You don’t want to stay up to date with Covid shots? Ok. That’s your call. Seriously. But if you are sabotaging updated Covid shots for the rest of us — shame.

I am really concerned about updated Covid shots for this fall and winter — as in they might not be available, or they will be seriously delayed, or likely restricted to just the “highest risk” people. New requirements like annual effectiveness studies before approval would make timely rollout impossible, leaving the public unprotected against new strains. And even if fall Covid vaccines are available, they might not be covered by insurance because of narrowed recommendations. The new top vaccine official at FDA is a notorious vaccine critic, as are most of the other adjacent people in power. Nobel prize-winning mRNA technology in general is now under assault, and older, less effective vaccine technologies are being glorified in the US with $500 million of precious research dollars. This is happening while billions of research dollars have been taken away from all sorts of now ruined cancer, infectious disease, and medical research. [I spoke with a patient last week who was in a big clinical trial for the past 5 years studying an autoimmune condition. That trial is now “broken, unfixable, ruined.”] Other countries are poised to take our mRNA tech and run with it, like a baton we dropped in a race before quitting. And even the Novavax Covid vaccine option, which is based on protein molecules, was arbitrarily not given approval this spring. [Update 5/18/25 - FDA, under massive pressure from Examined readers 😉, did give a partial approval to Novavax for >65 year olds and >12 yo with high risk medical problems.] And yet FDA is still requiring Novavax to run more trials, which might be the financial end of the company entirely.

Anticipating a major government-sponsored fail for the 2025-2026 Covid vaccine, I called a random pharmacy in Montreal, Canada. I introduced myself as a physician and explained the situation down here in the US. I asked the pharmacist if I showed up as an American tourist and asked if I could pay for an updated Covid shot, would they be allowed to give me one. She stated that yes, as of right now, the pharmacy would give me a Covid shot. For free. Oh, Canada. This might change, however, if Canadian pharmacies are overrun by American vaccine refugees, scientists, citizens, and Examined readers this fall/winter.

So in this post I want to share a quick vignette that illustrates the anti-Covid vaccine problem at the most endemic level. I’ll review some of the studies showing ongoing benefits from updated Covid shots that I’ve highlighted just over the past year or so. We will review what the current leaders of HHS, CDC, and FDA are doing to sack vaccines this fall. And finally I will ask for your help. Please leave your comment on the FDA public docket comment section before May 22, 2025. On that date the FDA is finally convening a meeting about the 2025–2026 formula for COVID–19 vaccines in the United States. Already there are over 5K comments.

This is a monster post, but there is a fast lane and a slow lane for different readers. Read on when you can.

The endemic problem

It’s hard enough counseling patients about Covid vaccines when there is such a massive campaign of uncertainty and misinformation out there. Sure, Covid is not killing millions of Americans a year, but it is still killing 50,000 to 150,000 a year, depending on whether you count immediate deaths or increased mortality rates. In its wake there are millions suffering from brain fog, fatigue, lightheadedness, shortness of breath and other lingering Covid effects. But I respect patients’ decisions to decline the vaccine, especially when they personally have felt very sick afterwards. I just follow consensus guidelines, the evidence of benefit over risk, and take extra time with my patients over age 65-75 who are at higher risk of severe Covid and who can/should be getting boosters right about now. It’s hard enough without other doctors pitching in to undermine vaccines, too.

A few days ago, one of my high-risk patients — a 70-year-old woman with hypertension, morbid obesity, asthma, and liver disease — came to me visibly distressed. She’d just seen a neurologist who advised her against getting the updated Covid vaccine, warning, They cause heart attacks. As her family doctor, I knew this claim didn’t reflect the current evidence, but I also understood how frightening such advice could be for someone with multiple health concerns. This encounter inspired me to dig deeper into the research and clarify what we actually know about COVID-19 vaccines and heart risk, especially for vulnerable patients.

What did the original trials show?

The initial randomized controlled trials of the Pfizer and Moderna mRNA vaccines were closely watched for any sign of serious adverse events, including heart attacks. The data showed a very low incidence of heart attacks among vaccinated individuals, with no evidence of increased risk compared to placebo. These findings were reassuring, especially considering the large number of older adults and people with chronic illnesses included in the studies. For a deeper dive on the original studies, the nuance between RCTs and observational studies, and how the whole magic comes together, read this piece from Dr. Jenn Dowd, too.

