Vaccines and Fat People - A History of Exclusion and Blame

Fat people and vaccines - Part 1

This is the first in a two-part series looking at vaccines and fat people. If you want to make sure that you don’t miss part two (and the rest of the posts I put out each Wednesday and Saturday,) you can always subscribe to the this newsletter!

I talk a lot about how not being included in healthcare research harms fat people and then, to add insult to literal injury, fat bodies are blamed for those harms. Vaccines are, unfortunately, an excellent example of this.

A History of Exclusion

Vaccines themselves have often been tested on groups that excluded fat people. Then, when the resulting vaccines had less efficacy for fat patients, it was blamed on their body weight and not on the faulty research sample.

This has carried forward to today. During the development stage of the COVID vaccines, for example, CNN ran an article with the headline “US Ob*sity* epidemic could undermine COVID vaccine.”

The article explained that fat people are often left out of drug trials, including for vaccines, and that we’ve known since at least 1985 that the vaccines produced through these trials can be less effective for fat people. So, was their conclusion that researchers need to do a better job of including fat people in research to make sure that they are also protected? Of course not! They concluded that the existence of fat people will undermine the effectiveness of a vaccine for COVID-19 for reaching herd immunity, which could harm thin people.

The article notes that previous vaccines are also less effective on older people and so a protocol was developed to solve that problem. For fat people – nothing but blame.

This is just blatant weight stigma. They’ve known for 35 years that the current process of creating vaccines puts fat people’s lives at greater risk, but have done nothing to solve that problem. Now, when it could seriously impact the lives of thin people, they are trying to pile the blame on fat people for existing.

The COVID Vaccines

Unlike vaccine development in the past, fat people were actually well-represented in, for example, the Pfizer COVID vaccine  trials (comprising 70% of the total subjects.) And the vaccine was shown to be equally effective on fat people. (Research on this is available here (look as slides 42 and 43) and here, with a trigger warning on both for fatphobic language and special thanks to Deb Burgard for finding these references.

The Guardian headline read “Pfizer vaccine may be less effective in people with ob*sity, says study” with the subtitle “Healthcare workers with ob*sity found to produce only about half the antibodies healthy people do”

The headline, subtitle, and article that follows are, at best, an example of the stunning scientific illiteracy that exists in mainstream reporting and, at worst an abandonment of journalistic ethics in the pursuit of the clicks that fatphobia always generates.

Just in summary, “fat people’ and “healthy people” are not two opposite, comparable categories. There are people of all health statuses at all weights, (and “person first language” for fat people is a terrible idea.) Also, the study actually found that older people, cis men, and fatter people had similar responses, but all we’re hearing about in this story (and every other one I’ve seen) is fat people.

The study had not even been peer-reviewed yet, and there was no action to be taken by the public based on its findings, so there was no reason (and certainly no rush) to publish it in a way that increased weight stigma, and possibly decreased fat people’s willingness to be vaccinated.

The study’s own authors explain that

A large clinical trial phase 2/3 with 44,000 people showed that a two-dose regimen of the vaccine BNT162b2, developed by BioNTech and Pfizer, has 95% efficacy in preventing symptomatic COVID-19.

To reiterate, those were large-scale trials designed to test efficacy, and they showed 95% efficacy in preventing symptomatic COVID-19 including for fat people.

The study that The Guardian is discussing is a small study (248 people, all healthcare workers) whose goal was to look at a specific immune response in vaccinated people, and then compare that response between groups based on factors including age, gender (on a binary only, as is often the case there is a complete lack of trans and nonbinary representation here,) and BMI (which they admit is a “crude measurement” which is just scratching the surface in terms of the issue with using a measurement that is rooted in racism and weight stigma.)

When it comes to study design, this line is of particular interest:

Although the role of neutralizing antibodies to SARS-CoV-2 is under investigation, measurement of serum neutralizing activity has been demonstrated to correlate with protection for other respiratory viruses, such as influenza(3) or respiratory syncytial virus(8) and is commonly accepted to be a functional biomarker of invivo disease protection(9).

Which is to say that they aren’t entirely sure if/how/to what degree the immune response they are studying actually impacts COVID immunity.

So they administered both recommended doses of the vaccine, and then tested for specific antibody levels seven days after the booster dose.

As I mentioned before, their results found that cis men, older people, and fatter people all developed fewer antibodies than cis women, younger people, and thinner people respectively (though there was a lot of overlap in the actual ranges.)

Now I want to be clear, it’s important that research like this happens. It is absolutely possible that different bodies have different immune responses and thus require different vaccine protocols (the “supershot” flu vaccine being created for older people whose response to the typical flu vaccine isn’t as robust is a good example of this.) There is no shame in having a different immune response to a vaccination. And, again, the fact that fat people also don’t respond as well to flu vaccine but that there is no alternate protocol developed for fat people is a good example of fatphobia in medicine, and there is deep shame in medical fatphobia.

What we cannot scientifically, and should not ethically, do is blame fat bodies for this issue. And what we should not do from a place of journalistic ethics is report on small, pilot studies as if they provide information that is immediately useful and relevant to the general public.

It’s also important to point out that, if the antibodies that they are testing do in fact provide immunity, the study authors have no idea what level of antibodies would be required to confer that immunity, so they don’t know if older people, cis men and fat people are producing enough antibodies or not, which is to say that the fact that they produce less may not have any impact on actual immunity.

What we do know is that in large-scale trials that included fat people, the Pfizer Vaccine was shown to be “95% effective in preventing symptomatic COVID-19”

I cannot stress enough that absolutely no conclusions can be drawn from the small study that the Guardian and other outlets “reported” on. More research is needed and until it is completed this type of “reporting” is dangerous and inappropriate.

I reached out to Deb Burgard, PhD, who is a psychologist and expert in weight science, for her thoughts, which she generously shared. She added the following (and found the links to the original Pfizer data.)

I really just have one question, which is whether the use of the measured antibodies from the swab test on day 7 should be an operational definition of ability to fight the virus, especially when we have other studies that did not show a difference between BMI groups in the actual relevant outcomes like getting sick or being hospitalized or dying.

She also pointed out other issues with the study:

There are other factors that can correlate with BMI among hospital workers – like Socioeconomic status (fewer fat doctors than nurses, fewer fat RNs than LVNs) – you have all kinds of possible confounding variables. It is even possible to posit that something about the physiology of thin and fat people could be different so that different snapshots might emerge on day 7 but it doesn’t make a difference in how people do after actual exposure.

She concluded

I understand their wanting to know if they should tweak the dosages for higher or lower BMI but there really isn’t a shortcut to doing the science and seeing what happens in the real world.

So what does this study mean? To researchers – that more studies are necessary. To the general public – not a damn thing. It’s been recommended that everyone get vaccinated and then continue to take precautions, and that recommendation is unchanged for men, older people, and fat people regardless of the findings of this study.

I also want to point out that all of this does more harm to the highest weight people as well as those with multiple marginalizations because of the additional harm done by a history of oppression around healthcare and vaccines including racism, homophobia, transphobia, ableism et. al.

So, then, what do all these headlines mean? My guess is they means that fatphobia sells and CNN, The Guardian, and other outlets that published similar headlines, are hoping we are buying.

In part two we’ll talk about whether higher-weight people need longer vaccine needles.

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More research and resources:
https://haeshealthsheets.com/resources/

*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings’ Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison’s Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.