The lack of trust for many of us was Public Health being wrong in real time and not acknowledging or apologizing for the mistakes. Instead, they acted like Shamans and Astrologists, always defending their failed predictions with after-the-fact explanations and promoting unfalsifiable terror scenarios (YLE for example in fall 2021 made a widely circulated post on Facebook stating that PICUs would be overrun by 30% with kids which never happened, but parents pleaded to have schools canceled based on fear like this).
I’m sure you are a very nice person, mean well, but you too have engaged in this and I am sure you aren’t even aware. (making claims of being close to Herd Immunity, supporting mandates on a non sterilizing vaccines, promoting the vaccine in children while the rest of the world paused vaccinations on people under 55-65, etc).
I brought myself up to speed on your writings over the last 4 years on Covid going through your blog over the weekend (I have a lot of free time 😊). A lot of your early work resonated with me.
For example from your 5/10/20 piece “Lessons from Graduate School for the COVID Pandemic” you note:
“It is easy to only pay attention to the data that supports your hypothesis (and ignore
the data that goes against your hypothesis)” and “It is easy to get fooled by early data.”
On 2/9/201, you have an excellent post on “When you can never be wrong: the unfalsifiable hypothesis” outlining the perils of having a theory where counterfactuals can’t be constructed to test and refute a theory.
Great stuff, and I agree with all of that of course, as you are describing the tenets of scientific pursuit outlined by Merton, Feynman, Sagan, Randi, Shermer, etc.
Yet as I continued to go through your blog, I felt you were inadvertently committing the very mistakes you warn your readers against.
Consider on 10/9/21 your piece “If you’re vaccinated, why does it matter if I am not?” where you make an attempt to justify the vaccine mandates and make what I consider to be an unfalsifiable claim:
“I just spent a month in New England (which has a higher vaccination rate overall), and my risk of getting COVID there was much lower than my risk of getting COVID back home in Texas (which has a lower vaccination rate).”
Consider that on 10/9, the 7 day average for cases in Texas was 7232, against a population of 29 million. That means .025% is positive for Covid. Vermont, which was touted as the state where “no one was left to vaccinate” (and I choose Vermont too because Katelyn Jetelina referenced them in a post around 2021 as well I encouraged her to double check her claim [1]) – on October 9th, Vermont had 197 cases/day against 647K population, rate of .03%. Slightly more than Texas.
Why in that post did you believe that Texas was doing poorly while you were safe in New England? Doesn’t the most vaccinated state in New England having more cases per population than Texas falsify your claim? If it doesn’t, can your hypothesis even be falsified?
Further, consider that Covid would absolutely explode across the country and the world, following the vaccine rollout. You make claim in 16 different parts of your essay how “being vaccinated significantly reduces transmission”, yet Covid cases would increase 10-fold in both Texas AND Vermont within 3 months. The NYT graph for vermont: https://imgur.com/a/tptVuaR
Vermont would hit a peak of 2K cases/day, representing .31% of the population, while Texas would have an almost identical peak of 68K cases/day, at .23% of the population.
To me, that should have been enough to reject your claim that Texas was doing worse than New England and caused you to reconsider your entire hypothesis. Your appeals to base rate fallacy crumble when Covid is now up a magnitude post vaccine.
Especially since any confounder you search for to prop up this now tenuous claim favors Texas.
Population denominator Texas grew due to mass migration into the state. The baseline health of Texans is far worse than Vermont..ians? There was a surging undocumented migrant population pouring into Texas, further increasing the population denominator. Texans had tossed aside the masks and social distancing long before Vermont would… at this point you have to get creative to data dredge/p-hack your way into supporting your claim.
You may say “Fine, Covid is surging equally in Texas and Vermont, despite my claim Texas is worse off than New England, but it still greatly reduces your changes of severe outcomes”
That is also wrong.
Following your 10/9/21 post, Texas would have 22.6% more deaths than expected through the end of 2021, near identical than Vermont’s 23.1% - and again, the confounders you may search for all favor Texas having a better outcome.
I am not trying to get you in a “gotcha”. Brilliant people who know how science works make these mistakes ALL OF THE TIME. It’s easy to get fooled as Feynman notes in his takedown of Social Science as “A science which isn’t a science”.[2]
William Farr, a brilliant man and one of the greatest statisticians of the modern era, had all the data he needed to see that Snow’s hypothesis disproved Miasma theory for Cholera, yet Farr stuck to his favored hypothesis for 9 more years.
I could keep going through your blog, finding examples of you making claims that were easily falsified [3], but then I would succumb to Brandolini’s Law.
