Needle Points ｜ Norman Doidge ｜ EP 222 (UfEkp_TFvY0)

https://youtubetranscript.com/?v=UfEkp_TFvY0

Hello everyone. I’ve begun to consider using my YouTube channel and podcast for material generated by people other than myself. I recently put up a lecture by Jonathan Pagio that was delivered to the Jung Society in Montreal. I thought it was particularly brilliant discussion of the underlying narrative structure and conceptual structure of Genesis. I added that to the sequence of my videos on Genesis. My wife is going to be releasing a series of interviews with Jonathan Pagio as part of her investigation into the nature of the divine feminine. So that’s coming up soon and in this instance I asked my friend and colleague psychiatrist Dr. Norman Deutsch to read a essay he wrote a few weeks ago called Needle Points which is the most penetrating analysis that I’ve read about the COVID policies that have bedeviled and helped us over the last few years. Dr. Deutsch is a psychiatrist and a psychoanalyst and a solid scientist renowned for his writing on science and the brain and in my opinion Canada’s most literate physician writer. He’s also a friend and colleague of mine he wrote the introduction to 12 rules of life. His essay Needle Points which he’s reading today first appeared a few weeks ago in Tablet magazine but it’s perhaps even more relevant today. Like me, Dr. Deutsch is vaccinated. He describes the history of vaccines, praises what he calls the kernel insight and makes a solid and intelligent case for the utility of the technology. Then he details the COVID state of mind, describes the working and nature of the brain circuits triggered by contagion and helps explain why the issue of vaccination is tearing families, friendships, professions and even states apart. He describes why debates about vaccination and infection policies are always emotionally radioactive on both sides of the debate showing us why our reason is threatened during contagion detailing why we are then tempted to treat each other so badly. He explains why those who hesitate in the face of the current policies surrounding vaccination have concerns more justified by history and experience than they are often credited with particularly when their views are caricatured and demonized. He makes the case that the best path through the current crisis is not through coercion. That such coercion is in fact a reliable indicator of failed government communication and policy. Dr. Deutsch describes the alternative participatory model in which humane physicians speak to patients respectfully and as individuals with their own agency and explains that those who adopt this approach do much better public health work as would governments if they wished to enhance instead of degrade trust in public health. I’ve now shared this article with conservatives and liberals alike in Canada and Democrats and Republicans in the US. Many of them all who have received it and read it in this polarized time have expressed their appreciation for its content and its writer. Dr. Norman Deutsch did his homework as he always does. He’s the author of The Brain That Changes Itself and is currently a contributing writer for Tablet magazine where this article is published and where all the links to the scientific references he quotes can be found. He’s also executive director of Health and the Greater Good, a new think tank devoted to finding solutions to health problems that respect civil liberties so that neither health nor civil liberties need needlessly be at the expense of the other. I wanted to bring this article to the broadest public attention possible given its importance and felt that having Dr. Deutsch read it so that people could watch it and listen to it on YouTube and in podcasts, assuming that would be the most effective way to disseminate the information. So without further ado, Dr. Norman Deutsch and Needle Points. Needle Points. Why so many are hesitant to get the COVID vaccines and what we can do about it by Norman Deutsch read by the author October 27th 2021. Since my days in medical school, I’ve had a fascination with the kernel insight behind vaccination. That one could successfully expose a person to an attenuated version of a microbe that would prepare and protect them for a potentially lethal encounter with the actual microbe. I marveled at how it tutors an immune system that, like the brain, has memory and a kind of intelligence and even something akin to foresight. But I loved it for a broader reason too. At times, modern science and modern medicine seem based on a fantasy that imagines the role of medicine is to conquer nature, as though we can wage a war against all microbes with antimicrobials to create a world where we will no longer suffer from infectious disease. Vaccination is not based on that sterile vision, but it’s opposite. It works with our educable immune system, which evolved millions of years ago, to deal with the fact that we must always coexist with microbes. It helps us to use our own resources to protect ourselves. Doing so is in accord with the essential insight of Hippocrates, who understood that the major part of healing comes from within, that it is best to work with nature and not against it. And yet, ever since they were made available, vaccines have been controversial, and it has almost always been difficult to have a non-emotionally charged discussion about them. One reason is that in humans and other animals, any infection can trigger an archaic brain circuit in most of us called the behavioral immune system, or BIS. It’s a circuit that’s triggered when we sense we may be near a potential carrier of disease, causing disgust, fear, and avoidance. It’s involuntary and not easy to shut off once it’s been turned on. The behavioral immune system is best understood in contrast to the regular immune system. The regular immune system consists of antibodies and T cells and so on, and it evolved to protect us once a problematic microbe gets inside us. The BIS is different. It evolved to prevent us from getting infected in the first place by making us hypersensitive to hygiene, hints of disease in other people, even signs that they are from another tribe, since in ancient times encounters with different tribes could wipe out one’s own tribe with an infectious disease they carried. Often the foreign tribe had its own long history of exposure to pathogens, some of which it still carried, but to which it had developed immunity in some way. Members of the tribe were themselves healthy, but dangerous to others. And so we developed a system whereby anything or anyone that seems like it might bear significant illness can trigger an ancient brain circuit of fear, disgust, and avoidance. It can also trigger rage, but rage is complex because it’s normally expressed by getting close to the object and attacking it. But with contagion, one fear is getting too close, so generally the anger is expressed by isolating the plague bearer. The BIS is thus an alarm system specific to contagion, and I should add to the fear of being poisoned, which before the development of modern chemistry often came from exposure to living things and their dangerous byproducts such as venoms. Thus it can also be triggered by non-animate things like body fluids of some kinds, surfaces others may have touched, or even more abstract ideas like going to the grocery store during COVID. There is one exception. The BIS doesn’t get or stay activated in people who don’t feel vulnerable, perhaps because they have good personal protective equipment, or because youth gives them strong innate immunity, or because they know they’re already immune, or because they’re seriously misled or delusional about the reality of the disease. For everyone else, though, what might trigger the system is rather plastic. But once triggered, the system is involuntary. The BIS is, I would argue, one of the instinctual reactions that missed appearing in medical textbooks, perhaps because we’ve not had a pandemic on this scale for a hundred years. Because it focuses on potential bearers of disease, the BIS triggers many false alarms, since an infected person may at first show only the mildest and nonspecific symptoms, such as a cough or sniffle, before they become deathly ill. That’s why even a small exhalation or a surface touched by a stranger could trigger the BIS. Were it a medical test of danger, we would say the system tends to err on the false positive side. We see it firing every day now. When someone drives alone wearing a mask, or goes for a walk by themselves in an empty forest, masked, or when someone, say with good health and no previous known adverse reactions to vaccines, hears that a vaccine can in one in 500,000 cases cause death, but can’t take any comfort that they have a 99.999% chance of it not happening, because it potentially can. Before advanced brain areas are turned on and probabilities are factored in, the BIS is off and running. One of the reasons our discussions of vaccination are so emotionally radioactive, inconsistent, and harsh, is that the BIS is turned on in people on both sides of the debate. Those who favor vaccination are focused on the danger of the virus, and that triggers their system. Those who don’t are focused on the fact that vaccines inject into them a virus, or a virus surrogate, or even a chemical they think may be poisonous, and that turns on their system. Thus, both sides are firing alarms, including many false positive alarms, that put them in a state of panic, fear, loathing, and disgust of the other. And now these two sides of the vaccination debate are tearing America apart at many levels. Families, friendships, states, and the federal government. It’s even affecting the country’s ability to deal with the pandemic, splitting hospital staffs and sundering relationships between the scientists studying it. As of this writing in the United States, about 85% of people over 65, the age group most at risk, are fully vaccinated against COVID, more if you include those who had one shot. 57% of the overall population is fully vaccinated. But around June, the rate of vaccination slowed drastically, down to less than 1 million a day from 3.4 million daily in April. Even though many more people, aged 12 and up, were now eligible. 5 million people who got the first shot had not gone to their follow up appointment. States started sending vaccines back, while some vaccination sites were empty. In response, US public health officials appeared to believe that the number of people who would voluntarily take the vaccine had reached a ceiling. The change could be seen from the top of the messaging system with President Joe Biden switching from persuasion to coercion of the armed services, federal employees, and as of September 9th, of everyone working for companies with 100 employees or more, a category that includes about 100 million Americans. In a way, this should be the least likely time in history for vaccine hesitancy. For years, vaccinologists explained vaccine skepticism by noticing that it largely existed because few had lived through a large scale pandemic, and because vaccines had already eradicated so many serious diseases that it gave rise to complacency about the threat. But today’s vaccine hesitancy is happening in the midst of a pandemic in which over 700,000 Americans have died. And a recent Rasmussen poll found that a staggering one third of Americans, quote, believe officials are lying about vaccine safety, close quote. It seems to me especially vital that we broaden our understanding of the history and current state of vaccines, because over the summer, many who chose vaccination for themselves concluded that it is acceptable to mandate vaccines for others, including those who are reluctant to get them. That majority entered a state of crystallization, a term I borrow from the French novelist Dendal, who applied it to the moment when a person falls in love. Feelings that may have been fluid become solid, clear, and absolute, leading to all or nothing thinking such that even the beloved’s blemishes become signs of their perfection. Crystallization, as I’m using it here, happens within a group that has been involved in a major dispute. For a while, there’s an awareness that some disagreement is in play, and people are free to have different opinions. But at a certain point, often hard to predict and impossible to measure because it is happening in the wider culture and not necessarily at the ballot box, both sides of the dispute become aware that within this mass of human beings, there’s now a winner. One might say that a consensus arises that there is now a majority consensus. Suddenly, certain ideas and actions must be applauded, voiced, obeyed, and acted on, while others are off limits. One person who understood how this works intuitively was Alexis de Tocqueville. In democracies, as long as there is not yet a majority opinion, a range of views can be expressed, and it appears that there is a great, quote, liberty of opinion, close quote, to use this phrase. But once a majority opinion forms, it acquires a sudden social power, and it brings with it pressure to end dissent. A powerful new kind of censorship and coercion begins in everyday life at work, school, choir, church, hospitals, in all institutions, as the majority turns on the minority, demanding it comply. Tocqueville, like James Madison, was concerned about this tyranny of the majority, which he saw as the Achilles heel of democracy. It isn’t only because divisiveness created a minority faction’s steeped and lingering resentment. It’s also because minorities can sometimes be more right than majorities. Indeed, emerging ideas are, by definition, minority ideas to start with. The majority overtaking the minority could mean stamping out thoughts and actions that would otherwise generate progress and forward movement. It’s a fascinating moment when this sort of crystallization happens in a mass culture like America’s, because seemingly overnight, even the definition of legitimate speech or thought or action also changes. Tocqueville observed that quite abruptly, a person can no longer express opinions or raise questions that only days