Vaccination for COVID-19 after an acute coronary syndrome (ACS) event was not associated with better cardiopulmonary outcomes or fewer major adverse cardiovascular events, according to a secondary analysis of the Brazilian VIP-ACS trial.
Censoring the first 90 days post-vaccination in this non-randomized comparison, people with ACS who had received at least one COVID-19 vaccine dose had 4.81 cardiopulmonary events per 100 patient-years as compared with 9.37 among those not vaccinated, Henrique Fonseca, PhD, of the Hospital Israelita Albert Einstein in So Paulo, and colleagues reported in JAMA Network Open.
Despite the numerical difference in cardiopulmonary events between the two groups, the result did not reach statistical significance after adjustment for multiple comparison (P=0.12). Cardiopulmonary events included all-cause death, myocardial infarction (MI), stroke, urgent coronary revascularization, as well as hospitalization for unstable angina, heart failure, or respiratory infection.
Vaccination -- which was mostly with AstraZeneca's COVID shot, a vaccine never authorized in the U.S. -- also did not significantly reduce the secondary endpoint of major adverse cardiovascular events (MACE; P=0.60). There were 4.32 such cardiovascular death, MI, or stroke events per 100 patient-years in the unvaccinated group versus 1.19 events in the vaccinated group.
These prospective findings counter recent retrospective studies demonstrating a short-term reduction in MACE risk after COVID-19 vaccination, Fonseca and colleagues noted.
While an interesting study, it had some important limitations, commented Susan Cheng, MD, a cardiologist at Cedars-Sinai Medical Center in Los Angeles, who was not involved in the study. "It appears they conducted the study relatively early on in the pandemic in a relatively high-CV-risk group of people," she told MedPage Today. "So it may be hard to generalize results to a broader population and to where we are now in the post-pandemic or endemic era."
The study was also relatively underpowered, Cheng pointed out. "This is probably a key issue," she said, noting that there was at least some separation of the 360-day Kaplan-Meier event curves between the vaccinated and unvaccinated individuals, but the total sample size and number of events was quite small in the vaccinated group.
"As a clinician, I would say the results are interesting, although [they] would not change my practice of advising patients who have a high risk for cardiopulmonary events to obtain a COVID vaccination if they have not been recently infected with COVID," she added.
The primary aim of the multicenter VIP-ACS trial was to investigate whether double-dose influenza vaccination during hospitalization for ACS would further reduce the risk of major cardiopulmonary events when compared with guideline-recommended standard-dose influenza vaccination. That randomized comparison -- conducted from July 19, 2019, and Nov. 30, 2020, at 25 centers in Brazil -- concluded that this strategy did not improve cardiopulmonary outcomes compared with standard-dose vaccination.
The prespecified secondary analysis examined COVID-19 vaccination, which was not randomly assigned. During the first 90 days after an ACS event, a total of 1,665 of the 1,801 trial participants did not experience a cardiopulmonary event and were included in the landmark analysis, which was designed to minimize ascertainment immortal bias.
Patients were followed to 360 days. About 30% were female, and the median age was 56.7 years. Approximately 16% had had prior myocardial infarction, and 36% were current smokers.
About half of the secondary analysis patients had received at least one COVID-19 vaccine dose, and at least one dose was the AstraZeneca ChAdOx1 shot for about 64% of these participants. That vaccine first became available in Brazil in early 2021. Other vaccines that were available in Brazil were the Chinese developed-Sinovac vaccine, Pfizer's BNT162b2 mRNA shot (Comirnaty), and Johnson & Johnson's Ad.26.COV2.S vaccine, which is no longer available in the U.S.
"Our results should not be generalized to other COVID-19 vaccines," the researchers cautioned.
Katherine Kahn is a staff writer at MedPage Today, covering the infectious diseases beat. She has been a medical writer for over 15 years.
Disclosures
The study was funded by grants from the Brazilian Ministry of Health-Programa de Apoio do Desenvolvimento Institucional do Sistema nico de Sade.
Fonseca reported receiving grants from AstraZeneca, Pfizer, Ach, Colgate, and Essity. Other study authors reported ties to industry.
Cheng reported no relevant financial disclosures.
Primary Source
JAMA Network Open
Source Reference: Fonseca HAR, et al "COVID-19 vaccination and cardiopulmonary events after acute coronary syndromes: A secondary analysis of a randomized clinical trial" JAMA Netw Open 2024; DOI: 10.1001/jamanetworkopen.2024.13946.
