Western University Mandates Third Booster

I am utterly dumbfounded on the recent mandated third booster for students by Western University. I cannot fathom a more atrocious policy that cannot possibly be scientific and in the best interests of students at the educational institution. A more egregious discovery is that they did not provide any information or scientific empirical evidence to support their mandate, only that they consulted their science experts and community on the issue. (1)

According to Western’s occupational health physician, “This decision supports the safety of our students, employees and our community with the goal of preserving our in-person experience” and from Western’s provost and vice president “While we can’t predict when the next wave of COVID-19 might come, we believe these measures will help us protect the in-person experience that Western is known for. We want to do everything we can to offer our students a great on-campus experience throughout the academic year.” (1)

Despite their enthusiasm, implementing such a mandate must be justified by hard scientific empirical evidence that substantiates the claim of protecting students from transmission, severe illness and mortality. If these mandates are not supported on a foundation of irrefutable evidence, then the mandate only creates more distrust in educational and governmental institutions that are supposed to uphold scientific rigor, honesty, and integrity.

What is the current evidence on Covid-19 reducing transmission?

According to Paul Offit, the Director of the Vaccine Education Center and professor of pediatrics stated that “even if 100% of the population were vaccinated and the virus hadn’t evolved at all, vaccines would do very little to stop transmission.” (2) This is because “the main point of vaccines is not to do with preventing transmission…. The main reasons for vaccines for covid-19 is to prevent illness and death” said Anika Singanaygam, a clinical lecturer in the section of Adult Infectious Disease of Imperial College. (3)

Evidence of this can be elucidated in an investigation of an outbreak caused by SARS-CoV-2 Omicron variant in Norway at a christmas party of 117 attendees. The participants were roughly between the ages of 30 and 50 with a vaccination rate of 96%. The authors determined that the attack rate at this event was 74% despite nearly everyone being vaccinated. Accordingly, the authors determined that “this SARS-CoV 2 variant is highly transmissible even among fully vaccinated people." (4) As well, in a longitudinal study that investigated community transmission of viral load in the SARS-CoV-2 Delta (B.167.2) variant in vaccinated and unvaccinated individuals in the UK, it was determined that secondary attack rates for unvaccinated and vaccinated individuals were 38% and 25% respectively. The authors delineated that “the finding indicates that breakthrough infections in fully vaccinated people can efficiently transmit infection in the household setting” (5)

This is inline with the CDC’s statement that “anyone with Omicron infection, regardless of vaccination status or whether or not they have symptoms, can spread the virus to others.” (6) Which is delineated in studies examining the waning effectiveness of vaccines, two or three doses, against Delta and Omicron variants. (6-8) It should be clear as day that whether you are vaccinated or unvaccinated, you are roughly at equal risk of contracting Covid-19 and once contracted, you will shed the same amount onto others.

What is the current evidence on Covid-19 reducing severe illness and mortality?

While the vaccines and boosters have been deemed efficacious in preventing severe illness and mortality, this is only true for certain groups of people. In Canada, there has been a total of 4,069,693 reported cases with the age group 20-29 aggregating 18.1% of those cases; the highest of all age groups. However, this age group only represented 4.5% of hospitalization and deaths to date. The only age groups that fall below are between 0-19, with a total of 4% of total cases. (9) As students would be representative of this age group between 20-29, it is quite clear that they are at the least risk for hospitalization due to severe illness.

Several studies have illuminated this as age is a significant factor for severe illness and death. Accordingly, those who have underlying health conditions such as: those who are obese; immunocompromised and have several comorbidities are at higher risk for severe illness and death. (10-12) While some students may fit into these categories, a blanket booster mandate for everyone is inexplicably uncalled for; as most students will not need a booster for an unidentifiable added benefit. A better solution would be to have their health experts discuss boosters and alternative solutions for those that fit into the high risk factor categories of severe illness and death.

