Yes, self reported side effects could be untrue. I think that the value is that if something pops up enough it can lead to a clinical trial. That is how they got a clinical trial underway for menstruated irregularities after the vaccine. The self-reporting system is unfortunately one of the few ways to document patient concerns, and though it’s nothing definitive, it has value. Relying on a medical provider to document the patients issues would also carry issues with bias, accurate reporting, and would also deter many patients.
I agree that the risk of the vaccine is relatively low. It’s not zero…but it’s low. I’d probably want to know the patients specific concerns about the vaccine before heart transplant, but it’s hard to imagine a great excuse. I think your question about whether this guy refusing medical advice would result in him not doing well if he got the heart has some level of truth. If someone is WILLING TO DIE over this vaccine issue, it makes you wonder about mental illness, and how he’d treat his new heart in general. Now whether Harvard should be dangling the vaccine over his head is questionable. I can honestly see the arguments both ways. I think it’s our job to not care about the politics and to care for patients. It may be Harvard’s policy to not perform elective procedures on unvaccinated because of risk of bringing them into the hospital. Maybe there is great evidence that COVID patients do poorly after transplant and the vaccine mitigates the negative risks of COVID on a transplanted heart. Not my specialty. I’d hope that they are making their decisions based on good science and not politics.