Q&A: The Third Vaccine Dose
The Third Vaccine Dose
Question
I don’t know whether I’m assessing reality correctly, but it seems to me that something very interesting is happening in the country right now.
First, let me say that I’m very much in favor of vaccines, and I got vaccinated myself as soon as I could. I also have a great deal of trust in medical and scientific professionals. Even so:
A month or two ago there were headlines about a vaccine shortage, about the possibility that there wouldn’t be enough because Pfizer would now be supplying other countries. After some time, a third dose was approved, in an unprecedented way and without FDA approval, and now the vaccine shortage has disappeared and Pfizer will supply us with however many doses we need.
Pfizer’s interest in the whole story of the third dose is obvious; it will also help them a lot get it approved by the FDA. I think the connection between the Health Ministry’s agreement to vaccinate a third time before FDA approval and the pace of vaccine supply from Pfizer is fairly plausible.
If so, it comes out that we are now participating in a huge experiment (unlike the first two doses, which were not experimental but came after a large clinical trial) that was approved here only so there wouldn’t be a vaccine shortage.
Even if that’s true, it doesn’t mean there aren’t good reasons to get a third dose (logic suggests it is more beneficial than harmful, even though the required trials have not yet been done). But according to the known rules of ethics in such a situation, the patient should be informed that this is experimental, etc.
On the other hand, it is obvious that if we tell the truth that there is something experimental here, we will cause harm by preventing many people from getting vaccinated.
So, assuming I’m right and that the approval here was influenced by the desire to obtain vaccines, is it ethical for a doctor to recommend vaccination while concealing the fact that it should properly be treated as an experimental product, in order to get people vaccinated—when overall that is probably for the public good?
Answer
These conspiracy theories are not helpful and have no basis whatsoever. It is a tower of suspicions built on unchecked facts and a non-necessary interpretation of them. So there is no point in dealing with it.
Just as you know, everyone else also knows that the third dose was not tested on its own. So there is no need to announce what is already known. And likewise, everyone knows that there is no real concern, since these vaccines were tested previously.
And if there is a shared interest with Pfizer, there is nothing wrong with that. That is how business works.
By the way, I thought yesterday that it now turns out that the main reason not to take a vaccine—namely not the risk in it, but the concern that it would encourage uncontrolled growth of mutations resistant to it—also falls away. It turns out that the vaccine does not prevent infection with Delta but only severe symptoms. That is an ideal situation, because herd immunity is created and there is no encouragement of mutations, all without the risk. I am not an expert, of course, so this is just a non-professional opinion.
Discussion on Answer
The real conspiracy theorists are those who believe (out of their innocence) that commercial entities joined up with political actors in order to transform their interests—from making profits by any means and at any cost—into a simple and innocent concern for the citizen’s health.
Those same naive citizens also truly and sincerely believe that the companies profiting from disease do not want the coronavirus and its variants to continue existing, and that they are doing everything to eradicate it even though this would harm their future profits.
Those same innocents also believe that there is no need to check what viral genetic code that enters our cells is being injected into us; after all, we trust those same commercial actors whose highest concern is our health, and there is no chance that this foreign, engineered, non-human code will harm us.
Whoever still remains a Jew knows that this teaching of the Mishnah is always true:
Be cautious with the authorities,
for they draw a person near only for their own needs;
they appear as friends when it benefits them,
but they do not stand by a person in his hour of distress.
During the coronavirus period as well.
It is not true that there is no real concern; it is not for nothing that a trial has to be conducted in order for the third-dose trial to be approved. And it is not for nothing that the FDA has not approved it so far. I think that even the experts here who approved it did so by giving preference to the advantages of the vaccine, despite the certain risk involved in an additional dose (which, as I understand it, on the individual level means autoimmune effects). I completely agree that the benefit is probably greater than the harm.
I do not subscribe to conspiracy theories, but I definitely think that the exceptional approval given here before the FDA was not done because the experts here were more certain that vaccinating was the right thing to do, but also for additional reasons, such as priority in line for receiving vaccines—considerations that are not purely medical. I may be wrong, but if I am right there is an interesting ethical question here: did those experts act justly if they brought in such considerations?
In any other situation, when a product that has not yet been approved is used, there are clear procedures, and one cannot rely on the assumption that the patient knows it is experimental. Imagine if people had to sign a form like the procedures for other experimental treatments—it is obvious that many would not have gotten vaccinated because of that, so the remark that there is no need to inform is incorrect.
And I’ll add here that in my opinion, despite everything I wrote, I will get vaccinated (and will also recommend that my relatives do so). But the question of ethical conduct still stands, in my opinion.
1. What exactly is conspiratorial here? What exactly is this tower of suspicions?
2. I’m not sure everyone knows. From my personal impression (in my surroundings), most of the people now going to get the third dose do not know this. Does it bother them? Not necessarily. Do they understand the meaning of it? Not sure. But I didn’t understand where you conclude from that that everyone is aware of it.
3. “There is no need to announce what is already known.” People also know cigarettes are harmful, so we shouldn’t tell them? Should we remove the warnings from the packs and the billboards? In your opinion is that useless?
4. “Because these vaccines were tested previously.” Acamol was also tested previously. Still, in a certain quantity it can kill me. The same goes for vaccines—the experiment Avishai is talking about is not on the vaccine itself but on the third dose. After all, even with the first and second doses there are side effects, sometimes not simple ones; the main and best-known one is myocarditis. At a very low frequency, but it still exists. That is, the body can also react to the vaccine in a life-threatening way, all the more so when it comes to a third dose. Again, it may be that this will pass with minimal side effects (and even that, I already see evidence that it’s not always so), and still it would have been proper to run a trial beforehand.
5. I wouldn’t take this so coolly as “shared interests”; after all, we are dealing here with human lives and public health. I can only rely on the Health Ministry having weighed the matter carefully.
6. “The concern that it would encourage uncontrolled growth of mutations resistant to it also falls away” — I’d be glad to read about that.
7. Herd immunity by definition cannot happen if the vaccine does not prevent infection. And it’s excellent that it prevents symptoms (for some people), but I wouldn’t call that an ideal situation.
8. “There is no encouragement of mutations” — I already have no idea how many studies have come out saying that mutations arise among the immunocompromised and not among healthy people.