January 23, 2022


Why I’m for COVID vaccines, but against vaccine mandates.

In the heated debate over vaccine mandates, science and logic have often been lost amid politics and fear.

Read Time 14 minutes

Tomorrow we’ll be releasing a follow-up discussion with Drs. Marty Makary, Zubin Damania, and Monica Gandhi on all things COVID. This episode was put together in response to the overwhelming, if not staggering, response to our first episode, released on January 3 (Monica was not on that one, but she is a brilliant addition to part 2). In this episode we aim to address most of the topics that so many of you have asked us to expand upon.

On the heels of this podcast, I want to write about something that we discussed on the podcast, something that is sure to upset some reading this or listening to the episode, whichever side you find yourself on: Vaccine mandates.

The goal of this article is not to irritate you for the sake of irritating you. My hope in writing this, first and foremost, is to invite you to think. In the heated debate over vaccine mandates, science and logic have often been lost amid politics and fear. Ever-evolving circumstances – such as the emergence of variants with radically different levels of infectiousness or virulence – have only further separated opinion from facts. (After all, if facts are changing, why haven’t opinions changed, too?)

Of course, I’d like to convince you of my point of view (denying this would simply be disingenuous—why else do we write or argue a point?). But if that fails, I hope, at least, that this newsletter may serve as a reminder that exchanging rational decision-making for fear and blind partisanship is a recipe for injustice, discrimination, and policies that may do more harm than good. Scientific policy must be based on scientific truth — otherwise it will be ineffective in the present — and damage credibility for the future.

Let’s start with my priors: COVID vaccines save lives.

COVID vaccines absolutely save lives. Full stop. My opposition to vaccine mandates does not in any way diminish my belief in the data supporting the efficacy of vaccines in preventing severe disease and death, particularly in people over 65 and in those with comorbidities. So, I’m not going to spend much time extolling the virtues of vaccines beyond sharing some data that should always be examined for any medical intervention: what is the benefit, in different risk groups, in both relative and absolute terms?

Deaths of Unvaccinated vs Vaccinated (mRNA vaccines only, at least 1 dose). Data collected from the Veterans Affairs system between December 2020 and March 2021.

The data above show that for people over the age of 18, the relative risk reduction (RRR) of death is between 84 and 88%, regardless of age. This is very close to the 90% risk reduction that was touted at the time of vaccine approval a year ago. But if you’ve paid attention to anything I’ve spoken and written about for the past 10 years, you will recall that we should always pay attention to absolute risk reduction (ARR) also. If the relative risk reduction is 90% (to make the math easy), you still don’t know if the risk is being reduced from 100% to 10% or from 0.1% to 0.01%. And this matters greatly.

Consider the following example: Let’s say we faced a virus that killed 100% of those who contracted it. A vaccine with a 50% RRR (i.e., only “50% effective”), meaning it reduced deaths by half, would save over 150 million lives in the U.S. But if we faced another virus that killed 0.1% of those who caught it, even a vaccine with 99% RRR (i.e., “99% effective”) would “only” save about 300,000 lives (by lowering the death rate from 0.1% to 0.001%). In other words, in this scenario the vaccine that is 50% is far more valuable—and saves orders of magnitude more lives—than the one that is 99% effective that reduces deaths from 0.1% to 0.001%. How is it possible that a vaccine that is only 50% effective could save more than 150 million lives, while one that is 99% effective can only save 300,000 lives? Because of absolute risk reduction. The 50% effective vaccine is up against a virus that infects and kills every single person in a given population, so in absolute terms it is wildly effective, literally saving one out of every two lives of the people who take it. Conversely, the vaccine that is 99% effective is up against a virus that only kills 1 out 1,000 people who encounter it.

Returning to the actual data for COVID vaccines, take a look at the absolute risk reduction column. Here, two things stand out. First, the absolute risk reduction (ARR) increases with age. Why? Because the older you are, the more likely you are to die from COVID, so the benefit from the vaccine is greater. Second, the ARR numbers are very small, especially for people younger than 65. A quick way to get an intuitive understanding of this is to take the reciprocal of the ARR. This number is known as the “NNT” or number-needed-to-treat, which tells you how many people you need to treat to save a life. If the ARR is 50%, the NNT is 2 (1/0.5). If the ARR is 0.1%, the NNT is 1,000 (1/0.001). Based on this data set from the VA (which I chose because of the age stratification), the the number of people you need to vaccinate to save one life in the 18-64 group is 10,000, versus 2,857 in the 65-74 group , and 1,370 in the over-75 group. By comparison, the NNT for a statin is between 50 and 200, depending on the study and patient population studied.

This is not to imply that COVID vaccines are ineffective or somehow useless. Far from it. A quick glance at the recent CDC data, covering more than 1.2 million people who completed their primary vaccination between December 2020 and October 2021, bears this out. In this broader group, 0.015% had a severe case of COVID and 0.0033% died. Not surprisingly, the risk of death was highest among people over 65 and among those who were immunocompromised or had significant comorbidities. But overall, the risk of death among people who were vaccinated was infinitesimal.

In fact, the rate of death from COVID if you are vaccinated is on par with, and likely less than, that from influenza. According to  CDC data from 2017 to 2018, there were approximately 41 million symptomatic cases of influenza that year. This resulted in over 710,000 hospitalizations and nearly 52,000 deaths, which means a fatality rate of 0.126%. Looking at the same data for 2018 to 2019, we can see the death rate was 0.095%. It is abundantly clear: If you are vaccinated, your risk of severe illness or death from COVID is very low, even compared to influenza.

