'Were the unvaccinated right?' Examining the claim against the evidence

What the vaccines were — and weren't — designed to do

The original COVID-19 vaccine trials measured whether vaccinated people were less likely to develop symptomatic COVID-19 in the weeks and months after vaccination. Against the original strain, the mRNA vaccines reduced symptomatic infection by around 95 per cent in that early window (Polack et al., 2020; Baden et al., 2021).

What those trials weren't designed to show was long-lasting protection against infection, or whether vaccination stopped people passing the virus on. Those questions could only be answered later, and the answers turned out to be more modest than some of the early public messaging implied. This gap between what was measured and what was communicated is, I think, at the heart of a lot of the anger.

Much of the distrust grew in the space between what the trials measured and what the public was told.

What the evidence shows on effectiveness

• Infection: protection against catching COVID-19 waned within months, and was considerably lower against Omicron, with boosters restoring it only temporarily (Andrews et al., 2022).
• Transmission: vaccination reduced onward transmission of the Alpha and Delta variants, but the effect was smaller for Delta and faded over time (Eyre et al., 2022). The vaccines did not reliably stop spread.
• Severe disease and death: this is where the evidence is strongest. Protection against hospitalisation was substantially more durable than protection against infection, including during Omicron (Stowe et al., 2022). A modelling study estimated that vaccination prevented around 14 million COVID-19 deaths worldwide in its first year (Watson et al., 2022). Modelling has uncertainties, but the direction is consistent across many datasets.
• Long COVID: a systematic review found vaccination before infection was associated with a lower risk of long COVID, although the certainty of the evidence was limited (Byambasuren et al., 2023).

What the evidence shows on safety

Like all medicines, COVID-19 vaccines have side effects, and a few serious ones were identified through monitoring. Being honest about them matters.

• Myocarditis: inflammation of the heart muscle was linked to mRNA vaccines, most often in young men after a second dose. Across the population, the risk of myocarditis was higher after COVID-19 infection than after vaccination (Patone et al., 2022a), but in men under 40 the risk after a second dose of one mRNA vaccine was higher than after infection (Patone et al., 2022b). Most cases were mild, but this was a real signal that rightly changed advice for younger men in several countries.
• Blood clots with low platelets: a rare but serious syndrome was identified after the AstraZeneca vaccine (Greinacher et al., 2021). Many countries restricted its use in younger adults as a result.
• Menstrual changes: many women reported changes to their cycles after vaccination and felt dismissed. Later research found a small average increase in cycle length — less than a day — that usually resolved by the next cycle (Edelman et al., 2022). The effect was small and temporary, but women were right that something was happening.
• Pregnancy: a systematic review found no increase in adverse pregnancy outcomes after vaccination and reported fewer stillbirths among vaccinated women (Prasad et al., 2022).
• Overall mortality: in a large US study, vaccinated people had lower rates of non-COVID deaths than unvaccinated people (Xu et al., 2021). Some of that likely reflects healthier people being more likely to get vaccinated, but it does not support claims of widespread vaccine-caused deaths.

Where public health communication genuinely fell short

If we want trust back, we have to be able to say this plainly. Some things were handled poorly:

• Transmission was overstated in some messaging, which made later evidence look like a betrayal.
• Prior infection was often underweighted in policy. A large analysis later found that protection from past infection against severe disease was comparable to that from vaccination (COVID-19 Forecasting Team, 2023), and hybrid immunity gave the strongest protection (Bobrovitz et al., 2023).
• Risk wasn't always tailored to age and health. The balance of benefit and risk for a healthy teenage boy was very different from that for an 80-year-old, and blanket messaging blurred that.
• Side-effect concerns, especially women's reports of menstrual changes, were sometimes brushed off before they had been investigated.
• Mandates and social pressure left many people feeling coerced rather than informed, and a lot of people never felt their questions were answered with respect.

Admitting where communication failed doesn't weaken the case for vaccines — it is the only way to rebuild trust in the evidence.

Where the claim doesn't hold

'The unvaccinated were right' usually means one of several things: that the vaccines didn't work, that they were more dangerous than the disease, or that avoiding them was the better choice. When tested against the evidence, the first two don't stand up. The vaccines did not stop infection or transmission as well as people were led to believe, but they did substantially reduce severe illness and death, especially in older and vulnerable people, and serious side effects were rare.

Some individual decisions were reasonable for specific people — those with prior infection, for example, or young men weighing myocarditis risk. But as a general verdict on the evidence, the claim that avoiding vaccination was the right choice for the population isn't supported.

What a functional practitioner takes from all this

One lesson I think was under-emphasised is metabolic health. Among adults hospitalised with COVID-19 in the US, obesity and diabetes were among the strongest risk factors for severe outcomes (Kompaniyets et al., 2021). Public health could have said much more about blood sugar, movement, sleep and nutrient status as part of resilience. That is a message I strongly support.

But honesty cuts both ways. In a large trial, a test-and-treat vitamin D programme did not reduce the risk of COVID-19 or other respiratory infections (Jolliffe et al., 2022). Lifestyle and nutrition matter enormously for long-term health, but they weren't shown to be a substitute for vaccination against severe disease.

