Social Media Swirls With Unsupported Claims About Cause of Justin and Hailey Bieber’s Medical Conditions

SciCheck Digest

Pop star Justin Bieber announced he has Ramsay Hunt syndrome, a form of facial paralysis caused by a reactivation of the virus that causes chickenpox. Social media posts have claimed his condition was caused by COVID-19 vaccination, but there is no established link between vaccination and the syndrome. Some posts have also baselessly claimed vaccination was behind a mini-stroke suffered by Bieber’s wife, Hailey.

How safe are the vaccines?

How safe are the vaccines?

More than half a billion doses of COVID-19 vaccines have now been administered in the U.S. and only a few, very rare, safety concerns have emerged. The vast majority of people experience only minor, temporary side effects such as pain at the injection site, fatigue, headache, or muscle pain — or no side effects at all. As the Centers for Disease Control and Prevention has said, these vaccines “have undergone and will continue to undergo the most intensive safety monitoring in U.S. history.”

A small number of severe allergic reactions known as anaphylaxis, which are expected with any vaccine, have occurred with the authorized and approved COVID-19 vaccines. Fortunately, these reactions are rare, typically occur within minutes of inoculation and can be treated. Approximately 5 per million people vaccinated have experienced anaphylaxis after a COVID-19 vaccine, according to the CDC.

To make sure serious allergic reactions can be identified and treated, all people receiving a vaccine should be observed for 15 minutes after getting a shot, and anyone who has experienced anaphylaxis or had any kind of immediate allergic reaction to any vaccine or injection in the past should be monitored for a half hour. People who have had a serious allergic reaction to a previous dose or one of the vaccine ingredients should not be immunized. Also, those who shouldn’t receive one type of COVID-19 vaccine should be monitored for 30 minutes after receiving a different type of vaccine.

There is evidence that the Pfizer/BioNTech and Moderna mRNA vaccines may rarely cause inflammation of the heart muscle (myocarditis) or of the surrounding lining (pericarditis), particularly in male adolescents and young adults.

Based on data collected through August 2021, the reporting rates of either condition in the U.S. are highest in males 16 to 17 years old after the second dose (105.9 cases per million doses of the Pfizer/BioNTech vaccine), followed by 12- to 15-year-old males (70.7 cases per million). The rate for 18- to 24-year-old males was 52.4 cases and 56.3 cases per million doses of Pfizer/BioNTech and Moderna vaccines, respectively.

Health officials have emphasized that vaccine-related myocarditis and pericarditis cases are rare and the benefits of vaccination still outweigh the risks. Early evidence suggests these myocarditis cases are less severe than typical ones. The CDC has also noted that most patients who were treated “responded well to medicine and rest and felt better quickly.”

The Johnson & Johnson vaccine has been linked to an increased risk of rare blood clots combined with low levels of blood platelets, especially in women ages 30 to 49. Early symptoms of the condition, which is known as thrombosis with thrombocytopenia syndrome, or TTS, can appear as late as three weeks after vaccination and include severe or persistent headaches or blurred vision, leg swelling, and easy bruising or tiny blood spots under the skin outside of the injection site.

According to the CDC, TTS has occurred in around 4 people per million doses administered. As of early April, the syndrome has been confirmed in 60 cases, including nine deaths, after more than 18.6 million doses of the J&J vaccine. Although TTS remains rare, because of the availability of mRNA vaccines, which are not associated with this serious side effect, the FDA on May 5 limited authorized use of the J&J vaccine to adults who either couldn’t get one of the other authorized or approved COVID-19 vaccines because of medical or access reasons, or only wanted a J&J vaccine for protection against the disease. Several months earlier, on Dec. 16, 2021, the CDC had recommended the Pfizer/BioNTech and Moderna shots over J&J’s.

The J&J vaccine has also been linked to an increased risk of Guillain-Barré Syndrome, a rare disorder in which the immune system attacks nerve cells. Most people who develop GBS fully recover, although some have permanent nerve damage and the condition can be fatal.

