When vaccines arrived, many healthcare workers posted pictures of themselves getting vaccinated. There were two reasons for this. First, many people were ecstatic about finally being protected against the virus after many months of seeing what it could do. People like to share their joy.
Second, like Dr. Jonas Salk giving his son the polio vaccine, they hoped to convey to others their confidence in the vaccine. Writing about the power of images to shape the vaccine narrative, Dr. Brit Trogen said:
For decades, anti-vaccine groups have relied on the power of personal narratives to bolster claims of vaccine danger. Vaccine selfies, accompanied by captions offering moving anecdotes or thoughtful reasoning, provide a fitting and necessary counterargument. Collectively, these images might strike a chord with the nonmedical public in a way that data-driven discussions of vaccine efficacy and infection rates cannot.
Recent research confirms this is true. A paper titled “Communicating Doctors’ Consensus Persistently Increases COVID-19 Vaccinations” showed that there was a “persistent increase in vaccine uptake” when people learn that nearly all doctors support them. Healthcare workers know they are trusted professionals, and most take that responsibility very seriously when sharing their vaccination choices with the public.
Omicron and boosters
With this in mind, let’s turn to a recent article in The New York Times titled “During the Omicron Wave, Death Rates Soared for Older People“. According to the article:
Almost as many Americans 65 and older died in four months of the Omicron surge as did in six months of the Delta wave, even though the Delta variant, for any one person, tended to cause more severe illness.
The reasons for this were the contagiousness of Omicron combined with waning of the first two vaccine doses and low booster rates. While we all hoped otherwise, there was never any guarantee that two doses of the COVID vaccine would provide years of robust protection against a rapidly mutating virus. Doctors with basic knowledge of the subject know that vaccine doses are occasionally added or subtracted as experts learn more about how immunity evolves over time. Changes in the vaccine schedule, even for old vaccines, are not unprecedented, and many vaccines require multiple doses. Children receive 4 doses of the polio vaccine for example, and they receive the DTaP at 2, 4, and 6 months, 15-18 months, 4-6 years, and 11-12 years. Few vaccine experts were shocked that the COVID vaccine needed a booster, especially given how rapidly it mutates.
There is now clear evidence from large studies in different countries (England, UK, Qatar, Israel, Israel, Israel, Israel, USA, USA) showing that boosters are extremely effective at limiting severe disease. The evidence of benefit is apparent even in teenagers (here and here). The first two doses are still the most important, but there’s no question that the booster saves lives and prevents suffering, especially for older people. The third dose should just be called the third dose, not a booster. Getting millions of Americans this dose is very low-hanging fruit for those who aim to prevent hospitalizations and save lives. Approximately 33% of Americans older than 65 have not received it.
“Unmasked, unboosted and unrepentant”
I can’t help but wonder if one small reason booster rates aren’t higher is that influential doctors staged a dramatic production of not receiving it themselves. Consider, for example, a podcast from 12/4/2021 called “Omicron Panic, Natural Immunity, Fluvoxamine, & More“, with three familiar names, Drs. Vinay Prasad, Marty Makary, and Zubin Damania (AKA ZDoggMD).
In this podcast, these doctors made a display of sitting close together in a podcast booth and boisterously boasted about not having been boosted. The transcript reads as follows:
– [Marty] Are you guys boosted being that close or is this an unboosted contact?
– [Zubin] We’re unmasked, unboosted and unrepentant, Marty.
– [Marty] Well, I’m an unboosted male. That’s my preferred pronoun, by the way.
– [Zubin] Oh, is that your pronoun? An unboosted male? Yes, my pronouns are it, they, those and currently unboosted because I got Moderna, which apparently kicks ass….
[Vinay] …I haven’t gotten my booster yet and-
– [Marty] You mean this week you haven’t gotten, ’cause you do weekly boosters, I’m sure.
– [Vinay] Well, eventually, we’re all gonna have to keep boosting.
– [Marty] Yeah, boosting.
– [Zubin] You know, my vaccine card looks like one of those like frequent flyer like coffee cards where they punch the hole, like I boosted here and boosted here and boosted here and when I get 10 boosters, Fauci sends me a Fauci bobblehead that says I am the science.
– [Marty] I’m getting my booster sent with the GNC nutrition vitamins.
– [Vinay] They had the same evidence, you know.
Dr. Makary, who elsewhere called the Omicron variant “nature’s vaccine,” and “omi-cold“, claimed that the booster’s only benefit was that it would lower the hospitalization rate from 1 in 26,000 to 1 in 260,000 in people older than age 65. He said that the “the average age of a breakthrough death is 80,” to which Dr. Damania would reply:
And if you look at a population of 80-year-olds, their time to death in general is not that long.
What was known then?
When this podcast aired, there was already clear evidence the third dose was beneficial. Though the results were only available as a press release, an RCT of 10,000 people showed that a booster was safe and 95% effective at preventing COVID. It has since been published, and it doesn’t take a genius to imagine a vaccine dose that lowered infection rates would also lessen severe disease.
The results from a large observational study were also available when this podcast aired. It found:
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.
Not only was there clear evidence the boosters were beneficial in December 2021, a new variant that evaded our immune system was on the horizon. The Omicron variant didn’t just sicken older Americans, it also caused unprecedented illness in children, especially unvaccinated ones. One study found:
Nearly 90% of the 397 children hospitalized during Omicron’s predominance had not gotten COVID-19 shots. Cumulatively, the hospitalization rate was more than two times higher among the unvaccinated. About 30% of the children hospitalized had no underlying conditions, and about 20% required time in the intensive care unit (ICU).
Despite this, these doctors framed concern about Omicron as a “panic” and made it clear they saw no need to subject themselves to a third shot, a dose that proved to be incredibly safe.
This was merely a continuation of a pattern for these doctors, especially with regards to vaccinating young people. 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 a very predictable riff on the classic “too many, too soon” trope, the unofficial slogan of the anti-vaccine movement. For good measure, they were also wrong to fetishize so-called “natural immunity” and wrong about the benefits of vaccination after infection (here, here, and here). Minimizing the vaccine’s benefits while fixating on rare, usually mild side effects is just what they do when they’re not busy saying the pandemic is over. It’s almost as if a diabolical deity is creating new variants specifically to make their Pollyannaish predictions age poorly (here, here, and here).
What is the opposite of a “vaccine selfie”?
Perhaps there was a case to be made in December 2021 that the risk of boosters outweighed the benefits. But these doctors didn’t make that case. A sober discussion wouldn’t have made good theater. Instead, they had to let everyone know they were unmasked, unboosted, and unrepentant. They couldn’t just privately decide to skip the booster and keep that information to themselves. They had to turn their petulant defiance into a public spectacle.
I strongly encourage you to watch the video itself. These doctors thought it was really funny to model risky behavior and announce their booster refusal just as Omicron was taking off. Unless you were an elderly person with cancer, if you were concerned about waning immunity and wanted to protect yourself with a booster, you were a joke to these doctors, an object of ridicule. I previously wrote about their tendency to shame and mock people whom they feel try too hard to avoid the virus. Notably, Dr. Damania strikes a much more conciliatory approach when he when he invites strangers to send him money, saying people should be “super kind and thoughtful to each other“.
Doctors who shared photos of themselves receiving the COVID vaccine were said to be posting “vaccine-selfies”. What term should be used for doctors who use their social media clout to influence others to skip a crucial vaccine dose?