A fair verdict

Critics were right that some messaging overpromised, that prior infection deserved more weight, that rare side effects were real and that women's concerns deserved faster investigation. They were not right that the vaccines failed to save lives, or that the evidence overall favoured avoiding them. Both things can be true at once, and holding them together is, I think, how we start talking to each other again.

If you have questions about your own vaccination decisions, the best next step is a conversation with a doctor who will listen to your history and your concerns without judgement — and who is willing to tell you what the evidence does and doesn't show.

Before you act on any of this

This article is for education and general information only. It isn't medical advice, it can't diagnose or treat any condition, and it doesn't replace a consultation with your own doctor or a qualified practitioner who knows your history. Please don't start, stop or change any medication, hormone or supplement because of something you've read here — take your questions to the person responsible for your care.

Vaccine recommendations depend on age, health, pregnancy and local guidance, and they change over time. Please discuss your own situation with your GP or another qualified medical professional.

References

• Andrews, N., Stowe, J., Kirsebom, F., et al. (2022). Covid-19 vaccine effectiveness against the Omicron (B.1.1.529) variant. New England Journal of Medicine, 386(16), 1532–1546.
• Baden, L.R., El Sahly, H.M., Essink, B., et al. (2021). Efficacy and safety of the mRNA-1273 SARS-CoV-2 vaccine. New England Journal of Medicine, 384(5), 403–416.
• Bobrovitz, N., Ware, H., Ma, X., et al. (2023). Protective effectiveness of previous SARS-CoV-2 infection and hybrid immunity against the omicron variant and severe disease: a systematic review and meta-regression. The Lancet Infectious Diseases, 23(5), 556–567.
• Byambasuren, O., Stehlik, P., Clark, J., Alcorn, K., & Glasziou, P. (2023). Effect of covid-19 vaccination on long covid: systematic review. BMJ Medicine, 2(1), e000385.
• COVID-19 Forecasting Team. (2023). Past SARS-CoV-2 infection protection against re-infection: a systematic review and meta-analysis. The Lancet, 401(10379), 833–842.
• Edelman, A., Boniface, E.R., Benhar, E., et al. (2022). Association between menstrual cycle length and coronavirus disease 2019 (COVID-19) vaccination: a U.S. cohort. Obstetrics & Gynecology, 139(4), 481–489.
• Eyre, D.W., Taylor, D., Purver, M., et al. (2022). Effect of Covid-19 vaccination on transmission of Alpha and Delta variants. New England Journal of Medicine, 386(8), 744–756.
• Greinacher, A., Thiele, T., Warkentin, T.E., et al. (2021). Thrombotic thrombocytopenia after ChAdOx1 nCov-19 vaccination. New England Journal of Medicine, 384(22), 2092–2101.
• Jolliffe, D.A., Holt, H., Greenig, M., et al. (2022). Effect of a test-and-treat approach to vitamin D supplementation on risk of all cause acute respiratory tract infection and covid-19: phase 3 randomised controlled trial (CORONAVIT). BMJ, 378, e071230.
• Kompaniyets, L., Pennington, A.F., Goodman, A.B., et al. (2021). Underlying medical conditions and severe illness among 540,667 adults hospitalized with COVID-19, March 2020–March 2021. Preventing Chronic Disease, 18, E66.
• Patone, M., Mei, X.W., Handunnetthi, L., et al. (2022a). Risks of myocarditis, pericarditis, and cardiac arrhythmias associated with COVID-19 vaccination or SARS-CoV-2 infection. Nature Medicine, 28(2), 410–422.
• Patone, M., Mei, X.W., Handunnetthi, L., et al. (2022b). Risk of myocarditis after sequential doses of COVID-19 vaccine and SARS-CoV-2 infection by age and sex. Circulation, 146(10), 743–754.
• Polack, F.P., Thomas, S.J., Kitchin, N., et al. (2020). Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine. New England Journal of Medicine, 383(27), 2603–2615.
• Prasad, S., Kalafat, E., Blakeway, H., et al. (2022). Systematic review and meta-analysis of the effectiveness and perinatal outcomes of COVID-19 vaccination in pregnancy. Nature Communications, 13, 2414.
• Stowe, J., Andrews, N., Kirsebom, F., Ramsay, M., & Lopez Bernal, J. (2022). Effectiveness of COVID-19 vaccines against Omicron and Delta hospitalisation, a test negative case-control study. Nature Communications, 13, 5736.
• Watson, O.J., Barnsley, G., Toor, J., et al. (2022). Global impact of the first year of COVID-19 vaccination: a mathematical modelling study. The Lancet Infectious Diseases, 22(9), 1293–1302.
• Xu, S., Huang, R., Sy, L.S., et al. (2021). COVID-19 vaccination and non-COVID-19 mortality risk — seven integrated health care organizations, United States, December 14, 2020–July 31, 2021. MMWR, 70(43), 1520–1524.