On a closing note, as I read your blog I see you inadvertently and repeatedly made the mistake of “one directional skepticism”. That is, the things you think are true get a free pass-regardless of how poor the supporting evidence – while only the ideas you disagree with do you apply skepticism.
Ivermectin and HCQ didn’t work, and you were right to explain why in your posts. Yet as noted in footnote [3], you fail to apply that same level of skepticism to the easily debunked claims in the Financial Times articles you cite that high vaccination rates are suppressing the spread of Covid.
A (to me) damning example of one-directional skepticism is your 7/22/20 post “Masked Science: Fact-checking Mask Studies” where you apply rigorous skepticism to a dozen studies claiming cloth masks don’t work, pointing out all the flaws in methodology, rigor, design, and conclusions.
Of course, the consensus on cloth and surgical masks has pivoted back to what we knew 1920-2019 – they don’t work – but you felt inclined to only debunk all the studies suggesting masks didn’t work. Why didn’t you eventually write a blog post admitting “hey we got cloth masks wrong – here is why”?
I wonder, why didn’t you apply that skepticism equally to the hundreds of nonsense studies claiming cloth masks were incredibly effective? Why not tear apart the 2 Stylists in a Missouri salon paper the CDC promulgated? The ridiculous Kansas Mask Study? Abaluck’s RCT in Bangladesh?
Katelyn has made the same mistake – any terrible study showing the wonders of cloth masks got a pass and added to her “Think masks don’t work? Look at the evidence” social media threads [4], while she suddenly became concerned with study design, confounders and p-values when an RCT suggested what we would find out to be true – they are largely worthless after all [5]
It seems to me, as a dispassionate scientist, that you entered the Social Media Covid Blog World with your mind made up – masks work, Covid vaccines work, lockdowns work, etc, and wound up stuck defending these extraordinary and failing theories for reasons I can only guess (Politics? Sunk Cost Fallacy? Availability bias?) using the very pseudoscientific practices you claim to reject.
I apologize if this comes off harsh, I am not trying to be mean spirited – there are just only so many characters we can put in a comment and I don’t know if any of this will be read anyway 😊
(PS 100% agree with your post “don’t censor threads” even if threads is dead – the message is spot on)
[3] For example your 7/21/21 piece: “Some vaccinated people are getting COVID. What does this mean?” cites a FT article based on terrible data making a claim that the UK and Portugal are doing great by comparing them to sub-Saharan Africa – and of course right after this article UK and Portugal would explode in cases and deaths, while Africa would shrug and throw out unwanted vaccines.
[4] It is fascinating to me to this day how after 100 years of not being able to find much benefit of masking against respiratory viruses, we conjured 35+ studies instantly showing how amazing they are in a few months
Couple points. I do not understand why you struggle with nuance- immunity is not a binary. Your continued point that cases surged after vaccines ignores the fact that vaccinated people (especially initially) had lower rates of infection, and continued lower rates of hospitalization and death. Why do you never address this?
Why do you just post your talking points continually barely addressing the content of the articles you are responding to?
Also I'd recommend some self reflection- I see a lot of projection in your posts. "One directional skepticism" is pretty rich given your propensity to ignore huge swaths of data, and continue to link to literal propaganda. All I see in your posts is continued logical fallacies- false equivalence, straw man arguments, cherry picking data, false dilemmas, and confirmation bias. You're using the same strategies you claim to rail against.
I would love to see the following questions answered by Katelyn and Kristen:
1) How do you recommend a vaccine in children where there are zero excess deaths? What is the NNT?
2) Why did some of the worlds most highly vaccinated countries have some of the worst all-cause mortality spikes *after* their populations were fully vaccinated (South Korea and Taiwan for example, given their love of masking)
3) Why didn't countries with low vaccination rates suffer the poor outcomes predicted and instead threw out their unused shots?
SK "(you) ignore the fact that vaccinated people (especially initially) had lower rates of infection, and continued lower rates of hospitalization and death. Why do you never address this?"
I agree that is what the early studies suggested, so I weighed that hypothesis as real time data came in. Two things stuck out:
1) The early studies were fairly weak
2) The predictions the studies made were failing simple tests as time moved on
I suspect your belief that vaccine was working (especially initially) is because you saw all the charts and graphs showing it was a miracle (Kristen shared one such graph in her initial post in this series).
Now I may be projecting as you say, but I suspect you don't have background in statistics, study design, nor probably are abreast of the replication crisis?