What about real-world surveillance and booster shots?

Since the rollout, global health agencies and researchers have monitored vaccine safety through large cohort studies and ongoing surveillance. The most robust data-including a Swedish nationwide cohort of over 8 million adults-showed that the risk of serious cardiovascular events, including heart attacks, was actually lower after full vaccination, particularly after the third dose. This protective effect is likely due to the vaccine’s ability to prevent severe COVID-19, which itself is a major risk factor for heart attacks and strokes.

Myocarditis vs. myocardial infarction: clearing up confusion

Some confusion arises because mRNA vaccines have been linked to rare cases of myocarditis (inflammation of the heart muscle), especially in young males. However, myocarditis is a different condition from myocardial infarction (heart attack), which is caused by blocked blood flow to the heart. The overwhelming majority of myocarditis cases after vaccination are mild and resolve with minimal treatment, and this risk is far outweighed by the risk of heart complications from COVID-19 itself.

That coronary artery disease study: what did it really find?

So what’s up with that neurologist who told my patient that “Covid shots cause heart attacks?” I called him to discuss, given that I consider myself up to date on the literature, and certainly more so than the average doctor as I toil writing in Covidlandia. He called back but I missed his call. Looking forward to that chance to talk, but in the meantime here is what I found that he might be giving too much credence. A recent meta-analysis did report a possible association between Covid vaccination (particularly the Pfizer vaccine) and an increased risk of coronary artery disease (CAD), with an odds ratio of 1.7 after the second dose. However, it’s important to scrutinize this finding coming from a less-than-top-tier journal:

• Observational design: The study pooled data from observational studies, which are prone to confounding. For example, people with more health problems are more likely to get vaccinated early, potentially skewing results.

• Short follow-up: CAD develops over years, not weeks like the majority of the included studies which ran for an average of 20-40 weeks

• No increase in actual heart attacks: The same analysis found “no increased risk of heart attacks, arrhythmias, or strokes” after vaccination. In fact, after the third dose, the risk of heart attack and stroke was lower in vaccinated individuals. Just an increased risk of “CAD” but without events? There were wide confidence intervals undermining the credibility of this finding, too.

• Contradictory evidence: Larger population studies, including those from Sweden and England, have consistently shown lower rates of cardiovascular events after vaccination.

In short, while the CAD finding is worth monitoring, it does not mean the vaccine causes heart attacks, nor does it outweigh the clear benefits of vaccination.

The bottom line for high-risk patients

For patients like my 70-year-old with multiple risk factors including hypertension, morbid obesity, asthma, and liver disease, the evidence should be clear: Covid infection itself is far more likely to trigger a heart attack, stroke, or other serious cardiovascular event than the vaccine is. Vaccination substantially reduces the risk of severe Covid, hospitalization, and death — including from cardiac causes, too.

Rebutting the neurologist’s advice

Telling a high-risk patient to avoid the Covid vaccine because “they cause heart attacks” is not supported by the best available evidence. We’ve found actual coronaviruses accumulating in coronary artery plaque where they accelerate blockages. That research was funded by the NIH, which has now been greatly defunded. I wonder why? As physicians, we must base our recommendations on rigorous science, not anecdotes or misinterpretations of isolated studies. We need to talk to each other, and back that up with a preponderance of evidence. Back in the day we were all on the same team.

Are Covid shots still worth it?

I’m going to drop some one liners taken from my Covidlandia series. The following is why I like to stay up to date with Covid vaccines lately, even if that means taking a trip to Canada this fall for some poutine, Parker’s Maple Cotton Candy, and an updated Covid vaccine.

And all this comes from studies published around 2024 and 2025. If you already know this stuff, feel free to hop in this Lamborghini and speed through this section, as it is quite long on purpose.

• In a U.S. surveillance study, vaccinated children aged 6 months–4 years had 40% fewer emergency room visits and hospitalizations with COVID-19 than unvaccinated children.

• Another study showed that Covid vaccination in kids was extremely (>90%) effective at preventing severe disease and hospitalization during the previous Delta and Omicron waves.