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Boosters that target the omicron subvariants of SARS-CoV-2 are still providing reasonably durable protection against infection, hospitalization and death from COVID-19, according to new data from a study led by researchers at the UNC Gillings School of Global Public Health.
Published in the New England Journal of Medicine, the study found that COVID-19 boosters targeting the XBB.1.5 subvariants were most effective one month after receiving one. After four weeks, the vaccines were 52.2% effective at preventing infection and 66.8% effective at preventing hospitalization.
The vaccines were also highly effective at preventing death, but exact certainty was hard to quantify given the small number of deaths reported during the study period.
After peaking at four weeks, booster effectiveness waned over time. Effectiveness at preventing infection decreased to 32.6% after 10 weeks and 20.4% after 20 weeks, while effectiveness at preventing hospitalization decreased to 57.1% after 10 weeks.
Danyu Lin, Ph.D., Dennis Gillings Distinguished Professor in the Department of Biostatistics at the Gillings School, is lead author on the study. Using data from the Nebraska Electronic Disease Surveillance System and the Nebraska State Immunization Information System, the research team studied the efficacy of vaccination before and after Oct. 25, 2023, when the JN.1 variant began to emerge.
Vaccine effectiveness was lower in the second group, suggesting that the booster was less protective against the now-dominant JN.1 strain.
"The JN.1 subvariant has been the dominant strain in the United States this year," said Lin. "The relatively low effectiveness of the XBB.1.5 vaccines against the JN.1 subvariant, together with the waning effectiveness over time, underscores the need for new vaccines targeting the JN.1 strain."
Lin says the Food and Drug Administration's general strategy is to deploy new COVID-19 vaccines annually in the fall that target the circulating strains in the spring, and that the findings in this study may contribute to this decision.
"It would be worthwhile to deploy new vaccines this fall that target the JN.1. strain," he said.
More information: Dan-Yu Lin et al, Durability of XBB.1.5 Vaccines against Omicron Subvariants, New England Journal of Medicine (2024). DOI: 10.1056/NEJMc2402779
Journal information: New England Journal of Medicine
Provided by UNC Gillings School of Global Public Health
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Early in the COVID-19 pandemic, Black Americans were more hesitant to take the COVID-19 vaccine than were white Americans. As the pandemic went on, however, the disparity in vaccination rates between Black and white adults declined.
In a paper titled "What Caused the Narrowing of Black-White COVID-19 Vaccination Disparity in the US? A Test of 5 Hypotheses," published in the current issue of the Journal of Health Communication, researchers at the Annenberg Public Policy Center (APPC) of the University of Pennsylvania assessed explanations for the positive change.
Using April 2021 to July 2022 data from the Annenberg Science and Public Health (ASAPH) survey, a national panel of over 1,800 U.S. adults, the team, led by APPC research director Dan Romer, assessed potential explanations, including increased trust in the Centers for Disease Control and Prevention (CDC), exposure to pro-vaccination messages in the media, awareness of COVID-inflicted deaths among personal contacts, and improved access to vaccines.
None of these factors explained the decline in disparity, however. Only increased knowledge about COVID-19 vaccination made a difference. Knowledge about the COVID vaccine among Black Americans increased over time, and this increase was associated with their receipt of the vaccine.
"Black Americans became less skeptical of the safety and efficacy of the vaccine as time proceeded, which appeared in our data to be an important contributor to increased vaccination rates among them," said Romer.
In the initial wave of the survey, in April 2021, Black respondents were more likely to believe various forms of misinformation about COVID vaccines, such as that the vaccines are responsible for thousands of deaths and that the vaccines can change someone's DNA. By the end of the survey period, knowledge about the vaccine among Black Americans had increased significantly.
It is noteworthy that national efforts by Black members of such organizations as the National Academy of Medicine sought to encourage COVID vaccination in the Black community by endorsing the safety and need for the vaccines. Better information about the vaccines also may have been transmitted within the Black community through religious organizations and local Black newspapers that supported the effort to increase vaccination coverage.
These findings could have important implications for future efforts to encourage vaccination, as they suggest that "exposure to knowledge about vaccine safety and efficacy from trusted sources" can matter.
"Reducing misinformation about vaccination for COVID and vaccines in general is a promising strategy going forward, as the risk of infection from COVID and other diseases will not go away," said Romer.
