Benefits of COVID-19 Vaccination Outweigh the Rare Risk of Myocarditis, Even in Young Males

A CDC study, published in September 2021, found that patients with COVID-19 had nearly 16 times the risk for myocarditis than those without the disease, although the risk varied by sex and age. Male and female COVID-19 patients under 16 had almost 37 times the risk for myocarditis than those without infection, the study suggested. The risk was 7.4 times higher for patients between 16 and 24, and 6.7 times higher for patients 25 to 39 years old. Males had a higher risk than females.

About half of children with MIS-C, a rare complication of COVID-19 infection, develop myocarditis. As of Jan. 31, the CDC had reported 6,851 cases of multisystem inflammatory syndrome in children and 59 deaths, with most cases occurring in children 5 to 13.

Studies suggest that in the general population the risk of myocarditis is significantly higher after a SARS-CoV-2 infection than after vaccination. 

A study from Israel published in the New England Journal of Medicine on Aug. 25, found that vaccination with the Pfizer/BioNTech vaccine was associated with a smaller excess risk of myocarditis (2.7 additional events per 100,000 people) than a SARS-CoV-2 infection (11 additional events per 100,000 people).

And a large study published in Nature Medicine that looked at rates of hospitalizations or death from myocarditis, pericarditis and cardiac arrhythmias following vaccination or a COVID-19 positive PCR test in the U.K. also found that infections were much more likely than vaccines to cause myocarditis and other heart complications. 

“[W]hilst there are some increased risks of rare heart related complications associated with vaccines these are much lower than the risk associated with getting COVID-19. For example, we estimated between 1 and 10 extra events of myocarditis in 1 million people vaccinated with a first or second dose, but 40 extra cases in 1 million people infected with COVID-19,” Julia Hippisley-Cox, professor of clinical epidemiology and general practice at the University of Oxford and study lead, said in an interview for an Oxford website.

That study, though, did find differences in risk by age, with vaccine-associated myocarditis more likely among the under-40 crowd. “The risks are more evenly balanced in younger persons aged up to 40 years, where we estimated the excess in myocarditis events following SARS-CoV-2 infection to be 10 per million with the excess following a second dose of mRNA-1273 vaccine being 15 per million,” the authors wrote, referring to the Moderna vaccine.

The unpublished study that Paul cited to support his claim that “the risk of myocarditis for young males is greater for the vaccine than it is for the disease” is an expanded analysis by the same team, which added data from children ages 13 to 17 and from people receiving a booster. The new data didn’t change the conclusions for the overall population — “the risk of hospital admission or death from myocarditis is greater following COVID-19 infection than following vaccination,” it says. But it found that in males under 40, the risk of myocarditis following vaccination was “similar” to infection — and in what the authors termed a “notable exception,” the risk was higher than infection following a second dose of the Moderna vaccine in younger males.

It’s possible, then, that the risk of myocarditis is higher after a COVID-19 vaccine than after COVID-19 for certain people, particularly younger males. But that doesn’t mean people shouldn’t get vaccinated. Focusing solely on myocarditis is misleading because it ignores the fact that SARS-CoV-2 infection comes with other dangers, including a medley of other heart complications.

No vaccine or medical product is 100% safe, but as CHOP’s Offit told us, the choice to not get a vaccine is not a risk-free choice, either. “It’s just a choice to take a different risk,” he said. “And that different risk is the greater risk.”

Elias agrees. “Heart issues, whether we call it myocarditis or myocardial injury or MIS-C — these issues are much more common and they’re much more severe with the infection compared to the vaccine” in young people, he said. “I strongly recommend that everyone who’s eligible for the COVID-19 vaccine receive the vaccine as soon as possible.”

Editor’s note: SciCheck’s COVID-19/Vaccination Project is made possible by a grant from the Robert Wood Johnson Foundation. The foundation has no control over FactCheck.org’s editorial decisions, and the views expressed in our articles do not necessarily reflect the views of the foundation. The goal of the project is to increase exposure to accurate information about COVID-19 and vaccines, while decreasing the impact of misinformation.

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