As well, several studies are demonstrating that vaccination with two or three doses is inefficient at stopping reinfection, especially with the omicron variant. According to a retrospective cohort study examining three cohorts: cohort 1, unvaccinated individuals with natural immunity versus unvaccinated with no natural immunity; cohort 2 and cohort 3 had individuals vaccinated with one dose hybrid immunity, two dose hybrid immunity; natural immunity had a 95% lower risk of SARS CoV-2 infection and 87% lower risk of hospitalization for up to 20 months of follow-up (cohort 1: 2,039,106 individuals with only 34,090 individuals reinfected with natural immunity, and 99,168 individuals refinected with no natural immunity). However, in cohort 2, one dose hybrid immunity and two dose hybrid immunity was associated with 58% and 66% lower risk of SARS-CoV-2 reinfection. Additionally, the authors mentioned hybrid immunity presented less hospitalizations than natural immunity. However, the natural immunity cohort had higher representations of the total individuals and comorbidities. (13) Furthermore, these findings coincide with other studies from a national population wide data set in Qatar demonstrating “prior infection alone was 91% effective whereas protection from two or three doses of vaccine alone was 66% and 83% respectively.” (14,15)

What are the risks of vaccine preliminary shots and boosters for university students?

According to the Public Health of Ontario surveillance report, from December 13, 2020 to September 11, 2022, there was a reporting rate of 63 per 100,000 doses of Adverse Events Following Infection (AEFI) and 3.5 per 100,000 doses including all vaccines. Notably, Pfizer and Moderna Spikevax had the lowest reporting rates of AEFI, while Johnson and Johnson, Astrazeneca, and Novavax had the most. In the interest of the particular age group we are looking at, 18-29 year olds had a total report of 2694 AEFI. (16) Although most of AEFI reports are congregated in dose 1 and dose 2, a lesser portion of total population has received their third and following boosters. Therefore, the lower numbers for dose 3 are expected. This could also indicate the reluctance of Canadians wanting to get the third dose.

More importantly, it is reported that there is a higher rate of myocarditis/pericarditis after Moderna Spikevax and Pfizer-BioNTech Comirnaty vaccine. Highest reporting rates are between the ages of 18 to 24. (16) This is of high concern as most university students belong in this age group. The reporting rate of myocarditis/pericarditis are 333.9 per million doses for Moderna Spikevax and the Pfizer-BioNtech Comirnaty was 72.5 per million doses. Of these adverse events, 76.6% of reports were male, and 70.4% occurred after the second dose. (16) Using the Vaccine Safety Datalink (VSD) information on booster vaccine-associated myocarditis rates in the age group 18-29, the rate of post booster myocarditis was 1 in 14,200 for Moderna Spikevax and 1 in 21,000 for Pfizer-BioNTech Comirnaty vaccines. (14,17)

In a first ever paper assessing SARS-COV-2 boosters for young previously uninfected under 40 years old, the authors estimated that there will be a net harm from boosters where “the negative outcomes of all severe adverse events and hospitalizations may on average outweigh the expected benefits in terms of Covid-19 hospitalizations averted.” This study considers the “overall rate of reported SAEs and Grade ≥ 3 reactogenicity…myo/pericarditis among males.” As well, their estimated expected harm used data from CDC phase 2/3 clinical trails, peer-reviewed observational data, and V-safe data from CDC.

Their risk benefit analysis estimates that their hypothetical campus of 30,000 students may expect “1,373 to 3,234 young adults (rate of 1 in 9-22) to experience Grade ≥ 3 reactogenicity disrupting daily activities or requiring medical care when vaccinated with Moderna Spikevax or Pfizer-BioNTech Comirnaty vaccine." Additionally, the authors “estimate between 1.7 to 3.0 occurrences of myocarditis (rates of 1 in 7,000 to 1 in 5000) among males and 0.7 cases among females. Boosting the entire campus could thus cause approximately 3-4 myo/pericarditis cases, among males predominantly, per single hospitalization averted.” (14)

Alongside real evidence and this risk assessment analysis, there is no conclusive evidence as to the long term effects from these adverse events. Even if these adverse events are rare, they are nonetheless a risk and students should be notified of these from the University; especially if they are mandating a third booster. The university should demonstrate transparency of their decision based on their evaluation of the evidence. Otherwise students and faculty will have no indication as to how they decided on implementing a third booster policy.