Many of these impressive charts often contained biases, errors, and non-transparent methods. Common issues included:
- Included deaths/hospitalizations of people vaccinated but only within last 4 weeks (needed 2 weeks from second shot to be moved to the "Vaccinated Bucket")
- Using incorrect denominator for population estimates which inflated unvaccinated risk
- Automatically assuming anyone they couldn't confirm vaccinations status as unvaccinated. (Imagine you are in NYC on a trip from Virginia, have a heart attack, and brought to morgue where PCR test confirms you also had Covid - you can't tell them your vaccine status so you're considered unvaccinated)
- Early belief that the vaccine was sterilizing, so people who died of but where vaccinated were assumed to have died from something else.
- Not showing cohort breakdown of the unvaccinated dead - why weren't they vaccinated? Was it because they were in Hospice and had a week to live? That's roughly the outcome of 10% of our deaths at any given time. If a fraction of hospice patients decided to skip a vaccine, that would wildly inflate "Unvaccinated Covid Deaths"
Now, I had those concerns early on, but still hoped these would be the miracle promised.
But simple sanity checks as time went on were failing. States with low vaccine rates having identical All Cause Mortality Curves as highly vaccinated states was early indicator. Highly vaccinated countries having explosions of Covid demonstrated there must be something wrong with the studies. Again, South Korea had an enormous amount of deaths in their vaccinated population, and not once has Katelyn or Kristen written about that.
You keep saying "Well it worked early", but the vaccines were administered *while* Covid was plummeting on it's own as it was seasonal. Credit was being given to the vaccine for cases and deaths receding Feb-May 2021, but vaccine uptake was 2%-10% in many places, or not happening at all, and Covid followed the same curve regardless. But you don't know this because it seems you aren't double checking everything you are told - I guess?
Then, when Covid was exploding despite vaccination, the new claim was that "Red Counties are doing worse than Blue Counties". Well guess what? That has been true for 100 years with the flu and common cold. The confounders aren't that Covid hates republicans, it's that Red Counties are older, fatter, suffer from more comorbidities.
SK: "Why do you just post your talking points continually barely addressing the content of the articles you are responding to"
Kristen's asking a great and important question "why is trust in vaccines failing" and I disagree with her premise that it was a just a communication issue. It was a "you got a lot of this wrong and aren't owning up to it" issue why people don't trust Public Health.
Today she is saying "we should have been nicer to the unvaccinated to convince them we were right"
I am pointing out, no, you got so much wrong the last 4 years and don't even seem to know it. The example I used of her telling readers "she was so much less likely to get Covid in New England than Texas" in a 2021 blog was demonstrably false the very day she wrote it, had she decided to quickly check her claim with data. These types of mistakes compounded, and there is an obliviousness to it. She and Katelyn recommend vaccinating children, and seem not to be aware there have been zero excess deaths in children 0-14 the *entire pandemic* in the *entire world*. The NNT is infinity.
I'm not trolling. I am trying to help these young scientists realize they got bamboozled.
SK: "All I see in your posts is continued logical fallacies- false equivalence, straw man arguments, cherry picking data, false dilemmas, and confirmation bias. You're using the same strategies you claim to rail against."
As we discussed yesterday, I am facing an unfalsifiable hypothesis.
We have been struggling to make sterilizing flu vaccines for 80 years, and would openly admit "we don't know why they don't work". We spent 20 years trying and completely failing to make a Coronavirus vaccine.
As Kristen notes in her blog "Medical research is a loooooooooong process. Like, really long." [1]
So it was extraordinary that we could solve an 80 year old problem in 6 months back in 2020. We should have been skeptical, and initially PH Social Media Influencers were skeptical [2] but it seems mainly because they were worried Trump would get credit.
Bottom line SK, the burden of evidence is on those making the claim. If you claim that tying an Onion to your Belt wards off the Flu, and I show you that countries who don't tie Onions on their Belts (as was the style at the time) have identical or better rates of Flu, don't come at me with claims of "Cherry Picking" or "False Dilemmas".
You are welcome to email me further if you don't want to explain the following major challenges to the Covid Vaccine I started with above:
1) How do you mandate a vaccine in children where there are zero excess deaths?
2) Why did some of the worlds most highly vaccinated countries have some of the worst all cause mortality spikes *after* their populations were fully vaccinated (South Korea and Taiwan for example).
3) Why didn't countries with low vaccination rates suffer outcomes predicted?
Bonus: 4) Claims were made that without boosters, hospitalizations and deaths would soar, yet the opposite happened as the public moved on from Covid.
"We were on a path for a vaccine emergency authorization (EUA) before November 3rd. Thanks to the FDA, Trump's plan was disrupted. That won't happen. First real sign of the independence of FDA since the pandemic started. And that's important."
I really wish you could focus your arguments and points, but I suspect this approach to gish gallop has worked for you.