before were acceptable, even though no facts of the matter have changed. At an individual level, people who were within the bounds can be surprised to find themselves, quote, tormented by the slights and persecutions of daily obloquy, close quote. Once this occurs, he wrote, quote, your fellow creatures will shun you like an impure being. And those who are most persuaded of your innocence will abandon you too, lest they should be shunned in their turn, close quote. In the midst of a pandemic, seeing the unvaccinated as impure is no surprise because, of course, they could carry contagion. But as Tocqueville pointed out, this also occurs when there is no contagion and we begin to experience those who are on the wrong side as impure, as in failing the purity test, and react to them as though they are dangerous. That we do this even when there is no pandemic suggests that there is, along with the realistic fear of infection, something else going on here. A sense that those with whom we may disagree are impurities in the body politic, bad people who need to be taught a lesson, even punished. A June 2021 Gallup poll found that among the vaccinated, 53% now worry most about those choosing not to get vaccinated. Quote, surpassing concerns about lack of social distancing in their area, 27%, availability of local hospital resources and supplies, 11%, and availability of coronavirus tests in their area, 5%, close quote. True to the behavioral immune system’s impulses, this fear is metastasizing into disgust, even hatred, of those who, because they believe or act differently, are now perceived as threats. On August 26, in a front page story in the Toronto Star, My Local Newspaper, a resident was quoted as saying, quote, I have no empathy left for the willfully unvaccinated. Let them die. Close quote. In the midst of such a death wish for fellow human beings, even the person quoted understood that an important mental capacity has been lost, empathy, or the ability to model other people’s minds. When we lose that en masse, the results can be tragic, not least because getting through this must be a group effort. As I understand it, there are two main approaches to public health and liberal democracies, and both have been tried historically in different places. One begins voluntarily, out of respect for civil liberties, but switches to a more conscious way of life. The other is a more conscious approach to coercion when some voluntary sealing deemed insufficient is reached. Ideally, this intervention is based on the principle of least necessary coercion. The benefit to this is that it may work to get more people vaccinated in shorter order. But it also conveys that the government does not trust its citizens on their own, a condescension that in turn, this is human nature 101, eventually generates resentment, even revolt, and the disengagement of significant segments of the population. The other approach, participatory public health, sees the need for coercion as a sign that something in the public health outreach itself has failed. If a sealing is reached, society’s leaders should not simply resort to force, but rather confront the flaws in their own leadership, that they should double down on their responsibility to generate trust in the public. The goal of participatory public health is not to crush, but to better engage. In that spirit, what follows is an attempt by a physician and neuroscience writer and someone who got vaccinated early and voluntarily to understand those who have not made this choice. This essay is not about COVID deniers or anti-vaxxers who oppose vaccines on ideological grounds, nor is it about the activists or political figures who feed off and benefit from the corrosive discourse around vaccines. It is instead about the vaccine hesitant, those who are concerned and anxious about COVID, but also anxious about these new vaccines. These are the people who are not yet vaccinated for reasons that the majority may not understand and which are often more anchored in history and experience than the majority would suspect. They are the Tocquevillian minority that the majority is threatening with job loss and other restrictions. One needn’t agree with the decisions or actions of the vaccine hesitant in order to learn something from them and about them and about society as a whole. They pay attention to and are vigilant about different issues than the vaccinated and have wrong feelings about the people and institutions involved in our public health, particularly politicians, the drug regulatory process, and pharmaceutical companies. For many, vaccine hesitancy is not simply about the vaccines. It’s about the absence of faith in the wider systems that brought us the vaccines. Quote, public health moves at the speed of trust, close quote, notes physician and author Rishi Manchanda. If we want our public health system to function better, safer, swifter, in ways that more effectively safeguard the lives and livelihoods of all citizens, it must be rooted not in coercion, but in confidence and not only among the majority. Chapter 2, the kernel brilliance of vaccines. The kernel idea of exposing a person to a weakened form of a pathogen or toxin, known colloquially as like to treat like, long preceded modern medicine and came in stages and through observation. Paracelsus, who was said to have treated persons during a plague of 1534, noted that quote, what makes a man ill also cures him, close quote. During the ancient plague of Athens, 430 to 425 BCE, the historian Thucydides noted that those who, like himself, got the plague and then recovered, never got the plague again. Chinese writing alluded to inoculation in the 10th century and in the 16th century, Brahmin Hindus were inoculating people with dried pus from smallpox pustules. Similar practices, which were common in Turkey in the 1700s, were brought to England by the remarkable Lady Montague, the English ambassador’s wife. But when some, such as King George III’s son, died of being inoculated with the smallpox, many became reluctant to undergo the procedure. A key advance occurred when farmers in England in the 1700s noticed the dairymaids who milk cows got cowpox on their hands from the udders. Cowpox was a very mild illness compared to smallpox, which had a 30% mortality rate by some estimates. It was observed that the maids with cowpox were immune to the dreaded smallpox. An English cattle breeder named Benjamin Jesty, who had himself contracted cowpox and was thus immune to smallpox, decided, supposedly on the spur of the moment, to intentionally inoculate his wife and children with cowpox. They remained immune to smallpox 15 years later. They remained immune to smallpox 15 years later. The English physician Edward Jenner, learning of this, began systematically exposing patients to cowpox, including an 8-year-old boy named James Phipps. He exposed James to cowpox and then exposed him to smallpox to see if he’d contract it, an experiment conducted quite obviously, without informed consent. The boy survived and was vaccinated 20 times without bad effect, said Jenner, who reported on the benefits of the procedure in warding off smallpox in a series of cases. He was initially ridiculed for this idea, but in the end prevailed. The phenomenon was soon called vaccination, from wakinia, the Latin for cowpox virus species, waka being cow. Some have even wondered whether the ancient Western symbol for the medical arts and healing still used today, the rod of Asclepius, a serpent wrapped around his staff, may itself be an allusion to the kernel idea that something dangerous can also protect. According to the Greek myth, Asclepius was said to have healed people with snake venom, which can have some medicinal properties that were written about by Nicanter. And interestingly, the same image appears in the Torah in Numbers 21, 8. And the Lord said unto Moses, Make thee a fiery serpent and set it upon a pole, and it shall come to pass that every one that is bitten when he looketh upon it shall live. And Moses made a serpent of brass and put it upon a pole, and it came to pass that if a serpent had bitten any man, when he beheld the serpent of brass, he lived. All of which is to say that the heal-harm paradox is a deep archetype in the human psyche. And it came not from Big Pharma, but from everyday, often rural observations, one might even call them front-line observations, about how nature works and how the immune system behaves. Among the great triumphs of vaccination are the elimination in the United States of the scourge of polio and the eradication of smallpox throughout the world. Indeed, perhaps because of these successes, many of us nostalgically imagine that their development in public acceptance came easily. But the real history shows a more textured picture. A number of polio vaccines had to be tried. The initial vaccine studies had very little oversight and the first vaccines left some children paralyzed. The first truly effective vaccine, the first vaccine that was able to contain polio, contained the live polio virus, causing 40,000 cases of polio and killing 10. The Cutter incident, as the event is now known, revealed the vulnerability of the polio virus in the United States of America. It was the first truly effective vaccine to contain polio and kill 10. The first truly effective vaccine to contain polio and kill The Cutter incident, as the event is now known, revealed the vulnerability of the systems that produce vaccines and remains one of the sources of the nightmare that so haunts the hesitant, getting the dreaded disease from the treatment. The incident was followed by efforts to improve the regulatory systems so that similar tragedies wouldn’t be repeated. In the public’s mind, perhaps the greatest triumph of vaccination was the mid-century worldwide eradication of smallpox, a horrifying scourge that was lethal in 30% of cases. The history, as it is often told, attributes the victory solely to vaccines. But as British physician Richard Halverson has written, it was not simply the product of a single block of vaccine, as it is so often described, but rather a regime of multiple public health measures instituted alongside vaccination. The details here are quite interesting. Beginning in the 17th and 18th centuries, there were a number of mass campaigns of inoculation with smallpox and then vaccination with cowpox that led to a decline in smallpox in the 19th century. By 1948, some physicians in England thought the illness was sufficiently well managed that mass vaccination of infants, which carried some risks, could wind down. And so, mass vaccination was replaced by a new, more individually focused strategy. If a case was reported, public health officials isolated the person and their contacts, and the contacts were vaccinated. This was called the surveillance containment strategy. It worked. After the cessation of vaccination in England, a few cases occurred in 1973 and 1978, but both were based on laboratory accidents. According to Halverson, the World Health Organization came to the same conclusion and also adopted the surveillance containment approach elsewhere. In 1980, the disease was declared eradicated. But alongside the public health system’s triumphant eradication of polio and smallpox from the 1940s through the 1970s, there was a horrifying change in the health system. In the 1970s, there was a horrifying chapter as well, one that included staggering abuses by public health and medical authorities. The Tuskegee experiment, conducted by the US Public Health Service from 1932 until 1972, sent out representatives to find African American men who were told they would receive treatment for their, quote, bad blood, close quote. No treatment occurred. The officials gave these men a placebo instead of penicillin, which would have saved them. This was done so the investigators, by watching the men die slowly, could study the natural course of the devastating disease. During the same period of time, the US public health system oversaw 70,000 sterilizations of, quote, mentally deficient, close quote, people with learning problems, the blind and the poor, and also forcibly removed the uteruses of African American and Indigenous women, all as part of an international eugenics movement that swept through public health. Psychedelics and other drugs were given to people in mental institutions without telling them, often leading to nightmare trips, and dangerous campaigns were undertaken based on only partial knowledge, such as the widespread radiation of healthy children’s thymus glands, a key part of one’s immune system, which later caused cancers. All of these programs were used to help children and their families, and people lost their rights to access and access to the programs, used abstract population-based thinking, dehumanizing people into numbers to be toyed with in the name of science and progress. None of the public health abuses during this period involved informed patient consent, in the name of the greater good. It took the revelation of Nazi medical experiments on Jews and others to give rise to a new ethics of consent for research subjects. The Nuremberg Code of Ethics of 1947, along with the 1964 Declaration of Helsinki, originally developed by the World Medical Association, required physicians and scientists to obtain the informed consent of all research subjects. This breakthrough led to the normalization of patient consent not just for research subjects, but for those undergoing all medical procedures, and became a bedrock of what many of us in the medical field now see as an inviolable code of ethics. But in the late 1970s and 1980s, there were new controversies. In 1976, a swine flu outbreak occurred in Fort Dix, New Jersey. Fearing that the country was on the cusp of a pandemic, the U.S. government approved a vaccine and undertook an aggressive rollout that involved 48 million people. But there were two unforeseen developments. First, the epidemic receded on its own and rather quickly. Second, 450 vaccinated people came down with a neurological disorder called Guillain-Barré syndrome in greater numbers than would be expected during that period. After producing and distributing