• That updated XBB Covid vaccine, which had low uptake among American adults at only 22%, demonstrated approximately 54% protection against symptomatic SARS-CoV-2 infection compared to no vaccination, with protection remaining strong at 49% even four months after administration.

• The updated XBB Covid vaccine provided protection comparable to seasonal flu vaccines with approximately 50% reduced risk of outpatient Covid visits overall, while offering even stronger protection (around 70% reduced risk) for those with prior Covid infection history.

• Between October and November of 2023 the vast majority — 95% of hospitalized adults with Covid — were not up-to-date on their annual Covid-19 vaccines.

• A Nature Communications study of nearly 1.2 million Hong Kong residents found that Covid-19 vaccination progressively reduces long Covid risk with each additional dose—unvaccinated individuals faced over 4 times higher cardiovascular disease risk post-infection compared to the fully vaccinated, while those with three or more doses experienced significantly lower all-cause mortality (nearly five-fold reduction) and showed no significant risk of clinical sequelae after 91 days post-infection.

• For parents considering childhood Covid vaccination, a study found extremely high vaccine effectiveness in adolescents (12-15 years) during Delta (98% against infection, 99% against moderate-to-severe disease, and 99% against ICU admissions) with strong protection maintained during Omicron (85%, 87%, 85%, and 91% respectively), while younger children (5-11 years) during Omicron showed 74% protection against infection, with effectiveness increasing to 85% against ICU admissions.

• Kids that received the bivalent booster had a 54% reduction in Covid illnesses in another study.

• A Lancet Infectious Diseases case report of a 62-year-old man who received an extraordinary 217 Covid vaccine doses over four years showed no clinical abnormalities or adverse effects attributable to hypervaccination, with his immune system maintaining robust T-cell responses against SARS-CoV-2 and other pathogens even after his final dose—though researchers emphasize this extreme case should not be replicated, it inadvertently serves to counter anti-vaccine concerns about immune system overload.

• A rigorous Lancet study comparing 10 million vaccinated and 10 million unvaccinated individuals across three European countries found Covid vaccination reduces long Covid risk by 30-50% across all age groups (including young adults), leading New England Journal Watch reviewers to suggest stronger booster recommendations for younger populations—challenging the limited view that vaccines should only be evaluated on their ability to prevent hospitalization and death.

• A Norwegian study published in The Lancet found that COVID-19 vaccination reduced long COVID symptoms by 40% while also preventing post-COVID thromboembolic and cardiovascular complications across all age groups and health conditions, confirming that previous findings from other countries are reproducible and generalizable to the Norwegian population.

• CDC study found 2+ doses of original mRNA COVID-19 vaccines provided 52% protection against pediatric hospitalization and 57% against critical illness when received within 4 months, with protection waning over time—supporting recommendations for children to stay current with vaccinations. Especially for kids that are still coming into the world.

• NEJM study showed updated XBB vaccines provided good but waning protection—initially reducing infections by 52% at 4 weeks (dropping to 44% against dominant JN.1 variant and declining to 20% by 20 weeks) while maintaining stronger protection against hospitalizations (67% at 4 weeks, 57% at 10 weeks)—following similar effectiveness patterns as previous years.

• NEJM study of 441,583 veterans found COVID-19 vaccines significantly reduced long Covid risk—unvaccinated veterans had 9.51% risk during Delta and 7.76% during Omicron compared to 5.34% and 3.50% for vaccinated veterans respectively, with vaccination accounting for 72% of the decreased risk while viral changes explained the remainder, though substantial risk persisted even among vaccinated persons during Omicron.

• A European study in the journal Influenza found the adapted XBB.1.5 COVID-19 vaccine provided 49% effectiveness against hospitalization between October 2023-January 2024, with higher protection for those over 80 compared to 60-79 year-olds, though protection waned from 69% in the first month to 40% by 60-105 days post-vaccination, adding to baseline protection from previous vaccinations and infections.

• A Lancet Respiratory Medicine study found COVID-19 vaccines directly saved at least 1.6 million European lives between December 2020 and March 2023 across 34 countries, with 60% of lives saved during the Omicron period and first booster doses accounting for 51% of all lives saved—likely an underestimate due to herd immunity effects and mortality underreporting.