Along with Romer, the authors of the study include APPC data analyst Shawn Patterson Jr., Adolescent Risk and Health Communication Institute director Patrick E. Jamieson, and APPC director Kathleen Hall Jamieson.
More information: Daniel Romer et al, What Caused the Narrowing of Black-White COVID-19 Vaccination Disparity in the US? A Test of 5 Hypotheses, Journal of Health Communication (2024). DOI: 10.1080/10810730.2024.2354360
Journal information: Journal of Health Communication
The state comptroller issued a report Tuesday on the countrys handling of the COVID-19 crisis, criticizing Prime Minister Benjamin Netanyahu for making major decisions without the approval of his coronavirus cabinet that was set up to oversee Israels response to the pandemic.
The report covered the period of 2020 to 2023 when the virus pandemic peaked and then faded away as Israel and other countries embraced mass vaccination programs.
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State Comptroller Matanyahu Englman said that Netanyahu made a key deal with the Pfizer company to give it exclusivity over providing COVID vaccines to Israel through March 2021, and did not update or consult the COVID cabinet. The deal was closed between Netanyahu and Pfizer CEO Albert Bourla over the phone but the cabinet was not informed of the strategic move.
Along with the benefits to the State of Israel, this is a decision that at the time involved risks to public health, even if these were calculated risks, he wrote.
The updated monovalent XBB.1.5 COVID-19 vaccines were effective against Omicron subvariants circulating during the most recent respiratory virus season, but their effectiveness waned over time, according to a brief report.
The three vaccines updated to target the SARS-CoV-2 XBB.1.5 subvariant -- Moderna's and Pfizer-BioNTech's mRNA vaccines and the Novavax vaccine -- were 66.8% effective against hospitalization at 4 weeks, decreasing to 57.1% after 10 weeks, wrote Dan-Yu Lin, PhD, of the UNC Gillings School of Global Public Health in Chapel Hill, North Carolina, and colleagues.
Vaccine effectiveness against infection was about 52% after 4 weeks, decreasing to 33% after 10 weeks, and to 20% after 20 weeks, the New England Journal of Medicine correspondence showed.
"We expected these vaccines to be effective, especially against hospitalization and death. We also expected the effectiveness to decline over time," Lin told MedPage Today. "However, we didn't know beforehand the levels of effectiveness or the duration of protection."
Although the effectiveness against death was higher -- 72% after 4 weeks and 61.4% after 10 weeks -- than against infection or hospitalization, "there remains substantial uncertainty," because there were few deaths in the study population, the authors pointed out.
Data appeared to point to lower effectiveness against infection, hospitalization, and death after the arrival of the JN.1 subvariant, the dominant strain in the U.S. through the end of March of this year.
For those vaccinated before Oct. 26, 2023 -- before the JN.1 variant became predominant -- the vaccines were 64.4% effective against infection after week 4, decreasing to 40.9% after week 10, and 22.4% after week 18. In comparison, for those vaccinated between Oct. 26, 2023 and Feb. 10, 2024 -- when the JN.1 variant was dominant -- vaccine effectiveness against infection was 44.3% after week 4 and decreased to 17.4% after week 10.
Effectiveness against hospitalization in those vaccinated during the period before JN.1 was 73.7% after week 8 and 59.1% after week 10, while effectiveness against death was 86.2% at week 4 and 72.9% at week 8 during this period. Among those vaccinated after the JN.1 variant became dominant, effectiveness against hospitalization was 60.1% after week 4 and effectiveness against death was 59.8% after week 4, and both steadily decreased over time.
"It would be worthwhile to develop and deploy new vaccines targeting JN.1 or future strains," the authors wrote.
The FDA's Vaccines and Related Biological Products Advisory Committee is set to meet on June 5 to discuss and make recommendations on the selection of the formula for the 2024-2025 season. Signs point to the selection of JN.1 or one of its newer descendants such as KP.2, which currently accounts for an estimated 29% of U.S. cases.
Last month, the World Health Organization (WHO) Technical Advisory Group on COVID-19 Vaccine Composition recommended that future formulations of the COVID-19 vaccine use a monovalent JN.1 lineage as the antigen for future formulations. FDA followed WHO's recommendations last year in selecting an XBB.1-based strain, approving the monovalent XBB.1.5-directed mRNA vaccines in September 2023.
