COVID-19 vaccines provide important benefits; SSRN preprint didn’t find COVID-19 vaccines to be “98 times worse” than the virus

In September 2022, several articles went viral, claiming that COVID-19 vaccines are “98 times worse” than COVID-19 itself. Examples include this one by the Gateway Pundit, another by The Epoch Times, and one by the Florida Standard. The claim is based on a preprint (a study that hasn’t yet been peer-reviewed) uploaded to Social Sciences Research Network, co-authored by scientists, among them faculty members from Johns Hopkins and Harvard.

The preprint concluded that university booster mandates would be unethical, because they were estimated to cause more harm than good in young adults, defined as individuals aged 18 to 29 years old. The authors of this preprint came to this conclusion through their calculation of how many previously uninfected young adults need to be boosted in order to prevent one hospitalization, and how many serious adverse events would occur with such a scale of booster vaccinations.

By using adverse event reports following vaccination collected by the U.S. Centers for Disease Control and Prevention, as well as vaccine manufacturers, the authors estimated that “per COVID-19 hospitalization 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”.

But the preprint findings don’t mean that the COVID-19 vaccines are worse than the disease itself, as the articles claimed. As we will explain below, the claim misrepresents the preprint findings.

Let’s take a look at the claim that the vaccines are “98 times worse” than COVID-19. This figure likely comes from the upper limit of the estimated number of serious adverse events per COVID-19 hospitalization.

But this doesn’t mean that the vaccines are “98 times worse” than the disease. Firstly, let’s keep in mind that the authors only considered COVID-19 hospitalizations as the only bad outcome for the disease. This excludes other serious outcomes, such as long COVID, which can be potentially disabling for young people as well.

Secondly, a single person can report multiple adverse events following vaccination, whereas COVID-19 hospitalizations are likely to be reported only once per person. This means that the number of COVID-19 hospitalizations is more likely to be dwarfed by the number of serious adverse events reported. The same issue was discussed in a previous Health Feedback review. And the preprint itself acknowledged this as a limitation:

“It is also possible that multiple severe side-effects were reported by the same participant and that the number of people impacted by such reactions is lower than our estimate.”

In an email to Health Feedback, Abram Wagner, a research assistant professor at the University of Michigan, pointed out that the analysis “does not take into account the complexity of SARS-CoV-2 infection dynamics”, explaining that increasing the vaccination coverage across all groups could reduce infection and in turn hospitalization risk for both the individual and the community.

Thus, the calculation doesn’t fully account for serious outcomes of getting COVID-19 or the benefits of COVID-19 vaccination, and the measures that represent bad outcomes from COVID-19 and vaccination aren’t counted in the same manner, since the former is counted on a per-person basis while the latter is counted on a per-event basis.

Finally, the calculations were based on adverse event reports after vaccination. Such reports on their own don’t constitute sufficient evidence that the vaccine was responsible for the adverse event. But this caveat is lost in the articles.

Overall, these limitations to the preprint’s method of calculation mean that the articles’ representation of the preprint’s finding is inaccurate and misleading.

One of the preprint’s co-authors, Allison Krug, a medical writer who holds a master’s in epidemiology, told Lead Stories that such representations of their preprint, like the Gateway Pundit article, were inaccurate:

“By leaving out ‘boosters’ and ‘young adults’ the article implied that the Covid-19 vaccines were harmful overall when in fact our research is specifically focused on 18-29 year-olds. We do not want misrepresentation of our work to imply that those at risk due to medical conditions or age should avoid vaccination.”

“Recommendations to vaccinate young adults in the U.S. and other locations are based on a consideration that vaccinating these individuals (particularly with the new bivalent vaccine) could boost the immune system and provide protection against newer variants,” Wagner said, adding that remaining vigilant over adverse event reports remains important.

While it’s essential to constantly assess the benefits and risks of COVID-19 booster doses as the pandemic evolves, it’s also critical to keep in mind that to date, COVID-19 has already killed more than six million people worldwide and more than one million in the U.S. alone.

And while most people who get COVID-19 survive, they can still face serious long-term consequences. Data from the U.S. Census Bureau from between June and July 2022 indicated that nearly one in five Americans are still experiencing symptoms of long COVID. An analysis by the Brookings Institute, using the same data, estimated that two to four million Americans are out of work due to long COVID, an outcome that can impose profound social and economic costs.

COVID-19 vaccines have proven to be highly effective at protecting people from severe disease and death, and they can also reduce one’s chances of developing long COVID. While previous infection confers some degree of protective immunity, infection-induced immunity is unpredictable, as there are multiple factors beyond our control that influence this form of immunity, such as disease severity and which virus variant a person was infected with. Vaccination remains the safer and more reliable means of inducing protection against COVID-19.

The authors of the paper attempt to estimate the number of adults that would need to be vaccinated to prevent one hospitalization. This analysis does not take into account the complexity of SARS-CoV-2 infection dynamics, as increases in vaccination coverage across all groups could decrease infection (and therefore hospitalization risk) for the individual and for the group. Moreover, at this point in time, almost everyone has some baseline immunity towards SARS-CoV-2, either through a vaccination, natural infection, or both. Thus their analysis (based on assumptions of previously uninfected individuals) may have limited utility for an actual, real world population.

Different countries in the world are implementing different types of recommendations for COVID-19 vaccines across the life span. Recommendations are based on local epidemiology of disease, hospital resources, levels of comorbidities in the local population, and cost-effectiveness analyses.

Continued surveillance of adverse events after immunization will be important. Recommendations to vaccinate young adults in the U.S and other locations are based on a consideration that vaccinating these individuals (particularly with the new bivalent vaccine) could boost the immune system and provide protection against newer variants. Having a high level of immunity across different population age groups is an important part of COVID-19 control.