On December 5, Taiwan News published “Taiwan should not risk booster shots over Omicron variant” by Yang Sen-Hong, DDS, MPH, and Shih Hue-Teh, MD, MPH.

Since the start of the pandemic, we have sought to provide a space for commentary by public health experts. Patrick Ng, MBA, MPH, is a regular contributor to The News Lens and a manager for the New School for Leadership in Health Care at the Koo Foundation Sun Yat-Sen Cancer Center.

There’s a case to be made for ignoring this article and others like it to avoid drawing attention to them. We believe, though, that the authors’ medical and academic credentials provided in the article justify a reply from a public health expert. We are therefore honored to publish Ng’s response to Drs. Yang and Shih below.

I was shocked to see a recent article by Drs. Yang Sen-Hong and Shih Hue-Teh that contained a remarkably cavalier assessment of Covid-19. Their statements are not only detrimental to global public health efforts but lack perspective on the toll this pandemic has wrought on healthcare workers, in Taiwan and elsewhere.

First, the article claims that Omicron is not a threat. Studies on Omicron are just starting to be published. At the time of the article’s publication, there was little indication of the severity of disease Omicron could bring, how contagious it is, nor how it responds to vaccinations or previous Covid infections.

Second, Drs. Yang and Shih sorely lack data to back their conclusions and resort to unjustified conclusions that Covid no longer strains medical resources. They refer to unsubstantiated claims that booster shot reports are rigged and cite outdated data not relevant to Omicron as justification for not using boosters.

Yang and Shih make reference to Krause et.al. This article was first published on September 13, 2021, two months before Omicron was classified as a variant of concern by the WHO and, despite their claims to the contrary, both former FDA officials use their FDA affiliations. Additionally, just because Covid’s mortality rate has gone from 10+% to 2% does not mean that medical resources are not strained. This rate is a better indicator that vaccines are working to prevent severe disease or a description that we did not know how to treat or prevent Covid cases early on, leading to higher deaths at the beginning of the pandemic.

Finally, the article attempts to discredit the Central Epidemic Command Center (CECC). I would have been sympathetic if they cited the persistent global vaccine inequality. I would have agreed with the authors if they called out G20 leaders who failed to waive intellectual property rights to vaccine technology so safe manufacturers can produce Covid vaccines. It would have been of interest if they argued that there is an ethical obligation to vaccinate the rest of the world first before giving out boosters. Unfortunately, they merely note that science and politics do not mix and their article follows suit, leaning heavily on politics and being void of science.

Well meaning public health officials are trying to make data-driven decisions in the midst of severely limited information. This week’s data from the UK Health Security Agency found that vaccine effectiveness against Omicron was 30-40% after two shots of Pfizer but effectiveness increased to 70-80% with a booster. This suggests that boosters will continue to reduce viral transmission. Therefore, it is important to emphasize the use of boosters in combating this ongoing pandemic.

Furthermore, booster shots are needed given evidence of waning immunity to the Delta variant. A preprint study posted in November showed that those with AstraZeneca vaccines saw a decline in anti-spike antibody levels which fell below a protective threshold 96 days after the second dose compared with 257 days for Pfizer. Krause et.al even state that boosting could eventually be needed for the general population if immunity wanes or a variant emerges that significantly undercuts the vaccines’ protectiveness.

The reproductive number or contagiousness of Omicron is estimated to be around 3 in some parts of South Africa with cases doubling every three to four days within infected countries. We can assume that Omicron may soon be the dominant strain worldwide.

While it is true that rare but serious adverse events have been reported after Covid-19 vaccination including Guillain-Barre syndrome (GBS) and myocarditis, it is clear from a public health perspective that continued vaccination has benefits which outweigh the risks of death, long-Covid, and complications from Covid infection. These rates are not significantly different from previous viral mass vaccination campaigns. From a public health perspective, booster shots should be made available while giving people the choice of whether to take it.

The authors give a flimsy argument that an additional booster shot would overwhelm our body and cause side effects. It is strange that two clinicians with MPH degrees fail to understand how vaccines are designed to work with the body’s natural defenses to develop immunity to disease. We have since argued that the benefits outweigh the risks. Unfortunately, they have also failed to consider what would happen if Taiwan were to experience an uncontrolled outbreak of Covid. The percentage of the population who are unvaccinated could put a burden on health systems and lead to more deaths. It remains to be seen if Taiwan’s healthcare infrastructure and workforce is prepared to handle a rapid surge in nationwide cases given the CECC’s effective handling of past outbreaks. To suggest that Covid would not strain medical resources is inconsistent with what is happening outside of Taiwan.

There is a popular phrase “lies, damned lies, and statistics” that refers to using numbers as a way to bolster weak arguments. I believe Drs. Yang and Shih believe what they wrote. They don’t marshal much by way of statistics, besides the declining mortality rate. But the phrase does capture much of what is going on with the bunk information circulating around Covid. Statistics do not speak for themselves, and must be embedded within a broad understanding, and to the greatest extent possible, political neutrality. On this account, Drs. Yang and Shih have let down the public in their role as public health experts.

Read Next: Overcoming the Next Challenges in Taiwan’s Vaccination Campaign

Editor: Bryan Chou, Nicholas Haggerty (@thenewslensintl)

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