What it means to be pro-vaccine

In a previous article I discussed what I discussed what it means to be pro-vaccine.  I wrote:

Being pro-vaccine means taking into account all of the relevant data to make a fair, accurate risk-benefit calculation about a vaccine…Though most vaccines are overwhelmingly safe and effective, their imperfections cannot be ignored or wished away.

No vaccine is 100% effective or safe, and being pro-vaccine means acknowledging their blemishes and areas of uncertainty, at least with new vaccines.

When the original COVID mRNA vaccine data was announced (here and here), they were 95% effective against COVID infection and even better against severe disease, though not 100% effective as several doctors claimed. There was a lot to be positive about, and it was vital to convey this information to the public. I encouraged vaccination with every patient I saw, and I still do. Countless people are alive today because doctors properly extolled the benefits of the COVID vaccines.

While optimism was entirely appropriate in early 2021, so was caution and humility. The virus was just a just year old, and January 2021 was the deadliest part of the pandemic. Over 3,000 Americans died on some days that month.  The virus had given us many reasons to respect it in that first year, and we didn’t know what variants might be on the horizon.

The vaccines, of course, were brand new. Only 36,930 people had been vaccinated in the two mRNA trials, and they lasted just several months. The median age was 52-years, and trial participants are often unrepresentative of the public at large. There were just 347 cases of COVID, 40 severe cases, and only 1 COVID death in these trials.

It wasn’t possible to conclude from the original vaccine trials that the vaccines would be 100% effective against death. These trials taught us a lot, but they were the starting point of us learning about these vaccines, not the end. Over the next few months, hundreds of millions of people around the world would be vaccinated. We still had a lot to learn about their real-world effectiveness, especially over the long-term. We had literally everything to learn about their impact on viral transmission.

Because I am pro-vaccine, I hope I never portrayed them as a perfect panacea that would end the pandemic, and I did my best to acknowledge their unknowns. For example, in April 2021 I said:

Im very very optimistic vaccines will cut transmission of disease. I’m not certain of it. This is why I wear a mask still in public and when treating covid patients.

In May 2021, I warned of the “potential for development of escape variants” and discussed the significance of low vaccine-uptake in adults. I wrote:

I hope this ages poorly, but given the large numbers of unvaccinated adults, COVID-19 is likely to remain a threat to American children for the foreseeable future, especially in regions of low-vaccine uptake. Many scientists doubt that the US will achieve the vaccination numbers needed for herd immunity.

Sadly, immune-evading variants arrived and that did not age poorly. My track record here is not spotless, but I tried to take a medically conservative approach to the both the virus and vaccines. A doctor who exaggerated the vaccines’ benefits set the public up for disappointment and opened the door for anti-vaxxers spread doubt and mistrust.

Indeed, other doctors took a very different approach at the time. They relentlessly minimized the threat of variants- variants schmariants–  and promoted vaccines as “essentially bulletproof”, both in terms of preventing severe COVID and halting viral transmission, with absolute certainty, just months after the first doses were given in December 2020. Some doctors mocked and ridiculed anyone who urged any caution at all after vaccination.

Assuming you agree with my definition of “pro-vaccine”, judge for yourself whether or not the following comments met that standard.

“For somebody who’s already been fully vaccinated…There’s an infinitesimally low probability of even having an infection that can be detected on a PCR test, let alone being able to spread it to someone.”

Dr. Monica Gandhi, January 9, 2021:

No time in history do we have this extraordinary detection of asymptomatic infection since latter can transmit to others. So, please be assured that YOU ARE SAFE after vaccine from what matters – disease and spreading. Two vaccinated people can be as close as 2 spoons in drawer!

Dr. Monica Gandhi, January 11, 2021:

So, why can two vaccinated people be as close as two spoons in a drawer? Because both are so highly protected from what matters- disease. Even though vaccines reduce asymptomatic infection (I bet much higher reduction after that 2nd dose, this is just before 2nd dose in Moderna)

Dr. Vinay Prasad, February 16, 2021:

A vaccinated grandparent can hug a young grandkid… we know the vaccine is 100% effective against protecting against bad outcomes for grandparent. (Author note:  this was false at the time).


Dr. Vinay Prasad, February 18, 2021


Drs. Monica Gandhi and Zubin Damania February 22, 2021:

Dr. Damania: So Monica, I gonna tell something publicly that I have not said. This table is new, right? The last time you were here, I had a six-foot round table. We were six feet apart. This table is now about three feet. And the reason I’m doing that is, I believe with a 95% efficacy that two vaccinated people can hang out.

Dr. Gandhi:  They could totally hang out. And remember, it’s not 95% efficacy against severe disease. It’s 100% against severe disease. (Author note:  this was false at the time).  And then yeah, maybe one person who got the vaccine will not feel well for a few days, because it was mild disease. So that’s the amazing thing. Keep on focusing on preventing what got us into trouble to begin with.

Dr.  Damania: And even with variants, you know, if they’re gonna be setting against… ’cause the variance of the new bugaboo, right? Like, oh, we always knew there was mutations. That’s what coronaviruses do, all viruses do that. But the thing is if the vaccines are effective against severe disease, which they are, even against the Brazilian variant.

Dr. Gandhi:  Yes. I really need to say something. I need to say variants shmariants.

Dr. John Mandrola March 10, 2021:

Ky (Kentucky) has vaccinated about 1 in 3 older people. CT (Connecticut) has done even better. The vaccine squelches severe cases. Millions have natural immunity. Young have almost no risk The pandemic (of bad disease) is nearly over. And this is a really worthy cause of celebration!!!!!!