Further analyses from Lin's group showed that the XBB.1.5 vaccines were effective across different age groups and among people who had not been previously infected or vaccinated. And Lin commented that the durability of the vaccines "were broadly similar to our previous findings on the durability of bivalent boosters against BQ.1-BQ.1.1 and XBB-XBB.1.5.3."
For their study, the researchers used data on vaccine uptake from the Nebraska Electronic Disease Surveillance System and the Nebraska State Immunization Information System. Researchers examined all discharge data from hospitals of the Nebraska Hospital Association and reviewed all death certificates in Nebraska to identify deaths related to COVID-19.
In the cohort of 1.8 million people, 218,250 received one of the XBB.1.5 vaccines between Sept. 11, 2023 and Feb. 21, 2024. Among the people who received one of the updated vaccines, 61.1% received the Pfizer-BioNTech vaccine and 38.6% received the Moderna vaccine.
The primary outcomes were COVID-19 infection, hospitalization, hospitalization or death (whichever occurred first), and death. There were 21,988 SARS-CoV-2 reported infections during the study period, with 1,364 COVID-related hospitalizations and 237 COVID-related deaths.
The study did not include results of at-home COVID-19 antigen tests.
Katherine Kahn is a staff writer at MedPage Today, covering the infectious diseases beat. She has been a medical writer for over 15 years.
Disclosures
The study was funded by the Dennis Gillings Distinguished Professorship and the National Institutes of Health.
Lin and coauthors reported no relevant financial disclosures.
Primary Source
New England Journal of Medicine
Source Reference: Lin DY, et al "Durability of XBB.1.5 vaccines against omicron subvariants" N Engl J Med 2024; DOI: 10.1056/NEJMc2402779.
The FDA just approved Modernas second-ever product. Image: Dado Ruvic (Reuters )
The Food and Drug Administration on Friday approved Modernas mRNA-based respiratory syncytial virus (RSV) vaccine for people 60 and older. The approval paves the way for the pharma giant, known for its COVID-19 vaccine, to launch its second-ever product.
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The FDA approval of our second product, mRESVIA, builds on the strength and versatility of our mRNA platform, Moderna CEO Stphane Bancel said in a statement.
Its also the FDAs first approval for an mRNA vaccine protecting against a disease other than COVID-19.
A phase 3 trial of mRESVIA involving about 37,000 adults aged 60 years or older found that it was almost 84% effective at protecting against RSV lower respiratory tract disease. About 60,000 to 160,000 older adults are hospitalized annually and about about 6,000 to 10,000 die in the U.S. from RSV, according to the Centers for Disease Control and Prevention.
Moderna has been steadily building its pipeline of new medications as its previously only product on the market has dropped in demand.
The company reported this month that its revenue in the first quarter of 2024 plummeted 91% year-over-year to $167 million, down from $1.9 billion in the same quarter last year.
Only 14% U.S. adults have received an updated COVID-19 vaccine, according to the CDC.
Moderna is forecasting that its respiratory franchise, which includes its COVID-19 vaccine and its RSV vaccine, will generate $4 billion in revenue this year.
The company is also developing a combined COVID and flu vaccine. Moderna has more than 40 products in development including a vaccine for the digestive system bug, norovirus.
Modern stock was down about 5% in Friday afternoon trading. But the stock is up 28% so far this year.
What threatens public health more, a deliberately false Facebook post about tracking microchips in the COVID-19 vaccine that is flagged as misinformation, or an unflagged, factual article about the rare case of a young, healthy person who died after receiving the vaccine?
According to Duncan J. Watts, Stevens University Professor in Computer and Information Science at Penn Engineering and Director of the Computational Social Science (CSS) Lab, along with David G. Rand, Erwin H. Schell Professor at MIT Sloan School of Management, and Jennifer Allen, 2024 MIT Sloan School of Management Ph.D. graduate and incoming CSS postdoctoral fellow, the latter is much more damaging. "The misinformation flagged by fact-checkers was 46 times less impactful than the unflagged content that nonetheless encouraged vaccine skepticism," they conclude in a new paper in Science.
Historically, research on "fake news" has focused almost exclusively on deliberately false or misleading content, on the theory that such content is much more likely to shape human behavior. But, as Allen points out, "When you actually look at the stories people encounter in their day-to-day information diets, fake news is a miniscule percentage. What people are seeing is either no news at all or mainstream media."