• This modeling study out of Yale and the Pan American Health Organization showed that Covid vaccines spared up to 2.6 million more lives in Latin America and the Caribbean alone.

• A study published in Open Forum Infectious Diseases found that healthcare personnel who received additional COVID-19 vaccine doses had 45% lower odds of experiencing symptoms at 6 weeks compared to those who hadn't received additional doses.

• The VENUS study in Japan analyzed 84,464 COVID patients and found those infected within 14-149 days after vaccination had significantly lower risk of developing long COVID symptoms (including 45% less fatigue and 42% less pain) compared to those infected at intermediate or distant timepoints—despite the recently vaccinated group being older with more pre-existing conditions, demonstrating that vaccination within 5 months before infection provides substantial protection against long COVID, especially for older adults.

• A Journal of Infectious Diseases study found 24% developed long COVID after Omicron infection, but those with three mRNA vaccine doses showed dramatically reduced risk compared to unvaccinated individuals—63% lower odds of gastrointestinal symptoms, 44% lower for neurologic symptoms, and 52% lower for other symptoms—confirming third doses as crucial protection against post-COVID conditions during Omicron dominance.

• Singapore study during JN.1 wave found XBB.1.5 boosters given within previous 8-120 days reduced infection risk by 41%, ED visits by 50%, and hospitalizations by 42% compared to older boosters—supporting annual updated vaccines for protection against emerging variants regardless of prior infection status.

• California study published in Vaccine found unvaccinated children were dramatically more likely to develop MIS-C after COVID infection (23 times higher risk in ages 12-17; 3.3 times higher in ages 5-11), with all four MIS-C deaths occurring in unvaccinated children who also experienced more severe multi-organ involvement—providing strong evidence that Pfizer-BioNTech vaccination substantially protects children from this serious post-COVID inflammatory syndrome.

• Lancet eClinicalMedicine study of 386,000+ American children found Pfizer vaccine highly effective against long COVID (95.4% during Delta, 60-75% during Omicron), primarily by preventing initial infections rather than modifying disease course—representing stronger evidence than previous studies due to its superior design and large sample size across 20 US health systems.

• A 2024 VA Healthcare System study of 44,598 respiratory infections found the current Pfizer COVID-19 vaccine provides strong protection—68% effectiveness against hospitalizations, 57% against emergency/urgent care visits, and 56% against outpatient visits between September-November 2024—though researchers noted continued low vaccine uptake despite these protective benefits

• Another VA study published in JAMA Internal Medicine of 141,520 non-hospitalized veterans showed unvaccinated COVID-19 patients in 2022-2024 had significantly higher 30-day hospitalization rates (17.5%) and 180-day mortality (3.1%) than flu or RSV patients, while vaccinated COVID patients experienced similar hospitalization and mortality rates to flu patients—confirming vaccination effectively reduces COVID-19 severity to levels comparable with seasonal influenza.

• A study of 7.6 million Medicare beneficiaries aged 65+ who received 2023-2024 COVID vaccines found no major safety concerns except a rare potential increase in anaphylaxis with Pfizer's vaccine—most seniors received either Pfizer (48.8%) or Moderna (50.8%), with Novavax (0.40%) potentially offering a better-tolerated alternative with similar effectiveness for those experiencing strong reactions to mRNA vaccines.

• CDC report found 2024-2025 COVID vaccines provide substantial added protection beyond existing immunity: 33% effectiveness against ER/urgent care visits for adults 18+ and 40-46% effectiveness against hospitalization for adults 65+ (slightly better in immunocompetent individuals)—confirming efficacy against current KP.2, KP.3, and XEC variants and supporting universal vaccination recommendations, with infection prevention estimated at roughly 50% initially, declining approximately 10% monthly.

• A study published in Nature found that Omicron infection provided significantly weaker and shorter protection against reinfection compared to pre-Omicron variants. While previous strains offered 81.1% effectiveness against reinfection with minimal waning over time, Omicron's protection was just 53.6% and declined rapidly, becoming negligible after one year. Immunity wanes. Target practice.

• JAMA Open Network study of 622 children found COVID vaccination dramatically reduced post-COVID condition risk—vaccinated children had 57% lower odds of experiencing any PCC symptoms, 73% lower odds of multiple symptoms, and 75% reduced likelihood of symptoms affecting daily function—providing compelling evidence for childhood vaccination while acknowledging the unknown long-term impacts of repeated infections over decades.

