“Now Just Waiting for the @ScienceBasedMed Crowd to Call Paul Offit an Anti-Vaxxer”

Dr. Paul Offit, the director of the Vaccine Education Center at Children’s Hospital of Philadelphia, has been a long-time hero to vaccine advocates such as myself. He is dedicated to children and science. He is an accomplished scientist, having invented the rotavirus vaccine. He is a prolific public communicator and has endured hatred and threats for his advocacy. He is a real nice guy who I’ve met several times.

He’s also not infallible. At the very start of the pandemic he predicted that COVID-19 would cause less than “one-tenth of the damage that influenza causes every year in the United States”. With humility and humor, he soon acknowledged his error saying, “If you’re going to be wrong, be wrong in front of millions of people. Make a complete ass of yourself”. This differentiates him from several other people who also underestimated the virus at that time. It is why I still trust him.

Today however, Dr. Offit shares something in common with many of the contrarian doctors I’ve criticized previously. They all feel young, healthy people, males in particular, would not benefit from a booster vaccine (here and here). Dr. Offit advised his own young son not to get a booster as “he believes that his son is well protected against serious illness with two shots, so a third just isn’t necessary”. This prompted one doctor and critic of our site to say:

Now just waiting for the @ScienceBasedMed crowd to call Paul Offit an anti-vaxxer. Wait for it…

To boost or not to boost

I’ve had little to say about boosters, especially for healthy young people. There’s certainly evidence (here, here, here) that boosters can reduce severe illness in older people. However, young, healthy people were at low risk to begin with, and two vaccine doses still offer powerful protection against severe illness. One recent study, prior to the arrival of the omicron variant, found that the vaccine was 94% effective at preventing hospitalizations in adolescents.

There is evidence from Israel that a third dose can further lower the infection risk for young people, and a recent preprint from there showed waning efficacy of the vaccine in adolescents. According to real-world data from Israel, “among 16–29 year olds, the rate ratio for infection in the non-boosted group vs boosted group was 17.2”. Among 22,441 infections in non-boosted people age 16-29 years, 10 were “severe”, though fortunately there were no deaths. A 1 in 2,441 risk of severe COVID-19 in non-boosted young people isn’t negligible. It’s certainly higher than the rate of vaccine-myocarditis. Moreover a booster would presumably help lower transmission of the virus.

However, I’m unaware of any evidence that boosters reduce the risk of severe disease for young, healthy people or children. World Health Organization Chief Scientist, Dr. Soumya Swaminathan, recently said “there’s no evidence right now” that suggests healthy children and adolescents need booster shots.

Moreover, the risk from the third vaccine dose is very small, below the already low risk posed by the second shot. According to data from the CDC, in just under 1 million people age 16-24 years who received a booster, there were just 4 confirmed myocarditis cases, all recovered, with 9 cases still under review. Data from Israel showed the third dose causes myocarditis in 1 in 15,000 males age 16-19 years. Moreover, researchers on vaccine-related myocarditis say that while long-term monitoring is needed, “most cases of suspected COVID-19 vaccine-related myocarditis in people younger than 21 are mild and resolve quickly”. So giving a booster to young males carries a very low risk of a condition that is almost always mild and transient.

At present, there is no definitive right answer. However, I am sympathetic to regulators who have to make difficult decisions with incomplete information in a rapidly shifting pandemic. They’ll be second guessed by those with no real-world responsibility no matter what they do.

Some doctors have requested a randomized-controlled trial of boosters. This could provide the clearest information, but the results wouldn’t be available until 2023, and new variants may render those results obsolete. Moreover, a randomized-controlled trial would not provide meaningful information on rare outcomes, such as myocarditis, which can only be detected once tens or hundreds of thousands of people have been vaccinated. The randomized-controlled trials of the first-two vaccine doses tell us much less about the vaccine than real-world data from hundreds of millions of doses.

The good news is that twice-vaccinated, healthy young males will almost certainly be fine regardless. Given all the attention this topic has gotten, the overall stakes seem pretty low, though it’s certainly grossly inequitable that healthy teens in some countries can get a third shot before vulnerable adults elsewhere can get their first dose.

I don’t know what the right answer is regarding boosters for young, healthy males, but since I couldn’t ship his dose elsewhere, I voted with my feet and got my healthy teenage son a booster. I am more fearful of waning protection from his first two doses, a new variant, or him spreading the virus than I am of a third vaccine dose. I am hopeful that this will be his last shot, but if it turns out we all need a periodic booster, this doesn’t seem that bad to me, especially compared to what the virus can do.

Beyond putting on a performance during the injection that the pharmacist called “my most memorable today,” my son was fine. However, this third dose was almost certainly much less of a benefit to him than the first two. Moreover, the risk wasn’t completely zero, and I understand why Dr. Offit disagrees with my decision. His past prudence against reintroducing the smallpox vaccine after 9/11 turned out to be the right call.

Dr. Offit versus contrarian doctors

Unlike the contrarian doctors I’ve criticized before, Dr. Offit is worth listening to when he advises against boosting healthy, young males. Dr. Offit doesn’t make blatant factual errors in national media, repeatedly overstating harms from the vaccine and understating harms of the virus. He hasn’t spent the past year trashing the first two vaccine doses for kids. He never told parents that an Emergency Use Authorization (EUA) for kids was unnecessary since the virus was going away. He never wrote an editorial objecting to the EUA for children or tweeted that “It is clear that the second dose brings WAY more hospitalizations from myocarditis than can possibly be prevented”. Unlike contrarians, he’s not against all boosters. In fact, he said, “I’m not opposed to booster dosing. What I think we need to make clearer is why we’re boosting.”