Moreso, it is hard for any individual to discern risk of vaccination to benefits considering most governmental, educational, and health institutions have been positively supporting vaccination insisting reduction in transmission, severe illness and mortality; without advising the general population of the caveats (who is at risk, the risk of adverse events, etc.). Robert M Kaplan and Sander Greenland in their article from Sensible Medicine states “There is no legitimate reason why scientists and the public should not have access to the evidence that justified that purchase. Yet evidence is being withheld, which adds uncertainty to our conclusions and leaves lingering questions about the scientific foundation for COVID-19 vaccine promotion.” (18) They are referring to their study published questioning the safety of COVID-19 vaccines.

Individual Agency

There is no reason for mandating a third booster at Western University - or any universities for that matter as there is no irrefutable evidence as of today that clearly supports a third booster in reducing transmission, severe illness and mortality (age group of university students). Since these vaccines aren’t meant to reduce transmission, even if an older faculty member were to attend the university and profess a class, he or she is not protected from students; only preventing his/her own fate of severe illness or death. Asking students to go above and beyond under unscientific claims is absolutely ludicrous.

Students should proceed under their own individual agency in deciding what health intervention is best for themselves. The university should provide all the information necessary to students so they themselves can decide on their own. This is key. This puts the responsibility and onus onto the individual student, rather than have a governing institution decide what health intervention is best for them. After all, we live in a capitalist and democratic society where we have individual freedoms. This allows us to be responsible for ourselves and realize that individual actions have consequences. This isn’t particularly in regards to vaccinating or not. This is in regards to every choice a student makes.

If some students decide to not exercise, not eat healthy, and not get enough sleep, they themselves have put their own health at risk for a plethora of other preventable or chronic diseases, including Covid-19. Those who take responsibility for their own health will fare better in the long run. This is called opportunity cost in economic terms. However, the important thing is that they learn to be responsible for themselves and not have the governing institutions be responsible. Educational and governing institutions can recommend the Covid-19 boosters, but not mandate it.

As well, I am unsure how this mandate is going to better the experience of in-class learning for students if those that chose not to vaccinate are not able to participate in class learning. They are also not able to participate in other social settings with their cohort. Moreover, what about the physical and mental health of those students that were forced to get the booster despite voicing their opinion to not wanting a third booster or the preliminary two dose vaccine? You don’t think this could have severe negative consequences outside of contracting Covid-19? Are the health experts at Western University this obtuse? To think there won’t be any kind of lingering grievances is pure naiveness.

Non Pharmaceutical Interventions

Additionally, Western University has also mandated the Non Pharmaceutical Intervention (NPI) of mandatory masking in classrooms and seminar rooms. I think everyone is well aware of the lineage of studies demonstrating the ineffectiveness of masks. To quote from a critical review of community cloth face masking by Ian T. Liu, Vinay Prasad, and Jonathan J. Darrow that looked into ALL face masking studies (roughly up until 2021),

“Mechanistic evidence shows a clear benefit as measured by laboratory surrogates, but it is not clear to what extent those surrogates are relevant to the clinical question of infection rate or offset by behavioral factors. Uncontrolled observational studies are confounded by numerous known and unknown variables, and most considered mask mandates or self-reported mask wearing is the key variable rather than actual mask usage…

Some models supporting community face masks reduce SARS-CoV-2 transmission by 40-50% assumptions that are not adequately supported by existing data. More generally, the given the low quality of evidence, the absence of statistically significant benefit indicated by most randomized control trials, and the possible harm suggested by few studies, scientists and public health officials must take care not to apply a double standard to available studies…

Taken as a whole, the available mechanistic and clinical evidence leaves substantial uncertainty as to whether, to what extent, and under what circumstances community-wide use of cloth face masks helps to reduce infection rates of SARS-CoV-2.” (19)

