When Politics Trumps Science: Florida's Deadly Gamble with Vaccine Misinformation
When Politics Trumps Science: Florida's Deadly Gamble with Vaccine Misinformation
Debunking Dr. Ladapo's claims and the critical importance of evidence-based health policy
On September 13, 2024, Florida's Surgeon General, Dr. Joseph Ladapo, issued guidance that contradicts the scientific consensus on COVID-19 vaccines. His recommendation to prioritize non-mRNA vaccines over the widely used Pfizer and Moderna vaccines, especially for older adults, has raised serious concerns in the medical and public health community. By taking a step back and critically examining Dr. Ladapo's claims, we hope to provide a comprehensive, evidence-based refutation of his misleading statements…
Here’s a statement taken verbatim from the guidance:
“Based on the high rate of global immunity and currently available data, the State Surgeon General advises against the use of mRNA COVID-19 vaccines. Any provider concerned about the health risks associated with COVID-19 for patients over the age of 65 or with underlying health conditions should prioritize patient access to non-mRNA COVID-19 vaccines and treatment.”
This is a real bummer…to say the very least.
First, we want to start by expressing our disappointment that a State Surgeon General would promote such potentially harmful public health misinformation (or, depending on who you ask, disinformation). Dr. Ladapo's guidance completely misrepresents the risks and benefits of mRNA COVID-19 vaccines, potentially endangering public health by discouraging the use of highly effective preventive measures. His claims are not supported by current scientific evidence and contradict the recommendations of leading health organizations worldwide.
Many of us in public health, science, and medicine are not happy, to say the least. Uptake of COVID-19 vaccines is already far lower than many of us hoped. Per NBC News, Dr. Paul Offit, a vaccine expert at Children’s Hospital of Philadelphia, said the Florida surgeon general's guidance is unnecessarily alarming people about the Covid vaccines. "It's just such a dangerous game he plays," said Offit, who has served on the FDA's independent vaccine advisory committee. "You only have a roughly 1,000 times greater likelihood of dying [from Covid] if you're over 65 than if you're under 18… The mRNA vaccines are remarkably safe.”
Let’s discuss this claim by claim.
Claim 1: mRNA vaccines target outdated variants
Dr. Ladapo suggests that current mRNA vaccines target outdated Omicron variants.
“The stated target of these boosters is the Omicron variant which is not causing a significant number of infections…Furthermore, this booster does not protect against the currently dominant strain, accounting for approximately 37% of infections in the United States. ”
Refutation: This claim is misleading. I highly recommend checking out Dr. Liz Marnik’s post on this topic, but I will summarize. The 2024-2025 vaccines are specifically designed to target current variants:
Moderna and Pfizer vaccines target the KP.2 variant
Novavax targets the JN.1 variant
As of the latest data, the estimated circulating variants in the US are:
KP.3.1.1.1: 52.7%
KP2.3: >12.2%
LB.1: 10.9%
K.P3: 10.6%
These current dominant variants are closely related to those targeted by the vaccines. Moreover, even when not a perfect match, prior data shows that these vaccines still increase protection against related variants.
How does that work?
Even when the vaccine strain isn’t a perfect match to the current circulating variant, data from previous years show that updated vaccines still boost immunity against related strains. This is because vaccines generate an immune response that can protect against multiple related variants through the production of broadly neutralizing antibodies.
For example, research on previous versions of the COVID-19 vaccines showed that while the vaccine might be tailored to one variant, the immune system's response could still offer substantial protection against newer variants due to overlapping regions in the virus’ spike protein. Here are two studies on this topic:
A study published in Nature showed that the immune system's response, particularly through memory B cells, can adapt and recognize different variants of the virus, offering protection even when there are mutations in the spike protein. This cross-reactivity helps to maintain protection against severe outcomes, even when the variant is not a perfect match to the vaccine.
Another study in Science demonstrated the ability of neutralizing antibodies, generated by the vaccine, to bind to different variants of the virus. This highlights the broad protection offered by vaccines, which target conserved regions of the spike protein.
Claim 2: Lack of Randomized Controlled Trials (RCTs) for updated vaccines
Ladapo implies that the lack of new RCTs for updated vaccines makes them unreliable.
“The most recent booster approval was granted in the absence of booster-specific clinical trial data performed in humans…Although randomized clinical trials are normally used to approve therapeutics, the federal government has not required COVID-19 vaccine manufacturers to demonstrate their boosters prevent hospitalizations or death from COVID-19 illness.”