the vaccine so quickly, the government then reacted with caution. But the idea that a vaccine could cause damage stuck in the public’s mind. Quote, This government-led campaign was widely viewed as a debacle and put an irreparable dent in future public health initiatives, quote, wrote Rebecca Creston in Discover, quote, as well as negatively influenced the public’s perception of both the flu and the flu shot in this country, close quote. That skepticism might have emerged so sharply because the swine flu debacle occurred against the backdrop of another contemporaneous event. In the 1970s, a number of parents began arguing that their children were left with serious brain problems and seizures after receiving the diphtheria pertussis vaccine. Numerous vaccine-related lawsuits followed and the parents scored many legal victories costing pharmaceutical companies millions of dollars. It cost 12 cents to make a dose of the DPT vaccine in 1982. But within a few years, the cost increased 35-fold thanks to litigation awards, and as a result, companies started leaving the vaccine business. To this day, there is disagreement about the primary cause of the brain problems with some of the parents insisting it was the vaccine and vaccine advocates arguing that these children actually had a genetic condition called Revett syndrome, possibly brought to the surface by the vaccination, but which they would have suffered from anyway. There is little disagreement, though, about what happened next. In 1986, the last pharmaceutical company still making the DPT, Lederl, told the government it would stop making the vaccine. Companies making vaccines for other diseases were also being sued and also stopped production. The government grew very concerned, and in 1986, Congress passed the National Childhood Vaccine Injury Act, NCVIA. The act established a new system for vaccine-related injuries or death linked to childhood vaccinations, wherein companies were indemnified from being sued for safety problems. Soon after, the program was enlarged to include adult vaccination injuries. If anyone believed that a child or person was injured by a vaccine, they could take the complaint to a newly established vaccine court run by the US government and plead their case. If they won, the government would pay them damages from a fund it created out of taxpayer money. This might have seemed the best possible solution. This might have seemed the best possible solution. The country retained a vaccine supply, and citizens had recourse in the event of harm. But because companies were indemnified from any harm their vaccines might cause, they no longer had a powerful financial incentive to rectify existing safety problems or even improve safety as time passed. Arguably, they were financially disincentivized from doing so. The solution shifted liability for the costs of safety problems from the makers onto the taxpayers, the pool that included those who were arguably harmed. This atmosphere of suspicion spread in the 1990s with even greater explosiveness and toxicity during the vaccine-autism debate. The landscape of the vaccine discourse in the United States never simple or one-dimensional to begin with was becoming even more complicated and hostile. To understand the polarized psychological reactions to vaccination now, as well as what to do about it, it’s essential to disentangle three things. First, there is the kernel idea behind vaccination as a treatment, arguably one of humanity’s greatest medical insights. Second, there’s the process by which a particular vaccine is produced, tested for safety and efficacy, and regulated. That is, the execution of the core insight, which as we know can vary in success from one vaccine to the next or fail completely. We’ve not yet been able to make an AIDS vaccine, for instance. Third, there is the way in which those who produce the vaccine and the public health officials in charge of regulating and disseminating communicate to the public. Only a person who rejects the first kernel idea could sensibly be called an anti-vaxxer. Many people accept the kernel insight and have been vaccinated multiple times in the past, but have come to doubt the execution or necessity of a particular vaccine, and hence also come to doubt the claims made in the course of disseminating it. They become hesitant about that particular vaccine and defer or avoid getting it. One reason hesitancy can take hold in relatively low trust societies is that reluctant vaccinees typically have no direct relationship with those mandating vaccinations and thus no personal evidence that those people are trustworthy. For a regular medication, a physician needs and has the ability to convince one patient at a time to take a particular drug. This is why pharmaceutical companies have huge marketing budgets to sway individual physicians and patients alike. In the case of vaccines, companies need to convince only a few key officials and committees who then buy their product and market it for them to an entire population. For companies producing vaccines, mass marketing is replaced almost entirely by political lobbying. A number of events occurred in the 1990s that suggested growing enmeshment between the pharmaceutical industry and scientists involved in drug production and approval decisions, along with the role of profit in the whole arrangement, was becoming an endemic problem. In 2005, the Associated Press reported that, “…two of the U.S. government’s premier infectious disease researchers are collecting royalties on an AIDS treatment they’re testing on patients using taxpayer money, but patients weren’t told on their consent forms about the financial connection.” One of them was helping to develop an interleukin-2 treatment tested around the globe. The problem, as those reports noted, was that, quote, “…hundreds, perhaps thousands, of patients in NIH experiments made decisions to participate in experiments that often carry risks without full knowledge about the researcher’s financial interests.” Close quote. One of the two people running these experiments was a researcher named Dr. Anthony Fauci, who first rose to prominence a decade before in the AIDS crisis. Not only was the assertion about royalties true, it was also perfectly legal. Royalties for public service scientists were first allowed under the Bayh-Dole Act of 1980, which had attempted to remedy two related problems—the lack of reimbursement for government-funded research and retaining top scientists who were being lured away from public work by the private sector. This act and other federal regulations permitted the NIH, for instance, to collect proceeds if its research made money in the private sector and allowed individual government scientists to collect up to $150,000ayearinroyaltiesontreatmentstheydeveloped.Atthetime,Faucisaidhetriedtoalertpatientstohisroyalties,buthisagencyrebuffedhim,arguingthathecould{n}^{\prime }tdosounderthelaw.Thenondisclosureoftheresearche{r}^{\prime }sinterestwaschangedafterthescandal,butthedamagehadbeendone.Inthemindsofsomeelementsofthepublic,therewassomethingfishygoingonbetweenthegovernmentandthepharmaceuticalindustry,andithadsomethingtodowithmoneyandawillingnesstodisregardordiluteinformedconsent.Thesesuspicionsheightenedinthe2000saskeyphysiciansbeganrevealingtothepublicthatBigPharmahadbeeninvolvedinanumberofmajorabusesofitsrelationshipswithgovernment,patients,physicians,andjournals.OneofthefirsttobreakthisstorywasMarciaEngel,whohadbeeneditoroftheNewEnglandJournalofMedicine,arguablythemostimportantmedicaljournalintheUnitedStatesatthetime.Inher2004book,TheTruthAboutDrugCompanies,HowTheyDeceiveUs,andWhattoDoAboutIt,shearguedthatthecompanyspentfarmoreonmarketing,administration,publicrelations,andrebrandingthantheydidonresearch,andthattheyactuallydiscoveredveryfewneweffectivedrugs.Instead,theyused,quote,lures,bribes,andkickbacks,closequote,togetdrugstakenupbyphysicians.Engelshowedhowthesecompaniespenetratedmedicalschools,conventions,andorganizations,oftenpassingoffmarketingas,quote,education,closequote,whichtheyprovidedfreeofcharge.Moretothepoint,Engelarguedthatgovernmentagencieswerehighlycompromised.ShedemonstratedhowconflictsofinterestpermeatedtheU.S.FoodandDrugAdministration,whichgaveexpeditedreviewsandapprovalsfordrugswithmajorsideeffectslikeheartattacksandstroke,suchasVioxxandCelebrex,andsomewithnoseriousbenefit.Engelalsorevealedthat,quote,manymembersoftheFDAadvisorycommitteeswerepaidconsultantsfordrugcompanies.Althoughtheyweresupposedtoexcusethemselvesfromdecisionswhentheyhaveafinancialconnectionwithacompanythatmakesthedruginquestion,thatruleisregularlywaived,closequote.Shedocumentedmultipleinstancesofcommitteemembersdiscussingdecisionsonsafetyviolationscommittedbytheverycompaniesthatpaidthemfromwhichtheydidnotrecusethemselves.Enge{l}^{\prime }sbook,whichwaspublishedtogreatacclaim,wasimpossibletodismissasfringe,quote,Dr.Enge{l}^{\prime }scaseistough,persuasive,andtroubling,closequote,claimedtheNewYorkTimes.PublishersWeeklywrote,quote,inwhatshouldserveasthefastfoodnationofthedrugindustry,EngelpresentsasearingindictmentofBigPharmaascorruptandcorrupting,closequote.Overthenextfewyears,thekindsofabusesshedocumentedmadeittothecourts.Asthesetrialsbecamepublic,Americanswhosufferedfromserioussideeffectscausedbythedrugsinvolvedtooknotice.In2012,physicianBenGoldacreofOxfordUniversitypublishedBadPharma,inwhichheexploredfraudsettlementsforpharmaceuticalcompaniescoveringupknownadverseevents,includinglethalones,andhidinginformation,includingaboutsafety.Theboo{k}^{\prime }ssubtitle,HowDrugCompaniesMisleadDoctorsandHarmPatients,waskey.Physiciansoftendid{n}^{\prime }tknowthewoolwasbeingpulledovertheireyesorwhathadbeenkeptfromthem.Butwhenthepracticesoflargepharmaceuticalcompanieswereexaminedinthecourts,withinternaldocumentsreviewed,oneillegalactivityafteranotherwasrevealed.Goldacr{e}^{\prime }slistmakesoneshudder,quote,Pfizerwasfined$2.3 billion for promoting the painkiller Bextra, later taken off the market over safety concerns, at dangerously high doses, misbranding it with the intent to defraud or mislead, in quotes, the largest criminal fine ever imposed in the US until it was beaten by GSK, KlaxoSmithKline, end of quote. Quote, in July 2012, GSK received a $3billionfineforcivilandcriminalfraud,afterpleadingguiltytoavastrangeofchargesaroundunlawfulpromotionofprescriptiondrugsandfailuretoreportsafetydata,closequote.Quote,Abbottwasfined$1.5 billion in May 2012 over the illegal promotion of Depakote, close quote. Quote, Eli Lilly was fined $1.4billionin2009,closequote.Quote,AstraZenecawasfined$520 million in 2010, close quote. Quote, Merck was fined 1 billion in 2011, close quote. After Goldacre's book was published, the fines kept coming. Johnson & Johnson was made to pay 2.2 billion in 2013, which including, according to the Justice Department, quote, criminal fines, close quote, for having, quote, jeopardized the health and safety of patients and damaged the public trust, close quote. In 2019, the company was fined another $572millionforitsroleintheopioidepidemic,andthenfinedawhopping$8 billion by a jury in a different case, an amount that will no doubt be reduced, but which signals public outrage at the violations. These huge fines, year after year, involve popular drugs taken by tens of millions of patients with negative effects, including death. Stories of devastation have become lore in many families and communities. The circle of concern is even wider if you include those who may not have been personally affected, but are aware of this problematic legal history. When you personally take a medication, you tend to notice news about it, especially bad news. Whether or not you’ve experienced any negative effects yourself, you are naturally alert to their existence. Each time a big pharma company is in the courts and in the media because of some problem, the seeds of skepticism are planted in the minds of many Americans. And not just skepticism of the company themselves. The transgressions mentioned above were only possible on such a scale because of a textbook case of regulatory capture consisting of a mixture of perverse incentives and priorities, a tolerance for non-transparency, and in some cases, a culture of collusion. The FDA bills big pharma $800millionayear,whichinturnhelpspayFDAsalaries.RegulatorsalsooftengetjobsinthepharmaceuticalindustryshortlyafterleavingtheFDAorsimilarbodies.Thereisahugeincentivetoimpressandcertainlynottocrossapotentialfutureemployer.I{t}^{\prime }susefultoseehowthisworksbyexaminingacasethatbecamefamousasataleofepicgreedandcorruptionandwhichpatientsandphysiciansweremisledanddeceived.Onlyafterpatients,families,activists,andeventhewholecommunitiesyelledthemselveshoarseaboutitforyears.In1995,theFDAapprovedOxycontinforshort-termseriouspainliketerminalcancerorpost-operativepain.Thisapprovalwasbasedonlegitimatescientificstudiesrelatedtothesenarrowexperiences.TheFDAthenmadeitavailableforminorpainswitharound-the-clockdailyusagein2001.Thatapprovalforlong-termusewasnotbasedonanystudies.Accordingtoa60Minutesreportin2019,equallysuspiciousbutlegalwasthelargenumberofkeyFDAregulatorswhowentthroughrevolvingdoorstojobswithdrugmanufacturers.Theopioidepidemichas,todate,lefthalfamillionAmericansdead.Thissamecompromisedregulatorysystemallowsbigpharmatopayforandplayakeyroleinperformingtheverystudiesthatleadtotheauthorizationofitsownproducts.Fordecades,itwasnotjustcommonforauthorsofstudiestoreceivepaymentsfromtheverycompaniesmakingthemedicinesbeingtested.Itwasalsosystematicallyhidden.Drugcompaniessecretlyghost-wrotestudiesoftheirowndrugs.Goldacreshowshowtheyconscriptedacademicstopretendtheyhadauthoredthem.Thepaperswerethensubmittedtomainstreamjournalswhoseimpriturewouldgivethestudiescredibility,allowingthesedrugstobecomequote,thestandardofpractice.16ofthe20papersreportingontheclinicaltrialsconductedonVioxx,theanti-inflammatoryandpainmedicationthatgotFDAapprovalin1999,thenwastakenoffthemarketin2004forcausingheartattacksandstrokes,wereghost-writtenbyMerckemployees,thensignedbyrespectedscientists.Merckultimatelyagreedtopayout$4.9 billion in Vioxx lawsuits. The academics who lent their names to the studies could then stuff their CVs with these articles, receive promotions and higher salaries within