You have so many claims, and so little sources.
Let's address a couple.
1. COVID-19 was causing hospitalizations and deaths in kids at a higher rate than any other infectious disease (yes a comparatively low rate to adults, but kids aren't supposed to die), and we had an effective vaccine to lower the risk of that. Also I'm not aware of any pediatric vaccine "mandates." California thought about it, but never did it. We don't have many excess deaths from measles right now in the US, should we not vaccinate? When has excess deaths ever been used as a metric for deciding to vaccinate?
2. No country was 100% vaccinated, and the vaccine didn't prevent every death. But it substantially lowered the risk. New variants, waning immunity and easing of restrictions explain the spikes to me.
3. First of all: https://www.sciencedirect.com/science/article/pii/S2772707623000115 Second, this keeps bugging me. You seem to expect the same results everywhere no matter what, ignoring all context. I'm not a global health expert, but I know countries that struggled with the administrative burdens of vaccination (or cost) also struggle with accurate reporting.
I do have some epi background and no I don't think I've been fooled by fancy graphs. I'm talking about multiple, large prospective and retrospective cohort studies that repeatedly and continue to demonstrate reduced risk of serious illness, hospitalization and death due to COVID-19 with vaccination. I'm happy to list them if you like.
One last point, since you brought up a background in statistics. Let's do a thought experiment. I think it is likely the majority of those working in biostatistics, epidemiology, public health and medicine would disagree with your view that the COVID-19 vaccines did not prevent serious illness and death. What seems more likely, that they, with all their knowledge and expertise are wrong, or that you (and a small minority of other scientists in this field) have cracked the code and they were all duped? This is not an appeal to authority, majorities of scientists have obviously been wrong in the past, but rather a thought experiment. How likely is it that you have figured it all out?
"SK: You have so many claims, and so little sources"
I encourage you to point out specific claims I failed to source, and I will do so, just as I did yesterday. A lot of the things I am saying I am taking for granted are common knowledge at this point (e.g., zero excess deaths ages 0-14 worldwide) so for a bit of brevity move quickly. Again, my email is in my profile and you are welcome to have side conversations through email where you might be more comfortable. I have had wonderful discussions with several readers of this blog and others the last 4 years this way.
SK: " Let's do a thought experiment. I think it is likely the majority of those working in (science) would disagree with your view that the COVID-19 vaccines did not prevent serious illness and death. What seems more likely..."
To be clear, I'm open to the vaccine having benefit to the elderly. I scheduled my parents shots in 2021.
But it's 2024. The crowd has thinned, many moved to the other side. Now we know:
The data is overwhelming that the vaccine did not slow transmission. https://imgur.com/a/9ueSF21 (I know you will say "cherry picking" but I could repeat this for any state, any country - they are all "cherries")
The data is overwhelming there were never any excess deaths in children, before covid, during covid, after covid
**There are enough counterfactuals of the highest vaccinated countries having excess mortality surges not seen in lower vaccinated countries to call into the question the hypothesis the vaccine prevented serious illness and death.** Again, and I await your explanation, what happened in Taiwan and South Korea? These two countries were constantly promoted as shining examples of "doing it right" throughout the pandemic by public health until deaths exploded. Then they stopped talking about them. Understanding how South Korea could have all cause mortality doubled (this is literally without precedent) Spring 2022 in an entirely vaccinated population (yes, all people over 65 in SK were vaccinated, and this is the cohort where all the deaths occurred) should one of the most highly studied topics of the pandemic as literally, the exact opposite of what we would expected happened to them.
I can't stress how big a problem the South Korea mortality data poses to you, but you seem incurious, which isn't surprising, as the people you follow are also incurious.
I am not the man shouting the crowd of experts "you are all wrong", because there is no crowd anymore. What is left is a handful of Social Science Media Influencers stuck "holding the bag" on the vaccine hype. Covid as a problem exists entirely now on Social Media. It's talked about on Twitter and r/ZeroCovid, and some SubStack blogs, but doctors with patients have moved on. They are largely not recommending the vaccine anymore to anyone except the elderly (and even that is hit or miss).
The vaccine passport and mandates were overturned and many who advocated for them have distanced themselves.
Covid Boosters and Vaccine uptake have cratered. Not among Republicans, but Democrats too. And politicians, and doctors, and nearly everyone. It's anecdotal, but my friend group largely consists of physicians in the Cleveland area, I am not aware of any who have bothered boosters since 2021. I am sure there are, but they are the outliers.