Dr. Offit has not catastrophized (or minimized) vaccine side effects. He noted that vaccine-myocarditis “is often transient, lasting 2 or 3 days, and resolves on its own for the most part or can be treated with anti-inflammatories”. He’s right. He made a video informing parents that the risks of the virus were much greater than the risk of vaccine-myocarditis.

He has consistently advocated for vaccinating children with the first two doses, while contrarian doctors objected to vaccinating children at all. He said in October 2021:

Now, at least the last few weeks, you’d have 200,000 cases in children a week, or 250,000 cases a week, 2,000 hospitalizations a week. And I was just on service at Children’s Hospital Philadelphia last week, and I can tell you, we had our share, representing the national average, of an increased number of children with SARS-CoV-2, some of whom were in the intensive care unit, and one of whom was on ECMO, meaning extracorporeal membrane oxygenator, the heart lung machine, and is fighting for her life. So it is, certainly the answer to the question can children suffer this disease, yes. Can they be hospitalized and go to the intensive care unit? Yes. Can they die? Yes, more than 500 children have died. So if you can prevent this vaccine, I’m sorry. If you can prevent this disease safely and effectively, then prevent it.

He then said in November 2021:

Make no mistake—COVID-19 is a childhood illness. When SARS-CoV-2 entered the United States early in 2020, children accounted for fewer than 3% of cases; today, they account for more than 25%. More than 6 million US children have been infected with SARS-CoV-2, including 2 million between the ages of 5 and 11. At the end of October 2021, about 100,000 children per week were infected. Of the tens of thousands of children who have been hospitalized, about one-third had no preexisting medical conditions, and many have required the intensive care unit. Almost 700 children have died from COVID-19, placing SARS-CoV-2 infection among the top 10 causes of death in US children. No children have died from vaccination.

These paragraphs summarize half the articles I’ve written on this site, and this is exactly the information that doctors who write about children and COVID-19 should communicate to the public. In contrast, contrarian doctors have never simply stated the facts like this. When it comes to children, contrarian doctors will almost never share information that casts the virus in a bad light or the vaccine in a good light. Thanks to myths spread by contrarian doctors, many parents think the flu is worse for children or that the death rate is 1 in a million.

Unlike them, Dr. Offit doesn’t hide the fact that over 1,100 American children have died of COVID-19 and that tens of thousands of children have been hospitalized with it. He fairly reports the evidence and the evidence is clear: the vaccine is not perfect, but it is much safer for children than the virus (study 1, study 2, study 3, study 4, study 5, study 6, study 7). Anti-vaccine cranks like RFK Jr. will never favorably share anything by Dr. Offit, though RFK Jr. will favorably share the work (here and here) of contrarian doctors. Anti-vaxxers still loathe Dr. Offit, which is perhaps the strongest signal that someone is both credible and well-intentioned.

When contrarian doctors discuss Dr. Offit’s opposition to the booster, oddly feeling it validates them in some way, they conveniently neglect his main point that it’s more important to try to get unvaccinated children their first two vaccine doses. Dr. Offit has treated sick, unvaccinated children in the hospital. They haven’t.

I am confident that if contrarian doctors had used their large platforms and influence to echo Dr. Offit’s beliefs instead of trying to undermine them, there would be many fewer unvaccinated children, there would be many more healthy children, and schools would have an easier time staying open. However, at various times, contrarian doctors have portrayed all doses of the vaccine as unnecessary or more dangerous than the virus for children. They objected to the first dose. They objected to the second dose. Of course, they were going to object to the third dose. It’s just what they do. It’s really all very predictable and boring.

But just because it’s predictable and boring doesn’t mean it is without consequence. Child vaccination rates are abysmal. Just 17% of children ages 5-11 and 54% of children ages 12-17 are fully vaccinated against COVID-19. Meanwhile, pediatric infections and hospitalizations are at their all time high, though fortunately, omicron seems milder than delta for children.

Children would be much better off if contrarian doctors with large platforms had shared Dr. Offit’s urgency to vaccinate children instead of constantly fear mongering about the first two doses of the vaccine.

Anyone who is waiting for this site to call Dr. Offit an anti-vaxxer will be waiting for a very long time

Dr. Offit’s current position may not pan out, but, unlike several other doctors, it stems from a thoughtful evaluation of the risks/benefits, not reflexive contrarianism. Dr. Offit has been thinking about these issues his entire career. Unlike doctors who’ve disagreed with him about the first two doses, he didn’t just become a pediatric vaccine “expert” in the past 6 months. He deserves to be taken seriously. As I wrote previously:

We need to leave room for people to have good faith disagreements and questions without inappropriately smearing them as “anti-vaxxers”.

Future data will clarify the risks and benefits of a booster in young people as it has for older people. When this data emerges, I will do my best to accept it and report it as fairly as possible. I am confident Dr. Offit will do the same.

That’s what makes him completely different from contrarian doctors who have yet to acknowledge the copious evidence the first two vaccine doses protect children.

It’s also why anyone who is waiting for me to call him an anti-vaxxer will be waiting for a very long time.

Author

  • Dr. Jonathan Howard is a neurologist and psychiatrist based in New York City who has been interested in vaccines since long before COVID-19.

Posted by Jonathan Howard

Dr. Jonathan Howard is a neurologist and psychiatrist based in New York City who has been interested in vaccines since long before COVID-19.