academia, and ultimately get more consulting fees from pharmaceutical companies, at which point they are seen as quote, experts by a trusting public. In the current regulatory environment, companies run the studies of their own products. A Danish study found that 75% of drug company self-studies assessed were ghost-written. A leading US editor of a specialist journal estimated that 33% of articles submitted to his journal were ghost-written by drug companies. These imposters don’t get adequately investigated by Congress because the pharmaceutical and health industries are now the highest-paying lobby in the country, having doled out at least $4.5billioninthelasttwodecadestopoliticiansofbothparties.Quote,Pfize{r}^{\prime }spackhasbeenthemostactive,closequote,STATreportedLevFacherwrites,quote,sending548checkstovariouslawmakersandotherindustrygroups,morechecksthantheactualnumberofelectedofficialsintheHouseandSenate,closequote.WhileGoldacr{e}^{\prime }sbookshowsthemanywaysthatdrugstudieshavebeenriggedtodelivercertainoutcomes,onedoes{n}^{\prime }talwayshavetorigastudytogetthesameresult.Amongthemostcommontechniquesistodelaythereportingofmedicationsideeffectsuntilafterthepatentrunsout,andthenusethebadpublicitytosellanewreplacementmedicationwhichisstillonpatent.Pollsrepeatedlyshowthatthechiefconcernamongthevaccinehesitantisaboutsideeffects,oratleasteffectsthatdo{n}^{\prime }tshowuprightaway.Thelatesteditionofthestandardtextbookinthefield,Plotki{n}^{\prime }sVaccine,hasanexcellentchapteronvaccinesafetywhichnotes,quote,becausereactionsthatarerare,delayed,orwhichoccurinonlycertainsubpopulationsmaynotbedetectedbeforevaccinesarelicensed,post-licensureevaluationofvaccinesafetyiscritical,closequote.Post-licensurefirstrequiresFDAapproval,soformostvaccinesthatmeansmorefollow-upafterthetypicaltwo-yearapprovalprocess,atleastseveralyearsofit.In2018,theNewYorkTimespro-vaccinesciencewriter,MelindaWenner-Moyer,notedwithshockthatshelearneditwasnotuncommonamongvaccineresearcherstotaketheattitudethatcensoringbadnewsabouttheirresearchwasnecessary,andthatsomewhodid{n}^{\prime }twereostracizedbytheirpeers.Quote,Asasciencejournalist,I^{\prime }vewrittenseveralarticlestoquellvaccineangstandencourageimmunization.Butlately,I^{\prime }venoticedthatthecloudoffearsurroundingvaccinesishavinganothernefariouseffect.Itiserodingtheintegrityofvaccinescience.InFebruary,IwasawardedafellowshipbythenonpartisanAliciaPattersonFoundationtoreportonvaccines.Soonafter,Ifoundmyselfhittingawall.WhenItriedtoreportonunexpectedorcontroversialaspectsofvaccineefficacyorsafety,scientistsoftendid{n}^{\prime }twanttotalkwithme.WhenIdidgetthemonthephone,aworryingthemeemerged.Scientistsaresoterrifiedofthepubli{c}^{\prime }svaccinehesitancythattheyarecensoringthemselves,playingdownundesirablefindings,andperhapsevenavoidingundertakingstudiesthatcouldshowunwantedeffects.Thosewhobreaktheseunwrittenrulesarecriticized.Closequote.Moyerwentontoquoteauthoritieswhoarguethatsmallerstudies,andeveninconclusiveones,oftengiveusthefirstglimpseofaninsightorproblem.Andthisistosaynothingofthewiderissue.Ifscientistsplaydowntheirundesirablefindingsinpotentiallymandatedmedicines,asMoyerfoundthemtobedoing,the{y}^{\prime }renotjustmissingopportunitiesforgoodscience.Theyarepotentiallygeneratinganti-scientificmisinformation.Quote,vaccinescientistswillearnalotmorepublictrustandovercomealotmoreunfoundedfeariftheychoosetransparencyovercensorship.Closequote.Shewrote.BythetimeMoyerpublishedherarticlein2018,manyAmericanswerealreadylonginthehabitofquestioningcertainelementsoftheirpublichealth,inpartbecauseofthishorne{t}^{\prime }snestofcorruptionandregulatorycapture.Butthishabitcouldalsobeexplainedinpartbythegeneraltrendinmedicineoverthepasttwodecadestowardsrecognizingthesuperiorityofindividuallytailoredinterventionsorpersonalizedmedicine,whichacknowledgesthatdifferentpeoplehavedifferentriskfactors,genetics,medicalhistories,andreactionstomedicalproducts.Itisnowcommonplaceforpeopletotakeresponsibilityfortheirownhealth,becausethisispreciselywhatwehavebeentellingthemtodo,encouragingthemtogettoknowtheirownuniqueriskfactorsfordiseasebasedontheirownindividualhistoriesandgenetics.Vaccines,incontrast,areaone-size-fits-allinterventionadministeredenmassebythosewhoknownothingspecificaboutthevaccineesortheirchildren.Andwhenpoliticalandmedicalauthoritieschangepoliciesfromdaytodayandpublichealthrecommendationsinonejurisdictionorcountrydifferfromthoseinothers,questionswillbeasked.Thepublichasbeenassuredthatweinhealthcarerecognizethattheeraofmedicalauthoritarianismandtheuglypracticesthatledustorequireinformedconsentarebehindus.Thismeansthatwheneverthereisatreatmentonhand,theburdenofprooftodemonstratethatitissafeandeffectivemustfallonthosewhoofferit.Itmeanswemustneverstiflequestionsorshamepeopleforbeinganxious.Iamapsychiatristandapsychoanalyst,andIdealwithpeopl{e}^{\prime }sanxietiesandtheirparanoia,too.Manypeoplethinktheanxiousarenecessarilyweak.Onemedicalcolleaguecallsthevaccinehesitantwimps.Butthisis,ifnotentirelywrong,asuperficialwayofunderstandinganxiety.Anxietyisasignal.Itevolvedtogetustopayattentiontosomething,sometimesanexternalthreatandsometimesaninternalone,suchasanignoredfeelingorforbiddenthoughtthreateningtoemergefromwithin.Anxietycanbeneurotic.Itcanevenbepsychotic.Itcanalsosaveyourlife,becausedangersdoexist.Whenpeopledo{n}^{\prime }texperienceenoughanxiety,wesaythe{y}^{\prime }reindenial.Thus,insomesituations,thecapacitytofeelanxietycanbeanadvantage,whichislikelywhyi{t}^{\prime }spreservedinevolutioninsomanyanimals.Aristotleunderstoodthisverypointlongago.Ashenoted,thecourageousperson,sayasoldier,canandshouldfeelanxious.Heisfacingdanger,afterall,andhiswisdomtellshimthereisrisk.Whatdistinguishesthecourageouspersonfromthecowardisnotthattheydo{n}^{\prime }tworryorfear,buttheycanstillmanagetomoveforwardintothedangeroussituationtheycannotavoidfacing.Allofwhichistosaythatthepresenceofanxietyaloneisnotdispositiveofsanityorinsanity.Italonedoesnottellyouwhethertheanxietyiswellorill-founded.Thesamegoeswithdistrust.Sometimesdistrustisparanoia,andsometimesi{t}^{\prime }shealthyskepticism.AsofaSeptember2019Galluppoll,onlyafewmonthsbeforetheCOVID-19pandemic,BigPharmawastheleasttrustedofAmeric{a}^{\prime }stop25industrysectors,number25of25.IntheeyesofordinaryAmericans,ithadboththehighestnegativesandthelowestpositivesofallindustries.Atnumber24wasthefederalgovernment,andatnumber23wasthehealthcareindustry.Thesethreeindustriesformaneattroika,thoughatnumber22wastheadvertisingandpublicrelationsindustry,whichfacilitatestheworkoftheotherthree.Thoseinsidethetroikaoftencharacterizethevaccinehesitantasbroadlyfringedandparanoid,butthereareplentyofindustriesandsectorsthatAmericansdotrust.Ofthetop25industrysectors,21enjoynetpositiveviewsfromAmericanvoters.Onlypharma,government,healthcare,andPRareseenasnetnegative,preciselythesectorsinvolvedintherolloutoftheCOVIDvaccines.Thissettheconditions,inaway,foraperfectstorm.Chapter3ANewPlagueDescendsInFebruaryandMarch2020,itbecameclearthatthedisasterthathadsweptthroughWuhanwasbecomingcatastrophicinBergamo.AsfrontlinehealthcareworkersweredyinginbothChinaandItaly,thevirushadalsospreadthroughoutWesternEuropeandarrivedinNorthAmerica.Earlyreportsofthecasefatalityratereachedover14.5$56,000 per year, which some worry could bankrupt Medicare, was wrong, quote, because of so many different factors, starting from the fact that there’s no good evidence that the drug works, close quote, that it was, quote, probably the worst drug approval decision in recent US history, close quote, and that this, quote, debacle highlights problems, close quote, with the FDA advisory committee relationship. It’s worth translating this episode into plain English. In the middle of the biggest vaccine rollout in US history, which the government determined to be the only way out of the pandemic, but which also faced stiffed headwinds of deep-seated popular hesitancy, the FDA approved a drug that would line a pharmaceutical company’s pockets with billions of taxpayer dollars, even though studies showed the drug did little but raised false hopes. Kesselheim wasn’t being rash, as it was apparently the second time you’d seen this kind of thing up close. In 2016, the director of the FDA’s Center for Drug Evaluation and Research, Dr. Janet Woodcott, approved a drug called ediplursin over the objections of all the main FDA scientific reviewers. The grounds for the approval were not that patients got better, they didn’t. Rather, a kind of lab value, which can function as a biomarker or indicator of disease, improved another pharma trick. That was taken as good enough evidence to approve the drug. As Kesselheim and co-author Jerry Avron later warned in the Journal of the American Medical Association, quote, speeding drugs to market based on such biomarker outcomes can actually lead to a worse outcome for patients. Soon after Kesselheim’s departure in June, the FDA’s two top vaccine officials announced they were also leaving. Reports explained that Dr. Marion Gruber, director of the FDA Office of Vaccines Research and Review, and a 32-year agency veteran, and Dr. Philip Krauss, a 10-year veteran, were leaving because of outside pressure by the Biden administration to approve boosters before the FDA had completed its own approval process. Meanwhile, Pfizer, doing more science by press release, a technique that often jacked up a company’s stock, was calling for boosters while, quote, hailing great results with COVID-19 boosters and shots for school-age children, close quote. In a piece in The Lancet, on September 13, Gruber Krauss and multiple international colleagues raised a red flag about pushing through a booster in the general population, quote, there could be risks if boosters are widely introduced too soon or too frequently, especially with vaccines that can have immune mediated side effects such as myocarditis, which is more common after the second dose of some mRNA vaccines, or Guillain-Barré syndrome, which has been associated with adeno-vectored COVID-19 vaccines like the AstraZeneca or Johnson & Johnson. If unnecessary boosting causes significant adverse reactions, there could be implications for vaccine acceptance that go beyond COVID-19 vaccines. Thus, widespread boosting should be undertaken only if there is clear evidence that it is appropriate, close quote. The Pfizer study was surprisingly tiny. Only 306 people were given the booster. As vaccine researcher David Wiseman, who did trials for rival Johnson & Johnson, pointed out at the FDA meeting, quote, there was no randomized control, close quote, in the Pfizer study. The subjects were younger, 18 to 55, than the people who were most at risk of COVID death or serious illness and were followed only for a month. So we didn’t actually know how long the booster would last or if adverse events might show up after the 30 days. They were not followed clinically, so there was no information on infections, hospitalizations, or deaths. Rather, only their antibodies were measured, precisely the kind of shortcut that was taken with the person. The study was too small, and the FDA panel held two votes on approval. In the first, it voted overwhelmingly 16 to 2 against approving Pfizer boosters for all ages. In the second vote, the panel supported boosters only for people over 65 or special at-risk groups. And yet, in mid-August, Biden began publicly supporting boosters for all. Why? On September 16, the Los Angeles Times reported that the president was following the advice of Fauci and the NIH with the help of Dr. Janet Woodcott, the same FDA official who overrode FDA reviewers in the Eteplerson incident. Woodcott was by that point acting FDA commissioner and was going around the FDA committee once again. It was not only the Pfizer booster study that was weak. A New England Journal of Medicine study, based on Israeli Ministry of Health data, claimed that third-shot boosters give 11 times to protect the second-shot. But the entire study lasted only a month and thus showed it was protective for that period, but not whether it would last as long or longer than the second-shot’s protection. During the spring of 2021, another wrinkle had emerged. Along with the widespread attacks on scientists who had criticisms of the simplified master narrative, including ones from major universities like Harvard, Yale, Stanford, Rockefeller, Oxford, and UCLA, many average Americans learned that certain major stories weren’t as widely known as they might have been, thanks in part to censorship by big tech. In May, Facebook announced that it would no longer censor stories about the lab leak theory, which was how many people found out that it was in fact a viable scientific theory in the first place. Facebook’s idea of transparency is telling you when it stops censoring something. The same goes for YouTube. But in July, the WHO itself admitted that it had been too hasty in ruling out a lab leak. Nicholas Wade’s excellent May 2 article, by contrast, showed the technical virological reasons for why the virus might well have come from gain-of-function research. We also learned more about big tech’s motives when it was revealed that Google’s charity arm had funded the same gain-of-function researcher that the NIH had funded, Peter Daszak of E. col. Health. At times, big tech’s censorship of misinformation coincides with its financial interests. Amazon, which has banned and unbanned books critical of the master narrative, has been looking into developing a major pharmacy division. Meanwhile, three US medical boards, the American Board of Family Medicine, the American Board of Internal Medicine, and the American Board of Pediatrics, went beyond censorship by threatening to revoke licenses from physicians who questioned the current but shifting line of COVID thinking and protocols. This forced doctors, who had any doubts about the master narrative, to choose between their patients and their livelihoods. Things got so bad globally that Amnesty International eventually issued a report on this crisis. The typical tactic the report’s authors say is, whereby censors justify these actions as simply banning misinformation and preventing panic. The report goes on, It is, of course, vital that public health officials be able to lead in a crisis, convey consistent