Safety surveillance data suggest that compared with the mRNA vaccines, which have not been linked to GBS, the J&J vaccine is associated with 15.5 additional GBS cases per million doses of vaccine in the three weeks following vaccination. Most reported cases following J&J vaccination have occurred in men 50 years old and older.

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Canadian pop singer Justin Bieber announced to fans on June 10 that he was canceling some upcoming shows because he has Ramsay Hunt syndrome, a rare neurological disorder that involves facial paralysis.

“Obviously, as you can probably see from my face, I have this syndrome called Ramsay Hunt syndrome, and it is from this virus that attacks the nerve in my ear and my facial nerves and has caused my face to have paralysis,” he said in a video posted to Instagram, which showed him unable to move the right side of his face.

Ramsay Hunt syndrome is caused by the varicella-zoster virus, the same virus that causes chickenpox. Similar to shingles, Ramsay Hunt occurs when the virus, which remains dormant in neurons after a chickenpox infection, reactivates — specifically in neurons in the facial nerve. This can cause facial paralysis as well as a rash on the ear and other ear or hearing problems.

“Ramsay Hunt is shingles of the ear,” Dr. Joseph R. Berger, a neurologist at the University of Pennsylvania, told us.

While Bieber made no mention of COVID-19 vaccination — and has not even publicly shared whether he is vaccinated — people online soon began suggesting or stating as fact that his condition was caused by a COVID-19 vaccine.

“Justin Bieber’s face paralysis is a side effect of the juice,” reads one post, accompanied by a hundred points emoji.

Other posts pulled in Bieber’s wife to baselessly claim her recent health problems were also caused by vaccination. Hailey Bieber, a model, suffered a transient ischemic attack, or ‘mini-stroke,’ in March, in part due to a heart defect with which she was born.

“Hailey Bieber had a blood clot in her brain. Justin Bieber now has Ramsey Hunt Syndrome,” an Instagram post reads, before using a syringe emoji to claim that both conditions “have been linked” to COVID-19 vaccination. “The media thinks we are stupid but everyone knows,” it adds, using the hashtags #itsobvious and #wetriedtowarnyou.

There is no good evidence that either of the Biebers’ conditions have anything to do with COVID-19 vaccination. As we said, Ramsay Hunt syndrome is caused by varicella-zoster virus. Because the COVID-19 vaccines do not infect people with VZV, COVID-19 vaccination cannot be the ultimate cause of Ramsay Hunt.

There are questions about whether the COVID-19 vaccines might be able to trigger reactivation of the virus in those who previously had chickenpox. But this remains speculative at this time, as studies have not consistently identified an association between vaccination and a higher risk of such conditions.

As for Hailey, there is no evidence COVID-19 vaccination played a role in her blood clot, which traveled to her brain through a congenital hole in her heart, and which her physicians attributed to other risk factors.

FactCheck.org could not find any instance of either Bieber publicly stating that they had been vaccinated. We reached out to Justin’s manager, Scooter Braun, and Justin’s record label, but did not hear back. However, the couple did attend the Met Gala in September 2021, which required full vaccination. At least some of Justin’s concerts have also required attendees to be vaccinated. Thus, while it’s likely both have been vaccinated, it’s not certain, and we don’t know when or how many doses they might have received.

Ramsay Hunt Syndrome

To support their claim about Bieber, several posts cite case reports of people who developed Ramsay Hunt following COVID-19 vaccination. This includes a report of a 37-year-old male in Hong Kong who developed symptoms two days after his first dose of the Pfizer/BioNTech vaccine, along with a 78-year-old woman in Spain who had ear pain and other symptoms three days after receiving the same vaccine.

Justin Bieber and Hailey Bieber attend the Grammy Awards on April 3, 2022, in Las Vegas, Nevada. Photo by Axelle/Bauer-Griffin/FilmMagic via Getty Images.

Other studies have reported a small number of people who have had VZV reactivations following vaccination, including a set of 10 patients with rheumatic diseases in Taiwan.

But case reports are not proof of anything.

