-or .
These mRNA and adenovirus vector COVID-19 "vaccines" have always been the 3rd best way of tackling the pandemic, after proper vitamin D3 supplementation and multiple early treatments, including melatonin, vitamin C, magnesium and ivermectin: https://c19early.com . For most people, the most urgently needed early treatment is boosting 25(OH)D ASAP.
The current vaccines make sense for those with obesity and other serious comorbidities even if their 25(OH)D levels are 50 ng/mL or more and if they have access to multiple early treatments. They have never been the best option for most people, and are now close to useless for reducing Omicron transmission. They provide significant benefits by way of protection from severe disease, but this is narrow and somewhat escaped by Omicron.
There's no reason not to vaccinate or boost - Omicron is upon us. There is no reason to vaccinate those who have already been infected and so have a much broader, stronger, longer lasting immunity - including mucosal immunity - than is possible with any number of vaccine injections.
Thank you for posting this and giving us evidence. This has seemed obvious and it's oddly reassuring to finally see it. I do wonder about two things.
One, you say this: "Boosting should happen in populations where it further reduces severe disease and death— aka older & vulnerable people." Are you saying that boosting for this population makes sense even though it only buys a little time with presumably accelerated waning of immunity in these populations? Why continue to recommend it for these groups? How does it further reduce severe disease/death?
And two, do we really even know if these vaccines hold up against severe illness and death? Or is it that almost all of the deaths occur is the very age group that all of us eventually die > 75 years old?
Thank You as always Dr. Prasad.
I was disappointed in your assessment of VAERS regarding deaths. We don't usually have to prove a connection when assessing adverse reactions with a new vaccine especially one rushed and based on new mRNA technology never before used. They removed the rotavirus vaccine RotaShield after a few dozen cases of intussusception but no deaths. There have been 21,000 deaths associated Covid vaccines reported so far. That's more than all other vaccines combined in 30 years. And when you combine that with the obvious poor efficacy of the vaccine it makes no sense to keep giving it until we sort this out. By the way why haven't we sorted it out? I haven't seen a single double blinded prospective study to assess deaths caused by the vaccine. This would be easy to do considering the available people who do and don't want to take the vaccine. The idea of throwing up our hands and saying we don't really know if these deaths are caused by the vaccine is bizarre. Statistical analysis would be simple to do. We could analyze these deaths that have occurred and find out what the cause of death was based on autopsy. I haven't heard any autopsies on any of them. I've had read stories of family members pushing for autopsies that have been refused. Its as if the goal is to minimize what VAERS is showing and not get to the bottom of whether the deaths were related to the vaccine. Please stop mentioning car accidents. It's a slap in the face of people who've lost loved ones possibly secondary to a vaccine being forced on them. It's not a thing. It's a talking point. VAERS is hard enough to navigate and filled on every page with threats of breaking federal law if you misreport. No one is dumb enough to put themselves through that after a car accident. Not the doctors who are primarily the ones who fill these out. But not the patients either who have had the wherewithal to complete one of those forms.
"the obvious poor efficacy of the vaccine" HUH ???????
"Second, this argument would mean the state could tell people what to eat and how much to exercise, and how much to drink. Food, drink and obesity are drivers of hospitalizations. Instead, we have not accepted these infringements in the past. The justification for vaccine mandates is that it helps curb population spread. The latest vaccine effectiveness figures show that effect is now nearly gone, and transient at best. Ergo, the mandates are unjustified."
You are conflating the arguments for booster mandates (which are weak) and vaccine mandates (which are much stronger). The justification for the latter is not about spread or rates of mild symptomatic illness. It is that they preserve health system capacity and decrease collective social costs by significantly reducing rates of hospitalization and serious illness. One can disagree about the balance of trade-offs from those mandates (infringements on individual autonomy, backlash effects, etc.) but they deserve a more serious treatment than you give them here.
I can name you dozens of things people could/should do that would far more reduce the rates of hospitalization and serious illness. And none of them come with the unknowns and attendant issues of being untested (yes, the shots are untested until they have been in use for a decade like all other vaccines or purported vaccines [you cannot really be a vaccine if you are not sterilizing] like the EUA covid shot. Elderly people often get pneumonia and die...they always have. The average age of death from covid is still older than the life expectancy in this country.
