An Opinion And Public Guidance On COVID-19 Booster Vaccination In Young And Otherwise Healthy Americans.
As winter break ends, many elite colleges and high schools across the nation are mandating booster vaccinations for their student bodies and faculty/staff. It may be reasonable to boost many young people, whose vaccine immunity is waning. But it is anathema to safe and ethical medical practice to mandate boosters in the large number of young Americans, who are immunologically “bullet proof” with “hybrid immunity” — and who do not meet the bar for medical necessity.
With the rise of the Omicron variant and the our increasing understanding of the COVID-19 vaccine’s less than binary efficacy in preventing infection, booster vaccination has become a major part of our national effort to defend against COVID-19.
The fact that COVID-19 vaccine immunity wanes over the course of months and leaves many susceptible to “breakthrough infections” makes a powerful argument for offering booster shots to Americans. And the Biden administration and Dr. Fauci are wasting no time at all, relentlessly pushing a “one-size-fits-all” approach to booster vaccination in every age group.
In fact the FDA has approved booster shots for Americans as young as 16 years of age and is moving to quickly approve it for those 12 and over too.
FDA’s approval of booster shots for young and otherwise healthy Americans is happening despite a serious and specific objection by one of our nation’s most prominent vaccine experts and senior member of the FDA’s vaccine advisory panel, Dr. Paul Offit.
As the Omicron variant is raging through our nation, many academic institutions have now instituted, “one-size-fits-all” booster vaccine mandates, without any real circumspection or consideration for whether the young and otherwise healthy people they are subjecting to this administrative mandate may already be well-immune.
It’s more than clear to most rational clinicians, ethical administrators and regulators that creating clearly delineated and medically rational “off-ramps” from the booster mandates for those who are already well immune to COVID-19 is an absolute necessity. Because a medically unnecessary third booster shot could prove dangerous and irreparably harmful in such already well immune individuals.
Alas, reason fails in many elite American quarters in 2022!
Therefore, I am duty bound to express my professional opinion as an Immunologist and public health advocate that the following four groups of young and otherwise healthy Americans ought to be formally and automatically exempted from any institutional vaccine booster mandate — should such persons elect not to undergo this medical treatment:
- Individuals who, within the span of the past 12–24 months, have had a natural COVID-19 infection AND two mandated mRNA vaccine shots (OR the single shot J&J vaccine). These individuals are by clinical definition, very robustly immune. In fact, Dr. Anthony Fauci has labeled such persons, “bullet proof” with “hybrid immunity”. To vaccinate such already well immune persons with an added booster by administrative mandate is medically unnecessary and, thus, only risks serious harm — possibly irreparably to some.
- Individuals who had already received the prior mandated vaccinations, and who during this Christmas break experienced a “breakthrough infection” with the Delta or Omicron Variants. Like individuals in the first category above, COVID-19 immunity in these persons also meets the definition of “bullet proof hybrid immunity”. Additionally, to vaccinate such very recently infected/convalescent persons with a medically unnecessary booster vaccine carries a risk of triggering a dangerous hyperinflammatory response. This should be avoided at all costs.
- Individuals whose second dose of the mRNA COVID-19 vaccine was less than 6 months ago. As you know, according to current FDA guidance, boosters are approved only for persons who underwent vaccination at least 6 months prior to boost.
- Individuals in whom a licensed physician has made a personalized serological evaluation and deems their level of COVID-19 immunity to be equivalent to that of recently vaccinated or boosted persons — my own daughter falls in this category.
I recognize that the institutional intent in imposing a booster vaccine mandate is to protect their communities — and especially those involving congregate community living scenarios, like college dormitories and dining halls. I empathize with the administrators who are struggling with such decision, because of an utter failure of adequate and safe federal leadership from the Biden administration and Dr. Fauci’s team of public health officials.
However, in the rush to protect our nation’s institutions, administrators ought not lose sight of rational ethical reasoning — or of the very important principle of medical necessity, when administratively imposing medical treatment on individuals, whose circumstances very certainly vary.
It is a vastly accepted truism that harm and irreparable damage to innocents in the minority, almost always resides in “one-size-fits-all” approaches to institutional and governmental policies and practices.
In summary, it is my professional opinion and guidance to the concerned public, that the above 4 categories of young Americans be treated with circumspection and be afforded the possibility of “off-ramping” from any booster vaccine mandate.
In defense of rationality in US public health,
Hooman Noorchashm MD, PhD
Winter 2022.
