Research in the Public Interest

By Denis G. Rancourt, Marine Baudin, Joseph Hickey, and Jérémie Mercier

Explains Why Some Have Severe Side Effects and Others Do Not

Most people seem to be under the illusion that the scandalous EU contract with Pfizer-BioNTech, absolving the companies of liability, is only available in redacted form. Is Twitter censorship to blame?

In 2022, students at North American universities with third-dose COVID-19 vaccine mandates risk disenrolment if unvaccinated. To assess the appropriateness of booster mandates in this age group, we combine empirical risk-benefit assessment and ethical analysis. To prevent one COVID-19 hospitalisation over a 6-month period, we estimate that 31 207–42 836 young adults aged 18–29 years must receive a third mRNA vaccine. Booster mandates in young adults are expected to cause a net harm: per COVID-19 hospitalisation prevented, we anticipate at least 18.5 serious adverse events from mRNA vaccines, including 1.5–4.6 booster-associated myopericarditis cases in males (typically requiring hospitalisation). We also anticipate 1430–4626 cases of grade ≥3 reactogenicity interfering with daily activities (although typically not requiring hospitalisation). University booster mandates are unethical because they: (1) are not based on an updated (Omicron era) stratified risk-benefit assessment for this age group; (2) may result in a net harm to healthy young adults; (3) are not proportionate: expected harms are not outweighed by public health benefits given modest and transient effectiveness of vaccines against transmission; (4) violate the reciprocity principle because serious vaccine-related harms are not reliably compensated due to gaps in vaccine injury schemes; and (5) may result in wider social harms. We consider counterarguments including efforts to increase safety on campus but find these are fraught with limitations and little scientific support. Finally, we discuss the policy relevance of our analysis for primary series COVID-19 vaccine mandates. All data relevant to the study are included in the article or uploaded as supplementary information. The data are cited in table 1 and in the references. All data and calculations are included in the manuscript. We are providing the following citations as well: 18. Oliver S. Updates to the evidence to recommendation framework: Pfizer-BioNTech and Moderna COVID-19 vaccine booster doses. ACIP Meeting. 19 November 2021 (Slides 26, 29, 30, 31, 37). Available at: . Accessed on 28 March 2022; 50. CDC. Grading of Recommendations, Assessment, Development, and Evaluation (GRADE): Pfizer-BioNTech, Moderna, and Janssen COVID-19 booster doses. 29 October 2021. Available at: [https://www.cdc.gov/vaccines/acip/recs/grade/covid-19-booster-doses.html23table03a][1]; 51. Shimabukuro T. Update on myocarditis following mRNA COVID-19 vaccination. Advisory Committee on Immunization Practices (ACIP). 23 June 2022. Available at: Update on myocarditis following mRNA COVID-19 vaccination (cdc.gov). Slides 10 and 23. Accessed on 20 August 2022; 52. Shimabukuro T. Myocarditis following mRNA COVID-19 vaccination. Advisory Committee on Immunization Practices (ACIP). 19 July 2022. Available at: Myocarditis following mRNA COVID-19 vaccination (cdc.gov). Slides 11 and 23. Accessed on 20 August 2022; 53. Sharff KA, Dancoes DM, Longueil JL, et al . Myopericarditis after COVID-19 booster dose vaccination. Am J Card 2022;172:165–166. ; 54. Friedensohn L, Levin D, Fadlon-Derai M, et al . Myocarditis following a third BNT162b2 vaccination dose in military recruits in Israel. JAMA Apr 26;327(16):1611–1612. doi:10.1001/jama.2022.4425. [1]: https://www.cdc.gov/vaccines/acip/recs/grade/covid-19-booster-doses.html23table03a51