Epidemiologist lays out her COVID-19 ‘campaign of honesty’

Tufts doctor Shira Doron worries about lack of trust in public health officials

WHEN THE CORONAVIRUS vaccines first emerged, they were shown to have 94 to 95 percent efficacy in preventing symptomatic COVID-19.

It was a situation where the message from public health officials was fairly simple – get the shot and help prevent the spread of the disease. Vaccine mandates, passports, and other measures were all deemed smart public health policy.

But as variants of the disease began to appear and multiply, the vaccines couldn’t keep pace. Infections spread rapidly and Shira Doron, an infectious disease physician and hospital epidemiologist at Tufts Medical Center, said public health messaging couldn’t keep up.

Doron said people were told to get their child vaccinated because children were dying from COVID. But most parents never heard of a child who died from COVID or even ended up in a hospital.

Younger people were told to get vaccinated to reduce the risk of elderly relatives becoming infected. But so many young people were becoming infected by the variants that the strategy no longer made any sense.

“What they’re hearing and what they’re seeing are not jiving with each other,” Doron said on The Codcast, echoing themes from a recent CommonWealth commentary piece she co-wrote with Monica Gandhi, a professor of medicine at the University of California – San Francisco.

Doron and Gandhi called for a “campaign of honesty” around COVID-19. Doron said public health officials didn’t lie about the disease, but suggested they were not fully transparent. She fully supports the vaccines, saying they are very effective in reducing the risk of serious disease, hospitalization, and death. But she said the spread of variants – and the inability of vaccines to prevent the spread of infection — needs to be reflected in the messaging.

“The virus has been defanged by our immunity from repeated vaccination and repeated infection,” she said. “The actual infection fatality rate has dropped below that of the flu.”

For example, Doron said, the US Centers for Disease Control and Prevention initially weighed all the available evidence and concluded the risk of getting COVID outweighed the risk of myocarditis, an inflammation of the heart muscle that can be a side-effect of the vaccine, particularly in young men 16 to 30.

“But as time has moved on, we now have a situation where, essentially, almost every person in that age group has had COVID and we’re talking now about what’s your risk of a bad outcome from COVID having had COVID, having had the initial vaccination series,” she said.

She said many young men are being asked to get their fourth shot even if there’s no risk-benefit analysis for that. “That’s the nuance that’s different from some of the earlier messaging,” she said.

Doron said she understands nuance doesn’t always lend itself to public health messaging. “You have to balance simplicity against transparency, and a complex message is really hard to put out there,” she said. “But the fact of the matter is that the science on this is really complex, and to try to oversimplify it comes at the expense of full transparency and honesty.”

What Doron worries about is that the simple message – get the shot – is leading to anger and skepticism about vaccines in general from people who previously accepted them.

“What I hear again and again and again is, ‘I accepted every vaccine that my doctor ever told me to get or my child’s doctor told me to get for them, but I no longer trust public health officials. I feel like COVID-19 pulled back the curtain and that they’re not being honest,’” Doron said, quoting the people she has heard from.

“When you look at the numbers of COVID vaccination rates in terms of our country, they’re low,” she said, pointing out that less than half of those over 65 have received a second booster, it’s been single-digit uptake for children under 5, and the rate of bivalent booster updates is around 10 to 12 percent.

“We can talk about the implications of what that might be for COVID-19,” Doron said. “But I’m much more worried about what the implications of that lack of trust in public health might be for other things that public health does like its recommendations for routine childhood and other vaccinations. We’re already seeing evidence that routine childhood vaccination rates are down.”

She said there have been outbreaks of measles in Ohio and polio in New York.

“I consider it catastrophic how extreme it has become,” Doron said, noting she hears from people who are swearing off all vaccinations. “That is a disaster. If we have made people think that vaccines in general are bad because of the way we have communicated [about] COVID vaccines, we have a serious problem on our hands.”