Vaccine advocate not sold on yet another booster

Jason Laughlin
The Philadelphia Inquirer

PHILADELPHIA -- Philadelphia’s most prominent immunization expert isn’t planning to get the latest COVID-19 booster shot, and doesn’t think most others need to either.

Paul Offit, who is among the Food and Drug Administration’s advisers on which vaccines the public should receive, disagrees with the current recommendations of the White House, FDA, and Centers for Disease Control and Prevention that everyone over the age of 5 should get the new vaccine.

Offit says he is standing up for science. He has dedicated his career to advancing vaccines to save children from preventable illnesses. He thinks the new vaccines are safe, but notes the Biden administration issued recommendations without strong evidence they offer significantly greater protection than the shots being given since 2020.

“This product was grossly oversold,” said Offit, who was in the minority on the FDA’s panel of independent experts that voted 19-2 in June to recommend that the COVID vaccines used for boosters should be updated to the bivalent vaccine now being offered across the nation.

He shrugs to see his opposition amplified on social media by groups that oppose most vaccines in general, and have been frequent foes of Offit’s.

“If Dr. Offit is questioning these vaccines, shouldn’t you??” one Twitter account, the Mama Bears Project, tweeted in October. Other vaccine skeptics are citing his comments in videotaped remarks circulating on social media that “the fix was in,” claiming falsely that COVID vaccines are part of a conspiracy.

Fast-talking and direct, Offit, 71, is a passionate debater, whether the topic is the latest vaccine data or the Eagles. For more than two decades, the pediatric vaccinologist has thrown himself into America’s culture wars over vaccination, fighting vaccine critics’ misinformation. In return he’s received death threats and antisemitic vitriol.

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For decades starting In the 1980s, he was part of a team that developed one of the two vaccines against the potentially fatal rotavirus, now routinely given to every infant in the United States and approved worldwide. He founded and co-directs the Vaccine Education Center at the Children’s Hospital of Philadelphia.

The government’s handling of this new COVID-19 vaccine frustrates Offit. He believes the average healthy person who has been fully vaccinated and boosted gets increasingly minuscule benefits from additional shots and probably doesn’t need the bivalent booster.

His advocacy for vaccines in books, lectures and opinion pieces, including for The Philadelphia Inquirer, is grounded in his commitment to trust the conclusions of the scientific method, wherever they lead. He says his objection to the government’s COVID-19 vaccination strategy comes from the same place.

Offit spoke with The Inquirer recently in a series of interviews about his concerns that his data-driven approach is increasingly at odds with a polarized America, where nuance and reasoned debate can be attacked as signs of ideological weakness.

“If we can’t have an open discussion about the strengths and weaknesses of data, the anti-vaxxers have won,” he said.

Offit does support the latest bivalent vaccines for vaccinated seniors 75 and older, or others particularly vulnerable to COVID due to underlying medical conditions. He doesn’t see the need for healthy people to keep taking vaccine doses — yes, they may contract COVID, he notes, but are unlikely to suffer a serious case.

When asked to decide whether America needed a new type of vaccine to address the latest COVID variants, the majority of experts on the independent FDA committee disagreed with him, including Archana Chatterjee, dean of the Chicago Medical School.

“There are still 300 to 400 people dying of this every day,” Archana Chatterjee, dean of the Chicago Medical School, who serves with Offit on the FDA’s independent advisory committee for vaccines said in an interview. “If we have any way of preventing it that is reasonable, I would say we probably should try that.”

A proponent of the new booster shots, Bob Wachter, chair of medicine at the University of California, San Francisco, said the risks of additional shots are so minimal even a little more protection is worthwhile. He still respects Offit’s position.

“There are questions about vaccines and masks where I don’t think reasonable people can disagree,” Wachter said. “This is not one of them.”

Wachter used a Yiddish term to describe Offit’s reputation for integrity: “He’s a mensch,” he told The Inquirer. “When he speaks, I and most people in the world of medicine and science listen very carefully.”

Offit says he welcomes disagreement. He readily admits when he’s wrong, such as when he underestimated how serious COVID would be at the start of the pandemic.

It’s good for the country, he said, when scientific debate happens publicly so people understand the nuances and discussions that shape health policy decisions.

Paul A. Offit, MD, is the Director of the Vaccine Education Center and an attending physician in the Division of Infectious Diseases at Children's Hospital of Philadelphia. (Charles Fox/The Philadelphia Inquirer/TNS)

What concerns Offit more is the federal government making a decision that isn’t backed by robust science. Evidence of the bivalent vaccines’ effectiveness, which included human trials, but with a bivalent vaccine designed for a COVID strain different than those now circulating, and tests with mice, was, “underwhelming,” Offit said.