Not just Africa, but Europe is trashing millions of vaccines. Yet the public health influencers you are following predicted that without boosters things would get worse, yet the oppositive happened. As our hysteria and disinterest in Covid subsided, so did excess deaths. Why?
Quick address of your 3 counters to my questions though:
1) The measles vaccine worked. The predictions materialized. Cases disappeared, overall mortality reduced. And we see (unfortunately) "tests" of this hypothesis anytime some population decides to stop being vaccinated against measles - cases surge and deaths increase.
But just because one medical treatment works doesn't mean another one does. We have had plenty of vaccines we thought would work, but when they didn't, we shelved it and went back to try again (Rotavirus in 90's for example). Difference is they weren't politicized.
The covid vaccines were determined after careful consideration by the rest of the world not outweigh their negatives in children, which is why the rest of the world rejected them (either initially or after it became clear the evidence wasn't there). Again, I am not the "man shouting you are wrong" to the crowd. "The Crowd" agrees.
2) There are enough examples of countries having a near 100% vaccinated cohort population (i.e., 65+) yet still experiencing incredibly high mortality spikes. I strongly encourage you to dig into Taiwan and South Korea data tables, and if you don't know how to do this, I would be more than happy to walk you through so you can see for yourself. It does not make sense.
As for your possible confounder explanations, let run through them:
a) "New variants" - low vaccinated countries had the same variants
b) "waning immunity" - If a vaccine only provides 2-3 durability, does it work? Or is it "kicking the can down the road"? Would it be realistic to get 4 shots a year? 6? Can that claim be tested?
c) "easing of restrictions" - In the case of Taiwan and South Korea, they were still wearing masks. Their lockdowns were ended over a year earlier (almost two). South Korea children back in school Spring 2020. This doesn't explain it. And corolllary, if the easing of restrictions was the reason, why did the countries wth the shortest lockdowns, earliest return to school, lowest mask use, etc, have the best outcomes? (Nordic Countries: Sweden, Norway, Finland, Denmark).
3) I expect reproducible results. That is the foundation of science. The hypothesis must pass rigorous scrutiny and exceptions must be faced head on. In the case of Sub Saharan Africa, yes, the administrative burden was high. Testing was spotty. Mortality data is almost nonexistent. These countries face challenges much higher than Covid, and that's the point - they face challenges bigger than Covid. Throughout 2020 and into 2021 there was so much hand wringing by Public Health about how much Africa would suffer from Covid, how we needed to pay for their vaccines, and in the end, the New York Times was puzzled why Covid didn't seem to be a problem there and their Public Health trashed the shots. Actions speak loudly on this.
I do love that you bring up the "Gish Gallop", as that is the challenge I face when discussion this.
I say "please explain how a completely vaccinated and masked 65+ population in South Korea had explosion of deaths", and I'm met with 100 old studies, models, preprints showing how much worse they would have fared without the vaccine.
Why not consider instead that the fastest vaccine developed in human history, by an order of a magnitude, against a virus we tried and failed to vaccinate for 20 years, against a family of viruses we have struggled to develop effective vaccines for 80 years, simply didn't work once we saw everyone get stick anyway and death regularly increase or stay unchanged?
I think we made assumptions, that everyone would see us as SMEs and that they would "understand" and comply with our advice. No one expected that the POTUS would openly challenge our expertise. No one expected that several Red State Governors would openly challenge our expertise. I don't have a counterargument for politicians who have little or no respect for science. I don't have any counterarguments for politicians who do not have the health, safety, and welfare of their citizens as their primary motivation during a pandemic. I know that we did the best, we could do, given the circumstances. But nothing changes the fact that (maybe) 3M Americans died needlessly during the pandemic, mostly because they either choose to ignore us, because they believed politicians over the "expertise" or politicians muddy the water enough, to confuse a significant number of Americans; that they decided that no action was their best option.
Nice column. A lot to consider. But if one side continually devalues fact, reason and patience in favor of fiction and outright lies - and engages in threats of violence - how can the attempt to focus on shared values gain any traction? You hit a wall at some point. I do my research and get the vaccinations I deem safe and appropriate. Too many others, though, go straight to the disinformation and take up permanent residence there with no thought of ever dislodging their minds from such a perch. I'll take care of myself first and foremost. I find it's fruitless to converse with the other side. I guess you can fault me for giving up, but that's where I am at age 68.
I'm with you. I'm exhausted from receiving only derision and outright lie-based responses to my years of attempting to engage positively from an empathy & data driven place. I can't approach people with reason anymore if they are behaving & speaking in dangerous, disrespectful, and thoughtless ways.