So, why not mandate vaccines, then?

There are many reasons I have heard put forth for why vaccines should be mandated, but one dominant argument stands out: Mandating vaccines will protect vaccinated people from unvaccinated people. This argument assumes three things:

  1. Vaccines DO NOT provide complete protection to the vaccinated (or else why would we care about what the unvaccinated do),
  2. Prior infection DOES NOT confer immunity on par with vaccination, and
  3. Vaccines DO prevent transmission of the virus (which is why we want the unvaccinated vaccinated, even if we don’t care about their health, per se).

Well, we’ve largely addressed the first point in an effort to get our facts straight on vaccine efficacy, and as we’ve seen, the basic assumption fueling this concern is valid at its surface: vaccines do not provide complete protection to the vaccinated. That is, they are not 100% effective at preventing infection, hospitalization, and death. In fact, although vaccines significantly reduce risk of detectable infection in the few months after vaccination, this protection drops precipitously once circulating antibodies decline, though protection against severe infections and death persists. Still, the protection isn’t absolute, and some risk of death remains even among those who have been vaccinated. However, the good news is that the risk is very low today. This was not necessarily the case 18 months ago, but three things have evolved over the past year-and-a-half to compound the risk-reduction of vaccines:

  1. Novel therapeutics have been developed specifically to treat COVID, including monoclonal antibodies, paxlovid, and molnupiravir, all of which reduce the risk of hospitalization and death by anywhere from 50% to 90%.
  2. At least one existing drug (fluvoxamine) has been repurposed to treat COVID successfully, reducing both hospitalizations and deaths by 66% and 91%, respectively, based on per protocol usage.
  3. Far more sophisticated critical care knowledge has evolved, specifically, to address COVID, including the use of dexamethasone and better strategies of ventilation.

The net result of these advances, layered on the benefits of vaccination, imply that a vaccinated person infected with COVID today is in a far less risky position than they were a year ago. And this says nothing of the fact that when it comes to the Omicron variant, which today accounts for >99% of document cases in the U.S., the risk goes down much further. Why? Because the data are unambiguously clear that Omicron is much less virulent than Delta and Beta and Alpha.

How much less virulent is Omicron?

Well, if we look at the most up-to-date information at the time of this writing (still in pre-print), analyzing data from Kaiser Permanente in Southern California between November 30, 2021 and January 1, 2022, there were a little over 52,000 documented cases of Omicron in the patients in their medical system, compared with nearly 17,000 cases of Delta (today these numbers skew much more to Omicron, of course, based on the current distribution of Omicron in the U.S.).

  • 235 (0.5%) of these Omicron patients required admission to the hospital, compared to 222 (1.3%) of the Delta cases;
  • of the 235 Omicron cases, zero required mechanical ventilation, compared to 11 patients with Delta;
  • one patient with Omicron died, compared to 12 patients with Delta; and
  • 84% of patients hospitalized with Omicron left the hospital in less than 2 days, compared to 31% of patients hospitalized with Delta.

Of course, none of this should be surprising given what we know from the data out of South Africa, where Omicron originated, which demonstrated the reduced severity of Omicron relative to Delta, even in a country with very low vaccination rates. Omicron is a very mild infection, compared to Delta, Beta, or Alpha, and based on the emerging data I’ve presented above, it seems to be mild even compared to influenza.

Therefore, we can conclude that while the vaccinated are not immune to COVID infections, their risk of severe illness or death is very low because of the following:

  1. The vaccines greatly reduce hospitalization and death, and
  2. We have a slew of novel and repurposed drugs that are very effective at treating COVID, and
  3. Our hospitals and ICUs are far better equipped to treat COVID patients based on nearly two years of empirical and trial data, and
  4. The dominant variant, Omicron, is a very mild virus (even to the unvaccinated).

How does natural immunity stack up to vaccines?

Next, let’s examine the assumption that prior infections do not provide immunity on par with vaccine immunity. Of the three sub-arguments in the case for mandates based on protecting the vaccinated, I find this the hardest to understand. I am not aware of any other virus from which a recovery does not confer immunity (and yet a vaccine does). In other words, the null hypothesis around this point, at the outset, should be that natural immunity is indeed as good as vaccine immunity, pending data to prove that assumption false. Looking back at the close coronavirus cousins of COVID, SARS and MERS, the data are overwhelming that patients who survived those infections had lasting immunity, even 12 years after infection. Do data exist to suggest natural immunity doesn’t exist for this particular coronavirus? No. To the contrary, there is ample evidence that natural immunity is robust and durable. In fact, the data suggest that recovery from COVID provides longer lasting and stronger protection against subsequent infection, symptomatic disease, and hospitalization caused by the Delta variant, compared to vaccination.

A quick examination of this figure from the CDC data released on January 20 shows that there is virtually no difference in hospitalizations from COVID between the vaccinated and unvaccinated, if a prior COVID infection took place.

In fact, if you look at Table 1 from the paper, and run the calculations yourself, you’ll see the risk of hospitalization is lowest in the group that was not vaccinated, but previously infected. I’ve summarized the data here for the fraction of each group that required hospitalization following a COVID infection:

This simple table, based on data from nearly 22 million COVID positive cases in California between May and November 2021, makes three points so abundantly clear, it’s hard for me understand how there can be any vestigial ambiguity:

  1. Vaccines unquestionably reduce the risk of hospitalization in previously uninfected people (by a factor of 16.5x), and
  2. In people who are previously infected vaccines offer zero additional benefit with respect to hospitalization, and
  3. In vaccinated people, being previously infected reduces the risk of hospitalization by a factor or 2.5x.

