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Illustration: PGN

What you need to know

  • Scientists are questioning the evidence behind the Florida surgeon general’s recommendation against COVID-19 vaccines for young males.
  • The risk of myocarditis—a type of heart inflammation—from mRNA COVID-19 vaccines for young males is real, but it is very rare and tends to be relatively mild.
  • COVID-19 vaccines provide substantial benefits to people of all ages, including young men, by protecting against severe disease, lowering the chance of long COVID, and preventing myocarditis from viral infection.

Last month, Florida Surgeon General Joseph A. Ladapo announced that he is no longer recommending Pfizer’s and Moderna’s COVID-19 vaccines for males ages 18 to 39. The decision makes Florida the first and only state to go against federal COVID-19 vaccination guidance, which recommends mRNA vaccines for everyone 6 months and older.

Ladapo’s recommendation is based on a flawed analysis released by Florida’s health department that found “an 84 percent increase in the relative incidence of cardiac-related death among males ages 18 to 39 within 28 days following mRNA vaccination.” Since its release, the announcement has led to misinformation and questions around the risk of myocarditis from mRNA COVID-19 vaccines, especially for young men.

Fact check

The analysis that forms the basis of Ladapo’s recommendation is not published, is not peer reviewed, and does not include any listed authors. These characteristics cast a shadow over the study’s legitimacy. Peer review serves as a form of quality control for scientific papers, aiming to ensure research is properly verified before publication. Besides these concerns around transparency, outside scientists and other experts also questioned the analysis’s methods. 

The analysis investigates whether there is an increased risk of death shortly after vaccination (first 28 days post vaccination) compared to during a control period (29 days to 25 weeks after vaccination). It found that males 18 to 39 experienced a notable increase in risk of cardiac-related death shortly after getting an mRNA vaccine. But to reach this finding, the authors of the analysis used death certificate data rather than medical records, which is not a reliable way to determine cause of death. The authors note this shortcoming themselves in the limitations section, stating that they “cannot determine the causative nature of a participant’s death” and “the underlying cause of death may not be cardiac-related.”

Critics also took issue with the study’s small sample size and the seemingly random selection of several heart-related diagnoses, rather than limiting the data to myocarditis and/or pericarditis—the two types of heart inflammation that have been linked to mRNA COVID-19 vaccines.

Should young men get vaccinated against COVID-19? Yes.

The risk of myocarditis from mRNA COVID-19 vaccines for young males is real, but it is very rare and tends to be relatively mild. Based on CDC vaccine safety monitoring data along with peer-reviewed studies, the risk of vaccine-induced myocarditis likely ranges from five to 112 cases per million among young men—a clear increase compared to the background risk of about 0.2 to 2.2 cases per million.

But looking at this statistic alone misses the full picture. Vaccines provide substantial benefits to people of all ages, including young men. They prevent severe disease, hospitalization, and death from COVID-19 and lower the chance of developing long COVID symptoms. Vaccines also prevent myocarditis from COVID-19 infection, which is typically more severe than myocarditis caused by a vaccine. Peer-reviewed scientific articles have found that among vaccine-induced myocarditis patients, 2 percent go to the ICU and nearly all fully recover. In contrast, among patients who experience myocarditis caused by COVID-19 infection, half go to the ICU, a quarter do not fully recover, and up to 22 percent die. 

Both the CDC and the FDA recommend COVID-19 vaccines for everyone 6 months and older, including young men, as data continues to show that the benefits of vaccination outweigh the risks. Public health organizations including the American Academy of Pediatrics and the American Heart Association also support COVID-19 vaccines as safe and effective.