1. Public health is PUBLIC. It depends on government funding with the usual government oversight. And in the early days of the pandemic, in the US, it became highly politicized. Orders from on high as to who was allowed to say what depending on the perceived political costs.
2. I cannot recall another event where we were all watching science happen in real time. We had to figure out if this was trasmited by fomites, droplets, or something else. We made a (reasonable in my view) guess that social distancing, masks, various closures, etc. would stop the spread or at least provide some limited personal protection. In hindsight, a lot of that advice was not great. But given what we knew and when we knew it, we did the best we could in the face of imperfect knowledge and government meddling.
3. Too many of us are scientifically illiterate. As a consequence, we want to be told ONCE what to do, that it works, and how to do it. The advice on Covid was not consistent (see point 2 above). And that drove a lot of people nuts because they just wanted to know what to do and got frustrated and angry when the advice kept changing. Ideally, science is self-correcting. Good advice WILL change. But when it changes fast and often, we just get frustrated.
I only hope to heaven we have learned from the mistakes we made with Covid and do not repeat them whenever the next virus from hell rears its ugly head.
And Drs Fauci and Hotez deserve a Nobel Prize, not the firing squad so many are calling for.
Since 2022, when my oldest was diagnosed with cancer at 19 months old and I had a 3 month old baby who clearly wasn’t fully vaccinated I have struggled with effective ways to counter antivaxxers in any sense. Appealing to emotion doesn’t work “why should I potentially harm MY kid in order to keep yours safe?!” (the most common come back I see) or “if you are so worried about it just stay home!!” (As if my kids don’t deserve the ability to be in the outside world at all because they don’t have the appropriate immune systems to fend off vaccine preventable diseases due to the lack of vaccines and chemo effects - they are already fairly isolated but they deserve to be able to exist in a society too!) it’s been a rough 2.5 years and isn’t over for us yet. Luckily my youngest is fully vaccinated up to date but my son still isn’t able to receive his re-vaccines.
I understand your points sure!! But in some ways maybe not that simple!! I think the issue of online misinformation & disinformation is so rampant that how that is countered is the bigger question. When there are still daily death threats against docs like Hotez & Fauci, political ones like Rand Paul calling for Fauci to be jailed, etc. etc. Yes, empathy is vital but not sure it's enough to counter all the stuff coming the way of public health professionals. Public health messengers never said they were perfect or got everything right in '20 or after.
The question that I have - who, or what, profits from the dis-informed world? And I remember that a sage from long ago said that politics is the highest science of man......
I just think everything has gotten so polarized & entwined especially with Fox, ones like RFK Jr, large segments of the GOP now that it will take a least a generation & likely longer to get back to most of the public listening to public health establishment. Yes, there might be some at the individual level that can be swayed away from the anti vax/science mentality which is fine, but any big changes will take a while.
Love the bottom line here: “We must use science to figure out how to regain trust in science. And the science is clear: shaming isn’t helpful.” A wonderful object lesson there, so clever. I also think the wise words in this piece are useful for every interaction we have, whether in person or online. Too often, ad hominem attacks and name-calling take the place of any civilized, respectful exchange of views. The suggestions here offer great ways to get past that problem. (I particularly enjoyed, in that regard, the advice to rant in private😎.)
This is a really important and difficult topic; thank you for writing about it. I’m an MD/PhD (immunology) and work in Neurocritical care, and now & then will see a family which makes decisions based on a data set entirely different from mine. I also use values-based discussion, and I lead with “We all have the same goal: to do as well by [the patient] as we can. Let’s start there.” The situation is so complex (ventilator, pressors, stroke, ICH, TBI, cerebral edema, etc) that we talk a lot (almost a mini med school course on what is happening and why) which helps people come to grips with how we look at cause and effect relationships and helps overcome distrust.
It’s all about the shared goal. I want the same thing you want, you can see the work being done, I’ll answer all of the questions you have, and we’ll both see results as they happen.
I think this kind of practical discussion might work in many different spheres.
"It [is] fundamentally about believing that evidence-based medicine actually works—that systematically collecting data and analyzing it will give us a clearer picture of reality than anecdotes. That we don’t have to go back to the days of basing medical decisions on hunches, fears, and vibes. We have a better way of figuring out what’s real and true.
The rejection of carefully collected, peer-reviewed data in favor of rumors and memes is understandably infuriating. If universally adopted, this would make our society collapse. For people who have devoted their lives to science, medicine, and public health, it makes sense that this gets under our skin and infuriates us."
