“Not the Way to Pull Vaccines Back from a “Dangerous Tipping Point”

In a previous article I mused on what it meant to be anti-vaccine and concluded:

The core that unites anti-vaccine thought is: 1) inappropriate minimization of the risk of the virus, and 2) inappropriate minimization of the safety and efficacy of the vaccine.

With this is mind, let’s visit an article titled Not the Way to Pull Vaccines Back from a “Dangerous Tipping Point by Dr. Adam Cifu, a “medical conservative” and founder of the monetized substack Sensible Medicine. Dr. Cifu himself mused on yet another article titled Is Vaccination Approaching a Dangerous Tipping Point. Not the Way to Pull Vaccines Back from a “Dangerous Tipping Point by Drs. Peter Marks and Robert Califf. Dr. Cifu, who described himself as “unabashedly pro-vaccine,” disagreed with their article, suggesting that we increase vaccine uptake with “honesty and transparency.”

Of course, no one who is “unabashedly pro-vaccine” and values “honesty and transparency” would associate themselves with Sensible Medicine.

As SBM readers know, we’ve documented countless instances of blatant factual errors and obfusciation from its authors. They always overstate risks of the vaccine and minimize the impact of the virus, leading them to treat rare, usually mild vaccine side effects, even abnormal lab values, as a fate worse than death from COVID. They’ve repeatedly declared the pandemic over for 3 years in a row, wildly overhyped vaccines in 2021, and now say only stupid people “still give a shit about COVID” or take precautions against it. They’ve spoken positively about infecting children with SARS-CoV-2 and said we should accept that some will die as a “matter of course.”

Beyond this, some Sensible Medicine doctors have partnered with anti-vaccine, pro-tobacco, child-labor advocates. They’ve defended anti-vaccine data-fraudster Dr. Joseph Ladapo and praised cranks like RFK Jr. They’ve likened public health measures to Nazism. They’ve publically mocked vaccine heroes like Dr. Peter Hotez, even though he received death threats and was threatened at home.

They’ve dunked not just on the COVID vaccine, but also the flu and chickenpox vaccines. Perhaps someone will have the fortitude to listen to Sensible Medicine x Vaccine Curious: Tracy Beth Høeg and Christine Stabell Benn Compare US & Danish COVID-19 Response and Child Vaccination Policy to let me know which other vaccines they trash. Both Drs. Høeg and Benn are members of Ron Desantis’s Orwellian “Public Health Integrity Committee“.

Like I said, no one who is “unabashedly pro-vaccine” and values “honesty and transparency” would associate themselves with Sensible Medicine.

“The proverbial elephant in the room, COVID boosters”

To be honest, I can’t recall a single Sensible Medicine article on vaccines where I thought “that was a well-argued, thorough presentation of the data which was devoid of factual errors.” Dr. Cifu’s article was no exception.

Dr. Cifu’s core objection was that “Marks and Califf choose to treat all vaccines the same”. He wrote:

Trying to convince all people that all vaccines are the same is probably the way to make people reasonably skeptical of some vaccine be unreasonably skeptical of them all.

Of course, no one treats all vaccines the same, and there are many vaccines (Yellow Fever, Cholera, Japanese Encephalitis, Ebola, Malaria, Anthrax, Typhoid) which are not suggested to Americans. However, Dr. Cifu’s straw man argument led him to embrace the absurd notion that the COVID vaccine is in competition with other vaccines. Without a shred of evidence, he blamed the “proverbial elephant in the room, COVID boosters” for an increase in overall vaccine hesitancy. Dr. Cifu wants us to imagine there are many parents who think: “I was going to give my kid the MMR, but after reviewing the data on COVID boosters, I changed my mind.” Apparently, Dr. Cifu is unaware that measles is surging in the UK now, even though their COVID booster policy is much more restrictive than the US.

