Paul Offit vs. NEJM on COVID Boosters
In a Perspective essay, Paul Offit writes, “We should stop trying to prevent all symptomatic infections in healthy, young people by boosting them with vaccines containing mRNA from strains that might disappear a few months later.” In an accompanying discussion by the NEJM Editors, they say, “being vaccinated and boosted is better than not being vaccinated and boosted.” They are ducking. Offit completely agrees that being vaccinated is better than being unvaccinated. For everybody. The real question is whether, once vaccinated and, especially, once also infected with the virus, ,does latest bivalent booster offer any benefit? Offit’s nuanced analysis is convincing. The Editors' waffling is pitiful and puzzling.
Offit’s short, data-driven, meticulously reasoned, and carefully qualified essay is worth ten minutes of everyone’s time. Offit is one of the world’s strongest proponents of immunizations. His lab at Penn has been a world leader in vaccine development. He has been a courageous advocate for immunization and as a result has been vilified and even had his life threatened by anti-vax groups. He was an early proponent of COVID vaccines. When the FDA first approved COVID vaccines for young children, Offit addressed skepticism by saying, “This virus can cause children to suffer serious illness that can lead to hospitalization or ICU admission or death.”
I am also a strong vaccine advocate. I have advocated the removal of any “personal belief exemptions” to mandatory childhood vaccines. I have suggested ways for policy makers to respond to opposition to vaccine mandates. I’ve asked pediatricians to be active on social media to combat misinformation. But when a leader and vaccine advocate like Paul Offit questions the value of COVID boosters, I listen.
Offit has been consistently skeptical about the value of the bivalent boosters for people in low risk groups, particularly for young healthy people. He served on the FDA committee that reviewed the initial studies of the bivalent vaccines. He voted against approval of the bivalent vaccine and, the next day, he explained why. He recommended that we limit boosters to three groups - the elderly (people over 65), people with serious medical conditions, people with compromised immune systems. Others don’t benefit.
He sees the story of vaccine development for COVID as a cautionary tale in which vaccine manufacture and testing simply cannot keep up with the constantly mutating virus. As a result, we are always making vaccines against strains that have already disappeared. Furthermore, the vaccines based on older strains still offer significant protection and the new vaccines simply don’t offer much increase in that protection.
The Editors of the New England Journal of Medicine find it hard to give up the idea that vaccines are beneficial, even though, as they note, the studies that they have published should no significant benefit in young, healthy people. Still, oddly, they call it “an open question” whether the new vaccines offer any benefit.
The implications for practicing physicians are clear. Do we follow guidelines from the CDC that recommend boosters for everyone over the age of 6 months? Or do we follow the evidence that suggests minimal benefit from a booster in low-risk patients? The data are pretty clear. The benefit of COVID boosters for young, healthy people are minimal. We should not routinely recommend them.