A Public Letter of Warning to Dr. Larry Madoff, Medical Director of The Massachusetts Department of Public Health: On the 2020 Influenza Vaccine Mandate in Asymptomatic SARS-CoV-2 Carriers.
A post-publication clarification to the reader: the author wishes to be 100% clear that in this letter, he is not advocating an anti-vaccine position - fully recognizing, as a physician and immunologist, the critical and well-established importance of timely vaccinations for the protection of individual and public health. However, herein, the author is delineating a potentially high immunological risk to asymptomatic SARS-CoV-2 carriers who non-selectively receive the 2020 Influenza vaccine (or any other vaccine). Additionally, this letter advocates for a specific mitigation approach to the risk described herein, which would allow well-mitigated administration of the 2020 Flu vaccine to proceed.
Honorable Professor Madoff and colleagues at the MA Department of Public Health,
I write this letter of serious concern to you as a fellow physician, and in your capacity as a Medical Director of the Massachusetts Department of Public Health — and in direct response to your agency’s recent press release regarding the Influenza Vaccine mandate in the state of Massachusetts:
Specifically, I am writing this public letter to you and your colleagues at the MA Department of Public Health, in order to urge your immediate focused attention to a serious public health concern regarding the upcoming 2020 Influenza vaccine season in this COVID-19 pandemic era — vis-a-vis an immunological risk to asymptomatic carriers of the SARS-CoV-2 virus.
As you know, a large fraction of SARS-CoV-2 carriers are asymptomatic and do not exhibit symptoms of COVID-19 disease. That is, these individuals are carriers of the SARS-CoV-2 virus, but for whatever reason(s) are able to “tolerate” it without mounting a significant immunological response. Additionally, it is also clear that those individuals who do develop serious or critical COVID-19 disease are ones whose own immune systems mount a “hyperimmune” response, which renders a substantial fraction of them ill — some critically, as you know.
Therefore, it is a fact that activation or hyper-activation of an immune response to SARS-CoV-2 in asymptomatic carriers, in whom the virus is present but latent, is a real and present danger, every government and institutional leader must take seriously. Specifically, as public health experts and leaders, you and your colleagues at the MA DPH must be asking: What environmental or iatrogenic factors could tip the balance in the direction of activating a pathogenic inflammatory response against SARS-CoV-2 in asymptomatic carriers of the virus?
Here, I am writing to remind you on the public record, of the known immunological fact that vaccines can trigger and activate latent immune responses in a “bystander” fashion. As you know, normally during non-pandemic times, such bystander hyperimmune or autoimmune responses following vaccination, including from the Flu vaccine, though real are exceedingly infrequent. Certainly, under normal circumstances, the public health benefits of vaccinating the population far outweigh the potential risks to a minority subset of persons in the population— but even then, all responsible physicians administer vaccines only to those individuals in whom there are no medical contraindications.
But now, given the unprecedented pandemic disaster the world faces, it is critical to consider the potential adverse effect of the immunological challenge millions of Americans (and billions worldwide) are about to face in the form of the 2020 Influenza vaccine. With potentially millions of Americans being asymptomatic/tolerant carriers of the SARS-CoV-2 virus in the coming months, all public health agencies, including yours, ought to consider whether the Flu vaccine might incite a pathogenic immune response to SARS-CoV-2 in a bystander fashion leading to COVID-19 disease.
Your state of MA is now one of the first to mandate all school children to undergo vaccination against the Influenza virus. Of course, it is also a fact that this subset of the population contains the largest frequency of asymptomatic SARS-CoV-2 carriers. So, I ask that you and your colleagues imagine the scenario in which this concentrated wave of Influenza vaccinations drives asymptomatic carriers of the SARS-CoV-2 virus to lose their immunological “tolerance” to the virus and mount a pathogenic inflammatory response following vaccination. Such an iatrogenic trigger would translate into many seriously ill members within the pediatric community in the state of MA (and elsewhere). In this risk scenario, COVID-19 disease will have been triggered iatrogenically by a non-selective vaccination strategy.
My urgent warning to you about the upcoming 2020 Flu vaccine season and your recent vaccination mandate in the pediatric population in MA, though a theoretical forecast at this juncture in August 2020, is an immunologically cogent one with catastrophic potential. Therefore, it is incumbent upon the Massachusetts DPH to consider and take every possible step towards mitigating against this potential risk.
I have already warned public health leadership at FDA and CDC, including the FDA’s Dr. Janet Woodcock and CDC’s Dr. Robert Redfield, of this possibility in both private and public communications — and I ask that you please read my warnings to these federal officials with care:
Because your state is one of the first ones to mandate the 2020 Influenza vaccine in the vast majority of pediatric and young adult populations in your state, and because your state is one of the nation’s hotspots with likely one of the highest frequencies of asymptomatic SARS-CoV-2 virus carriers, I am compelled to formally warn you about the immunological concern described herein.
Please note that I am NOT advocating for the population to avoid the 2020 Influenza vaccine — after all, to have a Flu epidemic superimposed with the COVID-19 pandemic would become a compounded public health disaster. Rather, I am suggesting that the vaccine only be administered to persons, who have been screened and demonstrated not to be asymptomatic carriers of the SARS-CoV-2 virus. Those who are asymptomatic carriers ought to be vaccinated only after their antigen test converts to negative. Herein, I am respectfully alerting you that non-selective vaccination of the pediatric and young adult populations, a fraction of whom are certainly going to be asymptomatic SARS-CoV-2 carriers, could have a catastrophic consequence to your population’s health.
Professor Madoff, because the Massachusetts DPH is mandating the vast majority of pediatric and young adult populations in your state to undergo a Flu vaccination this Fall/Winter, it is incumbent upon you and your colleagues in the leadership of the state’s DPH to seriously consider and mitigate against the potential adverse immunological effect of the 2020 Flu vaccine in asymptomatic carriers of SARS-CoV-2. I ask that as Medical Director of the DPH and as a fellow physician, you take this public letter of warning seriously, and carefully discuss and consider it along with physician-scientist colleagues specializing in Cellular Immunology, Rheumatology and Infectious Disease.
#ScreenB4Vaccine2020
Yours in friendship and in defense of public health,
Hooman Noorchashm MD, PhD.