I love reading this and strongly agree. This is one of the reasons I am so frustrated with gender medicine in our country. Medical organizations and political leaders are doing exactly what anti-vaxxers say that progressives do - use their authority and "science" to support purely political goals without regard to evidence. A different topic, of course, but I think the perception that the left is willing to promote non-evidence based policy and twist the facts for ideological purposes is absolutely true in the field of gender medicine. It is going to (justifiably) harm the public's faith in experts and science, which will make public health that much more challenging in the future. If we want to promote science and evidenced based decision making, we have to be consistent - that's kind of what science is.
“I so agree with your statement that “If we want to promote science and evidenced based decision making, we have to be consistent - that's kind of what science is,” and your example is right on point. It is particularly distressing to see the rejection of science persist in the area of gender medicine despite the publication of the Final Cass Report. (If of interest to anyone here, this is a link: https://cass.independent-review.uk/home/publications/final-report/)
What are you saying? It sounds like what you’re doing is dismissing the evidence-based science behind gender affirming care without citing which data you’re challenging or providing any of your own… almost as if your personal biases are getting in the way of making a logical argument.
I love this series! I’ve been able to be this way and have shared it with others. But not as clearly and articulately as you have here. Excellent. As an example, I saw that when I wasn’t well-informed about a subject, e.g., race, politics, and history, I couldn’t really “weigh in” effectively. So, over time, I started absorbing more and more information from my weaker areas, especially politics and history, because the topic became clearly important. Oh yeah, and systemic racism and repression. Now when I talk to people in the neighborhood, family gatherings, the grocery store, the clinic, workers fixing my house or yard, I can figure out their values and only respond to what they’ve already said with a suggestion like, “I recently read that Biden’s build back better program means …” this or that. You know you’re on the right track when the other person says, “I didn’t know that.” And you can say what relief or joy or amazement you felt when that happened, too. It opens the door of their mind even if you never see them again. It’s even better when you do see them again and haven’t offended them or put them on their guard against you.
Did you notice how JD Vance was speaking lies in the debate, but was doing so in a way that sounded friendly, kind, polite? It scared me more than Trump, because I can see that people will respond to him positively. It's an example of your point in action.
On reflection, just about everything CDC recommended turned out to be wrong.
At the same a number of countries in Europe got most of it right. Europes input was based on input from practicing physicians and some input from epidemiologists. US came primarily from epidemiologists which is largely using statistical input. All these decisions need a good douse of input from practicing physicians
I absolutely get what you are laying out here, and the goal of helping people see how science helps us is spot on. I will say that in this current climate trying to, even very politely, have a conversation on such topics is extremely difficult. I volunteer at Planned Parenthood as an escort helping clients get into the clinic while protesters yell horrible things at them. Since the spring I have made it my mission to talk to the protesters not about the issue of abortion or all of the other services going on at the clinic, as we of course don't agree, but to try and humanize each other, to try and not "other" each other, talking about regular life stuff. I will continue to participate in trying to humanizing each of us, but I honestly don't see any sign of these people seeing any reason to try and think differently, to try and learn from getting to know the "other" person. I know my example is different than what the article is about, but the challenge of what I'm trying to do seems similar to me.
One of the problems that I see is that folks are being forced into binary camps on this position: either for or against, and that doesn't necessarily reflect reality. As I have said previously, I am not "anti vax", but neither do I blindly swallow the current recommendations, which to me seem like a load of bullshit with a dose "I'm an expert trust the science" to try to mask the flavor. To put things in perspective, I was born in 1971. From what I can find it looks like at that time, the vaccinations I received would have been: DTP, Polio and MMR. There was no vaccine for chicken pox, which I contracted in first grade.
Now, let's compare that to the current recommendations:
RSV, Hep B, Rotavirus, DTP, HIB, Pnemonacoccal, Covid, Influenza, MMR, Chicken Pox, and Hep A.
Not mentioned would be HPV administered as a teenager.
I look at this and say, WHOA! And God forbid I should question any of this. Hepatitis? The first time I recall someone getting a hepatitis vaccine was it being offered to the person who cleaned the bathrooms at the first place I worked after graduating from college.
This is easily double the number of vaccines I was given and most of these are three and four doses. I didn't get three or four doses of anything as a kid. You're damn right I question this, especially when juxtaposed against some of the supposed "misinformation", which has become a buzzword to try to stop the conversation as a put down, about the effects. And don't give me crap about being a health expert or even a damned doctor. As an engineer I am quite capable of understanding and interpreting "the science" and even have more college education than most doctors. Calling yourself an "expert" doesn't cut it.