Can the case be any clearer, simultaneously, for both the efficacy of vaccines and natural immunity?

How do vaccines affect virus transmission?

Finally, let’s consider the rationale for mandating vaccines to prevent the unvaccinated from transmitting the virus to the vaccinated. A perfect vaccine would not only completely abrogate the severity of the virus on the host, but it would also completely prevent the host from transmitting it to another person, vaccinated or not. This is clearly not the case for any of the current COVID vaccines. In fact, it seems that they only slightly reduce the risk of transmission, and that vaccinated and unvaccinated persons with detectable infection have the same viral loads, despite the reduction in disease severity for the former group. Using a metric called the secondary attack rate (SAR), it’s possible to look at infection rates in household contacts stratified by contact vaccination status and index case vaccination status, and based on such analysis, it seems that vaccination only slightly prevents transmission. Vaccination does not reduce the peak viral load in the infected (though it does appear to reduce the duration of viral shedding, which may translate to the reduction in SAR). An important caveat here is that such analyses have been carried out prior to Omicron’s arrival, but considering everything we know about the mild nature of Omicron, the risk of transmission to vaccinated people is, again, likely much less.

What about mandating vaccines to prevent hospitals from being overrun with COVID cases?

It’s true that hospitals are stretched very thin right now with the n-th surge of COVID. But a few things are worth keeping in mind. During a bad flu season in the U.S. (recent examples would be 2017-2018, 2014-2015, and 2012-2013) it is common for 50,000 to 70,000 patients to be hospitalized at any one time across the country. This is not very different from what we see today (which says nothing of the fact that roughly half of the hospitalized COVID patients have incidental infections. That is, they are there for another reason, but also test positive for COVID). The difference, today, is that the hospital workforce is greatly reduced, relative to a bad flu season. Why is that? According to a survey by Morning Consult, approximately 18% of healthcare workers have quit their jobs since February 2020, while another 12% have been fired or laid off.

Furthermore, many people fail to realize that hospitals routinely function at 90% capacity in their ICUs. A reduction in workforce of even 10% is horribly disruptive to a system flying so close to the sun. It’s kind of like what happens when one of the OPEC nations, even if “only” producing 3% of the world’s oil, goes offline. Complete and total breakdown of the world’s energy markets ensues. It’s called a marginal supply problem.

Perhaps there was a rationale to mandate vaccines in healthcare workers 12 months ago, but given how many of them have quit or been fired for not being vaccinated, despite the fact that they undoubtedly have the highest rates of natural immunity of any profession, it seems illogical to continue to keep unvaccinated healthcare workers away because their immunity came from the actual virus, and not a vaccine.

So where does this leave us?

  • We have a virus that is far less lethal than the one that started the pandemic two years ago.
  • We have very effective vaccines that reduce the severity of illness and death by about 90%.
  • We have ample treatments to further reduce severity of illness in death (in vaccinated and unvaccinated alike) by another 90% or so.
  • We have better methods of providing in-hospital care to the infected.
  • For all their benefits, vaccines are not very effective at preventing transmission.

None of this is opinion. These are simply the facts upon us.

Politics and healthcare will always interconnect to some extent. So, the right question to ask at this time is not why are they’re intertwined, but rather: to what extent should they be?

As some of you heard me outline in my recent interview on Joe Rogan (#1735) and again during my podcast with Drs. Makary and Damania on January 3rd, there is an important distinction to be drawn between Science and Advocacy. Clear lines should be drawn between those two concepts. Vaccine mandates are a prime example of how those lines are often blurred.

Science is not a noun. It is not a person, or group of persons. It is a process. And it’s a process by which you perpetually adapt and evolve through the rigor of always testing your best guesses and seeking to disprove your own assumptions and firmly held beliefs. You welcome uncertainty in the interest of getting just one inch closer to the truth. Speaking in absolutes is not the aim.

Politics, one could argue, is radically different. Political leaders are criticized for speaking with uncertainty and punished for changing their minds. In that sense, politics is the antithesis of the scientific process.

None of the above is a new phenomenon, and little about this dichotomy is likely to change. However, the crux in which we now find ourselves is the present impact of this divide, manifested strongly in our current political policy and juxtaposed with our current scientific knowledge.

Another question that we don’t seem to be asking ourselves is, what, exactly, is the definition of unvaccinated? It’s becoming more and more subjective each day. Today, unvaccinated apparently applies to an 18-year-old college student who “only” received the full 2-shot vaccine dose, but did not receive a third booster shot. Such a student can’t attend a college for which their tuition has been paid. If they concede to the third dose, when will they require a fourth? A fifth? If we’re using circulating antibodies as our metric of immune success, we’ll need to give boosters every 3 months to keep antibodies high. And for what? Certainly not to help us avoid severe disease, hospitalization, or death. For that we can rely on the memory B-cells and T-cells we developed in response to an actual infection or to our first vaccination.

What is the impact of vaccine mandates?

Let’s consider the following examples of the impact vaccine mandates are having right now:

    • In my birthplace of Canada, an unvaccinated person cannot board a plane or a train, let alone go into a restaurant, gym, or skating rink. This is especially interesting, given that the rate of infections in Ontario is now higher in vaccinated than unvaccinated persons, a transition that occurred with the arrival of Omicron in late December. This finding presumably speaks to the low efficacy of the current vaccines at preventing Omicron infections.

