January 23, 2022

COVID-19

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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259 Comments

  1. After my own lengthy fight with COVID, I’ve become a proponent of recognition for natural immunity, and an opponent of COVID-19 vaccine mandates. Yours is one of the most thorough weighings of available data that I’ve seen. I applaud you. I will also add two things:

    First, as a data analyst, my argument against vaccine mandates boils down to the fact that vaccination status is not the top predictor of overall risk. It does not bring down one’s risk to anything close to zero, and you can’t predict an individual’s overall risk for infectiousness or serious illness with much accuracy based on vaccination status alone. Rather, the top predictors seem to be the obvious things, in rough order from most to least relevant: recent positive test, exposure to someone with a recent positive test, apparent symptoms, age, comorbidities, prior infection status, time spent in large and crowded groups, THEN vaccination status. Unless organizations are considering firing people for the things at the top of the list, then they shouldn’t focus on the things at the bottom.

    Second, you claim that the 90% protection rate against serious disease was as initially advertised. Except that’s not what was advertised, nor what was sold to the American public. We were told over and over again that it protected against 90% of COVID *cases*, meaning the person’s body allowed the virus to replicate, become transmissible, and cause symptoms. I’m not sure this was EVER true, but that number dropped precipitously during Delta, and even moreso during Omicron. This distinction doesn’t meaningfully change your analysis, but I think it’s important to highlight because 1) it shows that the assurances of public health officials turned out to be critically false and 2) it was false in a way that was predictable due to the nature of this particular virus and WAS predicted by many scientists who faced considerable pressure to conform to “the narrative”.

  2. Excellent Article. I’m certainly no expert on medical issues but I’m smart enough to realize that the vaccine works but at the same time natural immunity is probably better. I’m also recognize the vaccine “Mandate” is nothing more than an elitist power grab by corrupt politicians who want to control people’s everyday life.

  3. Ignore any or all of the hate mail. Just remember that you are effectively providing an invaluable public service trying to get to the truth of the matter in an impartial manner, and you should be warmly applauded for doing what you are doing.

  4. your proof that the so called covid vaccines are good for some people is completely based on the relative risk. you seem to completely ignore the absolute risk numbers. for me the absolute risk is mush more meaningful. it represents the actual risk for me. that number for is .01%, which is a miniscule number. i willingly participate in activities that have have higher absolute risk numbers and have no problem with it. i see no reason to take a drug that will reduce my absolute risk so little. same reason why i never take the flu shot — simple risk reward analysis. i can better reduce my risk by eating healthier, exercising more, etc. i do not, nor never have, looked for a world with zero risk. that world doesn’t exist and we really wouldn’t like it very much.

    • Hi Wes, I think you might have missed it, but he actually lists and addresses both the absolute and relative risks in the article and asks for us to pay attention to *both* numbers. He uses the absolute risk number to make the very argument that you are making as the basis for a differentiated vaccine policy (as opposed to the one size fits all approach of the mandates).

  5. Thanks for the fair approach in your analysis. The refusal to acknowledge immunity derived from previous infection is what gives light to the lies pushing mandates and very good reason for people not to trust the “experts.” Personally, I am not anti-vax per se, but I have significant concerns about the long term effects of the MRNA therapies and have chosen to forego them until more is known – especially since I have already had the Covid and have tested positive for antibodies multiple times. Already, in a year, we have learned that vaccines are far less effective than originally thought, that there are more adverse reactions than with traditional vaccines, and that the virus is capable of mutating in ways that diminish any vaccine efficacy. Further, there is troubling data emerging that suggests vaccinations may actually impede natural immunity. With this in mind, what might we learn in the next 3-5 years? It seems criminally absurd to push mandates – especially, when the goal seems to be simply to eliminate the control group.

