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Analysis: Demanding booster shots to study at universities is unethical

By Eli Vieira

A new article published in the journal of bioethics Journal of Medical Ethics concludes that the requirement of booster dose against Covid-19 in universities is “unethical”.

The nine authors, who are physicians and bioethicists affiliated with 11 institutions in three countries — Canada, the United States and the United Kingdom — performed a cost-benefit analysis of the dose and concluded that the harms outweigh the benefits.

In addition, the authors believe that the mandatory inoculation for enrollment, a current requirement in many Brazilian universities, violates the principle of reciprocity and causes widespread social harm.

Medical Ethics, Analysis: Demanding booster shots to study at universities is unethical
Mandatory vaccines “have harmful social consequences and are eroding trust in scientific and government institutions,” say the authors (Photo internet reproduction)

For each hospitalization prevented by the booster dose, they concluded, 18.5 adverse events from mRNA vaccines are generated.

These events would include up to 4.6 inflammations of the heart and its lining in young males, which typically lead to hospitalizations.

In addition to adverse events, each benefit of avoiding a hospitalization with the dose would also be offset by up to 4,626 side effects that interfere with daily activities, such as body aches.

Mandatory vaccines “have harmful social consequences and are eroding trust in scientific and government institutions,” say the authors.

In May of this year, they report that at least 1,000 higher education institutions in the US required the Covid-19 vaccination, and 300 required the booster dose.

Controversy is especially with booster doses, which there is a “lack of evidence” that they significantly reduce hospitalization among healthy adolescents and young adults, in addition to “increasing evidence that prior generalized infection confers significant protection against hospitalization due to (re)infection”.

That is, natural immunity could make these doses superfluous.


Researchers acknowledge that Covid risks vary by age, comorbidity, and gender. Their analysis focuses on young adults who make up the majority of those affected by university requirements and “vaccination passports”.

They recall that most countries outside North America have not implemented mandatory booster doses for university students. In the United States, the main government agencies that deal with the subject are the CDC (Center for Disease Control and Prevention) and the FDA (Food and Drug Administration).

In July 2021, both said that booster shots were not necessary. Two months later, a committee of FDA advisors decided, by 16 votes to 2, that it was against boosting healthy young people. But that recommendation was trampled on by the White House and the CDC, prompting two longtime experts to step down from their FDA posts.

There is a shortage, says the study, of cost-benefit analyzes that respect minimum rigor criteria.

Those available do not have enough safety data and, from the data used by the CDC, an update is missing that takes into account natural immunity and the new framework established a year ago by the omicron variant, less lethal than the previous ones.

Sometimes, natural immunity is taken into account only to be excluded as a confounder in the analysis of booster dose effectiveness, as was done by the CDC in a June publication. In short, there is a lack of data on young people, and — the researchers warn — on children as well.

The CDC has been remiss in producing salutary numbers, such as the “number needed to harm” — an epidemiological measure that indicates how many people need to be exposed to a risk before one is harmed.

For male adolescents, a Hong Kong analysis calculated this number to be 2,563 for two doses of the mRNA vaccine. Based on the risks, the UK, Norway, Taiwan and Hong Kong changed their policy to a single dose for the group. The United States and the CDC continued to insist on a booster dose.

The study authors did their own cost-benefit analysis of mRNA vaccines for youth ages 12-17 and adults ages 18-29.

In summary, these vaccines are 18 times more likely to cause a serious adverse event (such as myocarditis) than to prevent hospitalization in the cohort. In young men between the ages of 18 and 24, the third dose of Pfizer is nearly four times more likely to inflame the heart and its lining than to prevent hospitalization. In another sample with men aged 18 to 39, there are 4.6 more chances.

As for other complications that are less serious than myocarditis but still affect everyday life, the third dose of mRNA is 1,429 times more likely to cause them than to prevent hospitalizations. For people who’ve had Covid and recovered, it’s even higher: 2,340 times.


Liberal philosopher John Stuart Mill argues, in his classic essay on liberty, that authorities can only impose coercion on an individual in the name of preventing harm to others, never to compel the individual to do something “for his own good”.

The argument is known as the harm principle. Translated into the context of vaccines, this would mean that mandatory inoculations would be justified in the name of protecting the population by stopping transmission in the individual.

On a large scale, however, Covid vaccines have already been shown to be ineffective against the infection.

According to the IHME (Institute of Health Metrics and Evaluation at the University of Washington), the effectiveness against omicron infection is 24% for Coronavac, 36% for AstraZeneca and Janssen, 44% for Pfizer and Sputnik , and 48% for Moderna. Against severe disease, their efficacies are all close to or greater than 60%, with the exception of Coronavac, with only 37%.

In this case, the individual’s “own good” exists, but the low efficacy against infection and transmission suggests that the harm principle should not be used to justify mandatory doses.

A factor always ignored by sanitary authoritarianism is also the effectiveness of natural immunity acquired from previous infection. In February of this year, the CDC estimated that 64% of adults aged 18 to 49 had antibodies acquired with the infection.

Five months earlier, it was 30%. Now, it must be an absolute majority. The researchers say that “evidence increasingly shows that prior infection with [the virus] SARS-CoV-2 provides clinical protection at least similar (and perhaps more lasting) than current vaccines.”

In the valuable Qatari studies, vaccination alone and infection alone were equally effective against severe disease: over 70%. In one sample, prior infection was better against severe disease: 91% for natural immunity versus 66% for two doses and 83% for three doses.

Still, university vaccination passports ignore protection from prior infection. An exception was Denmark, whose passport accepted natural immunity.

Now, the country has decided that vaccinating children against Covid-19 is not an effective policy and no longer recommends such vaccination for most children. Similarly, the UK now recommends that booster shots only be offered, not imposed, on risk groups.

Furthermore, the protection that is gained from a booster dose rapidly decays. Effectiveness against hospitalization drops to less than 50% after three or four months.

Against symptomatic disease, it decays after a mere ten weeks. In people who have had a previous infection, protection becomes indistinguishable from natural immunity within a few months.

The first author of the analysis is Kevin Bardosh, affiliated with the University of Washington School of Public Health (US) and the University of Edinburgh School of Medicine (UK).

The study leader was Beth Høeg, who works at the clinical data research company Acumen and Sierra Nevada Memorial Hospital in California.

The authors close the article by expanding their ethical case against mandatory booster shots at universities on five points:

  • transparency, emphasizing the lack of reviews like theirs to let the public make its own decisions;
  • the potential net harm expected for each individual, which is the summary of the cost-benefit analysis and should provide ammunition for individuals to defend themselves against sanitary authoritarianism;
  • the lack of proportion in the public health benefit of the obligation;
  • the failure of reciprocity, as individuals harmed by the obligation are not being adequately compensated for it, when the responsibility lies with those who forced them;
  • and broader societal harm involving loss of trust in science and institutions as authoritarianism was enforced in their name.

With information from Gazeta do Povo

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