  • A Canadian friend of mine, this week, was prohibited from seeing a medical doctor for a corneal abrasion because the doctor refused to see unvaccinated patients (including those with natural immunity from a prior COVID infection). Bear in mind that this is occurring in Canada, a country with universal access to healthcare—a hallmark of Canadian values.
  • A Virginia man in need of a kidney transplant was removed from the transplant list, denying him a life-saving procedure, because he was not vaccinated (though he was previously infected with COVID).
  • In September, Canada’s Prime Minister, Justin Trudeau said that the unvaccinated are part of an extreme group that also included misogynists and racists.
  • Here in the U.S. some are even calling for the deployment of the National Guard “to ensure that people without proof of vaccination would not be allowed, well, anywhere.”
  • A previous guest on my podcast, who asked to remain anonymous, was recently fired from their job as a professor at a very prestigious university for not being vaccinated. This person was fired with cause, which meant they were not even able to apply for unemployment insurance.

The bottom line.

I have been clear about my support for vaccinations. They are an excellent tool to protect us against severe infection and death from COVID. What they are not, however, is a monolithic tool to be used as a sword against our citizens, rather than a shield against a virus. When we call the unvaccinated misogynists and racists as Mr. Trudeau has, or when we make it our goal as a society to make the lives of the unvaccinated as miserable as possible, as French President Emmanuel Macron has said, what are we hoping to achieve? Is this a strategy to increase vaccination rates, or to exact a vengeance?

Even though the U.S. Supreme Court last week struck down the federal government’s proposed vaccine mandate for large corporations, hundreds of U.S. companies and universities are still putting in place mandates of their own, which come with stiff financial penalties and even job losses.

As you consider this thorny issue, I urge to consider the following questions:

Even if you felt vaccine mandates made sense one year ago, when the Beta and Delta variants were raging, when it was too soon to say how well the vaccines would work in the real world, when we had few excellent treatments for infected, and when ICUs were still struggling to understand how to treat COVID, can we really say with a straight face we’re in the same difficult situation, today, especially with the Omicron variant?

What is the scientific evidence to support vaccine mandates today? Today, we have vaccines that are very effective at preventing severe disease in the vaccinated. Today, we have many treatments to further reduce the severity of illness, if infected. Today, we have enormous expertise to treat infected patients in hospitals. Today, we have a dominant variant in Omicron that is nowhere near as virulent as its predecessors. If this were really about science, why would we not allow previous infection, which confers all the benefits of vaccination, if not more, the same rights? Does it not seem that mandates are having the opposite effect to what is desired? Instead of increasing vaccination rates are mandates instead hardening and alienating the unvaccinated further?

If we are being honest with ourselves, are the mandates truly for the protection of the vaccinated, or do they exist to punish the unvaccinated?

How will history evaluate these mandates?

How will history evaluate us for how we have treated the unvaccinated?

And as we look at future science-based policy discussions, even beyond COVID, we need first to agree on the questions we are actually trying to answer. From there, we can begin to explore different possible solutions and debate their costs and benefits in a rational and civil manner. And always, we need to ask ourselves honestly: are we picking sides based on assertions and talking points (Advocacy) or testable hypotheses (Science)?

injecting injection vaccine vaccination medicine flu man doctor insulin health drug influenza concept - stock image

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  1. You said “COVID vaccines absolutely save lives. Full stop.” you should look at all cause mortality, especially after first dose and see if you get the same results. Full stop. (BTW, good luck getting unvaccinated vs vaccinated age cohort data in the United States.)

  2. Hello Peter,

    Great article, thank you! I sent it all around, including to an anthropologist/linguist who thanked me for sending it. But he also had some fun and wrote in response to your statement, “Science is not a noun,” the following:
    The structure of this sentence is:
    N V Neg Pred
    Noun Verb Negative Predicate. “be’ is a funny kind of verb, but Subject position in English always demands a noun. So the statement is self-contradictory. What he really meant is that Science isn’t static. But then, that might lead him to conclude that Science isn’t an adjective either.

    “Science is not a noun. It is not a person, or group of persons. It is a process.”

    Nouns can vary in terms of time-stability, but include processes like erosion, as well as rocks and wind.

    This is the kind of anti-linguistic propaganda that is dividing the nation into linguists and non-linguists and must be stopped or we’ll never have a stable system of grammar! 😉
    Anyway, thanks again!

  3. I love the way you present the known data. It’s a great summary that help us humans, who are very bad at evaluating small risks, figure out what we should do.

    But concluding that vaccine mandates are a bad idea based on the data seems less convincing.

    If I were unable to get on a plane or go to the doctor because I wasn’t vaccinated, I’d just get vaccinated. That seems like a small inconvenience for most of us.

    It’s also encouraging that infections provide good protection. I wonder if that’s also true for asymptomatic cases?

    In the end, I think asking the question “are mandates a good idea?” might be the wrong question to focus on. It might make more sense to focus on which people should get vaccinated and see what the data says about the future of the pandemic, which we hope will improve soon.

  4. Your analysis is fine to the extent if go’s. It is not fully data driven however. There is an absolute presumption built into it that the vaccines do no harm to anyone, that side effects do not exist. There is an abundance of actual data that refutes that presumption but you give it no consideration at all in the article even to try to refute what’s been reported. Perhaps you take Steve Kirsch up on his offer to debate if you really so data driven.

    • This was my issue with the article as well. He also used data from Dec 2020-Mar 2021 to demonstrate the effectiveness of the vaccines. His colleague Dr. Vinay Prasad has written some articles recently explaining the vaccines have not been as effective against Omicron. I like Dr. Attia a lot and I think he’s definitely one of the “good guys”. I would like to get his take on vaccine side effects and more recent vax data.