• Moderna's updated current vaccine demonstrated 53% effectiveness against hospitalization and 39% against medically attended illness over a two-month period, with slightly reduced protection in those with underlying conditions—providing meaningful protection for older adults who are now eligible for 6-month boosters.

• Swedish study in Journal of Infectious Diseases found COVID vaccination progressively reduces long COVID risk with each dose—19% reduction after one dose, 58% after two doses, and 63% after three doses compared to unvaccinated individuals—with consistent protection across all variants, age groups, sexes, and prior infection statuses.

• A Nature Communications study of veterans found the 2024-2025 Pfizer COVID vaccine provides strong protection—68% effectiveness against hospitalization, 57% against emergency/urgent care visits, and 56% against outpatient visits—with consistent protection across age groups including older adults, though vaccine uptake remained low despite these proven benefits.

• And don’t forget that when we first received the gift of free mRNA vaccines (Pfizer-BioNTech and Moderna), the randomized controlled trials showed about 94–95% efficacy in preventing symptomatic COVID-19. Those were the good old days.

Ok, that was exhausting, or exhilarating, depending on whether you took the Lamborghini or walked through that list.

But what about randomized controlled trials? Those are the only studies that matter!

In anticipation of some RCT purists dismissing all of the above with a flick of the wrist (but perhaps glorifying contrarian studies of all flavors), it is important to state the obvious — we cannot do RCT’s for everything.

While randomized controlled trials excel at establishing causality through bias reduction and controlled conditions, they shouldn't be medicine's sole gold standard. Their limitations—high costs, strict inclusion criteria reducing real-world applicability, ethical constraints, and typically short-term focus—make complementary methodologies essential. For example, cohort studies track populations over time to identify risk factors and outcomes without manipulation. Retrospective analyses efficiently utilize existing data to examine associations and trends, and case-control studies enable investigation of rare conditions by comparing affected and unaffected individuals. Some crucial medical questions simply cannot be ethically or practically addressed through randomization. Medical knowledge advances most effectively through methodological diversity rather than rigid adherence to a single study design, ensuring we capture both statistical significance and clinical relevance across diverse populations and contexts.

For annual Covid vaccine updates, RCTs are impractical due to the rapid viral evolution requiring quick adaptation, the ethical concerns of withholding potentially life-saving/health-protecting updated formulations, and the established safety profiles of the vaccine platforms making large-scale efficacy trials unnecessarily burdensome when immunogenicity data can effectively guide updates.

More problems : unscientific actions and controversial attacks

Here is what has me worried about future Covid vaccine updates and mRNA technology in general.

Trump Administration

• Supported/did not oppose legislative efforts in multiple states to ban or restrict mRNA vaccines, including proposals to criminalize administration of mRNA vaccines to humans

• Abruptly canceled federal research grants tied to mRNA technology, including projects on HIV prevention and pandemic preparedness, and compiled lists of mRNA projects for potential termination

• Significant cuts to NIH funding, particularly targeting mRNA vaccine research, which scientists warn could drive innovation overseas

• Removed or replaced long-standing immunization science advocates in federal agencies, undermining institutional support for vaccine science

• Spread political rhetoric that vilifies mRNA technology, contributing to public distrust and legislative backlash

Health and Human Services shenanigans

• Appointed Robert F. Kennedy Jr., a well-known vaccine critic and spreader of vaccine misinformation, as Secretary of Health and Human Services, signaling a shift away from science-based policy

• Directed the CDC to remove immunization messaging and warned NIH grant applicants to avoid referencing “mRNA” in their proposals

• Oversaw layoffs and cuts at the CDC and NIH, particularly affecting teams working on mRNA and immunization

• Canceled or suspended numerous mRNA-related grants, including those focused on vaccine hesitancy and pandemic preparedness

• $500 million is being directed toward older, usually inferior vaccine technology, much to the abandonment of mRNA technology. China used a similar century old tech for their Covid shots early in the pandemic with comparatively weak results compared to mRNA. God forbid we have an H5N1 or other pandemic take off, and we are flying 100 year old vaccine planes.