messages, and even ask citizens to change their behaviors. But the only way public health can legitimately ask for such changes is because the policies it recommends are based on a scientific process that is solid enough to withstand scientific criticism and debate. Why else should anybody listen? Science is not itself dogma or an authoritarian discipline, but the opposite, a process of critical inquiry, and the method requires ongoing debate about how to interpret new data, and even what constitutes relevant data. Science, as the Nobel Prize-winning physicist Richard Feynman pointed out, requires questioning assertions. Quote, science teaches such and such, he’s using the word incorrectly. Science doesn’t teach it, experience teaches it. If they say to you science has shown such and such, you might ask, how does science show it? How did the scientists find out? How? What? Where? Not science is shown, but this experiment, this effect, has shown. And you have as much right as anyone else upon hearing about the experiments, but we must listen to all the evidence, to judge whether a reusable conclusion has been arrived at. Close quote. Note how emphatic Feynman is that it’s not just the few who conduct the experiments, or even just the experts who have the right to discuss and judge the matter. This is especially true in public health because the field is so broad and composed of many disciplines, from those that deal narrowly with the viruses to those that deal with mass behavioral changes. When public health and allied medical and educational organizations censor scientists and healthcare professionals for debating scientific controversies, thus giving the public the false impression that there are no legitimate controversies, they misrepresent and grievously harm science, medicine, and the public by removing the only justification public health has for asking citizens to undergo various privations. These requests are based on a full, unhampered, and open scientific process. Those who censor or block this process undermine their own claim to speak in the name of science or public safety. If we didn’t get to have a properly open scientific process, what did we get instead? Government enmeshment with legally indemnified corporations, public health officials misleading Congress, multiple honest regulators leaving the FDA because of inappropriate approvals, FDA heads taking big pharma jobs directly related to products they had just been involved in improving, a possible lab leak that couldn’t be discussed as such for more than a year so that it couldn’t be clearly disconfirmed, faceless social media platforms admitting that they control what we see and don’t see, and institutional censorship of many kinds. If you were trying to create the perfect conditions for public skepticism about vaccines in the midst of a pandemic, could you have done any better than this? Over the summer, the master narrative began to show cracks. By August 18th, Israel had the world’s third highest number of new cases per capita. The health ministry retroactively released numbers showing that by midsummer the Pfizer vaccine, which had been used in Israel extensively, was only 39% effective in preventing COVID infections, though much more effective in preventing severe disease. But additional data showed that at a time when 62% of the entire Israeli population had been vaccinated, over 60% of Israel’s 400 hospitalized COVID cases were patients who had been fully vaccinated. This meant that the vaccine was much more leaky than expected. By September 14th, Israel’s health ministry director general, Nachman Ash, reported that the country, even more heavily vaccinated than it had been in the summer, with 3 million, mostly elderly of its 9 million citizens already having had a third shot, was now recording 10,000 new COVID cases a day. Quote, that is a record that did not exist in the previous waves, close quote Nachman said. It was also the highest number of COVID cases per capita of any country beating out Mongolia and making Israel the quote COVID capital of the world just months after leading the charge on vaccines, close quote. Many argued, correctly, yes, these breakthrough cases do occur, but they are usually mild and the vaccines are very good at protecting people from severe illness and death. But then conflicting statistics began to emerge. Israeli hospitals were so overloaded they were turning away COVID patients. 400 died in the first two weeks of September. Hospital staff were worn out and in a traumatic state, with one hospital director describing the situation as quote catastrophic, adding that quote the public knows absolutely nothing about it, close quote. The Israeli ministry of health statistics from August showed that of those deaths that had been classified, more than twice as many who died were fully vaccinated, 272, as opposed to those who were not vaccinated, 133. By late September, the data was in for the fourth wave and Dr. Sharon Alroy Price of the Israeli Ministry of Health revealed to the FDA vaccine advisory committee that quote what we saw prior to our booster campaign was that 60% of people in severe and critical condition were immunized, doubly immunized, fully vaccinated, and as I said, 45% of people who died in the fourth wave were doubly vaccinated, close quote. Israeli vaccine czar Salman Zarqa doubled down and said the country now had to contemplate a fourth dose in another five months, quote. This is our life from now on, in waves, quote he said. Israeli Prime Minister Naftali Bennett echoed this on September 13th, blaming six patients who were hospitalized because they were quote not fully vaccinated, quote, by which he meant they’d only had two jabs. The Throughout the pandemic, Israel had extensive lockdowns. In contrast, Sweden became famous for never having lockdown. Israel and Sweden have about the same size population, 9 million and 10 million respectively, and have almost identical rates of double vaccinated people if you take in all ages, including children, 63% Israel, 67% Sweden. But if anything, Israel has the edge over Sweden because 43% of Israelis are also triple vaccinated. Yet the difference in the number of hospitalized patients is staggering. For the week of September 12th, 2021, Israel had COVID hospitalizations, which was four times that of Sweden, 340. Israel had a rolling 7DA average of 2.89 deaths per million compared to a much lower number of deaths in Sweden, 0.15. What can account for this? Many argue that because Sweden, where public health works on a voluntary participatory basis, never locked down, many more people there were exposed and got natural immunity. The Swedes had hoped to protect the most vulnerable in nursing homes, which they failed to do because of poorly trained staff. But in this they were no different from most Western nations that did lock down. Sweden also suffered more deaths per 100,000 than Israel overall. But through the summer of 2021, Sweden dropped to about 1.5 deaths a day from COVID. Its hospitals were never overwhelmed, suggesting that once Sweden’s natural herd immunity was established, combined with its vaccines, it was now more protective than Israel’s largely vaccine-based immunity. This wasn’t what the master narrative had promised. Israel was the world’s lab experiment because being so early to complete a vaccine rollout on a large scale, about three months ahead of the United States, it was supposed to be a glimpse of everyone else’s future. Its people did seem to be among the first to break free of COVID. But they were now the first to show that the vaccine could wane. It’s not that the vaccinated in the United States weren’t doing better than the unvaccinated in terms of hospitalization for COVID. They definitely were. The fear, rather, was that this might only prove to be a short-term benefit. In the summer, the CDC, behind on reporting of its own US data in real time, had been advised that the Pfizer vaccine was leading to breakthrough cases in the vaccinated in Israel. But it did not share this hole in the master narrative with outside public officials until one month later, as the Washington Post reported, “‘What is very concerning is that we’re not seeing the data. It needs to come out,’ said former head of the CDC, Tom Frieden. “‘What you can criticize the CDC for, validly, is why aren’t you talking about the studies you’re doing of breakthroughs?’ Because there had been such a lag time, some people wondered if the CDC was hiding something. “‘And these are the people who are potentially friendly to the CDC,’ said Frieden. “‘So you know you’re in trouble, when even your friends are suspicious of your motives.‘” In the United States, a Mayo Clinic study found the Pfizer vaccine was 42% effective at stopping people from getting infected between January and July. In the UK, nearly 50% of new COVID cases in the summer were among the vaccinated. Each day, there were about 15,000 new symptomatic cases in people who had been partially or fully vaccinated. As of July 15, new cases among the unvaccinated, 17,581, were falling, and new cases among the fully or partially vaccinated, 15,537, increasing and set to overtake the unvaccinated. According to the CDC, of the 469 attendance at Provincetown, Massachusetts celebrations in July that tested positive for COVID, 74% had been fully vaccinated. Scientists determined that those with such vaccine breakthrough infections can carry viral loads as big as infected unvaccinated people. Vaccinated people were not just infecting others. They were also clearly not getting completely immune themselves, though perhaps they were infectious for a brief period. The CDC also emphasized this study to support its new policy of asking the vaccinated to wear masks. On CNN, Wolf Blitzer asked Walensky if she got the messaging wrong and hadn’t been nuanced enough. She answered that the breakthrough infections tended to be mild. Blitzer then asked whether those who were vaccinated and had breakthrough infections could pass the virus on to older people or more vulnerable people. Walensky answered, Our vaccines are working exceptionally well. They continue to work well for Delta with regard to severe illness and death. They prevent it. But what they can’t do anymore is prevent transmission. She said so to suggest to people who were vaccinated that if they were going home to people who were immunosuppressed or frail or with comorbidities, they should wear a mask. It was a nuanced response and admitted a problem. A performance like that might have, because it was honest, enhanced vaccine confidence. Unfortunately, the mainstream media was so over-committed to a master narrative that promised 95% effectiveness for the vaccines, which it also believed implied stopping transmission, that it was caught off guard. Instead of asking whether scientists had compared the infectiousness of the vaccinated with that of the unvaccinated, the media took Walensky’s statement to mean that vaccinated people with breakthrough infections were just as likely to infect others as those who were not vaccinated and now had COVID. In this way, the episode transmitted more reasons for the vaccine hesitants to have doubts. Internal documents showed that at this point, the CDC was scrambling to change its messaging, moving from the master narrative simplification that, quote, vaccines are effective against disease, close quote, to the idea that vaccines are essential because they protect against death and hospitalization. The agency even changed its official definition of what a vaccine does from producing immunity to a specific disease to producing protection from it. The FDA had originally said that a vaccine less than 50% effective, defined as reducing the risk of having to see a doctor, would not be approved by regulators. Now, something that appeared to the public to be significantly less effective was being not just approved, but mandated. According to Israel’s health ministry, the Pfizer vaccine data showed that in those who were vaccinated as early as January, about five months prior, it was only 16% effective. A large study in Qatar showed that the vaccine was waning at five months. In the United States, a Mayo Clinic found the Pfizer vaccine had dropped to 42% effectiveness, while the CDC found it dropped to 66% in just under four months’ use. US statistics showed that the vaccinated were still overall far less likely to get infected than the unvaccinated or to get serious illness. But, Israel had been vaccinated earlier than the United States. So what lay ahead for America? It is noteworthy that this was the moment that US government officials and the media chose to assert, soon on a daily basis, that the country was now in a quote, pandemic of the unvaccinated, close quote, even though it was now clear that the vaccinated could get infected and transmit the virus. Every day, famous Americans, including entertainers, athletes, and politicians who had been doubly vaccinated were having breakthrough infections. The message that this is only an epidemic of the unvaccinated is falling flat, close quote, noted Harvard epidemiologist Michael Mina. By this point, the hesitant were no longer the only ones who had doubts. There were many anecdotal reports of great worry about breakthrough cases among the vaccinated, including among those who put much faith in vaccines because their immune systems were compromised by age or illness. Headlines about waning vaccines expressed despair that this pandemic might never end. Instead of addressing how this disappointment might affect people, US public health talking heads and Twitter-certified human nature experts turn now to behavioral psychology, a very American form of psychology, to deal with the crisis, treating their fellow citizens like children or lab rats to be given rewards when good and punishments when bad. Some seem to relish telling people that if they didn’t just do what the experts told them to do, they’d lose their jobs, their place in school, or some other basic need, like mobility. Other more data-driven thinkers, including pro-vaccine physicians like Eric Topol, head of Scripps Research and a man who regards the production of