    • I completely agree. The analysis is top notch but to dismiss the risk vs. benefit of getting the vaccine and the potential for adverse events, leaves a gapping hole in argument for vaccines. Thanks Mike!

    • Well said. This article is well written and seemingly well intentioned, but overlooks the fact that vaccines can and have caused harm in many people. Full Stop. (BTW, the writer stole that line from Dr. McCullough).

  5. Would it be too much to ask you Dr. Attia – to go onto a major network – CNN, MSNBC, FOX, etc. and present this data?
    I am one of only a few in my entire school who chose not to get vaccinated. I’m not a Trumper. Not a conspiracy theorist (OK – maybe a little bit on UFO’s). Not a birther. Not a Jan. 6ther. I do have my MMR.
    In Jan. 2020, I taught about 12 Chinese International Students who had just returned from Chinese New Year and Winter Break – the majority of which became sick – had flown out of Shanghai or Beijing. I sat in a 6X6 room across from half of them – some at the same time. My son got sick and missed school for 2 weeks (usually misses no more than a day a year) with cough, congestion, temperature, extreme fatigue, (perforated ear drum), etc. I got sick with huh huh dry cough for 2 months, wife got sick. I know we had it. No biggie.
    I am thankful for my school not mandating vaccines. But, now we must test once per week and had to sign a new contract. I have said for nearly 2 years – vaccinated and unvaccinated can transmit COVID. Nobody listened. “Get vaccinated!”
    I am 49, fairly healthy, and likely have been infected. When I turn 65 – I will.
    By then, we will have had 3 more pandemics likely.

    It would be nice to see medical doctors such as yourself articulate ALL of the data you did here in your article – without fear and highly probability of cancel culture erasing you. Thank you for such a wonderful read.
    Warm regards,

  6. Btw, the Ontario data is misleading due to limited testing and especially the type of people which are eligible (high risk settings go only)


    In response to the rapidly spreading and highly transmissible Omicron variant, the Ontario government, in consultation with the Chief Medical Officer of Health, is updating its COVID-19 testing and isolation guidelines. Key changes include the following:

    Symptomatic testing will be available for high-risk individuals, and individuals who work in high-risk settings.

    Individuals with symptoms consistent with COVID-19 are presumed positive and they should follow isolation and/or self-monitoring guidelines.

    Testing for asymptomatic contacts of cases is generally no longer recommended, except for high-risk contacts/individuals that are part of confirmed or suspected outbreaks in high-risk settings, as recommended by public health.

    Positive rapid antigen tests will no longer require PCR confirmation.

    Based on the latest scientific evidence, individuals with COVID-19 should isolate for five days if they are fully vaccinated or under the age of 12, and if their symptoms are improving for at least 24 hours.

    • Agreed, this and other data that Peter presents here is often cherry picked. Peter makes several errors including:
      1. Not recognizing the benefits of vaccines likely reducing mutation rates.

      2. Not recognizing that ICU and hospitalization rates are actually much higher globally due to covid than ever before, and chalking healthcare stress up entirely to reduced workforce is factually incorrect.

      3. Presenting disingenuous data interpretation I.E. that symptomatic infections are occurring in higher or similar rates in those vaccinated. (This is straight up misinformation that I was shocked to see Peter post and is quite easily explained in the Ontario data as done here and beyond.)

      4. He sets up a strawman argument by proposing that the purpose of vaccination is to prevent symptomatic infection or infection at all, which is really more of a bonus than a purpose. Its true purpose is to reduce outcome severity and reduce the burden on already stressed healthcare systems. He almost ignores this entirely and instead on loosely addressed it by saying all the problems relate to lower workforces, which is factually incorrect (again, we have much higher hospital burden rates which is why surgeries and procedures are being cancelled en masse in Canada.) Beyond this, even if it were true that all of our problems came down to a reduced workforce, that doesn’t really solve the issue in any way – vaccinations reduce hospitalizations for extremely low cost, whereas training and hiring massive forces of healthcare workers is not cheap or easy.

      5. Peter rather strangely promotes the use of three answers to Covid that don’t make much sense. First he promotes the use of extremely expensive monoclonal antibody regimen’s that have less efficacy than the vaccine with more side effects. Then he promotes the use of fluvoxamine which actually has thus far not had convincing data (there was one positive study that he quotes but he completely glosses over the negative NIH study seen here: https://www.covid19treatmentguidelines.nih.gov/tables/fluvoxamine-data/). Lastly he follows this with critical care knowledge as a response to covid as if ICU treatment is a better response than prevention – which any physician throughout history can tell you that primary care is the basis of good medicine (odd Peter wouldn’t promote that given he himself has built his business on primary care.)

      6. Next Peter does some fancy dancing with stats again. This time he takes early Omicron data pre-dating the likely expected outcomes of ICU and hospitalizations (that tend to occur later in epidemic waves as a complication) I.E. pointing out there’s no ventilated patients due to Omicron. Yet at my centre we have 45 patients on ventilators from Omicron currently, so either the study is bullshit or as Peter as glossed over – it’s too early in the wave to comment on complication rates of Omicron. As a part of this he also again points out complications due to re-infection if previous immunization has occurred or previous infection, but takes data PRIOR to the novel Omicron strain. The truth is we have no idea if immunizations or a prior strain infection will be equivalent against a novel strain, so making any sort of argument one way or the other is disingenuous.

