Mandating COVID Boosters for College Students: Don’t Do It

I received an email from my son this week letting me know that his university has joined a parade of others requiring booster shots for students next semester. This would be great, except the vaccines are only modestly effective, their effectiveness wears off quickly, they cause significant side effects, most students won’t benefit from them, the science around natural immunity is ignored, the vaccines don’t stop the spread of infection to vulnerable members of the community, and the vaccines would be better utilized on other people around the globe.

Here are nine reasons why booster vaccine mandates at universities are a terrible idea.

1. There is an unacceptably high risk of myocarditis for previously vaccinated male college students. Let's assume that a university has 2,000 male students who would prefer to avoid a booster shot (irrespective of how many other students embrace vaccine boosters), and then calculate the risk/benefit analysis for this group of students using data from CDC.

According to CDC numbers, the myocarditis risk for men between the ages of 18 and 29 is 2.1 per million for the first Pfizer dose, and 24 per million for the second Pfizer dose. For females between 18 and 29 taking the second Pfizer dose, it is 2 cases per million. The risk is clearly much higher for men than women, and the risk goes up over tenfold for the second shot (after the immune system is primed).

Note that other studies have estimated substantially higher risks of myocarditis. For example, a large retrospective study in Israel found that the rate of myocarditis among men 16-19 taking the second dose of the Pfizer vaccine was roughly 150 per million. Moreover, the Moderna vaccine also likely provides a substantially higher risk than the Pfizer vaccine (e.g., a study out of Canada reported that among men aged 18-24, there were 37.4 myocarditis cases per million doses after administration of the second dose of the Pfizer vaccine and 263.2 myocarditis case per million people following second dose of the Moderna vaccine), and the reality is that many college males will get the Moderna booster shot. Additionally, the myocarditis risk is worse for younger men, so it is a safe assumption that college-aged men between 18 and 22 are at higher risk than men between 23 and 29. Nevertheless, let’s use the CDC data for men 18-29, recognizing that the real risk of myocarditis might be higher.

The myocarditis risk from booster shots for men between 18 and 29 is unknown. The risk may be the same as the second shot of the Pfizer vaccine (numbers provided above), but it could be significantly higher or lower. Given that the risk factor increases by more than a factor of ten in going from the first vaccine dose to the second, it might be reasonable to assume a doubling of risk in going from the second dose to the third, as the CDC does in one projection.

Let's consider a group of 2,000 previously vaccinated male students at a given university who do not want to receive a booster shot, but are forced to do so to remain on campus. According to CDC, by requiring all of these 2,000 male students (between the ages of 18 and 29) to receive COVID booster shots against their will, the benefit over a 180-day period will be a grand total of 0.23 hospitalizations prevented (114 hospitalizations prevented per million doses). That does not mean no one will get hospitalized. Rather, that the projected difference, if all 2,000 previously vaccinated men received booster shots rather than not receiving booster shots, would be 0.23 fewer hospitalizations.

What about myocarditis risk? If the risk from the booster shot (from the Pfizer vaccine) was double the risk from the second dose, then there would be 0.096 myocarditis cases (48 myocarditis cases per million doses). This is a ratio of less than 2.5 hospitalizations prevented to 1 myocarditis case. If the students received the Moderna vaccine rather than the Pfizer vaccine, there is a good chance that there would be more myocarditis caused than hospitalizations from COVID prevented.

Even if: (i) the myocarditis risk was the same for the booster as the second shot, (ii) none of the students received the Moderna vaccine (or the risk from the Moderna vaccine is no worse than the Pfizer vaccine), and (iii) the risk for college-aged men was no worse than men between the ages of 23 and 29, the ratio would still be less than five hospitalizations prevented per myocarditis case.

By any measure, that is an unacceptably high risk/benefit ratio to force upon someone against his will.

For those who would argue that 0.09 myocarditis cases in 2,000 people is a very low number not worth worrying about, then I’d make the essentially equivalent argument that 0.23 hospitalizations in 2,000 people is also a very low number not worth worrying about. Then again, as a father of a college student who had serious heart side effects from the vaccine (likely myocarditis based on the symptoms, but we weren’t even aware of that potential side effect at the time), I can say with some certitude that when it’s your son, one case out of 20,000 is worth worrying about.

2. In addition to the myocarditis risk, there are many other side effects as well, including the equivalent of six years of headaches to prevent one hospitalization. What about other side effects that would be expected from those 2,000 booster shots (noting that these other side effects are distributed more evenly between males and females)?

According to CDC, 51.7% of vaccine recipients aged 18-55 reported headaches after the second dose with the Pfizer vaccine, 35.1% had the chills, and 15.8% reported a fever. Assuming these numbers are fair representations of the side effects for fully vaccinated young men receiving a Pfizer booster shot, these 2,000 vaccine booster doses would produce over 1,000 headaches, 700 chills, and 315 fevers. Subtracting out the side effects from placebo shots still leaves over 500 headaches, 600 chills, and 300 fevers, including 180 fevers over 100℉, 50 severe headaches, and 42 cases of severe chills. All to prevent 0.23 hospitalizations!

