COVID-19 Vaccine Boosters for Young Adults: A Risk-Benefit Assessment and Five Ethical Arguments against Mandates at Universities

 

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4206070

50 Pages Posted: 12 Sep 2022

Kevin Bardosh
University of Washington; University of Edinburgh - Edinburgh Medical School

Allison Krug
Artemis Biomedical Communications LLC

Euzebiusz Jamrozik
University of Oxford

Trudo Lemmens
University of Toronto - Faculty of Law

Salmaan Keshavjee
Harvard University - Harvard Medical School

Vinay Prasad
University of California, San Francisco (UCSF)

Martin A. Makary
Johns Hopkins University - Department of Surgery

Stefan Baral
John Hopkins University

Tracy Beth Høeg
Florida Department of Health; Sierra Nevada Memorial Hospital

Abstract​

Students at North American universities risk disenrollment due to third dose COVID-19 vaccine mandates. We present a risk-benefit assessment of boosters in this age group and provide five ethical arguments against mandates. We estimate that 22,000 - 30,000 previously uninfected adults aged 18-29 must be boosted with an mRNA vaccine to prevent one COVID-19 hospitalisation.

Using CDC and sponsor-reported adverse event data, we find that booster mandates may cause a net expected harm:

per COVID-19 hospitalisation prevented in previously uninfected young adults, we anticipate 18 to 98 serious adverse events, including 1.7 to 3.0 booster-associated myocarditis cases in males, and 1,373 to 3,234 cases of grade ≥3 reactogenicity which interferes with daily activities. Given the high prevalence of post-infection immunity, this risk-benefit profile is even less favourable.

University booster mandates are unethical because:

1) no formal risk-benefit assessment exists for this age group;

2) vaccine mandates may result in a net expected harm to individual young people;

3) mandates are not proportionate: expected harms are not outweighed by public health benefits given the modest and transient effectiveness of vaccines against transmission;

4) US mandates violate the reciprocity principle because rare serious vaccine-related harms will not be reliably compensated due to gaps in current vaccine injury schemes; and

5) mandates create wider social harms.

We consider counter-arguments such as a desire for socialisation and safety and show that such arguments lack scientific and/or ethical support. Finally, we discuss the relevance of our analysis for current 2-dose COVIDovid-19 vaccine mandates in North America.

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