• Shifted vaccine policy, with new FDA Commissioner Marty Makary signaling that the FDA may require Covid vaccine makers to submit new effectiveness data before adjusting their products for new strains - a regulatory hurdle that could leave people unprotected from new variants of concern

• Dr. Makary has a record of questioning vaccine mandates and the necessity of widespread mRNA vaccination, contributing to public confusion and skepticism.

• Dr. Makary co-authored the 2022 paper with Dr. Prasad attacking booster recommendations for teens and young adults, concluding that boosters "would cause more injury than benefit" in these groups.

• Dr. Vinay Prasad, the next FDA vaccine chief, has been a "vocal critic of the agency's moves to greenlight COVID-19 vaccine boosters," particularly objecting to the lack of randomized clinical trial data for booster approvals. He stated last year that his predecessor Dr. Peter Marks was "either incompetent or corrupt to authorize a booster without clinical, randomized data.” He also compared Dr. Marks to a “bobblehead doll.” Classy.

• He warned, "Without trials, it is only a matter of time before the FDA approves a vaccine that causes some bad outcome like vaccine-induced narcolepsy. If this happens, you can kiss faith in vaccines goodbye. You will see vaccine hesitancy like you have never seen before.”

• Prasad has called for banning Moderna's vaccine in men under 40 and described it as "absurd" that the U.S. was still offering COVID vaccinations to young children.

• Specifically, Dr. Prasad said the CDC should pull the Covid shot for kids, “because there is no randomized evidence that kids ever benefit (in terms of real clinical outcomes) from this shot, and no evidence of any sort that a kid born today will need one in the future.” He is no pediatrician, and he insists on randomized trials only when it comports with his opinions. Last fall I compiled a convincing array of studies showing just how important Covid vaccines are for kids, especially those “born today” who will be denied a chance at vaccination if Prasad’s above statement is carried to fruition. This involves unvaccinated toddlers and kids dying and being hurt by Covid.

• Prasad also came under fire in October 2021 for suggesting Covid mitigations were the start of a national descent into authoritarianism, invoking comparisons to Nazi Germany. “Ironic that someone who compared vaccine requirements to the Holocaust and presented this as evidence of Fauci being a public health fascist is now a loyal bootlicker and apparatchik of actual fascists,” said Dr. Angela Rasmussen, virologist and scientific advisor to the Accountability Journalism Institute.

• Dr. Prasad has called for deprioritizing mRNA vaccine science, and suggested repealing vaccine manufacturer indemnification programs. The resulting wave of lawsuits would have a chilling effect on the production of current and future vaccines.

• Dr. Jay Bhattacharya, now NIH director, has a history of promoting the “Great Barrington Declaration,” advocating for natural infection over vaccination and minimizing the need for broad immunization. You know, let it rip? A stance widely criticized by public health experts as ignoring sound science and causing unnecessary deaths.

• Dr. Bhattacharya called for additional research into a link between vaccines and autism, despite broad scientific consensus and plenty of evidence that no such link exists.

So in short, these folks are undermining federal support for mRNA research, promoting/tolerating misinformation, removing pro-vaccine leadership, and advancing policies that restrict or stigmatize mRNA vaccine technology.

So… do you think future Covid vaccines are in trouble, too?

What can we do?

Forward this post. Like and restack it.

Make a friend in Canada, or consider a lovely fall trip to catch the foliage and more if it comes to that. Hopefully it won’t.

Leave a comment on the docket at Regulations.gov to be counted and considered at the May 22nd, 2025 meeting that is supposed to happen. Tell them you want to keep getting timely, updated Covid shots based on the preponderance of evidence in real medical journals. I don’t have an agenda for the meeting, but as the stated purpose is to figure out the 2025-2026 Covid vaccine formulation, let’s speak up in advance. I’ll copy and paste the comment I left there into the comment field on the Examined website after this post.

You could even copy and paste into the docket your favorite recent study quoted above which showed updated vaccine benefit. There are many to choose from.

I know from experience that many people choose not to stay up to date with Covid vaccines. I will honor that. But I will not abide ideology over evidence in primary care, nor misinformation over the truth gleaned from the world’s top researchers and medical journals.

And neither should you.