  6. The only problem is we already have the internal DARPA documents showing the truth. The vaccine will KILL you.

    1. “SARS-CoV-2 [COVID-19] is an American-created recombinant bat vaccine, or its precursor virus.”
    The intent of Daszak’s DARPA proposal was to immunize bats in Chinese caves by spraying them with a vaccine based on coronaviruses that would likely “jump” from bats to humans, thereby, preventing a pandemic.
    Sound far-fetched? Stand by, the details get worse.
    The DEFUSE team would collect a large number of bat coronaviruses from Chinese caves, test them for their ability to infect humans, select those most likely to make the “jump” from bats to humans, analyze their structures and map evolutionary pathways.
    Of course, the concept of a vaccine based on an evolutionary model, given the highly unpredictable nature of bat coronavirus mutations is, on its face, scientifically preposterous.
    Yet, if they had stopped at that point and created a bat vaccine based on a natural bat coronavirus, the project would have been a failure, but at least there would not have been a COVID-19 pandemic.
    They planned to isolate the spike protein, the component of coronaviruses that regulates infectively, and genetically manipulate it to make it more infectious to humans and insert it back into a bat coronavirus backbone as a virus precursor for making a bat vaccine.
    The DEFUSE team writes about introducing “human specific” structures, like furin polybasic cleavage sites, where they do not occur naturally, highly indicative of bioweapon development and consistent with the Chinese military’s joint pathogen development/vaccine production program.
    The DEFUSE proposal read like a recipe for COVID-19.
    Ultimately, the Daszak DEFUSE proposal was rejected because it included such dangerous “gain of function” research, the product of which also having dual use capability as a bioweapon.
    Nevertheless, the money kept flowing from Anthony Fauci’s National Institute of Allergy and Infectious Diseases, through Peter Daszak, to China.
    2. Without providing the evidence upon which his conclusion is based, Major Murphy stated that an incomplete precursor virus was released, presumably through a laboratory accident, in August 2019 and thereafter, again presumably, circulating and mutating within the Chinese population until reaching an epidemic-producing state in November-December 2019.
    3. Major Murphy also questioned the DoD’s vaccine mandate, given the potential toxicity of mRNA vaccines based on the COVID-19 spike protein, as well as opposing the official suppression by the U.S. government of early intervention therapeutics, like ivermectin and hydroxychloroquine, which his analysis found efficacious for treating coronavirus infections.

  7. Seems Peter is being hypocritical based on his comments in a previous podcast, or perhaps his views have evolved (no pun intended). Go back and listen to his conversation with Dr. Paul Offit on May 3rd, 2021. Listen at 53:29 – 56:12. Here are some quotes from Peter when the subject of vaccine mandates arises, Peter said “If you are going to work in a hospital and take care of patients, I do not believe you have the right to refuse vaccination… I think that society may have to make decisions about who can and cannot have certain other privileges, such as travel… so I think that there should be a day.. when.. if we decide, know what, people who haven’t been vaccinated or conferred natural immunity through some other means and can demonstrate it, maybe we don’t want to have all those people traveling on airplanes. Or maybe some countries are going to say, ‘you can’t enter unless you’ve done those things.”‘ He concludes by talking about a hypothetical unvaccinated person working in his space and it being okay and it being his own risk.

    It looks as though Peter’s views have evolved on this issue since he sees the crisis we are in and also has personal friends who are now being affected. The tyranny of Canada is probably jarring to him as well. Hopefully he can offer clarification on this.

    His article very well articulated, but I hope he can provide some explanation for his shift in views. I do not think I am taking him out of context. Go back and listen for yourself.

    Thanks.

  8. After examining the data it seems clear that whatever status being vaccinated conveys to people should also apply to people who have been confirmed to have recovered from a covid infection. The only problem is that it is much easier to verify someone has received an approved vaccination than one has recovered from an infection. If there was a better way to verify that then it seems to still make sense to have vaccine mandates for people that have neither had the vaccine nor recovered from an infection. Having such a mandate would seem to still fit with your arguments here.

  9. You have not followed this through. While a 0.01% ARR spread over 300m ppn = 30000, this figure takes no account of how much damage the vaccine does. In short, you weighed the benefits with showing the costs.

    And then, when you factor in that you do not need to vaccinate because of the re-purposed drugs that were very quickly known to work, there is no excuse for rolling out a vaccine in the first place. Let alone mandates.

    All you need is an un-corrupted regulatory system that allowed it as a front line defence with pre-cautionary development of a vaccine, which, as would have proved the case would not have been needed, since the fall of 2020. It is only the rich countries that have eschewed this course and have wrecked havoc on their populations.

  10. These are great points, and please correct me if I’m wrong, but shouldn’t we also be considering future mutations? Doesn’t an unvaccinated infected person have more replication of the disease in their body when compared to an infected vaxed person, and so multiply the potential for mutation?

  11. Peter,
    I enjoyed reading this piece and largely agree with it. However there is something I’d like to point out that you may have missed:
    In the paragraph under the heading “What is the impact of vaccine mandates?”, you say: “This is especially interesting, given that the rate of infections in Ontario is now higher in vaccinated than unvaccinated persons…” The implication is that it’s unexpected.
    Given the current full vaccination rate in Ontario for persons 12+ of 89% (from the same web site you link to in that paragraph), it’s not surprising that the majority of those infected are vaccinated. After all, going to the extreme — 100% vaccination rate — everyone infected would be vaccinated. 89% is not too far from this.
    I see this aspect overlooked by many people, and try to point it out when I see it.
    Thanks for putting out your emails, and especially your podcast.
    All the best,
    Karl

  12. Wish you could take the leap beyond the worry of causing further vaccine hesitancy. You cannot never recover from a “mild” myocarditis, for example; children can never recover from the trauma caused by the draconian measures, for example; Orthodox jewish communities will never get vaccinated again because on how it affected their women periods, for example.