To make his case, Dr. Cifu wrote the following:

Though I am convinced of the safety of the COVID vaccine and know that the initial series saved millions of lives. I, like many of my patients, have questions about the 7th, 8th, and 9th booster (I wish I was exaggerating). I have questions not because of unreasonable skepticism but because we just don’t have robust clinical data that allows me to tell my patients how much a vaccine, after an initial series, will help them…Now, don’t get me wrong, COVID remains serious business and we still losing 1500 people each (week) to “COVID related” deaths. We are also not without data that boosters help — I just can’t call it “robust data.”

What are the downsides of getting a 7th, 8th, and 9th booster, especially for older, vulnerable patients? Even though he acknowledges COVID vaccines are safe, Dr. Cifu doesn’t say. He knows his audience demands “robust data” only for vaccine benefits. Indeed, since the first booster came out in 2021, Sensible Medicine fans have been primed to mock and ridicule anyone who received more than the first two vaccine doses. Today, Dr. Cifu clearly implies-“I wish I was exaggerating“- there’s something wrong with someone who received multiple COVID vaccines. Seeking to encourage groupthink, one Sensible Medicine doctor even asked his readers to sign a pledge to refuse additional COVID vaccines. (As with the flu vaccine, it’s not clear the current COVID vaccines should be considered boosters, given how much the virus and the vaccine have changed.)

To be fair, I too have questions about the value of the 7th, 8th, and 9th COVID vaccines, and I do my best to acknowledge this uncertainty in my writing and with patients. Obviously, there are diminishing returns to additional vaccine doses, especially for young, healthy people who likely have contracted COVID several times by now. No one needs a weekly COVID vaccine. Moreover, new variants seem to change everything every few months.

However, unlike Sensible Medicine doctors, I wouldn’t publicly shame anyone, especially an older, vulnerable person, who has received their 7th, 8th, and 9th COVID vaccines. Immunity wanes quickly for this virus, and there’s nothing wrong with wanting to do safe, simple things to protect yourself from getting sick. It’s not kind for doctors to mock and shame people who want to avoid COVID or who have already been injured by it. After all, anyone who’s gotten that many vaccines has done something right. Specifically, they survived long enough to have received their the 7th, 8th, and 9th COVID vaccines.

The same can’t be said for many people who didn’t receive additional vaccines doses. According to one recent modeling study in The Lancet:

More than 7,000 hospital admissions and deaths in the UK could have been avoided in summer 2022 if people had received all their Covid jabs, research shows.

Another study estimated that:

Through June 30, 2022, the U.S. could have saved 29,000 lives among already vaccinated people by authorizing boosters sooner, and matching Israel’s uptake level and uptake speed.

Another pre-print estimated that in Europe:

Vaccines reduced deaths by 57% overall (CAT range: 15% to 75%), representing ∼1.4 million lives saved in those aged ≥25 years (range: 0.7 million to 2.6 million): 96% of lives saved were aged ≥60 years and 52% were aged ≥80 years; first boosters saved 51%, and 67% were saved during the Omicron period.

Dr. Cifu is right, not all vaccines are the same. If these modeling studies are close to correct, the COVID booster has been one of the most valuable vaccines.

“We are also not without data that boosters help

As Dr. Cifu said, we are also not without data that boosters help. Indeed, there are many studies, including a randomized-controlled trial (RCT), which show COVID vaccines beyond the first two doses already helped many people, though they are not a panacea. Here are the booster studies I could find, excluding those that only measured antibody responses.