I advise my patients over 65 to get the vaccine because it will mean they can eventually die of some other respiratory complication but at least this one can be deferred. There is little justification for anyone getting the shot below that age, and there are major contraindications below 40, especially in males. Clearly you have not examined the hospitalization rates by age or this would be clear to you. And the elderly population is mostly vaccinated and not subject to any of the mandates anyway...the only place they might be defensible (they are not, but you could at least make a case).
The media likes to trumpet the occasional young person who dies of COVID (most of whom have other comorbidities, but set that aside). Every year people of the same age die of the flu, other respiratory viruses, and sometimes for reasons not understood at all. None of those make the news, ever.
If you are interested in real hospital data, I suggest you will learn something from this current data: https://simulationcommander.substack.com/p/weekend-update-literally-updates. Any investigation will show that ICUs (forgetting a rare outlier hospital somewhere) have not been any more full than they are any other year. Hospitals depend on being full in the winter to make their budgets. Pediatric wards are full this year...with RSV, NOT covid.
Almost everything out there is misreported. The readers of this blog are generally pretty knowledgeable about the actual facts, not those promulgated by those with other agendas. There is plenty you can read to easily falsify the "we have to save the hospitals from overflowing" argument out there.
I agree with some of your points about individual risk-benefit analysis. Vaccine mortality benefits are definitely heavily concentrated in those >65 and those with underlying comorbidities. And there are plenty of other circulating respiratory viruses and opportunistic bacterial pneumonias that cause significant mortality and morbidity.
That said, any objective look at the data shows that SARS-Cov2 is much, much more serious than any other widely circulating respiratory infection. For example, in an unvaccinated population, it outstrips seasonal influenza's hospitalization and mortality #s by an order of magnitude in every age demographic except infants. Fortunately, unlike other causes of viral pneumonia, we have an incredibly effective vaccine against COVID-19 disease. So even if the benefits aren't as large for younger cohorts, they are still substantial. COVID-19 was a top 5 cause of death in people under 40 prior to the arrival of the vaccine. If we had a tool that could cut a major cause of death in any age group by 90%, we would deploy it without hesitation.
Furthermore, we know, thanks to extensive safety monitoring, that the only clinically significant adverse effects of the mRNA vaccines so far observed are concentrated in the population of men between the ages of 15-30. We also know vaccine side effects are almost exclusively concentrated in the short period of time after administration. So I feel pretty confident saying the benefits of vaccination vastly exceed the harms for everyone 30 and up.
As to your points about societal costs and hospital capacity - I think we are unlikely to have a productive dialogue if we are starting so far apart when it comes to the basic facts on the ground. I will simply say I place a lot more stock in the collective reporting of multiple hospital systems, local and state public health agencies, and the CDC than in a blog post that is cherry-picking data to fit its priors.
The mandate from my employer said nothing about reducing severe illness or hospitalizations/ preserving health system capacity. It was because the unvaccinated, despite having recovered from COVID were deemed to be unsafe to be around - pandemic of unvaccinated- "Given the dire statistics...we can no longer allow unvaccinated people back into the workplace until we better understand how they might interact with our customers and their vaccinated co-workers.".
The unfactual reasons above are what the government, and corporations, hospital systems still parrot today as the justification for across-the-board booster mandates- with no data/ no nuance.
Vinay did say that there is no argument that boosters should absolutely be targeted to the vulnerable/ elderly/ underlying health conditions
I agree that there are bad (or at least, more marginal) reasons for vaccine mandates, and they tend to get more play in the media because of the focus on transmission and spread. But the existence of worse arguments does not negate the reality of better ones.
Also, by pure libertarian logic, it's pretty reasonable for employers to respond to the pressures of the marketplace by enforcing vaccine mandates. At the end of the day, their job is to protect the bottom line. If they are going to lose employees and customers because of the perception they are not doing everything possible to maximize pandemic safety, then they have a fiduciary responsibility to implement vaccine requirements - even if the market pressures are based on weak data.