“It’s purely speculative when you look at a single case report and try to conclude causation or even an association,” Dr. Maria Nagel, a neurologist and neurovirologist who studies VZV at the University of Colorado School of Medicine, told us. Saying there’s a link would be “like a few people reporting that they stubbed their toe after vaccination and we conclude that [the] vaccine causes stubbed toes.”

“The fact that somebody’s gotten the vaccine and then gotten Ramsay Hunt, what you’d have to do is demonstrate not only a temporal relationship, but the fact that it occurs at a higher rate in that population than in the population in general,” Berger said. “You can’t use anecdote as data.”

The results from larger epidemiological studies about COVID-19 vaccination and shingles or VZV reactivations have been mixed. A few, including an analysis of data from a health care organization in Israel, have identified an association, but others have not.

Data from safety monitoring systems in the U.S. do not suggest a connection.

“CDC has detected no unusual or unexpected patterns of Ramsay Hunt syndrome following immunization that would indicate COVID-19 vaccines are causing or contributing to this condition,” a Centers for Disease Control and Prevention spokesperson told us in an email. “Evidence at this time does not support a causal association between COVID-19 vaccination and the development of Ramsay Hunt syndrome or herpes zoster (shingles). Safety monitoring for these outcomes is ongoing.”

“The evidence is pretty thin,” Berger said, adding that he was “skeptical” of a “meaningful association” between vaccination and Ramsay Hunt.

The available evidence also does not support a connection between COVID-19 vaccination and Bell’s palsy, a more common and less severe form of facial paralysis than Ramsey Hunt that is sometimes thought to be due to VZV reactivation, although more often is thought to be due to reactivation of herpes simplex virus. In the vaccine trials for the two COVID-19 mRNA vaccines, there were a few more people who developed Bell’s palsy in the vaccinated versus the placebo groups, but the frequency was similar to what would be expected in the general population. Subsequent monitoring has not revealed safety concerns.

Given that large-scale studies are inconclusive about a possible link between COVID-19 vaccination and VZV reactivation and the lack of such a safety signal in the U.S., the claim that there is a link or that the vaccine is responsible for Bieber’s condition is unsupported.

Even if vaccination does increase a person’s risk of VZV reactivation, the risk would likely be low, and would not mean the risks of the vaccine would outweigh the benefits, contrary to posts that attempt to use Bieber’s case to argue against vaccination. Indeed, even many of the published papers that propose a possible link to Ramsay Hunt or shingles are careful to note this.

Ramsay Hunt Syndrome Triggers

It’s not fully understood what causes VZV reactivations, such as with shingles and Ramsay Hunt syndrome, but is thought to primarily be the result of the immune system’s inability control the virus.

Older people and those with weakened immune systems are at higher risk, and medications, infections and stress are possible triggers.

But sometimes there is no obvious cause.

“We also see it in individuals that are otherwise perfectly healthy, immunologically, who are young,” Berger said of shingles. “It just is one of those things that can occur without there being a known precipitant or a good explanation.”

Nagel said that if she saw a younger patient, such as 28-year-old Bieber, with Ramsay Hunt, she would first ask when he had chickenpox as a child.

“If you’re four years old or under, you don’t have good immune memory. And those kids tend to flare up virus at a younger age,” she said. “They might get shingles, also known as herpes zoster, when they’re 12 years old, or in their 20s.”

She said she’d also ask about recent infections and other medical conditions or medications that weaken the immune system.

Bieber, notably, had a mild case of COVID-19 in mid-February.

Multiple case reports have suggested that COVID-19 increases the risk of VZV reactivation, but as with the case reports of events following vaccination, these reports do not mean anything on their own. One large study found that among adults 50 years of age and older, those who had had COVID-19 were 15% more likely to develop shingles than those who had not been sick with the coronavirus. But another large study — the Israeli one that found an association between the Pfizer/BioNTech vaccine and shingles — did not observe an increased risk of shingles with COVID-19.

Berger, who said he usually sees a couple of cases of Ramsay Hunt a year, said he has not seen an uptick in cases during the pandemic or with the rollout of vaccines.