  • Barda (2021): Vaccine effectiveness evaluated at least 7 days after receipt of the third dose, compared with receiving only two doses at least 5 months ago, was estimated to be 93% (231 events for two doses vs 29 events for three doses; 95% CI 88–97) for admission to hospital, 92% (157 vs 17 events; 82–97) for severe disease, and 81% (44 vs seven events; 59–97) for COVID-19-related death.
  • Arbel (2021): Participants who received a booster at least 5 months after a second dose of BNT162b2 had 90% lower mortality due to Covid-19 than participants who did not receive a booster.
  • Bar-on (2021): Across the age groups studied, rates of confirmed Covid-19 and severe illness were substantially lower among participants who received a booster dose of the BNT162b2 vaccine than among those who did not.
  • Muhsen (2022): The results of this cohort study suggest that receipt of a fourth BNT162b2 dose conferred high protection against COVID-19 hospitalizations and deaths among long-term care facilities residents during a substantial Omicron variant surge, but protection was modest against infection.
  • Thompson (2022): During both Delta- and Omicron-predominant periods, receipt of a third vaccine dose was highly effective at preventing COVID-19–associated emergency department and urgent care encounters (94% and 82%, respectively) and preventing COVID-19–associated hospitalizations (94% and 90%, respectively).
  • Andrews (2022): Against hospitalization or death, absolute effectiveness of a BNT162b2 booster ranged from around 97% to 99% in all age groups irrespective of the primary course, with no evidence of waning up to 10 weeks.
  • Menni (2022): Vaccine effectiveness for booster doses in 0–3 months after BNT162b2 primary vaccination was higher than 92·5%, and effectiveness for heterologous boosters after ChAdOx1 nCoV-19 was at least 88·8%.
  • Abu-Raddad (2022): Booster effectiveness against Covid-19–related hospitalization and death due to omicron infection, as compared with the primary series, was 76.5% (95% CI, 55.9 to 87.5). BNT162b2 booster effectiveness against symptomatic infection with the delta (or B.1.617.2) variant, as compared with the primary series, was 86.1%
  • Moreira (2022): A third dose of the BNT162b2 vaccine administered a median of 10.8 months after the second dose provided 95.3% efficacy against Covid-19 as compared with two doses of the BNT162b2 vaccine during a median follow-up of 2.5 months. 
  • Klein (2022): Two doses protect against COVID-19–associated emergency department and urgent care encounters among children and adolescents. However, vaccine effectiveness (VE) was lower during Omicron predominance and decreased with time since vaccination; a booster dose restored VE to 81% among adolescents aged 16–17 years. Overall, 2-dose VE against COVID-19–associated hospitalization was 73%–94%.
  • Regev-Yochay (2022): Vaccine efficacy was estimated to be higher for the prevention of symptomatic disease (43% for BNT162b2 and 31% for mRNA-1273)…Our data provide evidence that a fourth dose of mRNA vaccine is immunogenic, safe, and somewhat efficacious (primarily against symptomatic disease).
  • Mallah (2022): A booster dose of COVID-19 vaccine increases the protection against SARS-CoV-2 infection and COVID-19 severity in the general population and in comorbid patients.
  • Magen (2022): Relative vaccine effectiveness in days 7 to 30 after the fourth dose was estimated to be 45% (95% confidence interval [CI], 44 to 47) against polymerase-chain-reaction–confirmed SARS-CoV-2 infection, 55% (95% CI, 53 to 58) against symptomatic Covid-19, 68% (95% CI, 59 to 74) against Covid-19–related hospitalization, 62% (95% CI, 50 to 74) against severe Covid-19, and 74% (95% CI, 50 to 90) against Covid-19–related death. 
  • Adams (2022): During the first six months of 2022 in the US, booster doses of a covid-19 vaccine provided additional benefit beyond a primary vaccine series alone for preventing hospital admissions with omicron related covid-19.
  • Tenforde (2022): Bivalent booster doses provided additional protection against COVID-19–associated emergency department/urgent care encounters and hospitalizations in persons who previously received 2, 3, or 4 monovalent vaccine doses. Because of waning of monovalent vaccine-conferred immunity, relative effectiveness of bivalent vaccines was higher with increased time since the previous monovalent dose.
  • Tai (2022): This study found that in a young, healthy, highly vaccinated cohort frequently monitored for SARS-CoV-2, booster vaccination was associated with a significant reduction in incident infections during the Omicron wave. 
  • Ng (2022): Estimated mRNA booster effectiveness against severe COVID-19 was 87.4% with no evidence of waning up to 6 months after boosting, while the estimated 3-dose inactivated SARS-CoV-2 booster effectiveness against severe COVID-19 was 69.6%. Booster mRNA vaccine protection against severe COVID-19 was estimated to be durable over 6 months.