Dr. Marty Makary, March 10, 2021:

An unpublished study conducted by the Israeli Health Ministry and Pfizer showed that vaccination reduced transmission by 89% to 94% and almost totally prevented hospitalization and death, according to press reports. Immunity kicks in fully about four weeks after the first vaccine dose, and then you are essentially bulletproof.

Dr. Marty Makary, March 18, 2021:

If anyone hears of a person hospitalized or dead from Covid-19 after full vaccination, please let me know. The data show that vaccines confer near perfect protection against death and hospitalization from Covid. Can’t we be honest about that?

Dr. Monica Gandhi, April 2, 2021:

Don’t worry, even the most pessimistic, variant-discussing, doom-steeped people are no match for the vaccines!

Drs. Zubin Damania and Jay Bhattacharya, April 14, 2021:

Dr. Bhattacharya:  I mean, I think that the central problem right now I think is the fear that people still feel about COVID…

Dr. Damania:  Now, you and I are both vaccinated. We shook hands. We don’t wear masks. We’re about three feet apart from each other. And in the early days of the pandemic that would’ve gotten us both hung. But now I can say with confidence because I’ve looked at the data, like our chances of giving each other COVID are-

Dr. Bhattacharya:  Are zero.

Dr. Damania: Pretty much zero…

Dr. Bhattacharya:  The vaccine is incredibly effective… And in many ways has defanged the epidemic, it’s taken away the the specter of death and hospitalization that comes with the disease for the older population to the extent that the older population is vaccinated.

Dr. Jay Bhattacharya, April 16, 2021:

Dr. Fauci is probably the number one anti-vaxxer in the country in some sense, because he has modeled behavior that has made people think the vaccine won’t give you back your life, but it will. It’s an incredibly effective vaccine. You know, he was wearing a mask. He has been vaccinated, I don’t really understand what he’s trying to do here.

Dr. Monica Gandhi, May 5, 2021:

Vaccinated people can be as close as two spoons in a drawer- I have said it before and I will finally just say it again now that we have all this data out there on the vaccines (tons of data on real-world effectiveness & transmission – will add to this Saturday – more studies!)

Dr. Vinay Prasad, May 13, 2021:

For somebody who’s already been fully vaccinated, they can wear the mask out of solidarity or in a symbolic sense, but their wearing a mask indoors is not benefiting anyone else. There’s an infinitesimally low probability of even having an infection that can be detected on a PCR test, let alone being able to spread it to someone.

Dr. Monica Gandhi, May 17, 2021:

Good to see this January 9 tweet has so much evidence behind it now in real world that vaccines block transmission since biological plausibility was ample.

As we saw in Israel and Britain, vaccinating adults indirectly protects children. The same trend is evident here in the United States: Adult vaccination has lowered covid-19 incidence among children by 50 percent in the past four weeks.

Dr. John Mandrola July 29, 2021:

If you were vaccinated and had mild to moderate URI symptoms, why on earth would you get a COVID test? Have the vaccines not transformed SARSCOV2 into just another regular respiratory virus?

These statements were not pro-vaccine. They were pro-stop-worrying-about-COVID.

I fully recognize that this is all written with the benefit of hindsight, but the vaccines did not turn out to be the miracle-cure-all we hoped they would be. According to one article from KFF in November 2022:

The share of COVID-19 deaths among those who are vaccinated has risen. In fall 2021, about 3 in 10 adults dying of COVID-19 were vaccinated or boosted. But by January 2022, as we showed in an analysis posted on the Peterson-KFF Health System Tracker, about 4 in 10 deaths were vaccinated or boosted. By April 2022, the United States Centers for Disease Control and Prevention (CDC) data show that about 6 in 10 adults dying of COVID-19 were vaccinated or boosted, and that’s remained true through at least August 2022. (Author note:  keep in mind the base rate fallacy. )

Someone who received only the first 2 mRNA vaccine doses in early 2021 might as well be unvaccinated today, and the Johnson and Johnson vaccine, is officially a historical relic, unavailable in the US. Meanwhile, the vaccine’s impact on transmission has fluctuated throughout the pandemic, but it has often been middling at best. Until better vaccines arrive, I will always mask at work.

Assurances the vaccines were “100% effective against protecting against bad outcomes for grandparent” and that they lowered the risk of transmission to “zero” were not pro-vaccine. These were pro-stop-worrying-about-COVID. At the start of 2021, these same doctors also claimed the end of the pandemic was imminent.

The pattern isn’t that hard to spot. These doctors wanted us to stop “living in fear” and were willing to overhype brand new vaccines to pacify their audience. Unfortunately, the Delta and Omicron variants arrived and more Americans died of COVID after these podcasts and articles then before them. Yet today, many of these same doctors actively discourage COVID vaccines for the same reason- they want us to stop “living in fear”. Like I said, the pattern isn’t that hard to spot.

Despite their flaws, COVID vaccines are the greatest medical achievement of my lifetime, and in an update to this article, Drs. Katalin Karikó and Drew Weissman deservedly won the Nobel Prize for their research. They have already have saved many millions of people from death and serious suffering. Because I still support them unambiguously and publicly, I often receive hostile feedback from distrustful people who feel they were oversold initially. I get where they are coming from.

While their anger may be mistargeted, it is totally understandable.

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."