In order to understand the current controversies about access to the COVID-19 vaccine, we need to reflect on how we got here. The virus is called COVID-19 because it emerged in December of 2019 in Wuhan, China. The pandemic hit Europe and Iran with fury, and arrived in the U.S. by February 2020. In order to try to contain the virus, we largely shut down society with restrictions on travel, closure of schools, and the closure of many businesses other than essential ones. As we watched news stories from New York City, where refrigerator trucks were used to store corpses because the morgues had been overwhelmed – we health care workers feared for our own lives.
There were those who said that shutting down the economy will take a toll on the most economically vulnerable in society. And that a prolonged shutting down of schools would be bad for kids. They were right about those things. Yet we virology-curious wanted to beat down the virus. There were those, such as Jay Bhattacharya, at the time a health economist on the faculty of Stanford Medicine, now the Director of the National Institutes of Health, who argued against lockdowns. He was an author on the Great Barrington Declaration, which recommended allowing the virus to spread among the healthy and protecting the elderly. It was modeled on the approach taken by Sweden, which is a relatively equitable society. I don’t think that would have worked in the U.S. As it was, the way COVID played out in the U.S. was this: If you had the means and could work from home on your laptop, cool. If you were a wage worker, and you had to show up on the job to support your family, and your elders lived with you – they got the virus, too. This was the reason that we witnessed the class and racial disparities in COVID infections and deaths that we saw in 2020. In Hawaiʻ i, the Micronesians endured much sickness and death.
During 2020, we were told that the usual vaccine development process takes years, so we had to rely on so-called “non-pharmaceutical interventions” such as social distancing and mask-wearing. Under Operation Warp Speed, however, the first Trump administration spent over $12 billion to make mRNA vaccines available by December 2020. We were all eager to receive our two doses of vaccine at the time, relieved that (once vaccinated) we would not end up on a ventilator.
We labored under the public health messaging in early 2021 that once a significant majority of the population (was it 70%? 80%?) was vaccinated – we would then achieve “herd immunity” – the idea that when a sufficient proportion was vaccinated, the virus would not be able to find enough susceptible people to which to spread, and the pandemic would sputter out. We public health cheerleader-types found it mysterious that there were people who would decline to be vaccinated. Our impression was that these people were not only endangering themselves, but that they were also keeping society from beating down the pandemic.
Vaccine refusal preceded COVID-19, of course. A milestone in anti-vaccine history was the publication in The Lancet in 1998 by Andrew Wakefield and colleagues of a case series that purported to link the measles-mumps-rubella vaccine (MMR) and autism. Based upon a sample of twelve children, the report has been debunked and was finally retracted by The Lancet in 2010. Found to have committed “serious professional misconduct,” Wakefield lost his license to practice medicine in the U.K. Subsequent studies involving hundreds of thousands of children have not found an association between the MMR vaccine and autism.
Robert F. Kennedy, Jr., the current U.S. Secretary of Health has been a long-time proponent of the position that vaccines cause autism. He said so during his Senate confirmation hearings in January, and he has pledged to reveal the cause of autism in September.
But back to the COVID timeline. By mid- to late-2021, when it became evident that not everybody would voluntarily be vaccinated for the COVID vaccine, the federal government, educational institutions, and large health care organizations began to mandate that their employees receive the vaccine in order to remain employed. I myself was the medical director of a small Hawaiʻi community health center at the time, and I signed off on such a policy. Some physicians, such as hematologist/oncologist and podcaster Vinay Prasad, at the time on the faculty of the University of California at San Francisco, called for counting a natural COVID infection as equivalent to a dose of vaccine. In the eyes of many, this made him a contrarian. He also said that policies about masking lacked scientific evidence. I listened to Plenary Session podcasts with Vinay Prasad during the pandemic. Sometimes he also was on Sensible Medicine with John Mandrola and Adam Cifu. Sometimes he was on VPZD with Zubin Damania. Since May 2025, he has been the once, then former, and currently reinstated FDA Director of the Center for Biologics Evaluation and Research.