“It is that they preserve health system capacity and decrease collective social costs by significantly reducing rates of hospitalization and serious illness.”
What is the limiting principle with this rationale? Mandates for influenza vaccines? How about pneumococcal vaccines for the elderly? Mandatory suboxone therapy for opioid addicts? Or, reductio ad absurdum, mandatory gastric bypass surgery for those with a BMI over 40.
At least with those examples we have longitudinal safety data.
There is no single limiting principle. These types of public health decisions are based by weighing the expected social and individual benefits against individual costs. The other interventions you list are either much more costly to individuals (gastric bypass surgery) or offer less benefit to individuals (SARS-Cov2 is much deadlier than influenza and the vaccine is far more effective). The pneumococcal vaccine is a more interesting edge case, but on a societal level CAP hospitalizations are much less costly than COVID-19 hospitalizations.
And again, 'mandate' does not mean 'forcibly inject you.' It means 'assess a financial penalty on your taxes for incurring a higher expected healthcare utilization cost on society.'
And if your concern is longitudinal safety data, I'd be curious for you to outline the exact nature of novel adverse events you are expecting to emerge in the 12+ months after global distribution of the vaccines. We've already detected and characterized adverse effects (myocarditis) with a ~1:100,000 population level signal (obviously higher in the at-risk cohort). It is theoretically possible that late onset adverse effects could emerge...but they would be the first such late onset effects to ever be observed from a vaccination series, and I struggle to imagine a biologically plausible mechanism that could account for such an event. At some point, the tiny, tiny risks associated with the marginal uncertainty are outweighed by the known benefits - and the marginal uncertainty shrinks with every passing week.
It's also misleading to say that we have never had centralized, mandate-type efforts to control lifestyle-related cardiovascular disease. Soda taxes, mandating calorie listing, liquor licenses, indoor smoking bans, etc. It's true that have not had the state come door-to-door and gavage unwilling citizens with broccoli purees, but that's not what we'd be looking at with vaccine mandates either. Most likely it would be a financial penalty (similar to seat belt law violations) designed to offset the social costs of remaining unvaccinated.
You're right. The vaccine mandates are worse
I respect a lot of your work battling against marginal interventions with poor evidence bases (school closures, boosting low-risk individuals, cloth masks), but your recent string of Substack + Twitter posts about testing and vaccination mandates have lacked rigorous consideration of the stronger arguments at play.
They are the very definition of MARGINAL INTERVENTIONS. As Sweden has demonstrated, keeping MARGINAL INTERVENTIONS voluntary succeeds in many more ways than limitations on civil rights and racist policies.
The Swedish data is mixed, at best. And comparisons to a small, civically cohesive, wealthy Nordic country are just as spurious as when lockdown extremists compare the U.S. to New Zealand or Australia.
Hahahaha! Name a country who's data is not mixed! Yes, the countries with hard lockdowns are systematically worse off right now.
And Canada, where I live, *IS* a "small (population), civically cohesise, wealthy Nordic country.
And why are they worse? Because they have little to No background immunitity yet, whereas other nations have developed significant population resilience. Everyone is going to get it and soon, some are just in denial.
excellent as always. thank you.
Vinay: It is implicit in the title of your article ["Vaccine effectiveness (against infection not severe disease) goes down the drain"] that in the COVID context you equate the term "Infection" with *Having a Positive PCR Test Result* PERIOD. I do not disagree with that definition and I also have looked at the Kaiser paper, which you cited. In that elaborate test-negative case control study, it seems to me that their definition of "being a case" was *only* having a positive PCR test result, no matter the indication or circumstances for PCR test administration (obviously with some particular exclusion criteria applied, as was explicated by the authors).
This round table is happening now hosted by Sen. Ron Johnson from WI. This would be great for you to watch and weigh in on. https://www.redvoicemedia.com/video/2022/01/live-covid-19-a-second-opinion-ron-johnson-moderated-panel-discussion-with-experts/
Thank you for your summary and the courage to explain the conclusions. This won't end until people start saying No with conviction. Being informed with this data is essential to that goal.