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Jeff Sutherland

Twice the Energy with Half the Stress

COVID-19 Vaccine Boosters for Young Adults: A Risk-Benefit Assessment and Five Ethical Arguments against Mandates at Universities

50 Pages Posted: 12 Sep 2022

Kevin Bardosh

University of Washington; University of Edinburgh – Edinburgh Medical School

Allison Krug

Artemis Biomedical Communications LLC

Euzebiusz Jamrozik

University of Oxford

Trudo Lemmens

University of Toronto – Faculty of Law

Salmaan Keshavjee

Harvard University – Harvard Medical School

Vinay Prasad

University of California, San Francisco (UCSF)

Martin A. Makary

Johns Hopkins University – Department of Surgery

Stefan Baral

John Hopkins University

Tracy Beth Høeg

Florida Department of Health; Sierra Nevada Memorial Hospital

Date Written: August 31, 2022


Students at North American universities risk disenrollment due to third dose COVID-19 vaccine mandates. We present a risk-benefit assessment of boosters in this age group and provide five ethical arguments against mandates. We estimate that 22,000 – 30,000 previously uninfected adults aged 18-29 must be boosted with an mRNA vaccine to prevent one COVID-19 hospitalisation. Using CDC and sponsor-reported adverse event data, we find that booster mandates may cause a net expected harm: per COVID-19 hospitalisation prevented in previously uninfected young adults, we anticipate 18 to 98 serious adverse events, including 1.7 to 3.0 booster-associated myocarditis cases in males, and 1,373 to 3,234 cases of grade ≥3 reactogenicity which interferes with daily activities. Given the high prevalence of post-infection immunity, this risk-benefit profile is even less favourable. University booster mandates are unethical because: 1) no formal risk-benefit assessment exists for this age group; 2) vaccine mandates may result in a net expected harm to individual young people; 3) mandates are not proportionate: expected harms are not outweighed by public health benefits given the modest and transient effectiveness of vaccines against transmission; 4) US mandates violate the reciprocity principle because rare serious vaccine-related harms will not be reliably compensated due to gaps in current vaccine injury schemes; and 5) mandates create wider social harms. We consider counter-arguments such as a desire for socialisation and safety and show that such arguments lack scientific and/or ethical support. Finally, we discuss the relevance of our analysis for current 2-dose CCOVIDovid-19 vaccine mandates in North America.

Note: Funding: This paper was partially supported by a Wellcome Trust Society and Ethics fellowship awarded to KB (10892/B/15/ZE) and Wellcome Trust grants to EJ (216355, 221719, 203132).
Competing Interest Statement: We do not have any competing interests to declare.

Keywords: COVID-19 vaccines, mandates, ethics, young adults, risk-benefit analysis

Suggested Citation:

Bardosh, Kevin and Krug, Allison and Jamrozik, Euzebiusz and Lemmens, Trudo and Keshavjee, Salmaan and Prasad, Vinay and Makary, Martin A. and Baral, Stefan and Høeg, Tracy Beth, COVID-19 Vaccine Boosters for Young Adults: A Risk-Benefit Assessment and Five Ethical Arguments against Mandates at Universities (August 31, 2022). Available at SSRN: or