A study published in the CDC’s in-house journal, the Morbidity and Mortality Weekly Report (MMWR) in July 2021 of a COVID outbreak in Barnstable County, Massachusetts, had shown that two doses of vaccine did not prevent vaccinated individuals from contracting the COVID virus. At the time, this was called “breakthrough infections.” This meant that we were not going to achieve herd immunity by vaccinating a sufficient proportion of the population.
The insistence by us public health cheerleader-types that everybody be mandated to receive the COVID vaccine – so that we could beat down the epidemic – was thus misguided. The virus had, in fact, proven itself to be quite wily. It mutated quite rapidly for one. By mutating, it escaped our immune system which had been trained to combat the previous strain on either the vaccine or an actual infection. I wrote about variants and vaccines for CounterPunch in July 2021. (The reason that I don’t call it a “natural infection” with a “wild-type” virus is that I have believed since 2020 that the virus was engineered. See also “Anthony Fauci and Gain of Function Wargames.”)
Those who lost their jobs and had their careers curtailed because they refused to be vaccinated for COVID have a legitimate grievance with their former employers and the public health authorities who mandated vaccination. However, this is not to agree with them that the vaccines posed more risk than benefit. Vaccine denialists claim that the vaccine was worse than the disease. This is nonsense. The COVID vaccines did, indeed, reduce morbidity (ending up in the hospital) and mortality (ending up six feet under). Analyses of mortality rates during 2021-2022 demonstrate that many people in the U.S. died unnecessarily because they were not vaccinated for COVID. Estimates range from an excess of 232,000 (between June 2021 to August 2022, CDC) to 319,000 (between January 2021 to April 2022, Brown University and Microsoft AI Health).
Of course, most of those who died from COVID, whether they were vaccinated or unvaccinated, were those with the most risk factors – with the most salient risk factor being that of age (>65 years, even more so for >75 years). COVID has been, and will continue to be, most deadly for the elderly. The very young are at risk, too. In their August 19th guidance, the American Academy of Pediatrics notes that “The rate of COVID-19 hospitalization for children under 2 years is the highest among pediatric age groups and for children ages 6-23 months, it is comparable to people ages 50-64 years.” Pregnant women are also at risk. In their August 22 guidance, the American College of Obstetrics and Gynecology recommends a COVID booster before, during, or after pregnancy while breastfeeding. They note that “Pregnant women have historically been at an increased risk of severe disease, adverse pregnancy outcomes, and maternal death from COVID-19 infections.” Overall, the older you are and the more medical conditions you have, the more likely COVID is going to kill you. So, when China finally lifted its draconian lockdowns, after making sure that everyone was vaccinated, Western scholars noted that it was their most elderly colleagues in China who succumbed soon afterward.
So, during the worst days of the pandemic, 2020-2021, when nobody had been vaccinated yet, the benefits of the mRNA COVID vaccines greatly outweighed their risks. The vaccinated had their risk of hospitalization and death from COVID greatly lowered. We did find that these vaccines carried some risk of myocarditis for males aged 16 to 29. Most of the cases were mild and transient. Among those who opposed vaccine mandates for college students to receive boosters in order to return to campus were Prasad and Marty Makary, the current Commissioner of the FDA. At the time, Makary was on the faculty of the Johns Hopkins School of Medicine, where he pioneered laparoscopic pancreatic islet cell transplantation. Like Prasad, Makary advocated for counting a COVID infection as equivalent to a vaccine dose. In 2023, he told the House Select Subcommittee on the Coronavirus pandemic that “It’s a no-brainer that it came from the [Wuhan] lab” funded by the U.S. His most recent book is Blind Spots (2004), which recounts a number of examples of how the medical orthodoxy had it wrong.