    Trust has been eroded, potentially forever. When another crisis hit our world, violence will escalate. You also played a part by discriminating the unvaxxed. Your science had a ideological bias towards the “safe and effective” motto, as many other physicians as they have been taught in academia.

  13. Hi Dr. Attia,
    I’m a subscriber and love The Drive so please keep up the incredible good and valuable work.

    Regarding mandates, we have a lot of lunkheads in this country and now with fake news, little time nor the ability to understand the intricacies of statistics, biology, etc as well as the digitization of any and all opinions, it’s very easy for people to lose their way.

    Having said that, how in the world would we ever reach herd immunity if someone didn’t mandate something? (I have a brother who still refuses to wear seatbelts.) I assume herd immunity is a desirous goal and if so, how would you reach that goal in this country as it now operates without mandates?

    Thanks,
    M. Hassan
    PS I would love to hear one of your excellent podcasts on heart arrhythmias, the triggers and how to resolve them.

  14. You really aren’t staying up to date in current data and seen like you’re straining to justify the recent podcast.

    Some points you did not discuss include the inflammatory effects of natural infection (recent pre-print), minimizing new variants, and our responsibility to one another when we are part of society (is controlling thus virus TRULY such a horendous hardship?). So many other points to make… I’m very disappointed in your flippant attention to this important issue

  15. Thank you for this article, as I am pursuing my studies in the field of medicine right now in Canada, it seems clear to me that medicine has become a political tool used to advocate, divide and control. It scares me because I see medicine as a tool that is supposed to allow us to live better and longer lives, not as a way to further restrict our liberties, divide the population and justify massive erosion of the social fabric.

    It is refreshing to see a competent doctor trying to balance critical thinking, advocacy, respect for individual freedoms and pragmatic solutions to complex problems instead of of simply aligning with the current “politically correct” view.

    I wish the future of medicine is one that resembles your practice and perspective and not one of mindless activism and hostility.

  16. Aren’t more Americans vaccinated than not vaccinated. Neither group has protection from Omicron. So, why wouldn’t you have more vaccinated getting Omicron. The vaccinated thought testing before gathering would protect them but some tests were not correct and a lot of vaccinated got it.

  17. Thanks for your work Peter!

    1. Those shots are not Vaccines and they are immunsupressive.
    2. Vitamin D deficency and poor immune response is why most people have severe illness or die.
    3. For the majority of the population honest guidance and advise on how to fix their health and immune response/strenght would have saved millions of lifes.
    4. This would have been super cheap and easy to do, especially compared to the actual measures that took and take place. El Salvador did it.

  18. It’s mandatory in many places to wear seatbelts. Because people sometimes don’t know what’s best for them. It’s not a big deal to just get the vaccine, is it?
    Not a perfect comparison: I agree if you previously caught the disease there is no need and no point in punishing people excessively.

  19. You clearly highlighted that vaccines have many benefits and can still save lot of lives. That’s why I still belive that mandatory vaccines will do more good in than harm in a society. It’s a minor inconvinience for most of us and even if it can save tiny portion of population from death why shouldn’t everyone get a free vaccines shot that isn’t costing anyone penny? Unless you have other reasons for it not to get vaccine just for satisfying freedom loving ego does not cut it for me. Nobody is asking us to jump off an airplane or jump in front of a bus or to sacrifice our lives. It’s just a vaccine that can (potentially) help us save each others lives and overcome the pandemic faster. That should be a good enough reason for everyone to go and do their duty as the citizen. Is it too much to ask of people? I do not think so.

    • I think you’re missing the ethical side of this argument. By mandating vaccines you essentially are giving the state control over someone’s body. This is hallmark authoritarianism. I’m not saying that’s how you’re thinking, but just point out what was failed to be considered. Plus, what if we’re wrong and the vaccines do have some negative long term effects that we haven’t seen yet? I’m not saying it’s likely/probable, but is possible. Lastly, when mandated who decides what’s a good reason for someone to be exempt? There are those that are rightfully worried about it due to previous medical history, should we just force them all to get it “for the good of the whole”?

      Also, they’re not “free”. We paid for them via our taxes.

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