      7. Peter makes a bunch of uninformed comments about Canada, which as a Canadian physician I find insulting. First the Ontario data, which was lazily slapped on here with zero insight. Secondly, any physician that denies access to a patient due to them being covid positive is actually a reportable offence to our regulating colleges and his friend should have gone elsewhere and can report that physician to the college. Lastly he makes a argument of emotion by purposefully calling upon remarks made by a public figure as though it has any place in what he said was supposed to be a discussion in the merits of the SCIENCE.

      Peter this article is poorly researched. Your recent podcasts and appearances with political figures like Joe Rogan are informed by handpicked rather than a true review of all the available data and science on the issue. You did not adequately represent the merits of the side you don’t agree with, and you did not adequately demonstrate any harms of vaccine mandates. If you’re interested in having a discussion with someone who can adequately represent the issue then reach across the aisle to a stauncher opponent in favour of mandates with a better grasp of the available literature. This does not include physicians who pull at stuff like Vitamin D, fluvoxamine and ICS on the basis of poorly informed research and misreading of the available data.

      • This nurse in the US thanks you for such a coherent rebuttal. I’ve been saddened and confused to see this latest turn by Dr. Attia and it’s made me rethink both my subscription and my confidence level in his interpretation of the science in other topics. Not a big deal, as I’m sure every Rogan appearance nets tens of new subscribers for every one he loses.
        I agree an interview with a knowledgeable proponent of the opposite view would do alot to bolster the integrity of these arguments.

      • Can you expound further on how vaccines reduce mutation rates, and more importantly, how the possible reduction will impact, in real terms, the immune escape of SARS Cov 2 in the future?

        Are you talking about 2 months post immunization or 6? Which shot number? Has there been previous infection? How old is the subject? Any underlying health issues?

        It’s funny to me that both extremes of the vaccine argument want to claim the positive or negative roles of vaccination on “mutations,” and variants. Btw, we aren’t talking about DNA, so it’s not mutations.

        Theoretically, are the mutations most likely occurring in immunocompromised people? Probably. But it’s quite easy to make the case that people with a low level of immunity, say from vaccination and are immunocompromised, are most likely, facilitating the changes (it’s how mutations for SARS Cov 2 are generated in a lab). Want to put a scarlet letter on them? Further, someone who is triple vaxxed and healthy, although less likely, could do the same.

        It’s not productive to create a boogeyman. Further, if you are a medical professional, then surely you realize that a respiratory virus will not be neutralized and will not be prevented from mutating.

        Recommend vaccines in a kind and informed way and hope people will listen to you. Tell them what to do, and plan for failure. People hate a God complex.

        • Paul, this is the equivalent of Gish galloping. You’ve made a number of assertions that are fundamental misunderstandings of virology. As basic as stating it’s not mutations as it’s “not DNA.”

          Mutations relate to nucleic acids. RNA is included in that. The translation within our cells of RNA viruses occur for longer periods of time and in higher amounts with higher viral load. The basic science argument is apparent. If you want hard studies about mutation rates specific to covid-19 then you won’t find them because it’s far too early and goes against the principal of the argument here – which is founded in the basic science.

          Effectively you’re asking me to prove an airplane is faster than an air balloon and won’t take their registered speeds as proof until I race them against one another in a controlled environment every day for 1000 years.

          This meets the criteria of nothing that’s practical could change your mind. At least be honest about it.

          • Of course RNA, too. But amino acid substitutions in a protein like Spike are not referred to as “mutations,” and it’s these changes we are concerned with. Yes, these substitutions are the product of mutation within the viral genome.

            Sars Cov 2 is constantly mutating. Omicron is constantly mutating. But, do the mutations lead to changes in a protein like spike, that result in a fitness advantage?

            Omicron has 37 amino acid substitutions. These substitutions are a product of mutation, but they themselves are not “mutations.”

  7. Firstly, let me tell you that I have been studying the Covid pandemic daily since late January 2020, and initially believed that this was “the big one”the microorganistic response to overpopulation that was going to depopulate the earth. I was wrong. That task may be given to the World Economic Forum. Secondly, you must understand that the medical community in the U.S. has become politicized to the point where all the medical acumen, the finally honed diagnostic skills that doctors develop over years has been disappeared by their own hands. The entire population of physicians in this country for whatever reasons has declined to actively treat their patients, save 500 souls from Frontline Doctors and teledocs in varied locations, who have saved many lives using simple, safe effective outpatient drugs from the first day of clinical signs. Thirdly, no one has pointed out that the medical community decided to treat Covid-19 with vaccines rather than safe, sequential medications, and that these mRNA vaccines are inadequately tested,grossly unsafe, and ineffective. MRNA vaccines are not killed or modified live virus, but commandeer the cells own machinery to produce billions of spike proteins, precisely the pathologic agent of the original wild-type virus. These agents stay in the body for 15-30 months, and NOT according to plan, circulate throughout the body attaching to Ace-2 receptors at critical junctions in the ovaries, the heart, the lungs, and the endothelium of the vessels. Likewise, lipid nanoparticles also circulate, pass through tight junctions, attach to cardiac pericytes, and cause massive inflammation on their own. Peter, you ignore the deaths( 22,193 see openvaers) the cardiac myositises(27,674), the permanently disabled(39.150) at your peril, especially when these numbers are probably 5-41X what is revealed publicly. The methodology of distribution of these public gene-transfer experiments breaks all the informed consent rules, the agreements of the Geneva Convention, and the Nuremberg protocols. There has never been an effective, non-toxic mRNA vaccine produced, and this is looking like the worst medical catastrophe in the history of mankind. I do not exaggerate.
    What you should do is first see if you can watch a rerun of Senator Ron Johnson’s live stream today 1/24/2022 Covid-19 A Second Opinion. I recognize all of the doctors and some of the lawyers on the panel. Next get in touch With Dr. Peter McCullough and invite him for an interview. He will be happy to talk with you. He is the most published and well known of the doctors involved. If I can be of further help, please contact me. MBS

    • All of this above is why the Covid vaccines should not be mandated. Thank you for bringing all of this to light as it was what was missing from this great discussion! Thank you Mark Bennett Smith, V.M.D

    • Thank you Mark. An informed, measured, truth-filled comeback. How Peter is so pro-QuackScene (my word replacement) with himself, his family and patients leads me to seriously question his judgement, ethics and Hippocratic oath to the point where I wonder if he’s simply yet another paid Pro-V advocate actor in this ludicrously tragic global charade.

