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Covid-19: Fourth vaccine doses—who needs them and why?

BMJ 2022; 376 doi: (Published 07 January 2022) Cite this as: BMJ 2022;376:o30

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Re: Covid-19: Fourth vaccine doses—who needs them and why?

Dear Editor

We believe that the current panic about Omicron is unjustified, that “vaccinating” children is unnecessary and potentially dangerous and that banning unvaccinated staff from working in health services is not based on science.

Deaths from Covid-19 plateaued in this current wave of the pandemic and this has been attributed to the effect of the vaccination programme. In early December 2021, the running daily average number of deaths reported within 28 days of testing positive or in which Covid-19 is included on the death certificate was about 100 having peaked at 136. This compared with a peak running daily average of 1,128 during the 3rd wave at the end of January 2021 (1).

However the advent of the new Omicron variant sent the Government into a panic and this resulted in the reintroduction of mask wearing in shops and public transport and a greater emphasis on the vaccination of children and young adults and the administration of booster doses to younger and younger cohorts. Moreover such vaccination and booster doses are becoming mandatory for healthcare workers, whether in the care sector or NHS and there is talk of a fourth vaccine dose (a second booster).

The justifications for this extra push are threefold:
The observation that the vast majority of the deaths in the 3rd wave (January to July 2021) were in unvaccinated patients. In total, there were 256 breakthrough deaths* between 2 January and 2 July 2021 out of a total of 51,281.(2) The proportion of immunocompromised patients who had breakthrough deaths was more than twice that in the much larger group who were unvaccinated deaths.
The supposed reduction in transmission in the vaccinated cohort thus protecting the vulnerable.
Prevention of long Covid

A quote from the Office of National Statistics reveals that, as suspected, the death rate is highest in the elderly and non-existent in the young:
“The number of deaths involving COVID-19 was highest among those aged 85 years and over and lowest in those aged under 15 years, where there were no deaths.” (3)
See also Table 1 (below). Therefore vaccinating young people, and in particular those under 15, can only be for the second two reasons as they are not at risk of dying from the disease and were not even at risk with the earlier, more severe variants.

Although the initial data showed that transmission was reduced in the vaccinated group this has not been maintained with the later variants. A paper in the Lancet (4) states “Recent data, however, indicate that the epidemiological relevance of COVID-19 vaccinated individuals is increasing. In the UK it was described that secondary attack rates among household contacts exposed to fully vaccinated index cases was similar to household contacts exposed to unvaccinated index cases (25% for vaccinated vs 23% for unvaccinated).”

Thus vaccinating children to protect their parents and grandparents does not work and it cannot be justified on those grounds.

So that only leaves prevention of long Covid, which does certainly affect some children and young adults. Dyani Lewis, writing in Nature, (5) stated that some 13% of children aged 12-16 had at least one lingering symptom five months later. This is, however, considerably fewer than in adults. Moreover an unknown percentage of the children may have suffered from chronic fatigue syndrome without the advent of Covid-19.
The vaccines are known to have inherent dangers. Indeed the official leaflet (6) shown to people receiving the Pfizer as a booster** states that very fact: “Serious Side Effects. Worldwide there have been recent very rare cases of inflammation of the heart called myocarditis or pericarditis reported after Pfizer or Moderna Covid-19 vaccines. These cases have been seen mostly in younger men…” The leaflet also cites general aches and flu like symptoms as common side effects.

Astra-Zeneca and Johnson and Johnson vaccines are also known to cause venous thrombosis and there have been some reports of similar problems with Moderna.

We have heard anecdotal reports of an increase in myocarditis and myocardial infarction and of deaths of young adults within 48 hours of receiving the booster. We believe that the dangers are understated and that in young adults and children the risks from vaccination and boosters outweigh the benefits.

Reports now suggest that the rate of people admitted to hospital who are testing positive to Covid-19 is rising significantly and the death rate of people within 28 days of testing positive has doubled. This is inevitable because the Omicron variant is highly transmissible. However the number admitted because of Covid-19 is considerably lower than the stated figure: in some it is an incidental finding and in others the disease has been caught whilst in hospital. (7)

Problems are occurring in the health services due to a lack of staff. Healthy people who refuse to be vaccinated should not be excluded from working in the health services as there is no evidence that vaccination prevents transmission of the virus and their expertise is needed.


Having had three vaccine shots against Covid-19 does not protect against the Omicron variant and it is unlikely that a fourth vaccine dose will so so either. It is generally accepted that the Omicron is more contagious but considerably less harmful on an individual basis. Isolation and protection should now be limited to those who are extremely vulnerable. In particular it is important to stop the mandatory requirement for health care staff to be vaccinated and halt the roll out of vaccine to children.

Vaccinating young people is not justified moreover banning unvaccinated staff from working in health services is not based on science and is a serious “own goal.”

In addition the published data of people dying with Covid-19 must be changed such that only those in which Covid-19 was a significant factor in causing death are included.

“Breakthrough death is defined as a death involving COVID-19 that occurred in someone who had received both vaccine doses and had a first positive PCR test at least 14 days after the second vaccination dose…
**It is interesting that one of the authors of this paper (PRG) was shown the leaflet when having a booster but was not allowed to keep it. He did, however, photograph it so the quote is exact.


1) JHU CSSE COVID-19 Data 
2) Deaths involving COVID-19 by vaccination status, England: deaths occurring between 2 January and 2 July 2021
3) Coronavirus (COVID-19) latest insights: Deaths
4) The epidemiological relevance of the COVID-19-vaccinated population is increasing, Günter Kampf
6) Pfizer leaflet when author PRG having the booster.
7) How can we measure the true scale of UK Covid Hospital Admissions? Nicola Davis:
8) Chttps:// Covid-19 Fatality Rate by Age from Worldometer

Conflict of interests

Prof. Paul R Goddard BSc., MBBS, MD, FRCR, FBIR, FHEA is author of PANDEMIC (1st and 2nd editions) Clinical Press Ltd. 2020 and 2021
Prof. Angus Dalgleish BSc, MBBS, MD,FRCP,FRCPath, FRACP, FMedSci is co-author of The Origin of the Virus, Clinical Press Ltd 2021

Table 1
Age Death rate (all cases, confirmed or not)
80+ 14.8%
70-79 8 %
60-69 3.6%
50-59 1.3%
40-49 0.4%
30-39 0.2%
20-29 0.2%
10-19 0.2%
0-9 0%

Fatality Rate by Age (Extracted from Worldometer Data, updated May 2021 (8))

Note that the percentage with underlying conditions was high, particularly in the under 50s who died from Covid-19.
This is the chance of patients with Covid-19 dying per age group as a percentage not the percentage of overall deaths.

Competing interests: Prof. Paul R Goddard is author of PANDEMIC (1st and 2nd editions) Clinical Press Ltd. 2020 and 2021. Prof. Angus Dalgleish is co-author of The Origin of the Virus, Clinical Press Ltd 2021

10 January 2022
Paul Goddard
Retired Professor of Radiology
Angus Dalgleish
Emeritus Professor University of the West of England