  • Ridgway (2022): In a large US population, mRNA boosters were associated with decreased odds of hospitalization compared with the mRNA vaccine primary series alone, with the magnitude of the association attenuated with more time since the booster dose.
  • Lauring (2022):  mRNA vaccines were found to be highly effective in preventing covid-19 associated hospital admissions related to the alpha, delta, and omicron variants, but three vaccine doses were required to achieve protection against omicron similar to the protection that two doses provided against the delta and alpha variants. 
  •  McConeghy (2022): In this cohort study of 10 949 residents of 202 community nursing homes and 4321 residents of 128 Veterans Health Administration community living centers, booster vaccination was associated with significant reductions in SARS-CoV-2 infections, hospitalizations, and the combined end point of hospitalizations or deaths.
  • Accorsi (2022):  These findings suggest that vaccination with 3 doses of mRNA COVID-19 vaccine, compared with being unvaccinated and with receipt of 2 doses, was associated with protection against both the Omicron and Delta variants, although higher odds ratios for the association with Omicron infection suggest less protection for Omicron than for Delta.
  • Spitzer (2022): Among health care workers previously vaccinated with a 2-dose series of BNT162b2, administration of a booster dose compared with not receiving one was significantly associated with a lower rate of SARS-CoV-2 infection in short-term follow-up.
  • Kelly (2022): In a US cohort of patients receiving care at Veterans Health Administration facilities during a period of Delta and Omicron variant predominance, there was a low incidence of hospitalization with COVID-19 pneumonia or death following vaccination and booster with any of BNT162b2, mRNA-1273, or Ad26.COV2.S vaccines.
  • Surie (2022): Among immunocompetent adults aged ≥65 years hospitalized in the multistate IVY Network, a bivalent booster dose provided 73% additional protection against COVID-19 hospitalization compared with past monovalent mRNA vaccination only.
  • Fleming-Dutra (2022): Among children and adolescents, estimated vaccine effectiveness for 2 doses of BNT162b2 against symptomatic infection decreased rapidly, and among adolescents increased after a booster dose.
  • Grewal (2022): The findings suggest that compared with a third dose of mRNA covid-19 vaccine, a fourth dose improved protection against infection, symptomatic infection, and severe outcomes among long term care residents during an omicron dominant period. A fourth vaccine dose was associated with strong protection against severe outcomes in vaccinated residents compared with unvaccinated residents, although the duration of protection remains unknown.
  • McConeghy (2022): In a large cohort of nursing home residents, receipt of a second mRNA COVID-19 booster dose during circulation of SARS-CoV-2 Omicron subvariants was 74% effective at 60 days against severe COVID-19–related outcomes (including hospitalization or death) and 90% against death alone compared with receipt of a single booster dose.
  • Roberts (2022): COVID-19 vaccines were highly protective against infection and severe COVID-19 resulting in hospitalization, intensive care unit admission, or death. Administration of a booster dose significantly increased vaccine effectiveness against both outcomes.
  • Gazit (2022): A fourth dose of the BNT162b2 vaccine appears to have provided additional protection against both SARS-CoV-2 infection and severe covid-19 disease relative to three vaccine doses. However, relative effectiveness of the fourth dose against infection appears to wane sooner than that of the third dose.
  • Wei (2023): Overall vaccine effectiveness against death at 4 to 6 months after the third dose was greater than 90% for CoronaVac, BNT162b2, and the mixed vaccine schedule. While vaccines were generally estimated to be effective against severe outcomes caused by SARS-CoV-2 Omicron infection, this analysis found that protection in older patients was more likely to wane 6 months after the second dose. Hence, a booster dose is recommended for older patients to restore immunity.
  • Lundberg-Morris (2023): Vaccine effectiveness against post-covid-19 condition for one dose, two doses, and three or more doses was 21%, 59%, and 73%, respectively.
  • Finci (2023): Among Albanian healthcare workers, most of whom had been previously infected, COVID-19 booster dose offered improved VE during a period of Omicron BA.1 and BA.2 circulation. 
  • Wong (2023): Among nursing home residents who were up to date with COVID-19 vaccination (most had received a bivalent vaccine), vaccine effectiveness against SARS-CoV-2 infection was 31.2%.