In other words, normalizing for every hospitalization prevented, the unwelcome side effects on students booster-vaccinated against their wills would include over 750 fevers of greater than 100℉, over 2,000 headaches (including 200 severe headaches), and over 175 bad cases of the chills. That’s roughly six years of headaches in the aggregate in exchange for one hospitalization prevented.

3. Natural immunity is ignored. Like so many other ill-advised policy decisions throughout the pandemic, mandating booster shots (irrespective of prior infection status) ignores the overwhelming evidence that natural immunity provides stronger and more durable immunity against COVID than vaccine-derived immunity. Among college students, what percentage have already had COVID? What percentage will be exposed to and infected with the Omicron variant over the 6-week winter break? Why should doubly-vaccinated students who have just recovered from Omicron be forced to receive a booster shot that causes harmful side effects such as those described above? The purpose of vaccines is to simulate natural immunity. Ignoring COVID natural immunity is one of the great policy tragedies of the pandemic.

4. Look around - vaccination does not prevent infection or transmission. The mandatory booster policy ignores the clear evidence that vaccination does not prevent infection or transmission, particularly among the fast-spreading Omicron variant. The COVID vaccines have been and remain very effective (even against Omicron) at preventing serious disease.

I’m a fan of the vaccines, I’m vaccinated, and I own stock in Pfizer and Moderna. I’m not anti-vaccine, or anti-pharma.

That said, at this point, only an uninformed idiot would argue that this is a pandemic of the unvaccinated. 1,345 students at Cornell tested positive for COVID in the week of 12/15, many of whom were infected with the Omicron variant. In case you were wondering, at Cornell, 97% of the student body is vaccinated. OK, so more vaccines then, yeah?

5. There is no evidence that mandatory vaccine policies for college students have improved campus COVID safety. Imagine the barely concealed delight of much of the national media if dramatic COVID outbreaks (like the one currently ongoing at Cornell) had occurred in the wake of, for example, a football game between Alabama and Georgia, two universities without student vaccine mandates where thousands of unmasked students congregated in close proximity in the stands while chanting “Let’s Go Brandon”. It didn’t happen. Most universities saw COVID spikes in late August and early September as students returned to campus, then cases tended to drop nationally, irrespective of vaccine mandates.

We’ve been told that students must be vaccinated to protect the rest of the campus community, but is there any evidence that faculty and staff have had less hospitalizations and deaths at schools with student vaccine mandates than without? COVID dashboards are publicly available at most universities. One can compare case numbers and positive testing percentages at universities with vaccine mandates and those without vaccine mandates. One must be careful drawing conclusions, as some schools require testing of their students weekly, whereas others do not. This is particularly relevant given the prevalence of asymptomatic COVID. The important numbers are hospitalizations and deaths, and that data is not readily available. If one is looking at infections alone, the data does not appear to be favorable for mandatory vaccine policies.

Many university faculty and staff died from COVID before vaccines were available or before vaccines were widely used by undergraduates, but any infections/hospitalizations/deaths prior to the fall semester of 2021 predate the period of mandatory vaccination. Vaccine mandates for students were put in place for the fall semester of 2021, so that is the appropriate timeframe for comparison. To date, I have not seen any studies showing that vaccine mandates (as opposed to vaccines) for students have significantly reduced hospitalization and deaths at universities over the past four months.

Consider the message from Cornell. In order for students to be on campus during the fall semester, Cornell required full vaccination unless a student received a medical or religious exemption. According to the Cornell website, 97% of students and employees at Cornell are fully vaccinated. Yet the vaccines certainly have not prevented infection and transmission. During this week alone (as of 12/15), 1,345 students have tested positive, roughly 5% of the student body. All in-person gatherings have been canceled.

Cornell has not yet required boosters for the spring semester, perhaps because of the absurdity of doubling down on a policy that failed its stated goal, i.e., “the expectation will be that our campuses and classrooms will overwhelmingly consist of vaccinated individuals, greatly reducing the risk of infection for all.” Mandatory vaccinations did not prevent infection and transmission.

Would Cornell really be any healthier if 5% or 10% of the student body had remained unvaccinated? Obviously (although sometimes it appears we need a reminder), COVID is not the only determination of health. Depression is very common among college students, and college students are at least an order of magnitude more likely to commit suicide than die from COVID (e.g., in one unusual year, there were six suicides at Cornell).

6. Natural immunity generated against the Omicron variant might be more helpful than another dose of vaccine immunity. Current evidence suggests that the Omicron variant is (i) less aggressive in the lungs (by a factor of ten relative to previous COVID variants) and thus less likely to cause severe disease, and (ii) more infective and transmissible. In other words, Omicron could be exactly what we’ve been hoping for (and what virus evolution predicts); i.e., a less deadly COVID variant that out-competes other variants as COVID becomes endemic.