Since the 2016 U.S. presidential election, many thousands of papers have been published about the dangers of false information propagating on social media. But what this literature has almost universally overlooked is the related danger of information that is merely biased. That's what we look at here in the context of COVID vaccines."
DuncanJ. Watts, Stevens University Professor in Computer and Information Science atPennEngineering
In the study, Watts, one of the paper's senior authors, and Allen, the paper's first author, used thousands of survey results and AI to estimate the impact of more than 13,000 individual Facebook posts. "Our methodology allows us to estimate the effect of each piece of content on Facebook," says Allen. "What makes our paper really unique is that it allows us to break open Facebook and actually understand what types of content are driving misinformed-ness."
One of the paper's key findings is that "fake news," or articles flagged as misinformation by professional fact-checkers, has a much smaller overall effect on vaccine hesitancy than unflagged stories that the researchers describe as "vaccine-skeptical," many of which focus on statistical anomalies that suggest that COVID-19 vaccines are dangerous.
"Obviously, people are misinformed," says Allen, pointing to the low vaccination rates among U.S. adults, in particular for the COVID-19 booster vaccine, "but it doesn't seem like fake news is doing it." One of the most viewed URLs on Facebook during the time period covered by the study, at the height of the pandemic, for instance, was a true story in a reputable newspaper about a doctor who happened to die shortly after receiving the COVID-19 vaccine.
That story racked up tens of millions of views on the platform, multiples of the combined number of views of all COVID-19-related URLs that Facebook flagged as misinformation during the time period covered by the study. "Vaccine-skeptical content that's not being flagged by Facebook is potentially lowering users' intentions to get vaccinated by 2.3 percentage points," Allen says. "A back-of-the-envelope estimate suggests that translates to approximately 3 million people who might have gotten vaccinated had they not seen this content."
Despite the fact that, in the survey results, fake news identified by fact-checkers proved more persuasive on an individual basis, so many more users were exposed to the factual, vaccine-skeptical articles with clickbait-style headlines that the overall impact of the latter outstripped that of the former.
"Even though misinformation, when people see it, can be more persuasive than factual content in the context of vaccine hesitancy," says Allen, "it is seen so little that these accurate, 'vaccine-skeptical' stories dwarf the impact of outright false claims."
As the researchers point out, being able to quantify the impact of misleading but factual stories points to a fundamental tension between free expression and combating misinformation, as Facebook would be unlikely to shut down mainstream publications. "Deciding how to weigh these competing values is an extremely challenging normative question with no straightforward solution," the authors write in the paper.
Allen points to content moderation that involves the user community as one possible means to address this challenge. "Crowdsourcing fact-checking and moderation works surprisingly well," she says. "That's a potential, more democratic solution."
With the 2024 U.S. Presidential election on the horizon, Allen emphasizes the need for Americans to seriously consider these tradeoffs. "The most popular story on Facebook in the lead-up to the 2020 election was about military ballots found in the trash that were mostly votes for Donald Trump," she notes. "That was a real story, but the headline did not mention that there were nine votes total, seven of them for Trump."
This study was conducted at the University of Pennsylvania's School of Engineering and Applied Science, the Annenberg School for Communication and the Wharton School, along with the Massachusetts Institute of Technology Sloan School of Management, and was supported by funding from Alain Rossmann.
Sources:
Journal reference:
Allen, J., et al. (2024). Quantifying the impact of misinformation and vaccine-skeptical content on Facebook.Science. doi.org/10.1126/science.adk3451.
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Since the rollout of the COVID-19 vaccine in 2021, fake news on social media has been widely blamed for low vaccine uptake in the United Statesbut research by MIT Sloan School of Management Ph.D. candidate Jennifer Allen and Professor David Rand finds that the blame lies elsewhere.
In a new paper published in Science and co-authored by Duncan J. Watts of the University of Pennsylvania, the researchers introduce a new methodology for measuring social media content's causal impact at scale. They show that misleading content from mainstream news sourcesrather than outright misinformation or "fake news"was the primary driver of vaccine hesitancy on Facebook.
"Misinformation has been correlated with many societal challenges, but there's not a lot of research showing that exposure to misinformation actually causes harm," explained Allen.
During the COVID-19 pandemic, for example, the spread of misinformation related to the virus and vaccine received significant public attention. However, existing research has, for the most part, only established correlations between vaccine refusal and factors such as sharing misinformation onlineand largely overlooked the role of "vaccine-skeptical" content, which was potentially misleading but not flagged as misinformation by Facebook fact-checkers.