  • Klein (2023): BNT162b2 protected children and adolescents against mild to moderate and severe COVID-19. VE was lower during Omicron predominance including BA.4/BA.5, waned after dose 2 but increased after a monovalent booster.
  • Link-Gelles (2023): A bivalent mRNA booster dose provided additional protection against symptomatic XBB/XBB.1.5 infection for at least the first 3 months after vaccination in persons who had previously received 2–4 monovalent vaccine doses.
  • Andersson (2023): Heterologous booster schedules are associated with increased protection against severe, omicron related covid-19 outcomes compared with primary course schedules and homologous booster schedules.
  • Andersson (2023): Vaccination with bivalent BA.4-5 or BA.1 mRNA booster vaccines as a fourth dose was associated with reduced rates of covid-19 related hospital admission and death among adults aged ≥50 years. 
  • Stecher (2023): Our results indicate an increased protective effect of a fourth dose against severe outcomes compared with a third dose, with decreasing effect with time since the last dose.
  • Link-Gelles (2023): In this case-control study of COVID-19 vaccines and illness, VE associated with protection against medically attended COVID-19 illness was lower with increasing time since last dose; estimated VE was higher after receipt of 1 or 2 booster doses compared with a primary series alone.
  • Lin (2023): Although the two bivalent vaccines were designed to target the BA.4–BA.5 subvariants, they were also associated with a lower risk of infection or severe infection with the BQ.1–BQ.1.1 and XBB–XBB.1.5 subvariants. The effectiveness was higher against hospitalization and death than against infection and waned gradually from its peak over time.
  • Lin (2023): Vaccine effectiveness against severe infection resulting in hospitalization or death was 24.9% (95% CI, 1.4 to 42.8) for one monovalent booster dose and 61.8% (95% CI, 48.2 to 71.8) for one bivalent booster dose.
  • Jang (2023): The 4-dose booster, irrespective of history of SARS-CoV-2 infection, was associated with higher protection against critical BA.5 infection, as shown in previous studies.
  • Lewis (2023): Vaccine booster doses increased protection against COVID-19 hospitalization compared with a primary series. 
  • Tartof (2023): A BNT162b2 BA.4/5 bivalent booster restored protection against a range of COVID-19 outcomes, including against XBB-related sublineages, with the most substantial protection observed against hospital admission and critical illness.
  • Liu (2023):  The effectiveness of boosters against mortality wanes with time but a booster still provides substantial residual protection six months after receipt. Increasing population hybrid immunity is likely to reduce observed vaccine effectiveness as the pandemic progresses but COVID-19 boosters continue to provide significant benefits in mortality reduction, particularly in high-risk populations such as those aged 65+ years and those resident in aged care facilities.
  • Hanberg (2023): A fourth dose of COVID-19 mRNA vaccine reduced the risk of SARS-CoV-2 infection and severe COVID-19 among patients with systemic autoimmune rheumatic diseases using DMARDs during the Omicron era.
  • Piekos (2023): COVID-19 vaccination protects against adverse maternal–fetal outcomes, with booster doses conferring additional protection.
  • Amir (2023): In adolescents aged 12–15 years, the booster dose decreased confirmed infection rates by 3.3 times (2.8–4.0) compared with in the internal control group. 
  • Chemaitelly (2023): Boosters substantially reduced infection and severe COVID-19, particularly among individuals who were clinically vulnerable, affirming the public health value of booster vaccination.
  • Tartof (2023): The BNT162b2 XBB1.5-adapted vaccine provided significant additional protection against a range of COVID-19 outcomes during a period when XBB sub-lineages were predominant but JN.1 was also co-circulating and rapidly increasing in prevalence. Older versions of COVID-19 vaccines offered little, if any, additional protection compared to the unvaccinated, including against COVID-19 hospital admission, regardless of the number or type of prior doses received.
  • Jara (2023):  The overall adjusted effectiveness of a second mRNA booster shot is 88.2% (95%CI, 86.2–89.9) against ICU admissions and 90.5% (95%CI 89.4–91.4) against death. 
  • Payne (2024): During September 2022–March 2023, receipt of bivalent mRNA COVID-19 vaccine was 47% effective in preventing thromboembolic events among immunocompetent persons aged ≥65 years and 51% effective among adults aged ≥18 years with end stage renal disease (ESRD) receiving dialysis, compared with receipt of the original monovalent vaccines alone.