Healthy, previously vaccinated young adults have little to fear from Omicron, but they might have something to fear from subsequent variants that mutate from Omicron. Since the overwhelming majority of the data at this point shows that natural immunity is stronger and more durable than vaccine-derived immunity against COVID, a vaccine booster right now might ironically be counterproductive for some people.

COVID is endemic and will be with us forever. You will be exposed to COVID: it’s a question of (i) when, not if, you get COVID, and (ii) how many times you will be infected. Given that natural immunity appears to be stronger and more durable than vaccine-derived immunity, there is an argument that if the Omicron variant becomes predominant and serves as the precursor of subsequent variants, then for an individual with little risk (e.g., a vaccinated 20-year-old), then it could be better to be infected with Omicron (and develop robust natural immunity against Omicron) rather than get a third shot of a vaccine designed to target the original COVID virus.

In other words, becoming infected today with the Omicron variant might provide sufficient natural immunity to protect against a potential future Zeta variant that resembles Omicron but is more deadly, whereas receiving a booster vaccine today might ward off the Omicron variant, but not provide protection against the putative Zeta variant. Many people will vehemently disagree with this concept, but it ought to be up to an individual whether he or she wants to roll the dice with the Omicron variant based on their personal risk profile. No one can be sure that the existing vaccines (which are the ones being mandated) won’t be the Maginot Line of defense against the next COVID variant.

7. Vaccines are a precious commodity which are (relatively) wasted on healthy, already vaccinated college students. As discussed above, according to CDC estimates, giving a booster shot to the entire student body at a university with 9,000 students is likely to prevent a single hospitalization. Giving those booster shots instead to 9,000 previously vaccinated people over the age of 65 in Germany (which forecasts a shortage of vaccines in the near future) would prevent roughly 20 hospitalizations. Giving those 9,000 shots instead to elderly people who have not been vaccinated at all (e.g., people living in parts of the world where you can’t run out to your local CVS for a booster shot) would prevent over 170 hospitalizations. Yet in these times of COVID, personally abstaining from a vaccine and requesting it be given to someone 170 times more likely to benefit is deemed “selfish”.

As “citizens of the planet”, is this really acceptable? As universities, we proudly wave the citizens of the planet banner, for example, in urging countries in the developing world to prevent deforestation (while our carbon footprint per capita is an order of magnitude higher). Yet when it comes to vaccines, we’ve decided to “act locally” (and perhaps repurpose that citizens of the planet banner into face masks). Are we only citizens of the world when those decisions have no chance of negatively impacting the personal health of the university leaders making those decisions?

We take our third cookie before others have had any, then point at the unvaccinated members of our community and call them selfish. We call it a “pandemic of the unvaccinated”, yet we insist on booster shots for twice-vaccinated college students who are at almost no risk, all the while many vulnerable people around the world have not been vaccinated. If it really is a pandemic of the unvaccinated, shouldn’t we prioritize vaccinating everyone? Especially the most vulnerable? Shouldn’t a 70-year-old with diabetes get a first shot (or a third shot) before a healthy college student gets a booster shot?

8. An effective, orally available antiviral COVID drug will be approved very soon. Pfizer has developed a seemingly safe, effective drug against COVID called Paxlovid. It will likely be approved by FDA within weeks if not days, and the US government has already committed to purchase 10 million courses of treatment. In a clinical trial of high-risk patients, Paxlovid reduced hospitalization by nearly 90%, and no one in the treatment group died.

Paxlovid is expected to be a game-changer in the pandemic, and it will almost certainly be approved by FDA before the start of the spring semester. Rather than attempting to protect the vulnerable population by mandating booster vaccines for students who don’t need them in the clearly futile hope of preventing transmission, a far better solution is for high-risk people who become infected with COVID (most of whom are already vaccinated and have received booster shots) to take an orally available, antiviral drug that is highly effective against hospitalization and death.

If the goal is to protect the vulnerable members of the community, why subject people at virtually no risk themselves to wasteful medical treatments that are unwanted, unneeded, and cause unpleasant side effects, when instead the vulnerable members can get vaccinated and if they still become infected, undergo treatment with Paxlovid?

9. Mandating booster shots for college students is not only medically indefensible (see points 1-8), it is morally indefensible. If you want a COVID booster shot, go get one. Make the risk-benefit assessment for yourself. For many people, the risk/benefit assessment is positive. For others, it is not.

Forcing a student to get a booster vaccination against their will as a condition for attending college (particularly after having already invested years and large sums of money) is a coercive violation of bodily autonomy. It is a violation of the Hippocratic Oath. For many young people, the risk of harm disproportionately exceeds the benefit. Coercive vaccination will cause significant stress, which contributes to so many different medical problems. It is morally and medically corrosive to force someone to take an unnecessary vaccine of limited duration and effectiveness, particularly given the known and unknown harms from the vaccine.

It has already been done once, with the initial round of mandatory vaccines. Now we are seeing mandatory boosters. Will a new round of modified, improved booster shots be required on campus next fall? When does it end? Let's hope now.

Mandating booster shots for college students is just a bad idea. Don't do it.