As the new school year approaches, medical students across the nation are being forced to put their health at risk to receive an unnecessary and potentially harmful vaccine if they wish to continue their educational path of becoming a doctor.
The Association of American Medical Colleges (AAMC), the leading governing body for medical education in the United States, recently added the Covid-19 bivalent booster to its standardized immunization form, a list of recommended vaccines used to guide medical schools on required vaccinations for students. Although the adoption of this form by medical schools is optional, this document is highly influential as some schools use the form as school policy for the vaccinations required of incoming medical students. Students may have the option to request a waiver for the Covid shot, but at some universities, the only exceptions permitted must be medical and comply with CDC guidance on what is considered a contraindication.
Additionally, many schools use this form for visiting students who wish to complete an away rotation (an opportunity for fourth-year medical students to work in a residency department at another medical school). This opportunity is extremely important for students as it is like a month-long interview at the program where they hope to receive their postgraduate training. Now, students who wish to complete their away rotation at any of the schools listed on the AAMC registry must receive the bivalent booster.
As a current student at an institution that is part of the AAMC, I’m disappointed that the organization is not following the science on the Covid-19 booster to guide its policy recommendations for its member institutions. Medicine has long been a profession steeped in evidence-based practices to guide policy and recommendations.
The bivalent booster, which was released in September of last year, targets both the original strains of the virus and the BA.4/5 omicron subvariants. In the spring of 2022, before the bivalent booster was introduced, the BA.2 omicron subvariant was the dominant viral strain circulating the country. At that time, the AAMC published an article about this strain, acknowledging its low potential for hospitalization and death. The article stated that those who had received the original vaccine and the first booster should not worry about becoming seriously ill from Covid-19.
It is not clear what has changed since the spring of 2022 regarding Covid and the need for an additional bivalent booster. CDC data shows hospitalization and death rates continue to fall on a week-to-week basis. Additionally, the BA.4/5 variants have been almost entirely replaced by other mild omicron subvariants in circulation, which calls into question the efficacy of a bivalent booster that targets strains of Covid-19 that are no longer prevalent in the population.
Doctors have begun to speak out against vaccine requirements for younger adults, as many view it to be unethical to force this risk upon a population that is extremely unlikely to suffer any negative consequences from Covid. Prominent medical journals such as The New England Journal of Medicine have published articles outlining the needlessness of this booster. Additionally, studies have failed to show any significant benefit for younger populations to receive the bivalent Covid booster following the original monovalent vaccine and booster series.
Risks Versus Benefits
With any medical treatment, health care providers must assess the relative risks and benefits imposed upon the patient. The Covid-19 public health emergency has officially ended. Death rates and hospitalizations from infections have plummeted since 2020. We also know that receiving the vaccine does not prevent the transmission of the virus. Of all Covid-related deaths, 0.6 percent have occurred in individuals between the ages of 18 and 29. Of these deaths, the vast majority occurred early in the pandemic before omicron became the dominant strain. Thus, it is unclear how a mandate for an additional bivalent booster that targets a mild form of the virus for a population largely in their 20s poses any clear benefit for those receiving it.
The risks, however, are clear. We know that this vaccine has the potential to cause harm to young, healthy individuals, especially men who receive boosters of the Covid vaccine. Considering half of all medical students are young men, why have the AAMC and medical schools decided to put this age group at risk for the known side effects of this treatment?
Medical students now find themselves stuck between a rock and a hard place. If they do not comply with the bivalent booster mandate, they risk expulsion from their medical school and facing financial ruin, given that the average medical student graduates with around $200,000 of debt.
Bad Communication of Mandate
The way in which medical students across the country have been notified of this new mandate is also concerning. Rather than announcing this additional vaccination to students with an explanation for this decision, the AAMC quietly added the bivalent booster to its list of recommended vaccines that many medical schools mandate.
Medical students, like myself, are finding out for the first time about this requirement from their institutions’ health centers informing them that they are no longer compliant with current school vaccine policy. Since it is commonplace for many schools to trust the use of the AAMC standardized immunization form, I suspect some schools were also unaware of the addition of this booster and have not had time to determine if it is necessary for their students.
The AAMC’s communication strategy may have been adopted to reduce public awareness and pushback from the medical community. It is my hope that in light of this, schools will abandon the use of the AAMC’s form as school policy in favor of their own vaccine requirements that follow evidence-based medicine.
Hypocrisy in Health Care
In a request for comment from the AAMC regarding the addition of the bivalent booster to its list, a spokesman referred me to their webpage detailing how the list is created. There, the AAMC states that the list is reviewed and updated annually in accordance with CDC recommendations.
Ironically, employees at the National Institutes of Health and CDC are not required to receive the bivalent booster. The Biden administration ended Covid vaccination requirements for federal employees in May. The Centers for Medicare and Medicaid Services has also dropped all Covid vaccination requirements, meaning hospitals do not have to mandate the vaccine for their health care providers. This means the nation’s leading biomedical scientists, epidemiologists, and doctors can opt out of the bivalent vaccine, yet medical students cannot.
This type of decision-making at the AAMC and the schools that enforce its guidelines should be of great concern to both physicians and the public. If we do not require the institutions responsible for the training of future physicians to implement evidence-based decision-making, how can we expect the physicians trained under these organizations to use evidence-based medicine when treating patients?
Forrest Bohler is a rising second-year medical student interested in rural medicine and how to best address the physician shortage in these areas. He is also particularly interested in health policy and the way it is applied to different groups of people in the United States.
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