The FDA has stressed that human testing was not needed because the new combination vaccine still contains the component from the original vaccines, which were extensively tested and now have been administered to billions of people.

Offit is also upset federal health officials authorized the doses for widespread use without the FDA advisory committee’s input or before receiving robust data on their effectiveness through human trials.

After the June vote to update the vaccines used for boosters, the agency said there was no need for the advisory committee to be heard again.

“Had the agency had additional questions that would benefit from committee input after that initial meeting, the FDA would have convened a subsequent meeting,” FDA spokesperson Abigail Capobianco said in a statement Monday.

Offit sees in the approach echoes of the confusion in 2021 over who should be eligible to receive booster shots, with mixed messages coming from the administration and federal health agencies.

Offit also repeatedly criticized the Trump administration for pressuring federal authorities to approve ineffective COVID treatments like hydroxychloroquine and undermining policies designed to stop COVID from spreading.

“It isn’t different,” he said. “If you’re advocating for a position where the science doesn’t really support that position, then what happens is you lose trust.”

Offit’s mornings begin about 4:30 a.m., writing in the third-floor office of his Old City home. He’s working on his 11th book, with the working title "Tell Me When It’s Over," focused on what the future with COVID might look like.

Awards and plaques, and some baseball memorabilia, cover every wall. Opposite his desk is a framed photo of Offit with the Phanatic on the Citizens Bank Park Jumbotron, taken when he threw out the first pitch at a Phillies game.

Offit was raised in Baltimore but has fully adopted Philadelphia. He’s an Eagles season ticket holder, and spent October nights immersed in the Philadelphia Phillies improbable playoff run.

“He goes to another level of emotional fervor that I can’t even get to,” said his wife, Bonnie Offit, also a pediatrician. The couple have a grown son and daughter.

His desk is bare except for some family photos, a box of tissues, and one of his books. It reflects how he approaches writing, tidying his prose through revisions.

“It’s always a process,” Offit said, “of making things neat, ordered, clear.”

He has known from an early age that viruses are not so easily tamed.

Offit was 5 when surgery on his right foot left him hospitalized for six weeks with children being treated for polio. He saw children in iron lungs, and heard others scream as nurses put hot packs on their arms and legs in an effort to relieve pain and relax muscles.

“The scars of your childhood become the passions of your adulthood,” Offit said. “On some level, I am just always seeing myself in that polio ward.”

After studying at the University of Maryland School of Medicine and an internship and residency in Pittsburgh, he came to CHOP in 1980. He joined Stanley Plotkin and Fred Clark’s team studying rotavirus, which causes potentially deadly diarrhea in infants and young children. Plotkin, also a pediatrician, explained the allure of research for doctors working with children, saying the number of children a pediatrician can help by treating illness is dwarfed by the impact of an effective vaccine.

The team created a working vaccine against the rotavirus, and Offit was singularly responsible for convincing the pharmaceutical company Merck in 2006 that the vaccine could be produced economically, Plotkin said.

“He doesn’t let himself be swayed or pushed aside because of disagreement,” he said. “He is a very good speaker, a very good arguer, and he certainly is sincere in his beliefs.”

Offit said he learned salesmanship as a boy watching his father, head of a men’s shirt manufacturer, talking strategy with sales staff.

Though Offit doesn’t see it, several who know him, including his wife of 32 years, say he can be “intense.” Friends say his tendency to think out loud can come across as undiplomatic.

To Offit, the case for science comes before diplomacy.

Offit pivoted from research to science communications and education more than 20 years ago following the high-profile debate about thimerosal, a preservative derived from mercury used in some vaccines, and falsely blamed for causing autism. Public concern led to the substance being removed from most vaccines, even though there was no evidence it was actually harmful.

He considers it an instance of federal health authorities caving to baseless concerns, which served only to fuel the arguments of vaccine opponents.

“That was an unforced error,” he said.

He founded the Vaccine Education Center in 2000 to promote the voices of scientists in important health policy discussions through webinars, television interviews and lots of lectures.

Offit has no plans to retire. He expects to stay an active member of the FDA advisory panel too, despite his frustration over it being recently sidelined.

“At least I have a platform where I can say something,” he said.

At a recent speaking event beneath the vaulted ceilings of the College of Physicians of Philadelphia, he discussed what he sees as the CDC’s communications error in introducing the term “breakthrough case” to describe instances in which fully vaccinated people catch COVID.

“Breakthrough implies failure,” he said, emphasizing that the vaccine should not have been expected to fully eliminate even mild cases of the virus.

He fears COVID has made vaccine skepticism even more prevalent. Offit suspects polio is circulating in Philadelphia’s water, and is stunned by people who would suggest a measles vaccine is worse than the measles itself.

“Science is losing its place as a source of truth,” Offit said.


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