Refutation: National regulatory authorities, such as the FDA, require RCTs to be conducted. These studies must show the protective benefits of a new vaccine before the vaccine is licensed for regular use. There were multiple RCTs conducted before the COVID-19 vaccine authorization that were required to demonstrate safety and efficacy. Here’s a link to an RCT on Pfizer’s COVID-19 vaccine, an RCT on Moderna’s, and another RCT on Pfizer’s. You can read details on Pfizer’s landmark study here, and more on Moderna’s trials here.
While RCTs are crucial for new treatments, annual updates to vaccines like those for COVID-19 and flu do not require new full-scale human RCTs. The underlying vaccine technology remains the same; only the targeted viral variant changes, similar to flu vaccines, which are updated annually without conducting full human RCTs. This practice is based on established evidence that the platform works. Instead, manufacturers measure the immune response by looking at blood markers, such as neutralizing antibody levels, to show that updated vaccines are effective against the circulating strains.
Data from vaccine manufacturers for the 2024-2025 updates show that these vaccines effectively boost antibody production against the latest variants. Previous real-world data also consistently demonstrate that even updated vaccines, which may not be a perfect match to circulating variants, significantly reduce the risk of symptomatic infection, severe disease, and hospitalization.
Additionally, as discussed above, numerous studies have shown that immune responses elicited by COVID-19 vaccines are broad enough to offer cross-protection against related variants, even when mutations occur in the virus’s spike protein. This explains why updated vaccines continue to protect against severe outcomes, even without new RCTs specific to each booster version.
Here’s a post from two years ago that summarizes this issue:
And another from last year:
Claim 3: mRNA vaccines unsafe due to myocarditis risk
Dr. Ladapo emphasizes the risk of myocarditis from mRNA vaccines, particularly for older adults.
“The mRNA COVID-19 vaccines present a risk of subclinical and clinical myocarditis and other cardiovascular conditions among otherwise healthy individuals.”
Refutation: While there is a low risk of myocarditis after COVID vaccination, especially for young males, the risk of myocarditis from COVID-19 infection is significantly higher. Moreover, individuals who develop myocarditis from the vaccine are less likely to die, be rehospitalized, or experience other serious cardiovascular events compared to those who develop myocarditis from COVID-19 infection.
We just did a detailed breakdown of myocarditis in our last newsletter. The main takeaways?
Myocarditis Risk After Vaccination: For every 10,000 teenagers who get the Pfizer vaccine, about 2-5 might develop mild myocarditis, and for Moderna, it’s 13-19 out of 10,000. Most cases resolve quickly with little medical care.
Higher Risk from Infection: If your child gets COVID-19, the chance of myocarditis is much higher—about 220 out of 10,000, compared to just 2-19 out of 10,000 after vaccination.
Severity and Recovery: Most teens who experience vaccine-related myocarditis recover within 3 months, with 77-94% returning to normal.
Comparing Infection vs. Vaccination for Males: Boys aged 12-17 are much more likely to get myocarditis from COVID-19 (55 in 100,000) than from the vaccine (15 in 100,000). For men aged 18-29, the risk of myocarditis from COVID-19 is over 8 times higher than from the vaccine.
Pfizer vs. Moderna: The chance of myocarditis is slightly higher with Moderna, but both are still much safer than risking COVID.
Here’s a follow-up post that discusses the risks among people who are vaccinated and also get infected:
Bottom Line: While there’s a small chance of myocarditis after the vaccine, it’s much rarer and less severe than the risk from catching COVID.
Claim 4: mRNA vaccines increase risk of POTS
Ladapo suggests that mRNA vaccines pose a significant risk of developing Postural Orthostatic Tachycardia Syndrome (POTS).
“The mRNA COVID-19 vaccine may be associated with an increased risk of postural orthostatic tachycardia syndrome (POTS).”
Refutation: A recent study does suggest a potential link between COVID-19 vaccines and POTS, but the same research shows that COVID-19 infection increases the risk of POTS fivefold compared to vaccination. The study authors emphasize that while a small association exists, vaccination is still the best way to reduce the risk of POTS because it prevents COVID, which poses a far greater risk. Most post-vaccine POTS cases are also milder than those following infection.
Claim 5: mRNA vaccines increase risk of autoimmunity
The guidance suggests that mRNA vaccines significantly increase the risk of autoimmune conditions.
“The mRNA COVID-19 vaccine may be associated with an increased risk of autoimmune diseases including systemic lupus erythematosus (SLE), rheumatoid arthritis, and psoriasis.”