Regardless of the cause, if someone is experiencing facial paralysis or other symptoms of Ramsay Hunt, Berger and Nagel both said to seek medical attention as soon as possible.

“The longer you wait, the more likely there is to be permanent damage to the nerve,” Berger said. Ramsay Hunt is typically treated with antiviral medications and steroids to reduce swelling, he said, and about half of patients fully recover, but it can take months.

Ramsay Hunt Syndrome Prevention

There are chickenpox and shingles vaccines that can reduce the risk of VZV infection or reactivation, and thereby lower the risk of Ramsay Hunt syndrome.

The chickenpox vaccine is a two-dose vaccine made from weakened, or attenuated, varicella-zoster virus, which is around 90% effective in preventing the disease. While some people who are vaccinated get shingles later, the CDC says this is “much less common after vaccination than after chickenpox disease.”

The chickenpox vaccine was first used in the U.S. in 1995 as a single-dose vaccine. Bieber, who is Canadian, likely was never vaccinated, as the vaccine wasn’t licensed there until 1998 and was not part of routine childhood immunization programs until 2000 or later, when he was 6.

Older people 50 and above and immunocompromised adults 19 years of age and older are eligible to receive the shingles vaccine, which prevents shingles and long-term nerve pain due to shingles called postherpetic neuralgia. The vaccine, known by its brand name Shingrix, is a two-dose vaccine that does not contain live virus and is 85% effective or more, depending on age, in healthy people.

Baseless Claim About Hailey Bieber

In addition to Justin’s Ramsay Hunt syndrome, social media posts have — without evidence — blamed Hailey Bieber’s transient ischemic attack, or TIA, on COVID-19 vaccination.

As we have written, only one of the FDA-authorized vaccines, the Johnson & Johnson vaccine, has been linked to blood clots, but it is a very particular and rare problem known as thrombosis with thrombocytopenia syndrome, or TTS. In the condition, which has occurred in about 4 cases per million doses of vaccine administered, blood clotting occurs together with low levels of platelets.

Hailey’s description of her clinical case, however, bears no suggestion that she suffered from TTS, nor is there evidence that she was even vaccinated with the Johnson & Johnson vaccine.

In an April 27 YouTube video, Hailey described her experience in detail, never mentioning COVID-19 vaccination — and in fact giving other reasons why doctors suspect she had a blood clot in her brain.

According to her account, her doctors attributed the clot to a “perfect storm” of three factors.

“One was that I had just recently started birth control pills, which I should have never been on because I am somebody who suffered from migraines anyway, and I just did not talk to my doctor about this,” she said.

“The second thing was I had recently had COVID, and that was something that they thought was a contributing factor,” she continued. “And the third thing was that I had recently gone on a really long flight — I had flown to Paris and back in a very short amount of time — and I slept through the whole flight both ways, didn’t get up and move around, never thought about wearing compression socks.”

Hailey’s doctors also discovered she had a natural opening between the two chambers of her heart called a patent foramen ovale, which she had been born with and had likely allowed the clot to travel to her brain and cause the TIA. She has since had surgery to close the hole.

It’s unclear when she had COVID-19, but numerous studies have now shown there is an increased risk of clotting and cardiovascular problems after infection with the coronavirus.

Dr. Adam Cuker, a hematologist with expertise in blood clots at Penn Medicine, told us that her case did not raise any concerns about the vaccines.

“It sounds like she developed a DVT and then a piece broke off, traveled through the hole in her heart … and into her brain,” he said, referring to the deep vein thrombosis, the technical term for a blood clot. “This process is called paradoxical embolism.”

If she did have TTS as a result of the J&J vaccine, Cuker said, her platelets would have been low — something that he thought was highly likely to have been checked — and anti-platelet factor 4 antibodies would also be elevated. Bieber mentions neither, but does say in her video that while at the hospital her doctors ran a lot of tests, including “blood tests to see if I had a clotting disorder.”

“Much more likely, she developed a garden variety DVT with the risk factors of hormonal contraception, long-haul travel, and possibly recent COVID,” he said. “There is nothing here that suggests a link with this event and vaccination.”