**Update**

To unpack the illegitamacy of community wide masking as a solid intervention in preventing transmission even more - recently there was a re-analysis of the publicly and widely cited "Bangladesh study." Originally, this study was already in hot waters when it was released becuase of many confounding issues and the effect was small when comparing villages that wore masks to those that didn't. As well, noted by Vinay Prasad, "applied only to adults pre-vaccine and pre-natural immunity." (20)

As per the authors of the recent study, "The observed decrease in the primary outcome is the same magnitude as the population imbalance but fails significance by the same tests..This reanalysis thus complicates drawing any causal link between masks and the observed decrease in population-rate of symptomatic seropositivity." The main reason why we do randomized control studies is to reduce the amount of confounding and bias from the researchers, yet the authors found that the "staff was tasked with both enrolling households and providing masks in the treatment villages and hence were aware whether they were surveying a treatment or control village." This is absolutely astounding, as this devalues the whole purpose of a RCT. (21)

The study had determined that behavioural biases produced a 9% difference between control and intervention arm - which is HUGE. This was in part due to the outcomes that were highly based on self-reporting of symptoms leading to their serology endpoints of blood draws only for those who had reported symptoms... Oh my lord... The authors concluded that "The study in question raises intriguing questions about the role of public health interventions in changing behavioral patterns to decrease COVID case rates in low- and middle-income countries. The mask intervention was highly effective at modifying behaviors (distancing, mask-wearing, symptom reporting). Nonetheless, the data is consistent with mask wearing having modest or no direct effect on COVID-related outcomes in this experimental setting."

***

Once again, the students should have their own individual agency in deciding whether they want to mask or not to mask. It should not be mandated as there is no irrefutable evidence to masking in prevention of Covid-19. If we take all the evidence into account, there is no clear indication what is best in reduction of transmission. I think we need to take the old message of "if you're sick, stay at home." That is the best solution alongside reducing your severity of illness by eating healthier, exercising, and getting a good night sleep - which has substantial evidence in improving physical and mental health - as well boosting your natural defences against infections.

In Conclusion, university mandating a third booster and masks is not based on irrefutable evidence that has concluded that the benefits of doing so are greater than the harm. The mandate does not uphold the highest scientific rigor, and the university has not held up their honesty and integrity in providing sufficient data and information regarding the mandate. They have decided on their own what health intervention is best for their students and faculty, removing individual agency to choose what is best for themselves. This news has been a large disappointment and I think there should have been a proper debate between those for the mandate and those against according to their health experts - open to the public to view and give their own opinions.

1. Western Communications. Western requires COVID-19 booster and masking in instructional spaces this fall. August 22, 2022. Accessed September 16, 2022. https://news.westernu.ca/2022/08/western-requires-covid-19-booster-masking-instructional-spaces-this-fall/
   

2. Vogel G. Omicron booster shots are coming - with lots of questions. August 30, 2022. Accessed September 16, 2022. https://www.science.org/content/article/omicron-booster-shots-are-coming-lots-questions
   

3. Stokel-Walker C. What do we know about covid vaccines and preventing transmission?. BMJ. 2022;376(o298):1-2 doi:https://doi.org/10.1136/bmj.o298
   

4. Brandal LT, Macdonald E, Veneti L, et al. Outbreak caused by the SARS-CoV-2 Omicron variant in Norway, November to December 2021. Euro Surveillance. 2021;26(50):2101147. Doi: 10.2807/1560-7917.ES.2021.26.50.2101147.
   

5. Singanayagam A, Hakki S, Dunning J, et al. Community transmission and viral load kinetics of the SARS-CoV-2 Delta (B.1.617.2) variant in vaccinated and unvaccinated individuals in the UK: a prospective, longitudinal, cohort study. The Lancet Infectious Diseases. 2022;22(2):183-195. Doi: https://doi.org/10.1016/S1473-3099(21)00648-4
   

6. Levine-Tiefenbrun M, Yelin I, Alapi H, et al. Waning of SARS-CoV-2 booster viral-load reduction effectiveness. MedRxiv. Preprint posted December 29, 2021.
   