Systematic reviews meta-analyses:

  • Zhu (2022):The pooled results demonstrated a 71% (OR = 0.29, 95% CI = 0.17-0.48) reduction in SARS-CoV-2 infection rates among subjects who received a booster shot compared with those who did not receive a booster shot of coronavirus disease (COVID-19) vaccine. In addition, this analysis emphasized that during the period when the Delta variant was predominant, subjects who received the booster shot showed an 82% (OR = 0.18, 95% CI = 0.13-0.25) reduction in infection rates. Moreover, during the period of dominance of the Omicron variant, subjects who received the booster vaccination displayed a 47% (OR = 0.53, 95% CI = 0.35-0.81) reduction in infection rates. 
  • Au (2022): For people with delta or omicron related infection, a two dose regimen of an adenovirus vector vaccine with one dose of mRNA booster was 77% (42% to 91%) effective against asymptomatic or symptomatic covid-19 infections, and a three dose regimen of a mRNA vaccine was 93% (76% to 98%) effective against covid-19 related hospital admission.
  • Menegale (2023): Booster doses restored VE to levels comparable to those acquired soon after the administration of the primary cycle. However, 9 months after booster administration, VE against Omicron was lower than 30% against laboratory-confirmed infection and symptomatic disease.
  • Xu (2023): The risk of SARS-CoV-2 infection, the risk of admission to the ICU, and the risk of death were all higher in the non-booster group than those in the booster group.
  • Yang (2023): The efficacy of SARS-CoV-2 vaccines is higher for preventing severe infection and death than for preventing milder infection. Vaccine efficacy wanes over time but can be enhanced by a booster. 
  • Xu (2023): Inactivated vaccine protection against SARS-CoV-2 infection was moderate, decreased significantly after 6 months following primary vaccination, and was restored by booster vaccination. VE against severe COVID-19 was greatest after boosting and did not decrease over time, sustained for over 6 months after the primary series, and more evidence is needed to assess the duration of booster VE. VE varied by variants, most notably against Omicron. It is necessary to ensure booster vaccination of everyone eligible for SARS-CoV-2 vaccines and continue monitoring virus evolution and VE.
  • European Centre for Disease Prevention and Control (2023): Under the Omicron variant, effectiveness of EU-licensed COVID-19 vaccines in preventing any SARS-CoV-2 infection or mild disease is low and only short-lasting after primary immunization, but can be improved by booster vaccination. Vaccine effectiveness (VE) against severe COVID-19 remains high and is long-lasting, especially after receiving the booster vaccination.
  • Mohammed (2023): VE against severe Omicron infection following the primary course was 63.6% (95%CI: 57.5–69.7%) at three months, decreased to 49% (95%CI: 35.7–63.4%) within six months, and increased to 86% after the first or second booster dose.