Refutation: The Nature Communications study in question was misrepresented by Ladapo’s guidance. The authors explicitly state in the abstract that there was no significant increase in the risk of most autoimmune connective tissue diseases (AI-CTDs) following mRNA vaccination. The few associations that were found did not account for whether participants had previously been infected with COVID-19. This is critical because COVID-19 itself is strongly linked to the development of autoimmune conditions. Moreover, some evidence suggests that mRNA vaccines can actually reduce autoimmune risk post-infection by preventing severe disease outcomes.
The study noted that systemic lupus erythematosus (SLE) and rheumatoid arthritis were not found to increase significantly after vaccination. Additionally, it pointed out that the baseline incidence of autoimmune diseases remained stable, implying no major shifts due to vaccination alone.
Let’s recap why this matters:
COVID-19 infection is known to trigger autoimmune diseases, as SARS-CoV-2 can provoke immune system dysregulation.
Vaccination lowers the risk of severe COVID-19 infection, which in turn may reduce the likelihood of developing autoimmunity post-infection.
The association of mRNA vaccines with autoimmune conditions is small and not consistent across studies, with many experts considering the benefits of preventing COVID-19 to far outweigh the risks.
Ladapo's interpretation overlooks key points: the study does not prove that mRNA vaccines increase the risk of autoimmune diseases, and any risk must be weighed against the substantial benefits of preventing COVID-19.
Claim 6: Claims about “negative effectiveness” after 4-6 months
The claim that mRNA vaccines lead to "negative effectiveness" after 4-6 months misinterprets how vaccine protection works.
“Throughout the pandemic, studies across geographic regions found that the mRNA COVID-19 vaccines are associated with negative effectiveness after four to six months. As efficacy waned, studies showed that COVID-19 vaccinated individuals developed an increased risk for infection.”
After initial high efficacy, waning immunity is expected over time, especially for preventing mild infections. This does not mean vaccines become harmful or increase infection risk. Instead, annual shots designed to restore immunity, particularly against newer variants (and certain vulnerable subgroups such as those who are immunocompromised or elderly, may be recommended to receive additional doses). Importantly, studies consistently show that mRNA vaccines continue to provide strong protection against severe illness, hospitalization, and death, even as immunity to infection may decline
Here are some key studies addressing the claim:
CDC Study: A large-scale study conducted by the CDC demonstrated that while vaccine effectiveness against infection may decrease over time, protection against severe outcomes like hospitalization and death remains strong. You can find the details here.
Nature Medicine Study: This study highlights how mRNA vaccines continue to protect against severe disease even after efficacy against mild infection wanes over time. Read more here.
Claim 7: Concerns about mRNA persistence
Ladapo raises concerns about the persistence of mRNA in the body after vaccination.
“Elevated levels of mRNA and spike protein from the mRNA COVID-19 vaccine persist among some individuals for an indefinite period, which may carry health risks.”
Refutation: This claim demonstrates a misunderstanding of how mRNA vaccines work compared to viral infections (again, highly recommend Dr. Liz Marnik’s post on this and her perspective as an immunologist) which I have attempted to summarize here:
This claim reflects a misunderstanding of how mRNA vaccines work. Unlike the SARS-CoV-2 virus, which replicates in the body by producing 29 different proteins, the mRNA vaccine contains only one piece of mRNA that instructs the body to produce a single protein (the spike protein). It cannot replicate. The mRNA from vaccines is broken down relatively quickly by cellular processes, typically within days to weeks, and does not persist indefinitely. I found this quote from Stanford researchers to be quite impactful: “For virtually every spike-protein molecule induced by vaccination, the cell that made it becomes its jail cell.”
In contrast, COVID-19 infection exposes the body to far more foreign RNA and proteins, increasing the risk of prolonged viral presence and potential long-term health complications, including long COVID. Studies suggest that the persistence of SARS-CoV-2 after infection contributes to these risks, while the spike protein from the vaccine is less stable and does not carry the same risk.
Moreover, research has shown that the spike protein produced by the vaccine differs structurally from the spike protein produced by the actual virus, making it less likely to contribute to long-term complications. The vaccine-induced spike protein is less stable and more prone to rapid degradation compared to the spike protein from a viral infection.
For more scientific insights on mRNA persistence, see these helpful resources:
In summary, mRNA from vaccines is rapidly degraded and does not carry the same risks as prolonged viral replication seen in natural infections. This makes vaccination a much safer option.
