As anyone semi-sentient knows the great Serbian tennis player Novak Djokovic has won more Grand Slam tennis tournaments than any male player in history. He might have won two more had he not been denied entry to Australia and the US last year because he refused to take the COVID vaccine and thus was unable to play in two Grand Slam competitions. I doubt that he was aware that he was engaging in one of medicine’s most essential exercises – a risk/benefit analysis.

Any regimen that has beneficial effects will also have undesirable effects. The clinician must weigh the treatment’s desired outcome against the likelihood of unwanted reactions. When the COVID vaccine first appeared it was issued under emergency authorization with almost no evidence as to both its therapeutic value and the incidence of serious side effects resulting from its use.

What was known before the advent of the first vaccine was that COVID was a disease of the ill and the elderly. Thus, those most in need of a vaccine were those at greatest risk from the disease. A higher incidence of ill effects from the vaccine would be tolerable in a population at high risk of serious illness or death from the new virus. The same incidence of side effects in a low risk population – ie, the young and healthy – would be unacceptable.

As predicted here, and at several other sources, the virus became more infectious and less lethal as time passed. The vaccines proved to be of evanescent duration and uncertain effectiveness as is the norm for vaccines against respiratory viruses. The frequency and severity of the vaccine’s ill effects have been fiercely debated since it first appeared. Such a debate is required to fully understand the risk/benefit ratio of any new treatment. What’s not acceptable has been the vaccine’s adherents attempt to stifle this discussion by censoring doubters and engaging in ad hominem attacks. Declaring vaccine mandates on the young and healthy was extremely ill advised in the absence of full knowledge of whether the series of vaccine variants posed a serious health threat to those who were at extremely low risk from the coronavirus. The recommendation of a vaccine booster every few months has no precedent in medical therapy and could pose a new set of unwanted immunological events.

Back to Mr Djokovic. He was and still is in about as superb physical condition as is possible for a human to be. His risk from COVID was almost certainly less than that from the vaccine. His rejection of the vaccine was a valid medical decision that almost any disinterested physician would have supported. There was likely no upside for him from the vaccine – it was all side effects in his case. If I were in as good condition as he is I too would have refused the jab. Punishing him and others who stood to benefit almost nothing from the vaccine was an act of extreme foolishness verging on malice. The failure of much of medicine’s leadership to make decisions based on individual patient characteristics is a stain on the profession.

What follows is an opinion based on decades of observation, but it remains an opinion not an incontrovertible fact. My experience has been that many physicians who attain leadership positions, especially in the government, do not represent the best medical teachers, practitioners, and/or medical scientists. They often are better at politics than they are at medicine. They frequently tailor their analyses and recommendations to what they think is desired from the political class rather than give advice that is distasteful to those who want easy solutions to complicated problems. Politicians typically want to use a crisis, any crisis medical or otherwise, to gain control over populations who do not conform to the wishes of those in authority. An epidemic does not obviate the Constitution.

Ironically, a foreign athlete made a better analysis of the COVID epidemic than did the leaders of our national medical institutions charged with the management of a serious public health emergency. Serious problems deserve serious analyses and recommendations for their alleviation.

The COVID virus will be with us for the foreseeable future. It will almost certainly resemble the annual flu epidemics that we have come to accept as an unpleasant, but unavoidable fact of life. Mandates should not be part of the response to either virus. There will always be a few who will be so devoted to face masks that they will be buried with one in place. Fine, that’s their choice. The rest of us will have to make the best decision in conjunction with our physicians as to how to respond to this new and persistent threat to health. With luck and forethought, the treatment will not be worse than the disease.