Dr. Cifu linked to just one of these studies and then told his readers that a lack of data on COVID boosters in to blame for overall vaccine-hesistancy.

Do these real-world studies constitute “robust data”? Perhaps not. Observational studies can have many flaws, and it’s possible all these studies are “shit“, as one Sensible Medicine doctor put it.

Do I wish I could snap my fingers and will into existence a large RCT for every vaccine dose for every variant for every demographic group? Absolutely. That’s why I asked my readers to pledge not to skip the COVID vaccine, but rather to get involved in COVID RCTs. I believe in COVID vaccine-RCTs so much I was in one. My role was small, but it constitutes an infinitely larger real-world contribution than doctors who merely uttered the words “do an RCT” on YouTube videos.

Do I think more “robust data” on COVID boosters would quell anti-vaccine sentiment? Uh, no. Anyone who thinks that doesn’t know anything about the anti-vaccine movement.

We now need to accept that this is here to get infected with again and again.”

In an ideal world of fantasy, there would be large RCTs to answer every clinical conundrum. However, in the real-world, especially in a pandemic where both the population and the virus change rapidly and constantly, doctors have to make decisions all the time without “robust data” from pristine RCTs to guide our every action. I would further argue that telling people to accept repeated COVID infections, especially without the protection of an updated vaccine, is absolutely a decision.

Yet, when it comes to repeated COVID infections, Dr. Cifu’s desire for “robust data” mysteriously vanishes. Indeed, he said to me in May 2022:

We now need to accept that this is here to get infected with again and again.

Another Sensible Medicine doctor said the same thing:

Repeat infections are inevitable. More the longer you live. Nothing can be done about it.

Of course, we do have robust data that repeat COVID infections have killed and injured many people around the world. While I counsel my patients about uncertainties regardings the vaccine, it’s also my obligation to counsel them about uncertainties regarding the virus. We’ll be learning about the consequences of our 7th, 8th, and 9th COVID infections for the rest of our lives. SARS-CoV-2 is still new, mutating virus, and it’s medically conservative to approach it with some respect and humility. We are still learning new things about old foes like measles and Epstein-Barr virus.

In contrast to the virus, additional COVID vaccines have mostly given people a sore arm. One study from 2023 found:

The use of bivalent mRNA vaccines as a fourth vaccine dose against covid-19 was not associated with an increased risk of 27 different adverse events in adults aged ≥50 years

I am confident that while many people suffered because they declined additional COVID vaccines, very few suffered from having received them. Despite this, Dr. Cifu is much more concerned by the possibility that someone might get a vaccine dose they don’t need, than by the certainty that people are missing doses they do need. This is especially absurd considering that COVID vaccine uptake has been “abysmal” recently, and 1,500 Americans are dying of COVID every week, as Dr. Cifu noted. Encouraging just one dose of the updated COVID vaccine, especially amongst vulnerable adults, is extremely low-hanging fruit, though this task is made harder by Sensible Medicine doctors. At least Dr. Cifu acknowledged COVID’s ongoing death toll and that boosters are “not without data.” However, no Sensible Medicine doctor would ever devote more than a sentence or two to these essential points. Most refuse to acknowledge them at all.

So much for “honesty and transparency.”

I wish I was exaggerating.

It bears repeating:

The core that unites anti-vaccine thought is: 1) inappropriate minimization of the risk of the virus, and 2) inappropriate minimization of the safety and efficacy of the vaccine.

Though Dr. Cifu boasted of his “pro-vaccine stance”, telling people to accept repeated COVID infections, while implying there’s something inappropriate about accepting repeated COVID vaccination strikes me as rather anti-vaccine. This is par the course for the “medical conservatives” at Sensible Medicine, and if Dr. Cifu were genuinely concerned about vaccine hesitancy, I would strongly encourage him to learn about the anti-vaccine movement. He’ll discover that it is fueled not by a lack of “robust data”, but rather by exactly the sort of anger, mistrust, and misinformation spread by his own blog and collaborators.

I wish I was exaggerating.



  • Dr. Jonathan Howard is a neurologist and psychiatrist who has been interested in vaccines since long before COVID-19. He is the author of "We Want Them Infected: How the failed quest for herd immunity led doctors to embrace the anti-vaccine movement and blinded Americans to the threat of COVID."

Posted by Jonathan Howard

Dr. Jonathan Howard is a neurologist and psychiatrist who has been interested in vaccines since long before COVID-19. He is the author of "We Want Them Infected: How the failed quest for herd immunity led doctors to embrace the anti-vaccine movement and blinded Americans to the threat of COVID."