As 2022, 2023, and 2024 rolled by, however, and people received their third, fourth, or fifth booster doses AND they contracted and survived actual infections – their immune systems learned, in general, how to handle the next exposure to the virus. Of course, some elderly and those with underlying medical conditions still became quite ill – which is why they should continue to receive the yearly booster against the most recent strain. The evidence for the efficacy of yearly boosters presented to the Advisory Committee on Immunization Practices (ACIP), however, was not based on randomized controlled trials of clinical outcomes, but rather on immunologic studies.
These days, for most young, healthy people the symptoms of a new COVID infection ranges from no symptoms at all, to a mild upper respiratory infection, to a rather severe flu-like illness – but not something that puts one in the hospital. Most young, healthy people have realized this, and therefore are not bothering any more with yearly boosters. The CDC reports that as of the end of April 2025, 23% of adults and 13% of children in the U.S. had received the 2024-2025 booster.
On May 21 of this year, the New England Journal of Medicine (NEJM) published an article by Vinay Prasad (as Director of the FDA Center for Biologics Evaluation and Research) and Marty Makary (as the Commissioner of the FDA) on “An Evidence-Based Approach to Covid-19 Vaccination.” In their NEJM paper, Prasad and Makary point to how while the CDC continued to recommend boosters for most children and adults, most have not receiving them – reflective of skepticism on their part as well as their providers about their utility. They note that skepticism about the COVID vaccine can generate skepticism about all vaccines, including MMR, which they note to be “safe and highly effective.” In the name of the FDA, they propose that COVID vaccines be recommended for all persons 65 years and older, as well as all persons 6 mos. or older with an underlying medical condition. They also call on manufacturers to conduct randomized controlled trials in healthy adults to determine if boosters do or do not prevent hospitalization and deaths among them.
On August 27, the FDA authorized the current boosters for the U.S. population as outlined in the Prasad-Makary article: persons 65 y.o. and older and those 6 mos. or older with an underlying medical condition. The list of medical conditions is broad. It includes conditions such as immunosuppression, cancer, heart, and lung conditions – but also pregnancy, mental health conditions, obesity (BMI > 30), and physical inactivity. The era of Emergency Use Authorizations is over, and depending on state regulations, it may become necessary for these vaccines to be ordered by a provider. Insurance corporations are likely to continue to pay for the vaccines, but the publicly funded Vaccines for Children (VFC) program will likely follow the FDA guidances.
It is obvious that those who expressed contrarian views about how to deal with COVID, i.e. those who opposed the messaging coming from Anthony Fauci or the CDC – such as Bhattacharya, Prasad, or Makary – now occupy positions of responsibility within the Federal health administration. We would like to think that such individuals will seek to apply the evidence to policy. Their boss, however, Robert F. Kennedy, Jr. – as pointed out by pediatrician and vaccinologist Paul Offit – doesn’t believe in the germ theory. And in this brief May 27 X.com video with RFK Jr., Bhattacharya and Makary vie to complete his sentences. It is also undeniable that this vaccine guidance is being released in the context of the gutting of the CDC, the FDA, and the NIH, as well as other federal agencies.
For most of the careers of practicing physicians and other providers, the recommendations of the Advisory Committee on Immunization Practices (ACIP) have been distributed by the CDC and largely rubber-stamped by medical specialty organizations such as the American Academy of Pediatrics (AAP), the American College of Obstetrics and Gynecology (ACOG), the American Academy of Family Physicians (AAFP), and the American College of Physicians (ACP). The CDC (under which the ACIP meets) and the FDA are U.S. government agencies under Health and Human Services, for which RFK Jr. is currently the secretary.
Practictioners have been used to pulling up the ACIP vaccine schedule to guide their vaccination practices. We now face a situation in which the specialty medical societies hold opinions that are at odds with those of the federal government. We can expect that practitioners will, in general, sympathize with the opinions of their specialty societies – but will find it a hassle to reconcile those opinions with the glossy vaccine schedules distributed by the CDC.
All practitioners want what is best for their patients. All practitioners want to deliver the best evidence-based care. We are now in an era in which we have to think a little harder about what that is.
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This post was originally published on CounterPunch.org.