the mRNA vaccine as, quote, one of science and medical research’s greatest achievements, close quote, now seem quite concerned about the Israeli data. Topol assembled many articles showing how vaccinated populations still fare much better relative to unvaccinated populations in the United States. But he also pointed out that breakthrough infections can’t just be written off as simply caused by the new Delta variant escaping vaccine protection. Israeli data showed that the potency of the vaccines was fading after five months, contrary to what Pfizer claimed. Thus the data showed that the earlier one was vaccinated, the less protection one had against Delta. That finding was crucial because it meant that the new wave in Israel was not simply caused because of a new variant that came along. The vaccines were losing potency over time. Fauci and Surgeon General Vivek Murthy stuck to their guns, continuing to emphasize to the public that the vast majority of all COVID deaths, 99.2% according to Fauci and 99.5% according to Murthy, were among the unvaccinated, a narrative that was picked up by news outlets, which started reporting obsessively about states with high in vaccinated rates and filling the news cycle with one story after another about stupid retrograde Americans succumbing to COVID, their final wish not being for those they loved, but for their medical practitioner to broadcast to the world their vaccine regret. But, as David Wallace Wells showed on August 12th in New York Magazine, Fauci’s and Murthy’s numbers were not rooted in what was currently happening in America. They were instead based on the COVID death data from January 1st, 2021 to date. If you think this through, you’ll see what’s obviously wrong. For the first months of the year, few Americans were yet vaccinated. So of course most deaths would technically be among the unvaccinated. Two-thirds of 2021 cases and 80% of deaths came before April 1st when only 15% of the country was fully vaccinated, Wallace Wells wrote, which means calculating year-to-date ratios means possibly underestimating the prevalence of breakthrough cases by a factor of three and breakthrough deaths by a factor of five. What we desperately needed was a comparison of vaccinated to unvaccinated people by each month. But as Wallace Wells noted grimly, more accurate month-to-month data is hard to assemble because the CDC stopped tracking most breakthrough cases in early May. Wallace Wells cited a New York Times analysis that claimed the vaccines were working to suppress severe outcomes from COVID infection by more than a factor of a hundred for some states. But as Topol told Wallace Wells, quote, the breakthrough problem is much more concerning than what our public health officials have transmitted. We have no good tracking, but every indicator I have suggests there is a lot more under the radar than is being told to the public so far, which is unfortunate, close quote. The result Topol said was a widening gap between the messaging from public health authorities and the meaning of the data emerging in real time. Quote, I think the problem we have is people, whether it’s the CDC or the people that are doing the briefings, their big concern is they just want to get vaccinations up and they don’t want to punch any holes in the story about vaccines. But we can handle the truth and that’s what we should be getting, close quote. On August 23rd, FDA approval of the Pfizer vaccine came through. It was based on the same patients who were in the study that previously included only two months of follow-up, but which now had six months of follow-up. With the approval, Pfizer officially stopped the randomized control trials and informed the controls they never got the vaccine. Now that they know they are not vaccinated, the controls may well choose or be mandated to get vaccinated, so we won’t be able to follow them as a control group anymore. That means the only randomized control trials we have of these vaccines are just six months long. Should some new independent party, not a drug company, want to do a new randomized control trial of the vaccine, they will find it almost impossible to do so because it’ll be hard, if not impossible, to find people who are not vaccinated or not already exposed to COVID. This is especially important because we don’t yet, we can’t yet have any good randomized control trial data to rule out long-term effects. Vaccine supporters, including government officials, will say, quote, there’s not been a serious side effect in history that hasn’t occurred within six weeks of getting the dose, close quote. But as Doshi and others argue, there are examples of long-term problems that come to light after two months. For example, Doshi points out that it took nine months to detect that 1,300 people who received GlaxoSmithKline’s Pandermix influenza vaccine after the 2009 swine flu outbreak developed narcolepsy, thought to be caused by the vaccine. Myocarditis, inflammation of the heart tissue, is a rare but real side effect in young males, about ages 16 to 29, that did not show up in the two-month long trials that led to the emergency youth authorization, even though those studies included males as young as 16. It was not generally recognized by the scientific community or our safety report systems until four months into the vaccine rollout. And we are still learning about how this manifests in vaccinated males. In general, severe myocarditis can lead to scarring and even cause death, so it must be taken seriously and followed long-term. Right now, Paul Offit, Professor of Vaccinology at the University of Pennsylvania, says that most cases are mild and resolve on their own. The actual FDA approval for the Pfizer vaccine acknowledges higher rates of myocarditis and pericarditis in males now and states the obvious, quote, information is not yet available about potential long-term health outcomes. The Comornati, the new name for the Pfizer vaccine, prescribing information, includes a warning about these risks, close quote. An Israeli study found that in boys aged 12 to 15, myocarditis occurred in only 162 cases out of a million, but this rate was four to six times higher than their chances of being hospitalized for a severe case of COVID. But to get a sense of the complexity of the decision facing parents, in the United States the situation keeps changing, with more and more cases of children now showing up in hospitals for COVID. The decision is further complicated by the crucial fact that COVID can cause myocarditis as well, and we’re just now learning that different vaccines seem to cause myocarditis at different rates. As of October, several countries, including Norway, Sweden, and Denmark, have put the Moderna vaccine, which is especially potent, on pause for younger people, and Iceland has suspended it for all ages. But these countries are not ending childhood vaccination, just recommending different vaccines. We’re lucky to have options, but we could use good studies comparing the COVID-induced myocarditis rates and the vaccine-induced myocarditis rates by age and sex. Which is why it’s so unfortunate that the RCTs were not much larger and that they didn’t go on longer. Had they continued, and if their data ever became transparent, it could really help us in assessing long-term safety in a more reassuring way. That’s what RCTs are good at. One can more persuasively demonstrate that a vaccine doesn’t have these effects if there’s a proper vaccine-free, COVID-free control group. But if vaccines continue to be pushed as the one and only answer, we will never know if certain health problems emerge, because there will be no normal vaccine-free group left for comparison. It’s a development that’s quite disconcerting, for it suggests a wish not to know. When the pandemic first broke, many were certain that the developing countries, with their inability to afford vaccines, malnutrition, crowded cities, and lower numbers of health care workers, would be universally devastated. But that prediction turned out not to be true. The population of Ethiopia is about 119 million, just over one-third of the United States. COVID vaccination rates are very low there. 2.7% have had at least one shot, and 0.9% have had two. As of September 28, 2021, the country recorded only 5,439 COVID deaths over the course of the entire pandemic. If the United States had such a death rate per capita, it would have lost just over 16,000 people, rather than over 700,000. Why does Ethiopia have such comparatively low numbers? It’s not that the country was late to the pandemic. It recorded its first case in March 2020. It had three comparatively small waves in July and August 2020, April 2021, and most recently in August-September 2021. During these waves, the daily deaths averaged about 37, 47, and 48 people a day. The country had very brief lockdowns in select harder-hit towns at the beginning of the pandemic, and brief periods during which large gatherings, schools, stadiums, and nightclubs were closed. Then, during the second wave of April 2021, hospital capacity and oxygen supplies were stretched. But by June 2021, Ethiopian physician friends with whom I was in weekly contact told me that they could see the second wave receding as numbers were decreasing and hospital occupancy with COVID cases was going down. All this occurred with only about 1% of the country vaccinated, mostly the country’s healthcare workers, the elderly in key hot spots, and the vulnerable. Now, the third wave appears to be receding, especially in the capital, Addis Ababa. The Ethiopian physicians I know, extremely skilled, are also more accustomed to serious infectious disease than many Western physicians and have a different attitude towards herd immunity. When they saw that the death counts were low compared to other countries, they didn’t advocate to keep the country closed, observing, as one put it, it’s running through, taking its natural course, and lockdowns will only delay resolution.” For part of the COVID period, there has been armed conflict in one Ethiopian province, which could be affecting numbers. Still, how are numbers anywhere close to this low even possible, and what might be learned? Interestingly, neighboring Kenya also reports a similarly low death rate. Clearly, what determines the death count in at least some countries is far more than vaccination rates. There is the average age of the population. In Ethiopia, the median age is 19.5 years, in the United States, 38.3 years. Population density. Ethiopia is about 80% rural. Travel within the country. Ethiopians rarely travel outside their own province or far from their villages. Ventilation. Most Ethiopians live in thatched huts, and even in the cities, homes are draftier and more open. Sun exposure, hence vitamin D levels, protected. Exercise. Ethiopians are always walking with three cars per 1,000 people, and possible seasonal effects. They also had fewer lockdowns, and so they may have more natural immunity. Crucially, levels of obesity, being overweight, and type 2 diabetes are almost non-existent in Ethiopia, but epidemic in the United States, the UK, and Australia. Staggeringly, none of these factors is even mentioned in the master narrative, yet their cumulative potency in protecting a population seems, in Ethiopia for the last 18 months until now, to have been very protective. A study of 160 countries in 2020 showed that the risk of death from COVID is 10 times higher in countries like the United States, where the majority of the population, 67.9%, is overweight or obese. CDC data shows that a whopping 78% of all hospitalized cases in the United States, and therefore most at risk of death, suffered from obesity or being overweight. By lowering immunity, obesity increases the chance of severe illness and also increases the chance of death. In the United States, decreases vaccine efficacy, as has been shown in studies of the flu vaccine. Another key element left out of America’s master narrative is the role of natural immunity. After 18 months of near total silence about it, Fauci was asked by CNN’s Sanjay Gupta about a study that showed natural immunity provides a lot of protection, better than the vaccines alone. Gupta asked Fauci if people who already had COVID needed to get vaccinated. Quote, I don’t have a really firm answer for you on that, close quote Fauci said. That’s something we’re going to have to discuss, close quote. Instead, the US administration and media still maintain, with a kind of ideological fervor, that everyone must get vaccinated, even the already immune. On the face of it, this is a strange assumption, because vaccines work by triggering our pre-existing immune system and by exposing it to part of the virus. If our bodies can’t produce good immunity by exposure to the virus, they won’t usually be able to produce it by exposure to a vaccine, which happens in immunocompromised people all the time. Vaccine immunity relies on the body’s ability to produce natural immunity. An epidemiologist named Dr. Martin McCary of Johns Hopkins University showed that about half of unvaccinated Americans have been exposed to the virus and therefore are already immune. By December 2020, over 100 million Americans had been exposed to the virus and 120 million by January 31st, according to a Columbia University study. Now, 10 months later, with the more infectious Delta variant, the number is probably closer to 170 million, or half the country. Are the immune unvaccinated safe for others to be around? According to McCary, we have more than 15 studies showing that natural immunity is very strong and lasts a long time, so far the length of the entire pandemic, and it is effective against new variants. The reinfection rate for someone who had COVID was shown to be 0.65% in a Danish study or 1% in a British study and some others. A number of studies suggest it may last for years. Even when antibodies go down, cells in the marrow are ready to produce them. There is one CDC study often used to justify vaccinating the already immune, but it is an outlier. To its credit, the study begins by stating that, quote, few real-world epidemiological studies exist to support the benefit of vaccination