7. Levin EG, Lustig Y, Cohen C, et al. Waning immune humoral response to BNT162b2 Covid-19 vaccine over 6 months. The New England Journal of Medicine. 2021;385(84),1-11. https://www.nejm.org/doi/full/10.1056/nejmoa2114583#article_references
   

8. Ferdinand JM, Rao S, Dixon BE, et al. Waning 2- Dose and 3-Dose Effectiveness of mRNA Vaccines Against COVID-19-Associated Emergency Department and Urgent Care Encounters and Hospitalizations Among Adults During Periods of Delta and Omicron Variant Predominance - VISION Networks, 10 States, August 2021 - January 2022. Morbidity and Mortality Weekly Report (MMWR). 2022;71(7):255-263
   

9. Government of Canada. COVID-19 Epidemiology Update. Updated September 16, 2022. Accessed September 17, 2022. https://health-infobase.canada.ca/covid-19/#a5
   

10. Government of Canada. COVID-19 vaccination in Canada. Updated September 16, 2022. Accessed September 17, 2022. https://health-infobase.canada.ca/covid-19/vaccination-coverage/
    

11. Yu W, Rohli KE, Yang S, Jia P. Impact of obesity on Covid-19 patients. Journal of Diabetes and Its Complications. 2017;35(3),1-14. https://www.sciencedirect.com/science/article/pii/S1056872720306115”
    

12. CDC. People with Certain Medical Conditions. Updated September 2, 2022. Accessed September 17, 2022. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html
    

13. Nordstrom P, Ballin M, Nordstrom A. Risk of SARS-CoV-2 reinfection and COVID-19 hospitalization in individuals with natural and hybrid immunity: a retrospective, total population cohort study in Sweden. The Lancet Infectious Diseases. 2022;22(6):781-790. Doi: https://doi.org/10.1016/S1473-3099(22)00143-8
    

14. Bardosh, Kevin and Krug, Allison and Jamrozik, Euzebiusz and Lemmens, Trudo and Keshavjee, Salmaan and Prasad, Vinay and Makary, Martin A. and Baral, Stefan and Høeg, Tracy Beth, COVID-19 Vaccine Boosters for Young Adults: A Risk-Benefit Assessment and Five Ethical Arguments against Mandates at Universities (August 31, 2022). Available at SSRN: https://ssrn.com/abstract=4206070 or http://dx.doi.org/10.2139/ssrn.4206070
    

15. Food and Drug Administration. Emergency Use Authorization (EUA) for an Unapproved product. September 21, 2021. Accessed September 17, 2022. https://www.fda.gov/media/152432/download
    

16. Ontario Agency for Health Protection and Promotion (Public Health Ontario). Adverse events following immunization (AEFIs) for COVID-19 in Ontario: December 13, 2020 to September 11, 2022. Toronto, ON: King’s Printer for Ontario; 2022.
    

17. Shimabukuro T. Myocarditis following mRNA COVID-19 vaccination. Advisory Committee on Immunization Practices (ACIP). July 19, 2022. Accessed September 17, 2022. https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2021-06/03-COVID-Shimabukuro-508.pdf
    

18. Kaplan R, Greenland S. Why We Question the Safety of COVID-19 Vaccines. Sensible Medicine. September 14, 2022. Accessed September 17, 2022. https://sensiblemed.substack.com/p/why-we-question-the-safety-of-covid?utm_source=email
    

19. Ian TL, Prasad V, Darrow JJ. Evidence for Community Cloth Face Masking to Limit the Spread of SARS-CoV-2: A Critical Review. CATO Working Paper. 2021;64:1-61. https://www.cato.org/sites/cato.org/files/2021-11/working-paper-64.pdf
    

20. Prasad V. The Bangladesh Mask Trial is re-analyzed and it falls apart. Vinay Prasad's Observations and Thought. Published September 18, 2022. Accessed September 18, 2022. https://vinayprasadmdmph.substack.com/p/the-bangladesh-mask-trial-is-re-analyzed?utm_source=email
    

21. Chikina M, Pegden W, Recht B. Re-analysis on the statistical sampling biases of a mask promotion trial in Bangladesh: a statistical replication. Trials. 2022;23:786. https://doi.org/10.1186/s13063-022-06704-z