To address that gap, the researchers first asked a key question: What would be necessary for misinformation or any other type of content to have far-reaching impacts?
"To change behavior at scale, content has to not only be persuasive enough to convince people not to get the vaccine, but also widely seen," Allen said. "Potential harm results from the combination of persuasion and exposure."
To quantify content's persuasive ability, the researchers conducted randomized experiments in which they showed thousands of survey participants the headlines from 130 vaccine-related storiesincluding both mainstream content and known misinformationand tested how those headlines impacted their intentions to get vaccinated against COVID-19.
Researchers also asked a separate group of respondents to rate the headlines across various attributes, including plausibility and political leaning. One factor reliably predicted impacts on vaccination intentions: the extent to which a headline suggested that the vaccine was harmful to a person's health.
Using the "wisdom of crowds" and natural language processing AI tools, Allen and her co-authors extrapolated those survey results to predict the persuasive power of all 13,206 vaccine-related URLs that were widely viewed on Facebook in the first three months of the vaccine rollout.
By combining these predictions with data from Facebook showing the number of users who viewed each URL, the researchers could predict each headline's overall impactthe number of people it might have persuaded not to get the vaccine. The results were surprising.
Contrary to popular perceptions, the researchers estimated that vaccine-skeptical content reduced vaccination intentions 46 times more than misinformation flagged by fact-checkers.
The reason? Even though flagged misinformation was more harmful when seen, it had relatively low reach. In total, the vaccine-related headlines in the Facebook data set received 2.7 billion viewsbut content flagged as misinformation received just 0.3% of those views, and content from domains rated as low-credibility received 5.1%.
"Even though the outright false content reduced vaccination intentions the most when viewed, comparatively few people saw it," explained Rand. "Essentially, that means there's this class of gray-area content that is less harmful per exposure but is seen far more often and thus more impactful overallthat has been largely overlooked by both academics and social media companies."
Notably, several of the most impactful URLs within the data set were articles from mainstream sources that cast doubt on the vaccine's safety. For instance, the most-viewed was an articlefrom a well-regarded mainstream news sourcesuggesting that a medical doctor died two weeks after receiving the COVID-19 vaccine. This single headline received 54.9 million viewsmore than six times the combined views of all flagged misinformation.
While the body of this article did acknowledge the uncertainty of the doctor's cause of death, its "clickbait" headline was highly suggestive and implied that the vaccine was likely responsible. That's significant since the vast majority of viewers on social media likely never click out to read past the headline.
According to Rand, one implication of this work is that media outlets need to take more care with their headlines, even if that means they aren't as attention-grabbing.
"When you are writing a headline, you should not just be asking yourself if it's false or not," he said. "You should be asking yourself if the headline is likely to cause inaccurate perceptions."
For platforms, added Allen, the research also points to the need for more nuanced moderationacross all subjects, not just public health.
"Content moderation focuses on identifying the most egregiously false informationbut that may not be an effective way of identifying the most overall harmful content," she says. "Platforms should also prioritize reviewing content from the people or organizations with the largest numbers of followers while balancing freedom of expression. We need to invest in more research and creative solutions in this spacefor example, crowdsourced moderation tools like X's Community Notes."
"Content moderation decisions can be really difficult because of the inherent tension between wanting to mitigate harm and allowing people to express themselves," Rand said. "Our paper introduces a framework to help balance that trade-off by allowing tech companies to actually quantify potential harm."
And the trade-offs could be large. An exploratory analysis by the authors found that if Facebook users hadn't been exposed to this vaccine-skeptical content, as many as 3 million more Americans could have been vaccinated.
"We can't just ignore this gray area-content," Allen concluded. "Lives could have been saved."
More information: Jennifer Allen, Quantifying the impact of misinformation and vaccine-skeptical content on Facebook, Science (2024). DOI: 10.1126/science.adk3451. www.science.org/doi/10.1126/science.adk3451
Journal information: Science
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Germany has scrapped a requirement for its military servicepeople to be vaccinated against COVID-19, a mandate that had been in place since late 2021, the government said Wednesday.
People serving with the German military, the Bundeswehr, are required to get vaccinations against a number of diseases including measles, mumps and flu so long as individuals have no specific health issues to prevent that.
COVID-19 was added to the list in November 2021, meaning that anyone who refused to get vaccinated against it could face disciplinary measures.
