In mid-December I received an email from Harvard that I did not expect. After several months of encouraging students to receive Covid-19 boosters, Harvard was making boosters mandatory. In the email, Harvard told students to “not call or email Harvard University Health Services with questions,” but didn’t say where students should direct their questions and concerns. This is an odd approach coming from an institution that is supposed to be committed to intellectual inquiry, and it surprised me on two levels. First, it seemed like a terrible public relations move: anyone who is on the fence about vaccine mandates would certainly be pushed away by a do-not-question-us attitude. Second, I was surprised that Harvard chose to ignore the many unanswered scientific and ethical questions surrounding boosters.
On September 17th 2021, the FDA’s independent advisory committee, made up of leading vaccine experts, voted 16-2 against authorizing boosters for all adults. Instead, they approved boosters only for those who are at high risk of severe Covid-19 and those with frequent exposure to the virus. However, about two months later, the FDA decided to ignore these recommendations and expand booster approval to all adults. Such internal conflict at the FDA is uncommon, and when it does happen, the FDA is usually more restrictive than its committee, not less. Since then, two high ranking FDA employees have resigned, saying the booster decision was based on politics and not sound regulatory science. One of them has since written an op-ed in the Washington Post calling out the Biden administration for ignoring vaccine experts.
Understanding why some regulatory scientists are opposed to giving boosters to young, healthy people is complicated. In short, young people are already at such low risk of severe Covid-19, so it’s difficult to gather compelling evidence that boosters will offer significant added protection. This lack of evidence, combined with the low level risks that accompany any Covid-19 vaccination, make it difficult to say whether boosters make sense for the average young person. Several academic doctors including Marty Makary at Johns Hopkins University and Vianay Prasad at University of California San Francisco have been quite vocal in pointing out the gaps in current booster data. There is next to no compelling evidence that boosters will significantly benefit the average twenty year old—a fact which throws into sharper relief Harvard’s refusal to provide any evidence themselves.
A big caveat to this whole argument is that the lack of benefit is specific to young people who are otherwise healthy. The discussion is entirely different for those who are older, immunocompromised, or have other risk factors. There is plenty of evidence to show that high risk individuals really do benefit from boosters. This evidence, plus fear of the Omicron variant, is likely what motivated the CDC to recommend boosters broadly despite so many unanswered questions.
However, the theoretical benefit of boosters for young people is further complicated by natural immunity, as many Harvard students have both been vaccinated and recovered from Covid-19. Recent data suggests that this type of hybrid immunity is even stronger than receiving two vaccine doses. So, for those students who have recently recovered from an Omicron infection, the theoretical benefit of receiving a booster is even smaller than it otherwise would be. Despite the accumulating evidence showing the power of natural and hybrid immunity, Harvard’s policy still requires all students (without special exemptions) to receive boosters. I have yet to find any data-driven explanation for why this is the case.
Vaccine mandates and public health initiatives are not without real costs. We must be thoughtful before pushing broad policies, especially those that infringe on people’s bodily autonomy.
Boosters are problematic in other ways, too. In November, three professors at Harvard medical school contributed to an article questioning whether a broad booster rollout is the best use of resources when initial vaccine uptake is limited and global vaccine shortages remain. Many African countries have fully vaccinated fewer than 10% of their populations, and, in December, the WHO specifically criticized “broad-based booster programs” that include “sub-groups at lower risk of severe disease.” Most Harvard students would certainly fit that description, but the administration has said nothing about why the WHO’s recommendations do not apply to them.
Still, many justify universal boosters by arguing that they reduce transmission and slow the spread of Covid. This could be true, but may not be significant enough to alter the course of the pandemic. According to NIAID director Dr. Anthony Fauci, “Omicron… will, ultimately, find just about everybody.” The FDA commissioner has made similar remarks, but both leaders emphasize that vaccines and boosters will protect individuals against severe disease even if they don’t prevent infection outright.
But what about the high-risk individuals in our community, who might benefit from a broad booster program? It’s strange to me that there’s been no discussion about who these high-risk people are or what kind of public health policies they want. The high-risk members of the Harvard community are likely limited to the portion of individuals who have not been fully vaccinated and also have significant comorbidities. That is, less than 3% of Harvard affiliates. With such a small group, why not adopt a more targeted set of pandemic policies? We have effective treatments (Paxlovid and Remdesevir), effective masks, and flexible work-from-home policies to protect the vulnerable. Additionally, we can predict those who may be at risk of severe breakthrough infections, and offer them additional resources. There is no good reason to adopt a broad public health approach when a less disruptive targeted one would do the job.
As far as I can tell, Harvard’s administration has made no substantial effort to answer any of these questions and instead has expected students to follow blindly. This is the wrong approach for an institution that is a world leader in biomedical science. Vaccine mandates and public health initiatives are not without real costs. We must be thoughtful before pushing broad policies, especially those that infringe on people’s bodily autonomy. At the very least, we should expect Harvard to provide thorough justifications for mandates before pushing them onto their students.
James Woods (jameswoods@g.harvard.edu) is a G1 in Harvard University’s chemical biology program.