  8. First, is anyone interested in returning to the life and health standards of the pre-Pasteur ages of human medical history? It is arrogant to assume we would be fine, healthy, and prosperous today without the legacy of the scientific process which, largely through availability and use of immunization programs, has raised the levels of health and well-being world-wide. In our relatively short history with this current pandemic, it does appear that this year, as opposed to just one little year ago, it seems less urgent to be vaccinated given the 5 points made by Dr. Attia. However, while a mandated program may seem less reasonable now, a mandate early on in 2020 and 2021would have thousands of lives and suffering still felt by so many bereft of loved ones today. How many more children would have died in my era without school vaccination mandates for polio, whooping cough, measles, et al.! By relying on the scientific process, we have many times used the logic of vaccination mandates with unsurpassed progress .

  9. First, is anyone interested in returning to the life and health standards of the pre-Pasteur ages of human medical history? It is arrogant to assume we would be fine, healthy, and prosperous today without the legacy of the scientific process which, largely through availability and use of immunization programs, has raised the levels of health and well-being world-wide. In our relatively short history with this current pandemic, it does appear that this year, as opposed to just one little year ago, it seems less urgent to be vaccinated given the 5 points made by Dr. Attia. However, while a mandated program may seem less reasonable now, a mandate early on in 2020 and 2021would have saved thousands of lives and suffering still felt by so many bereft of loved ones today. How many more children would have died in my era without school vaccination mandates for polio, whooping cough, measles, et al.! By relying on the scientific process, we have many times used the logic of vaccination mandates with unsurpassed progress .

  10. As always Peter your stalwart examination of the data is highly appreciated. There is no place for vaccine mandates in civilized society. What is happening now in some parts of Europe and elsewhere is truly disturbing. Science is being ignored to pander for the fears of those who expect the government to protect life regardless of the enormous costs. Let us hope this madness will soon end and freedom will return.

  11. The main example you use of why people favor mandates is the belief that they “protect the vaccinated from the unvaccinated.” In my experience, the primary argument is the exact opposite… that they “protect the unvaccinated”, namely people who can’t get vaccinated for some reason or another…

  12. Firstly I agree wholeheartedly that if you can show Covid antibodies from a prior infection that should be acceptable and you should not be required to be vaccinated. However apparently north of 75% of those dying are unvaccinated. Why are people unvaccinated? Apparently many are choosing for political reasons, and choosing to ignore the best medical advise. They are becoming infected and infecting others some of whom are dying… Today more than 2,000 Americans are dying daily. My view is society has a right to protect its older and more vulnerable members, just as it protects itself from drunk drivers -Thus mandates are needed for those without proof of antibodies. Either from vaccinations or prior Covid infections.

    • Thanks but I don’t listen to internet ‘doctors’

      “You have a 21% increase of dying in the next 6 weeks if you take the vaccine.” Dr Robert F Kennedy

  13. Peter —

    As always, a very well-written, thoughtful, and compelling piece.

    I think one of the great points you make here, and one that you have been repeatedly emphasizing, yet one that is so often over-looked (or purposely omitted, at least by mainstream media, to misuse the attraction, power, and effect of big, fear-disseminating numbers), is that the relative risk reduction of an intervention only carries significance and can function as a decision-making tool if stated alongside the related absolute risk reduction. While it seems so basic, it’s so fundamental.

    On this note, I would like to pose a question that may sound generic for some (at least for those who believe that all you need to know is that shot #1, shot #2, and then a booster reduce your relative risk by XYZ%, so there shouldn’t be any argument to be made against it, should there?!):

    Why, on earth, is there no CDC (or other government) website, where every single person can go, select their gender, age, comorbidities, prior vaccination (yes/no) as well as prior infection (yes/no) status, and get an approximate risk assessment in terms of their absolute risk of getting hospitalized and/or dying from Covid?

    To me, as simple as it sounds, this concerns one of the most fundamental data sets that should be available to anyone and everyone, yet it isn’t. It would be data that could take most of the ambiguity out of the discussion we are having. It’s simply incomprehensible to me, how such basic data is not easily available to the public after two years, millions of cases, and stagnating vaccine uptake in vulnerable groups. I truly think, if someone was to conduct a survey (and you, Peter, had an anecdotal story of this on your most recent podcast), the results of people’s absolute risk evaluation for themselves in these categories would be simply mind-boggling, towards both sides of the spectrum. I’m convinced this would allow a much more honest and elucidated debate. Until the present day, we still try to debate without having created a common baseline on many levels. Most people have problems assessing risks when asked to think in abstractions. Risks need to be made personal, be illustrated, and eventually be compared to well-known comparative figures. Instead of making it more personal (personalized risk assessments, personalized behavioral recommendations, personalized treatment/prevention strategies), politics repeatedly decides to employ the scattergun approach.