LARGEST-EVER COVID VACCINE STUDY LINKS SHOT TO SMALL INCREASE IN HEART AND BRAIN CONDITIONS
Defense Minister Boris Pistorius has now dropped the COVID-19 requirement following recommendations from the Bundeswehr's chief medical officer and a military medical advisory committee, ministry spokesperson Mitko Mller said. It has been replaced by a strong recommendation to get the vaccine.
A soldier of the German military stands inside a vaccination center at the former Tempelhof airport in Berlin, Germany, before its opening on March 8, 2021. Germany has scrapped a requirement for its military personnel to be vaccinated against COVID-19, a mandate that had been in place since late 2021, the government said on Wednesday. (Tobias Schwarz / Pool via AP, File)
News of the decision came as Germany's Federal Administrative Court considered a complaint by a noncommissioned officer in the navy against the continued vaccination requirement.
Germany contemplated a COVID-19 vaccine mandate for all adults in the country in late 2021 and early 2022, but some government lawmakers and most of the opposition balked at the idea.
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In April 2022, lawmakers rejected a narrower bill that would have required all people 60 and over to be vaccinated.
Believe it or not, legal disputes over vaccine mandate policies from the COVID-era continue to work their way through various courts. This month, the 10th U.S. Circuit Court of Appeals granted a preliminary injunction to employees of the University of Colorado at Anschutz, who were denied a religious exemption from the schools COVID-19 vaccine requirement, overturning a district courts ruling which upheld the vaccine policy.
Most notably, the 2-1 court majority held that the universitys inquiry into the nature of each employees religious objection violates their First Amendment rights under the Establishment Clause. Each employee requesting a religious exemption was asked:
1) Please explain why your sincerely held religious belief, practice, or observance prevents you from getting a COVID-19 vaccination? Please include a detailed response. 2) Have you had an influenza or other vaccine in the past? How does this differ?
The university explained that such questions were designed to determine whether the beliefs at issue were in fact religious and were sincerely held. As the dissent noted, that is a difficult and delicate task, but the mere assertion of generic religious objections is not sufficient to invoke First Amendment protections.
The majority, however, found the inquiry to be too invasive. Here is an excerpt from the opinion:
The Administrations official religious exemption form did not ask whether an applicants sincerely-held religious belief prevented her from receiving the COVID-19 vaccine. It instead asked why an applicants sincerely held religious belief, practice, or observance prevents her from getting a COVID-19 vaccination. The Administration also demanded that applicants explain whether they had an influenza or other vaccine in the past, and justify how this differ[s]. In response to the Administrations demands, some applicants submitted numerous pages of explanation of their religious beliefs, including deeply personal and private details about their religious journeys.
[The] Administration decided that a Roman Catholic applicants religious objection to the COVID-19 vaccine does not constitute a religious belief, but a personal objection, because in the Administrations view, it is of a personal nature and not part of a comprehensive system of religious beliefs. That is precisely the sort of religious entanglement the Establishment Clause proscribes.
Dissenting judge David Ebel agreed that a policy favoring one religious belief (those who object to all vaccinations) over another (those who object only to the COVID-19 vaccine) is unconstitutional, and would have granted the injunction on that basis. But he disagreed that the policy is evidence in itself of animus and hostility toward religions. Further, he would have upheld the universitys inquiry into employee beliefs as constitutional. The University is entitled to ask an individual requesting a religious exemption to explain the belief upon which that request is based, he argued. How else could the University determine whether and how it could accommodate the request? Judge Ebel would also have upheld an amended policy that removed the employee inquiry and based exemptions on the nature of the employees job requirements, but the majority found the amended policy to be pretextual and creating the same outcome.
The appeals court ruling orders the trial court to grant the plaintiffs motion for an injunction that would reverse plaintiffs religious exemption denials pursuant to both the original (September 1) and amended (September 24) policies, and it requires the university to revoke and re-examine all other denials of religious accommodation requests.
Importantly, the decision impacts only the vaccination mandate examined in this particular case. The court emphasized the specific details surrounding the universitys implementation of the policies in question. But it does raise important general questions about how and to what extent an employees religious accommodation request can be scrutinized for its sincerity.
For more on the intersection of vaccine mandates and religious liberty, check outSeason 3, episode 3 of BJCs essential podcast, Respecting Religion. BJC General Counsel Holly Hollman and Executive Director Amanda Tyler discuss the issue with clarity and detail in that episode from 2021.