for previously infected persons. Close quote. It then purports to show that COVID vaccine immunity is 2.3 times as protective as natural immunity based on a single two-month study from Kentucky. McCary says that the study was, quote, dishonest, close quote, and asks why the CDC chose just two months of data to evaluate when it had 19 months worth on hand and, quote, why one state when you have 50 states, close quote. But perhaps the key weakness, as Harvard’s Martin Kulldorf points out, is that they used a positive PCR test to measure whether someone was infected and not whether the person actually experienced a symptomatic infection, the key point. The problem with the PCR test is it is good at detecting viral DNA, but can’t distinguish whether the materials are intact particles, which are infectious, or merely degraded fragments, which are not. But when actual symptomatic infection has been looked at, natural immunity comes out better. A huge Israeli study of about 76,000 people, the largest on the subject, has compared the rate of symptomatic reinfection in those who had been vaccinated, the breakthrough infection rate, with the symptomatic reinfection of those who had COVID. The data has been circulated, though not yet peer-reviewed, and it is consistent with other studies showing better protection for the previously infected. It found that people who had a previous COVID infection and beat it with natural immunity in January or February 2021 were 27 times less likely to get a symptomatic reinfection than those who got immunity from the vaccine. A Washington University study showed that even a mild infection gives long-lasting immunity. Along with McCary of Johns Hopkins, among those on record willing to question the need for vaccination of the already immune are Drs. Kulldorf, the Harvard epidemiologist, Vinay Prasad, a hematologist oncologist and associate professor of epidemiology and biostatistics at the University of California, San Francisco, Harvey Rich, a Yale epidemiologist, and Jayanta Bhattacharya, a Stanford epidemiologist. Offit, who is on the FDA vaccine advisory committee, is an interesting case, as he both argues for mandates but concedes that it’s reasonable for the already immune to not want to be vaccinated. Asked by the pro-vaccine Zubin Damanya, a Stanford trained internist who goes by the pseudonym ZDoggMD on his viral interview show, what he would say to someone who asks, why should I be forced, compelled, mandated to get a vaccine when I’ve gotten natural COVID? Offit answered, I think that’s fair. I think if you’ve been naturally infected, it’s reasonable that you could say, look, I believe I’m protected based on studies that show I have high frequencies of memory plasma blasts in my bone marrow. I’m good. I think that’s a reasonable argument. The problem, as Offit noted in another interview, is that bureaucratically, it’s a nightmare. But a bureaucratic problem is not a scientific one, which is how this is widely presented. And the question is, a problem compared to what? Several million immune people fired and now resentful of public health? When asked by Damanya whether there might be a test that can prove a person has had COVID and recovered and thus has natural immunity, Offit explained that there is a blood test for antibodies to the nuclear protein of the virus, which could show up if someone had had the virus and is now immune. Imagine how much mental anguish and needless societal disruption might be relieved if, among the billions we are spending, we spent enough to make such tests widely available. Indeed, the very fact that we frame the threat debate between the vaccinated and the unvaccinated has always been peculiar. Some epidemiologists point out that the categories we should be thinking of instead are the immune and those who are nonimmune. The European Union has a digital COVID certificate, which is not limited to proof of vaccination. You can get one and travel if you have been vaccinated or if you have recovered from COVID-19. This allows travel among all EU member states. American officials always proclaim they are following the science, but obviously, if the science gave clear orders, then European scientists would have received them too. Let’s say, for the purpose of argument, that you accept natural immunity as equally good or better than vaccine immunity. What are the ethical consequences? Vaccinating people who have had COVID without informing them that the data says they don’t need it overrides both informed consent and the classical medical ethic of not treating without a medical necessity. When one gives any intervention that is not medically necessary or especially beneficial, then the cost-benefit analysis of risk versus little or no benefit is weighted in favor of risk, which overrides the first principle of Hippocratic medicine. First, do no harm. It’s also arguably selfish to vaccinate those in wealthy countries who already have natural immunity, for it deprives poor countries, short of vaccines, of protection for their vulnerable populations. It’s not lost on the vaccine hesitant that vaccine exemptions for those who already had COVID would immediately slash the projected profits of big pharma. Pharma knows that poor countries might not be able to afford the leftovers at full fee. Vaccination is a tool, a means to an end, immunity. But the American government has made the means, vaccination, the new end. This strange substitution or reversal reveals the master narrative to be the expression not of science, but of a new kind of scientistic ideology, which we might call vaccine-ism. But vaccine-ism is not a treatment. It’s a mindset, one that takes a wonderful invention which, if used properly and carefully, can be outstandingly productive, and makes it the only tool worth having until it becomes, at times, counterproductive. It makes no exceptions. Indeed, it’s insulted by the idea of any exemptions. In its all-or-nothing approach, it is the ideological mirror of anti-vaxxism. Chapter 4 Getting Out Science has had many surprises for us in this pandemic. We’ve learned that while the vaccines don’t always stop the spread, they do protect the vaccinated from getting severe disease and death for a number of months. We’ve learned, as the New York Times points out, that, quote, an unvaccinated child is less at risk of serious COVID illness than a vaccinated 70-year-old, close quote. Though we learned that Emily Oster, the author and academic who first called that fact to our attention, was mistreated for months because she was off-narrative. We’ve also learned that you’re safer in a room, or even on a plane, with people who have recovered from COVID than you are with people who were vaccinated, especially over four months ago. In other words, the immunity of those who suffered COVID is holding up so far. So, why doesn’t good news like this sink in? I submit it’s because of our old friend, the behavioral immune system. Many people’s mental set for the pandemic was formed early on when the behavioral immune system was on fire, and they were schooled by a master narrative that promised there would be only one type of person who would not pose a danger, the vaccinated person. Stuck in that mindset, when confronted by unvaccinated people, about half of whom are immune, they respond with BIS-generated fear, hostility, and loathing. Some take it further and seem almost addicted to being scared, or remain caught in a kind of post-traumatic lockdown nostalgia demanding that all the previous protections go on indefinitely, never factoring in the costs, and triggering ever more distrust. Their minds are hijacked by a primal, archaic, cognitively rigid brain circuit, and will not rest until every last person is vaccinated. To some, it started to seem like this is the mindset not only of a certain person, but of the government itself. Moreover, because COVID vaccine hesitancy is based in significant part on distrust of the government and related institutions, it has to be understood not only in terms of vaccines, but in the context of the pandemic more broadly, first and foremost, in other words, of the experience of lockdowns. For example, the pandemic has been a major threat to many businesses. For many, trust was broken by the lockdowns, which devastated small businesses and their employees even when they complied with safety rules, such that an estimated one-third of these businesses that were open in January of 2020 were closed in April of 2021, even as we kept open huge corporate box stores where people crowded together. These policies were arguably the biggest assault on the working classes, many of whom protected the rest of us by keeping society going in the worst of the pandemic in decades. That these policies also enriched the already incredibly wealthy, the combined wealth of the world’s 10 richest men, the likes of Jeff Bezos, Mark Zuckerberg, Bill Gates, and Larry Page, is estimated to have risen by $540 billion in the first 10 months of the pandemic, and that various politicians who instituted lockdowns were regularly caught skirting their own regulations, solidified this distrust. And yet, it is the unvaccinated who many leading officials still portray as recklessly endangering the rest of the country. The unvaccinated are the people who are now presented as the sole source of future variance, prolonging the pain for the rest of us. For those in favor of mandates, the vaccine is the only way out of the crisis. To them, the vaccine hesitant are merely egotistical, and the unvaccinated are the only way out of the crisis. For those in favor of mandates, the vaccine is the only way out of the crisis. To them, the vaccine hesitant are merely ignorant and defy science. We tried to use a voluntary reproach. They believe, but these people are Neanderthal who must now be coerced into treatment or be punished. Among the punishments called for is not just loss of employment, but also of unemployment insurance, health care, access to ICU beds, even the ability to go to grocery stores. It’s not trivial to override the core felt sense in a democracy that if anything is one’s own, it’s one’s body. The idea of the state or a doctor performing a medical procedure forcibly on a person or drugging them into compliance without their consent is an abiding, terrifying theme of many science fiction dystopias, and it is a fear that runs very deep in the modern psyche. This fear runs deeper in some people than their fear of the virus or losing their jobs or pensions as we are seeing. History shows that these are not just fantasies. Past medical and public health abuses really did make use of forced injections of drugs, operations, sterilizations, and even psychiatric abuses in totalitarian and democratic societies both. Moreover, to say to the unvaccinated, but it’s in the name of the greater good, is to make the utilitarian argument that we must strive for the most good for the greatest number of people. Aversion of utilitarianism is often the governing philosophy of public health, but this raises a series of questions. How are we measuring the good? Is it the same for all people? Should it be up to your 89-year-old grandmother, who has little time left, to decide whether to spend the remaining years of her life in total isolation or risk COVID but see her loved ones? And the bigger questions. Can you explain how you are helping the group when, by overriding individual rights, you degrade the group as a whole by weakening each individual within it? Are you aware that the greatest evils in history have also always been done in the name of that abstraction, the greater good? Without first answering such questions, utilitarianism is but a shallow form of arithmetic, one passing itself off as moral philosophy. It is not irrational for people to insist that public discourse seriously engage questions like these, and that any state compulsion related to people’s bodies be based on a flawless airtight argument that is well communicated. That has not happened. What, in rational, political, and public health terms, is the state’s best justification for mandating that people be injected en masse with a medicine? The first justification for mandates is that they get us to herd immunity faster. But, as Stanford epidemiologist J. Patacharya and Arizona State University economist Jonathan Ketchum note, quote, we have good reason to doubt that if most everyone got vaccinated, we’d achieve herd immunity, close quote. This is because, as we’ve seen, current vaccines are fading at about five months. Even scientists who believe vaccines will help get us to herd immunity are divided on what percentage of the population needs to be vaccinated to get us there. Early in the pandemic, Fauci said we needed as low as 60 to 70 percent to reach herd immunity, but as time went on, he increased the numbers. In December 2020, when the New York Times noticed Fauci was, quote, quietly shifting the number upward, close quote, he explained he was generating these percentages based on a mix of the science and what he felt the public was ready to hear, admitting, quote, we really don’t know what the real number is, close quote. President Biden recently said we could need 98 percent of Americans to be vaccinated to reach the goal. Is there a scientific consensus behind the 98 percent claim? In fact, a number of epidemiologists and infectious disease experts and officials dispute that we need a number anywhere near it. Even those who are pro-mandate, like Dr. Monica Gandhi, professor of clinical medicine at the University of California, San Francisco, believes that, quote, there is no evidence that we need that high of a vaccination rate, 98 percent, to get back to normal, close quote. Other countries, like Denmark, have opted for a 74 percent vaccination rate as acceptable in order to lift certain restrictions, especially if the most vulnerable are vaccinated at a higher rate. Norway lifted all restrictions when it got to a 67 percent vaccination rate. The point here is that the science is shifting, sometimes by the day. It is reasonable for people who notice this to feel concerned about it, and it is, at the very least, churlish to present them as