    Even when it comes to the use of Covid-related vocabulary such as “mild” and “severe.” I do believe it’s extremely counterproductive using one or the other term without clearly defining what the pathology behind either term is. And there should be no mystique, or nebula, surrounding these terms, nor should that be the case for absolute risk percentages per age group (and a 65+ age group, as it can be found in many studies does not suffice, especially since in the older demographic groups one additional year of age carries a higher marginal risk compared to younger demographic groups).

    The same applies to vaccine safety and side affects. From my perception and personal experience talking to numerous people who are vaccine-hesitant (and I am a big proponent of vaccines in all cases that are scientifically supported), it’s not so much about myocarditis, pericarditis, and thrombotic thrombocytopenia anymore. Myocarditis may still be the focal point of the discussion surrounding vaccination of younger people, no doubt. However, if we want to address the insecurities, anxiety, and hesitancy in other demographics, we much more have to speak to the “invisible” side effects, those that haven’t yet been documented and captured by VAERS and other surveillance programs, at least in the eyes of those who are reluctant; and most might argue (including me), those are side effects that don’t even exist. I would make a guess that people, by now, could more closely estimate the general risk of getting myocarditis after vaccination than their own risk of getting hospitalized from Covid; that’s how frequently it has been rehearsed in the media and in scientific publications. The discussion about the risk of myocarditis from vaccination vs. the risk of infection is not one that changes many peoples’ minds, at least in my opinion. People are more concerned about long-term side effects, the development of intolerances following vaccination over time, auto-immune disease, and other diseases that they believe have not yet been picked up by any of the vaccine reporting systems. It is always much more about the “invisible enemy” than the one everybody knows about. This can be called irrational, or maybe even absurd. However, it’s not helping with convincing vulnerable people of getting vaccinated that are feeling it’s more about politics and agenda than transparency and scientific reasoning.

    To me, two primary things need to happen and are major shortcomings of this pandemic so far: 1) a website that is easy to navigate, that gets constantly updated with the newest figures, and where everybody can get an approximate absolute risk assessment for outcomes such as hospitalization and death (the things people really care about!) based on individual characteristics/risk factors, and 2) a comprehensive explanation to the general public of how vaccine safety surveillance programs work and how these systems provide a close-meshed structure that can be trusted.

    • Merlin hits the nail on the head when it comes to assessing risk. Access to data sets would at least make sure everyone is making informed decisions about managing risk. Humans are mostly terrible at assessing relative and comparative risk. A case in point is a phenomenon I began to notice in late 2020 – people riding bikes in uncrowded areas while wearing masks but no bike helmets. I commented on this (to me) amusing phenomenon on Facebook and was pilloried for it. I had to launch into a detailed discussion of the risks involved. The data on reducing head injuries and/or death while wearing a bike helmet in the event of a mishap are clear and staggering. The only way someone wearing a mask but no helmet vs. a helmet but no mask could have an overall positive impact on public health is if their highly increased probability of dying reduced their probability of being hospitalized enough to offset all other risks. Later that day, peak phenomenon occurred. I barely avoided sending a bicyclist over my windshield when the biker, who was wearing a mask with no helmet and holding coffee in one hand while riding one-handed, didn’t stop at the stop sign on the side street I was passing. Luckily I have well-maintained brakes and tires. He definitely would have gone to the hospital if he survived.

  14. There are a number of other incorrect, poorly supported, and misleading statements in this article. I’ve provided two examples below.

    “At least one existing drug (fluvoxamine) has been repurposed to treat COVID successfully, reducing both hospitalizations and deaths by 66% and 91%, respectively, based on per protocol usage”.

    This is referencing a RCT out of Brazil. It fails to mention the intention-to-treat analysis showing no significant difference in mortality, and fails to mention the pitfalls of per-protocol analysis. There is no convincing evidence at this time to suggest that fluvoxamine reduces mortality.

    “but given how many of them [healthcare workers] have quit or been fired for not being vaccinated”.

    This line suggests that a large number of healthcare workers have quit/been fired for not being vaccinated but fails to provide any exact figures. Here are some numbers: Kaiser – placed less than 1% on administrative leave in 10/2021 for non-compliance (out of roughly 240,000), Mayo Clinic – fired ~1% in 1/2022 for non-compliance.

  15. virginia man… ‘”I’d rather die of kidney failure,” Connors said.’ seriously? how can you use that as a rational example. wouldn’t you just get the vaccine to stay on the active list if that was the policy? is there some sort of high risk for this person to get the vaccine that i don’t know about?

  16. On Covid mandates, I think you may have missed the only reason why I disagree: because getting infected provides a breeding ground for new variants. That hurts us all and possibly future generations. If not for that I would agree with you.

  17. All these facts and so little understanding. The reason we need vaccine mandates is that you do not get to choose who you infect. Once you are infected, you are spreading the virus. People under those conditions often behave irresponsibly. If you need an example, just look at how many people in the US have the Trump Virus compared to other countries. In the US, we claim we want freedom while refusing the larger virtue of Public Health. Vaccine mandates are on way to control and minimize the damage from the irresponsible idiots.

  18. I think we are all missing the underlying problem with the vaccinated and unvaccinated. The real issues are that no one wants to talk about. Americans cannot handle being told they are unhealthy from the beginning. We are all big babies and we should be ashamed of how we treat our bodies that in turn CAUSE many health problems. There will be many diseases come and go but if we don’t take care of our bodies then we have already defeated ourselves. Get if the couch , stop eating junk and get healthy. This is why we can’t fight off anything. We are sick from the start.

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