We’ve done deep dives on the spike protein issue since the vaccines became available:
Claim 8: DNA integration concerns
The bulletin references a pre-print study suggesting concerns about DNA in COVID-19 vaccines.
“Potential DNA integration from the mRNA COVID-19 vaccines pose unique and elevated risk to human health and to the integrity of the human genome, including the risk that DNA integrated into sperm or egg gametes could be passed onto offspring of mRNA COVID-19 vaccine recipients.”
Refutation: This claim is unsupported and problematic. Regulatory agencies like the FDA impose strict limits on DNA content in vaccines, measured using a well-validated technique called qPCR. Regulatory agencies like the FDA set strict limits for DNA content in vaccines, typically allowing no more than 10 nanograms per dose. In the pre-print, the authors detected DNA levels below this regulatory threshold when measured using qPCR (the standard method). However, they used non-standard, unvalidated techniques to suggest higher DNA content. Even in their own findings, the DNA levels detected using qPCR were within safe limits and did not correlate with increased adverse events, contradicting the alarmist conclusions they draw from their non-validated methods. Notably, the pre-print's data does not support its own conclusion—samples with more DNA actually had fewer adverse events, contradicting the study's hypothesis.
Additionally, the concern about DNA integrating into human genomes, especially gametes, is highly speculative and not grounded in how mRNA vaccines function. mRNA vaccines instruct cells to produce a spike protein and do not interact with the cell nucleus, where DNA resides. There is no plausible biological mechanism by which mRNA vaccines could integrate into human DNA.
Moreover, studies on mRNA vaccines have shown that the mRNA is rapidly degraded after its job is done, with no lasting presence in the body that could pose a risk to the genome or be passed on to offspring.
The pre-print's claims rely on questionable methodologies and contradict established data on vaccine safety. More reliable peer-reviewed research shows no evidence of DNA integration risks from mRNA vaccines.
Claim 9: Unknown risks
The claim that there are "unknown risks" with additional mRNA COVID-19 doses misrepresents the data.
“There is unknown risk of potential adverse impacts with each additional dose of the mRNA COVID-19 vaccine; currently individuals may have received five to seven doses (and counting) of this vaccine over a 3-year period.”
The suggestion that there is an unknown risk associated with receiving multiple mRNA COVID-19 vaccine doses over time is not supported by the data from recent studies. Extensive research, including independent and pooled data studies, demonstrates that while mild side effects such as fatigue or soreness at the injection site are common after multiple doses, severe adverse events remain rare.
A 2023 study published in BMC Medicine found that even after three or four doses, mRNA vaccines continue to provide robust protection against severe outcomes like hospitalization, particularly during the Omicron wave. This study also analyzed the effects of extended dosing intervals and found no increase in safety concerns compared to the standard dosing schedule, even with additional doses administered over time.
Another comprehensive analysis by the British Society for Immunology (BSI) also reaffirms the safety of multiple doses. Their 2023 statement emphasized that adverse events remain rare and are well within the expected ranges, consistent with what is observed for other vaccines, including those that have been used for decades.
A pooled data analysis from MDPI underscored the importance of large-scale, real-time surveillance data to detect rare safety signals early, including for myocarditis or thrombosis, and confirmed that these risks remain low across multiple doses.
In conclusion, the idea that unknown risks accumulate with additional vaccine doses is not backed by current scientific data. Multiple independent studies continue to show that mRNA vaccines maintain a strong safety profile even after several doses, with the benefits of preventing severe illness far outweighing the rare risks of serious adverse events.
For more detailed information, review CDC’s vaccine safety tracking here.
Omission: Long COVID Risk
Importantly, Ladapo's guidance failed to mention long COVID, which remains a significant risk after infection. Many studies have shown that vaccines help reduce the risk of developing long COVID, even in children. Talk about “unknown risks”... we are only beginning to understand the short and long-term effects of the virus on our bodies!
We published a newsletter on long COVID a few months back if you want a refresher but the TL;DR is we are only starting to understand how the virus impacts us– and we have a far better handle on the risks of the vaccines which do exist but are far less common and severe (understatement).
Understanding the 'Why': Roots of Misinformation
It's natural to wonder: How could a trained medical professional, tasked with safeguarding public health, promote views that so starkly contradict scientific consensus? We don’t know the answer— but we can speculate.
Dr. Ladapo doesn't operate in a vacuum; he's part of a larger political and social ecosystem that can profoundly impact his actions and statements.
