Editor’s note: This letter is in response to the Opinion article “SKADOW: Vaccine mandates deserve justification”.

I was honestly a bit shocked to read the recent opinion piece published on January 26th, entitled “Vaccine Mandates Deserve Justification.” I knew I was in for a doozy just by the title itself, but I somehow was still surprised by the sheer number of half-truths and twisted statements within the article. As an infectious disease epidemiologist in training, I knew I would have to be prepared to fight against misinformation from those outside my field, but I didn’t expect this misinformation to be spread by colleagues within the biological sciences.

I’m not going to spend time in this piece extolling the benefits of vaccination or rebutting the author’s statements on the vaccine-associated risk of cardiomyopathy. Many people, with much more training and expertise in medicine and pathophysiology have already repeatedly explained the minimal risks and major benefits of the available vaccines against COVID-19. Instead, I would like to look at two supposed pieces of evidence that the author uses that show a fundamental misunderstanding of the fields of infectious disease epidemiology and public health.

The author claims that “Canada’s National Advisory Committee on Immunization does not recommend this booster for otherwise healthy young people” yet the report he cites does not support this statement in any capacity. Canada’s current guidelines state that “a booster dose may be offered to individuals 5 to 64 years of age without risk factors for severe illness from COVID-19 if one has not already been received since the start of fall 2022” and that for individuals aged 5 and up, the recommended booster to be used is the bivalent booster. These recommendations align pretty clearly with those given by the CDC, so I don’t understand why the author felt it necessary to (inaccurately) pull a reference from somewhere else.

Additionally, as an institution based within the United States, there is no reason for Yale to be deferring to a different country’s recommendations. The demographics, geography, and culture of the US and Canada are very different, which are all significant factors to be considered when making public health recommendations. The recommendations made in one place, using the data from that location, are not transferable to another country.

Perhaps most egregiously though, the author pulls what seems to be an attempted scare quote, quoting Canada’s guidelines as referencing “‘uncertainty in the evidence of advantages and disadvantages’ for the bivalent booster” for their justification of their decision. That quote is taken not from a statement about the vaccines, but rather a boilerplate table at the end of the document that explains the differences in the wording used for NACI recommendations. This is not about the vaccine at all, but just about whether this recommendation is phrased as something that “should be offered” or something that “may be offered.” Different organizations and public health authorities have different standardized language regarding recommendations, and it is standard practice to include explanations of this wording in recommendation documents.

Later in the piece, the author argues that “randomized control trials are the gold standard for determining benefits associated with medical interventions,” but provides no justification to support his claim. While randomized control trials can be a useful study design in assessing efficacy, they are by no means the only tool that epidemiologists have in their arsenal. Just like any other research methodology, they have their strengths and weaknesses and there are many instances in which utilizing a randomized control trial is either unethical or literally impossible. Many huge public health advancements have been made without randomized control trials, perhaps most famous is the identification of the relationship between smoking and lung cancer. We know that smoking increases the risk of lung cancer, even though we’ve never randomly assigned people to a “smoking” or “non-smoking” group and compared their outcomes. Cohort studies, case-control studies, and cross-sectional analyses are all incredibly powerful tools to evaluate potential benefits and strengths of public health interventions, and to disregard them just because they’re not randomized control trials does a huge disservice to the entire field of epidemiologic research.

Additionally, randomized control trials are not standard practice after FDA approval of a vaccine. Every year, the seasonal influenza vaccine targets new serotypes that are chosen based on available epidemiologic data and predictive models. If a randomized control trial was required for each of these updated vaccines, we would never be able to implement seasonal influenza vaccine campaigns, since the vaccine would be outdated by the time any statistical analysis was completed. The updates made to the COVID-19 vaccine to produce the bivalent booster are similar to the changes that are made every year with the flu vaccine, so requiring a randomized control trial for updates that are regularly approved on other vaccines is an unnecessary double standard that would limit public health advancements.

I don’t know if the author’s use of Canada’s guidance was a purposeful misinterpretation of the recommendations or if he truly believes what he wrote, but either way the Yale Daily News did not do their due diligence in ensuring the accuracy of these statements, and I am disappointed that the editorial staff did not notice this error. Similarly, I wouldn’t be surprised if his experience leads him to believe that randomized control trials are the only way to evaluate vaccine efficacy; I didn’t fully understand epidemiologic study design until starting in an MPH program. But that is also exactly my point. Public health is its own discipline, with skills and knowledge that are unique to the field. I’m not saying that there is no room for nuance or evidence-based disagreement within the field (believe me, I’ve seen a lot of it), but there is a reason that public health practitioners, and not physicians or biologists, are the people making and designing public health guidance. It would do us well to listen to them.

Arielle Hazi is an MPH candidate in the Epidemiology of Microbial Diseases department. Contact her at arielle.hazi@yale.edu.