merely irrational. The second justification for mandates is that the state has an obligation to protect those who cannot protect themselves from an infectious disease passed on to them by others, i.e. the unvaccinated do not have a right to, quote, recklessly endanger, close quote, and infect others. But as many have pointed out, it is hard to describe our current moment quite this way, since vaccines and now boosters are freely and widely available so people can protect themselves if they wish. Of course, this reveals the real problem, which is that vaccinated people do not, in fact, get comprehensive immunity, as in the case, for example, of the polio or measles vaccines. And on this, there is increasing scientific agreement. We can’t eradicate this mutating virus at this point. It is likely not a case like smallpox, which was eradicated because both the virus and the vaccines met a host of criteria. Donald Ainsley Henderson, who directed the WHO smallpox eradication campaign, wrote that smallpox was uniquely suited for eradication because it didn’t exist in animal reservoirs, it was easy to identify cases in even the smallest villages by its distinctive awful rash, so a test for it wasn’t needed, the vaccine gave immunity that lasted a decade, and natural immunity was easy to identify by the scars smallpox left. COVID satisfies none of these conditions. If we are forced to choose a vaccine that gives only one year of protection, said Larry Brilliant, an epidemiologist also involved in smallpox elimination, then we are doomed to have COVID become endemic, an infection that is always with us. He and five other scientists have since argued together that COVID is not going away because it’s growing in a dozen animal species, and variants allow it to pop up in places that once beat it back. Indeed, this is the reason that some scientists argue we need over 90% of people vaccinated to keep America safe from a virus that will ping-pong around the unvaccinated parts of the globe for years. As Brilliant and colleagues wrote recently, quote, among humans, global herd immunity, once promoted as a singular solution, is unreachable. Close quote. So, if it’s correct that we can’t eradicate the virus, and we can’t get lasting vaccine-induced herd immunity, what is our goal? It would be to use Monica Gandhi’s phrase, to get back to normal. It would mean accepting some natural herd immunity and putting more focus on saving lives by other means alongside vaccines, including better outpatient medications to catch COVID early and keep people out of a hospital, lowering our individual risk factors, and speeding delivery of vaccines to the highly vulnerable when an outbreak occurs and prioritizing them over people who are already immune. That the justifications originally given for mass public mandates are so weakened is one of COVID’s many unexpected challenges, one that requires flexible thinking, new kinds of planning, and above all, acknowledgement, lest its denial becomes yet another example of bungled trust. In tackling the trust problem generally, we can return to the two kinds of public health systems, the coercive and the participatory. The United States has all sorts of mandates, but also continues to have significantly high rates of vaccine hesitancy and vaccine avoidance. In contrast, Sweden is the leading example of a participatory public health model. Sweden has one of the highest vaccination rates in the world and the highest confidence in vaccines in the world, but there’s absolutely no mandate. Koldorf, again, one of the world’s leading epidemiologists and a specialist in vaccine safety and consultant to the ACIP COVID-19 vaccine safety technical subgroup notes, quote, if you want to have high confidence in vaccines, it has to be voluntary. If you force something on people, if you coerce somebody to do something, that can backfire. Public health has to be based on trust. If public health officials want the public to trust them, public health officials also have to trust the public. Close quote. Just as pharma’s indemnification removed its incentive to improve safety, so do mandates remove public health’s incentive to have better, more consistent communication, to listen, understand, educate, and persuade, which is what builds trust. Koldorf is echoed by Damania, who is by my estimate one of the most effective persuaders of the vaccine hesitant. Quote, I’ve been so wrong in the past about things, close quote he noted in a video. Quote, I actually, at one point in my career, felt that shaming anti-vaxxers was a good idea because they were so dangerous to children. This was pre-pandemic stuff, and it never works to convince anti-vaxxers. I would rarely ever get emails from people saying, hey, I was on the fence and you convinced me with your crazy rant about how stupid anti-vaxxers are. Then I started to wake up a bit. Why is it people feel the way they do? And when you really dig into it, you go, I can empathize with that. Actually, we share the same goal, which is our kids should be healthy, and you really think this is going to help. So of course you’re going to, in fact, I should love you for trying to do the right thing for your kids. Close quote. Indeed, demonizing people for having doubts is the worst move we can make, especially since there are serious problems in our drug and vaccine regulatory systems. Some health organizations have become concerned enough about the effects of non-transparency that a group has formed made up of the Lesley Dan Faculty of Pharmacy, University of Toronto, Transparency International, and the WHO Collaborating Centre for Governance, Accountability, and Transparency in the Pharmaceutical sector. In a report released recently, the Alliance analyzed 86 registered clinical vaccine trials across 20 COVID vaccines and found only 12% have made their protocols available as of May 2021. Scores of key decisions affecting the public were never made available. The US government should immediately give the public and outside scientists access to raw data on which studies are based and the minutes of meetings where major decisions are made on policies like mandates. We need the kinds of transparency Peter Doshi has asked for from pharma and Kesselheim did from the FDA. Doshi and some colleagues from Oxford have asked, for instance, what the rationale was for the regulatory agencies to allow pharma companies not to choose hospitalization, death, or viral transmission as endpoints in the authorization studies. Let’s see the internal deliberations. Let’s see the minutes of crucial meetings. All these researchers are doing is being true to the motto of the Royal Society, the first national scientific institution ever established. Nullius in werba. Take nobody’s word for it. Acknowledging severe problems in regulatory agencies or within pharma doesn’t mean believing that everything that system produces is tainted or that all the people in those institutions are corrupt. In fact, it defends those with the most integrity because it is they who are the most frustrated by a system that requires radical restructuring and new leadership. Even if, especially if, we think of ourselves as pro-vaccine, we should want to rescue this extraordinary technology from the flawed and broken system of poor regulation, insufficiently transparent testing, and manipulative messaging. But now, many are choosing instead to replace this conversation about the system underlying the vaccine rollout with vaccine mandates, a strategy that troubles even some of those who have been very invested in the success of the vaccines. Right now, with these vaccine mandates and vaccine passports, this coercive thing is turning a lot of people away from vaccines and not trusting them for very understandable reasons, Kaldorf says. Those who are pushing these vaccine mandates and vaccine passports, vaccine fanatics, I would call them, to me, they have done much more damage during this one year than the anti-vaxxers have done in two decades. I would even say that these vaccine fanatics, they are the biggest anti-vaxxers that we have right now.” Those congratulating the United States on mandates working conveniently leave out that each of those wins is potentially a recruit for a resentful army that does not believe in vaccines. Imagine a scenario already unfolding in Israel in which regular boosters are deemed necessary. How easy do you think it will be to drag those people into this action every six months? Wouldn’t it have been more effective to have enabled them to own these actions for themselves much earlier, thereby making it more likely that they would sustain them? There are ways for all of us, medical professionals or not, to stop the bleeding, beginning with changing our orientation to those who are sceptical. I have to return here to Damania, whose widely watched videos have attempted to persuade the hesitant to get vaccinated. I love the coronavirus vaccines, he has said. They work, they save lives, they prevent severe disease. Immunity is our only way through a pandemic, whether it is naturally being infected or being vaccinated. And yet he too believes that mandates are going to set back the cause of vaccination and increase tribal division. Instead of coercion, he offers engagement. When a viewer in the chat or in a personal email to him raises concerns, Damania doesn’t minimize it or go around the problems, he works through them. He addresses conflicting studies, bringing on some of the world’s finest epidemiologists and public health experts, and shows us the real world of physicians and scientists agreeing and disagreeing. He acknowledges when the science is not as airtight as officials present it. And he doesn’t use a one-size-fits-all approach if he can avoid it. If a person raises a personal health issue, an allergy, or an immune issue, or cardiac problem, he factors it in, and sometimes a person decides to get the shot. Sometimes they decide not to, and he wishes them well. As a result, people feel listened to, and in turn become more open to listening to what he has to say. Whether one agrees with his advice or not, I often agree or come to agree, but not every time. His respectful approach seems to me irreproachable and, to judge from the results, effective. In addition to primary care physicians, those who are pro-vaccine but not professionals also have a role to play here in acknowledging that some of their fellow citizens’ distrust is utterly warranted. The seemingly bottomless lining of pharmaceutical pockets, the unconscionable censorship of scientists, the grotesqueness of seeing the rich unmasked at a Met Gala waited on by a masked servant class, the downsides of and controversy around masking schoolchildren, and more. If they are not listened to when they are obviously right, why would they listen to others? Some might come to the end of this essay and wonder why I, so cognizant of all the problems with the US regulatory process and study transparency, got vaccinated. I did so when I had time to think through my own situation, as many physician friends did. We knew that COVID was, for many, a beast not taken lightly. Like them, I used an individualized approach, which ideally everyone should be able to do with their own physicians if they have special health issues. For me, this meant taking into account how prevalent the virus was at the time in my area, its lethality and possible long-term effects in someone my own age, sex, with my own health history, and the probability of side effects known at the time, and my own response to vaccines in the past, and the fact that I had no allergies to the additives. There were transparency problems with the clinical trials, which meant there was a lot we did not know, but already by the time I got my own shot, we did have some knowledge that the vaccines were lowering deaths. While factoring in my own risk tolerance, I tried not to pretend I knew more than I really did about COVID or the vaccines. Of course, governments will not want to rely on a system in which everyone is encouraged to go to their physician for some kind of individualized discussion. But we are not talking about everyone here. We are talking about people who remain unconvinced after our public health system has done its best at a mass-marketed vaccine campaign. It is a minority of citizens, but a sizable one. We can either choose, as we have, to coerce them with economic and social deprivation, or we can work to better engage them. For Tocqueville, the tyranny of the majority over the minority is the ever-present danger in democracies, the remedy for which John Stuart Mill argued was a protection of minority rights and, above all, the right to continue speaking, even if a majority opinion seemed to be crystallizing. Mill, in the end, was influenced and changed by Tocqueville’s notion of the tyranny of the majority, and pointed out that the tyranny unique to democracy gave rise to, quote, the peculiar evil of silencing the expression of an opinion, close quote, in the social sphere, in our so-called free societies. It moved him to write his great plea for free speech in On Liberty. Quote, protection, therefore, against the tyranny of the magistrate is not enough. There needs protection also against the tyranny of the prevailing opinion and feeling, against the tendency of society to impose, by other means than civil penalties, its own ideas and practices as rules of conduct on those who dissent from them, to fetter the development and, if possible, prevent the formation of any individuality not in harmony with its ways, and compel all characters to fashion themselves upon the model of its own. There is a limit to the legitimate interference of collective opinion with individual independence, and to find that limit and maintain it against encroachment is as indispensable to a good condition of human affairs as protection against political despotism. Close quote. To find that limit and maintain it becomes the difficult but essential task when a plague besets a democracy, especially one that wishes to remain in good enough condition to survive it. Needle points the article, plus all the links to the references, is available at tabletmag.com