Political Alignment: In Florida, where Governor Ron DeSantis has been vocal in his skepticism of federal COVID-19 policies, there's a palpable political current that favors individual freedom over collective public health measures. Dr. Ladapo, appointed by DeSantis, may feel pressure to align his medical guidance with this political stance. It's a stark reminder of how public health can become entangled with political ideologies, potentially compromising evidence-based decision-making.
Contrarian Appeal: By positioning himself as a maverick challenging the establishment, Dr. Ladapo gains a platform that he might not have if he simply echoed the consensus. This dynamic creates a perverse incentive for public figures to make controversial statements, even if they're not supported by evidence. Dr. Ladapo's emphasis on rare vaccine side effects, while downplaying the more common and severe risks of COVID-19 itself (aka cherry-picking data) has been effectively used to further this narrative.
Misinterpretation of Scientific Uncertainty: Science is a journey, not a destination. The COVID-19 pandemic has given us a front-row seat to how scientific understanding evolves in real-time. However, this natural process of refinement and adjustment can be misinterpreted as indecisiveness or incompetence. When public health guidance changes – as it should when new evidence emerges – it can fuel distrust among those who expect science to provide immediate, unchanging answers. Dr. Ladapo may be capitalizing on this misunderstanding, presenting evolving scientific consensus as a weakness rather than a strength of the scientific process.
As we consider these factors, it's crucial to remember that they don't excuse the spread of misinformation. Rather, understanding these dynamics helps us recognize how even well-educated individuals can fall into the trap of promoting misleading narratives. It underscores the importance of robust systems of peer review, scientific consensus, and public health structures that can withstand political pressures and the allure of contrarianism.
By acknowledging these roots of misinformation, we can better equip ourselves to critically evaluate the information we receive, regardless of its source. It reminds us that no one, not even a State Surgeon General, is immune to biases and external influences. This realization reinforces the value of relying on broad scientific consensus rather than individual opinions, no matter how authoritative they may seem.
In the face of Dr. Ladapo's claims, it's crucial to understand the value of scientific consensus. Consensus is built on the careful analysis of evidence by multiple experts over time, involving peer review, replication of results, and large-scale studies.
The overwhelming majority of health experts, including those at the CDC, FDA, WHO, professional medical and public health organizations, universities, health systems, and in peer-reviewed studies, agree that mRNA vaccines are safe and effective. Individual opinions that contradict this consensus without strong evidence should be met with skepticism.
Conclusion
As we reflect on Dr. Ladapo's guidance, it's impossible to overstate our profound disappointment. The role of a State Surgeon General is to protect and promote public health based on the best available scientific evidence. Instead, we've witnessed a deeply concerning misrepresentation of data that could potentially endanger lives.
While nothing in life is completely risk-free, it's crucial to consider the overwhelming body of evidence when making decisions about vaccination. The data consistently shows that COVID-19 infection poses a far greater risk than the vaccine for the vast majority of people. By cherry-picking data, misinterpreting studies, and ignoring crucial information like the risk of long COVID, this guidance not only misrepresents the current scientific understanding but also undermines public trust in our health institutions.
This situation underscores the vital importance of scientific consensus. In a world where individual opinions can be amplified through media and political channels, consensus serves as a crucial safeguard against misinformation and bias. It's important to remember that even the most well-intentioned individuals, including scientists and health professionals, can fall prey to personal biases or external pressures. This is precisely why the scientific process relies on collective knowledge, rigorous peer review, and replication of results.
The power of consensus lies in its ability to counterbalance individual biases and errors. When thousands of researchers, clinicians, and public health experts from diverse backgrounds and institutions around the world arrive at similar conclusions, it provides a level of reliability that no single opinion, regardless of the individual's credentials, can match. This consensus-building process is our best defense against the kind of misleading guidance we've seen from Dr. Ladapo.
As we navigate the complex landscape of public health, we must redouble our commitment to evidence-based decision-making. The overwhelming scientific consensus supports the safety and efficacy of mRNA COVID-19 vaccines, particularly for protecting vulnerable populations. This consensus isn't a matter of opinion—it's the result of countless hours of research, clinical trials, and real-world data analysis by experts across the globe.
Our disappointment in Dr. Ladapo's actions should serve as a call to action. We must work harder than ever to foster trust in the scientific process, to combat misinformation, and to ensure that public health decisions are based on robust, peer-reviewed evidence rather than political ideologies or individual biases.