Should Scientists Openly Debate Vaccine Policies?

Derick Alison
Derick Alison
10 Min Read

In this video, Paul Offit, MD, of Children’s Hospital of Philadelphia, discusses his frustration with U.S. public health officials for not having nuanced messaging on COVID-19 vaccine and booster recommendations. Offit is also a member of the FDA’s Vaccines and Related Biological Products Advisory Committee.

The following is a transcript of his remarks:

So, I was trained as a scientist. As a scientist, the way it works is you do studies and you present them at national or international meetings, you draw conclusions, and you’re criticized. When you present at a national meeting, you’re often criticized, which is good because you want to hold your science to the highest standard.

Were the conclusions that you made supported by your evidence? Did you do the right controls? Was it internally consistent? Was it robust? Was it reproducible? That makes for better and better scientific studies. So, you want to be criticized. It’s a value to criticize the strength of the science.

That doesn’t work well in a public health arena. It doesn’t. For example, in December of 2020 when the FDA Vaccine Advisory Committee considered these two vaccines, Moderna and Pfizer’s vaccines, they were held to a high standard of science. Were these vaccines safe? Were they effective? And more importantly, you had systems in place to prove just how safe they were. Did they cause rare or very rare side effects? So when you recommended vaccines or when you said that they were safe, you stood on a mountain of evidence.

But that’s not always true. And when it’s not true, then what?

So I’ll give you two examples. One is the bivalent vaccine. At the end of December 2021 to the beginning of 2022, Omicron came into the United States, and the Omicron variants were immune evasive. So, you weren’t well protected against mild disease if you’d been vaccinated or previously infected because it was immune evasive.

So the government reasoned that — okay, let’s start to get away from this Wuhan-1 strain, the ancestral strain that we’ve been giving throughout 2021, and at least have these Omicron strains represented in the current vaccine. The thinking was — let’s give a half a dose of the Wuhan strain and a half a dose of what ended up being one of the Omicron strains, BA.4 or BA.5, because that will then give you better protection against these Omicron strains.

Now, that wasn’t true. If you looked at both the immunological data and the clinical data, there was no advance with that vaccine. It boosted. The boosters boosted, but it wasn’t any better than what we had because of this original antigenic sin problem. By tethering BA.4/BA.5 to the Wuhan strain in that vaccine, you really selected for an immune response against shared epitopes and not the novel epitopes on BA.4 or BA.5.

If you looked at the immunological studies out of David Ho’s lab in Columbia or by Dan Barouch’s lab out of Harvard, you didn’t have a higher level of neutralizing antibodies against BA.4 or BA.5 in that BA.4/BA.5 bivalent vaccine. That was also true of the clinical study that had been done in France, which was a prospective control study looking at the monovalent Wuhan strain versus the BA.4/BA.5.

Nonetheless, public health officials kept pushing the fact that this was better — much better, dramatically better. “You need to get this vaccine because it’s dramatically better.”

Do you say something?

Do you say something, because occasionally I’m given the opportunity to speak to the media, either television or radio or newspaper, whatever — do you say that? My feeling is you do, because I think it’s your obligation to do that, to always sort of point to the truth. But I think in this current climate, which is a divisive climate, you’re either on the bus or you’re off the bus.

And I think that the minute that you say, “This isn’t exactly what’s claimed. Boosters boost, people who are at high risk should get this vaccine, but it’s really not much better or arguably any better than what we just had” — and we learned that lesson, right? Because now this year’s vaccine is a monovalent vaccine: the XBB.1.5. That was a lesson learned, because you learn as you go, because you don’t know everything at once and you may not get it right the first time. I think it’s okay to explain all that.

But when you do that, you’ve gone to the other side. So I started to get all these sort of love letters from anti-vaccine activists. I mean, I got letters from anti-vaccine activists saying things like, “We have been praying for you and your family for years. And finally our prayers have been answered.”

I was asked to be on Newsmax. Not a good sign. That’s a sign that your message is not getting out there. I don’t know if you’ve ever watched Newsmax, but it’s like an “SNL” parody of a conservative news program. I mean, it’s bad.

Do you do that?

Then with the most recent recommendation for the current boosters, now we, the United States, recommends a booster dose with this current monovalent vaccine for everyone over 6 months of age.

Most countries don’t recommend that, most countries have a targeted recommendation. So the United Kingdom, Germany, three Scandinavian countries, Australia, and the World Health Organization all say, “Let’s boost high-risk groups. People who are immune compromised, people who are elderly, people who have comorbidities, pregnant people — let’s boost them because they’re the ones who are most likely to be hospitalized. They’re the ones who are most likely to die.” And that’s the goal of this vaccine: prevent serious disease. Not prevent all disease, because that’s not going to happen for very long, prevent serious disease.

Do you say something? Do you say, “I don’t completely agree with that?” When you do that, then you’re off the bus. I think that’s not the way it should be.

I’ve talked to prominent public health officials about this and they have said to me occasionally, “No, I think you’re right. I think we should target high-risk groups. But when you do that, when you say that, it’s a nuanced message and a nuanced message is a garbled message.” Their argument, and they may be right, is that it’s better to say “everybody over 6 months should get it,” because then it’s more likely that those groups at highest risk will get it.

Now, I don’t know if that’s true. Are you better off saying, “Here are the groups who should get it,” and then would that result in those groups being more likely to get it or not? That’s a testable hypothesis.

I think that’s the climate we’re living in, is that you’re on this side or you’re on that side. And I think a lot of information gets lost when you handle it that way.

I think for physicians who are talking to patients or physicians who are public health officials or scientists who are talking to the media, I think you should explain it as carefully as you can, to explain why it is that one is making a particular recommendation. Why vaccines do work or why they’re safe or why masking can work. I think it’s okay to explain all that, because I think people deserve it.

There’s actually a cartoon that was in the New Yorker of a patient sitting on an examining table while the doctor’s walking in, and the doctor’s obviously about to give him news. And the patient looks at the doctor and says, “Give it to me nuanced, Doc.” I like that.

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    Emily Hutto is an Associate Video Producer & Editor for MedPage Today. She is based in Manhattan.

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