If you'd like some fun reading, here is some great background on how the ACIP decides what gets put on the vaccine schedule. It is fascinating and comprehensive stuff!:
Kristen,
The lack of trust for many of us was Public Health being wrong in real time and not acknowledging or apologizing for the mistakes. Instead, they acted like Shamans and Astrologists, always defending their failed predictions with after-the-fact explanations and promoting unfalsifiable terror scenarios (YLE for example in fall 2021 made a widely circulated post on Facebook stating that PICUs would be overrun by 30% with kids which never happened, but parents pleaded to have schools canceled based on fear like this).
I’m sure you are a very nice person, mean well, but you too have engaged in this and I am sure you aren’t even aware. (making claims of being close to Herd Immunity, supporting mandates on a non sterilizing vaccines, promoting the vaccine in children while the rest of the world paused vaccinations on people under 55-65, etc).
I brought myself up to speed on your writings over the last 4 years on Covid going through your blog over the weekend (I have a lot of free time 😊). A lot of your early work resonated with me.
For example from your 5/10/20 piece “Lessons from Graduate School for the COVID Pandemic” you note:
“It is easy to only pay attention to the data that supports your hypothesis (and ignore
the data that goes against your hypothesis)” and “It is easy to get fooled by early data.”
On 2/9/201, you have an excellent post on “When you can never be wrong: the unfalsifiable hypothesis” outlining the perils of having a theory where counterfactuals can’t be constructed to test and refute a theory.
Great stuff, and I agree with all of that of course, as you are describing the tenets of scientific pursuit outlined by Merton, Feynman, Sagan, Randi, Shermer, etc.
Yet as I continued to go through your blog, I felt you were inadvertently committing the very mistakes you warn your readers against.
Consider on 10/9/21 your piece “If you’re vaccinated, why does it matter if I am not?” where you make an attempt to justify the vaccine mandates and make what I consider to be an unfalsifiable claim:
“I just spent a month in New England (which has a higher vaccination rate overall), and my risk of getting COVID there was much lower than my risk of getting COVID back home in Texas (which has a lower vaccination rate).”
Consider that on 10/9, the 7 day average for cases in Texas was 7232, against a population of 29 million. That means .025% is positive for Covid. Vermont, which was touted as the state where “no one was left to vaccinate” (and I choose Vermont too because Katelyn Jetelina referenced them in a post around 2021 as well I encouraged her to double check her claim [1]) – on October 9th, Vermont had 197 cases/day against 647K population, rate of .03%. Slightly more than Texas.
Why in that post did you believe that Texas was doing poorly while you were safe in New England? Doesn’t the most vaccinated state in New England having more cases per population than Texas falsify your claim? If it doesn’t, can your hypothesis even be falsified?
Further, consider that Covid would absolutely explode across the country and the world, following the vaccine rollout. You make claim in 16 different parts of your essay how “being vaccinated significantly reduces transmission”, yet Covid cases would increase 10-fold in both Texas AND Vermont within 3 months. The NYT graph for vermont: https://imgur.com/a/tptVuaR
Vermont would hit a peak of 2K cases/day, representing .31% of the population, while Texas would have an almost identical peak of 68K cases/day, at .23% of the population.
To me, that should have been enough to reject your claim that Texas was doing worse than New England and caused you to reconsider your entire hypothesis. Your appeals to base rate fallacy crumble when Covid is now up a magnitude post vaccine.
Especially since any confounder you search for to prop up this now tenuous claim favors Texas.
Population denominator Texas grew due to mass migration into the state. The baseline health of Texans is far worse than Vermont..ians? There was a surging undocumented migrant population pouring into Texas, further increasing the population denominator. Texans had tossed aside the masks and social distancing long before Vermont would… at this point you have to get creative to data dredge/p-hack your way into supporting your claim.
You may say “Fine, Covid is surging equally in Texas and Vermont, despite my claim Texas is worse off than New England, but it still greatly reduces your changes of severe outcomes”
That is also wrong.
Following your 10/9/21 post, Texas would have 22.6% more deaths than expected through the end of 2021, near identical than Vermont’s 23.1% - and again, the confounders you may search for all favor Texas having a better outcome.
I am not trying to get you in a “gotcha”. Brilliant people who know how science works make these mistakes ALL OF THE TIME. It’s easy to get fooled as Feynman notes in his takedown of Social Science as “A science which isn’t a science”.[2]
William Farr, a brilliant man and one of the greatest statisticians of the modern era, had all the data he needed to see that Snow’s hypothesis disproved Miasma theory for Cholera, yet Farr stuck to his favored hypothesis for 9 more years.
I could keep going through your blog, finding examples of you making claims that were easily falsified [3], but then I would succumb to Brandolini’s Law.
On a closing note, as I read your blog I see you inadvertently and repeatedly made the mistake of “one directional skepticism”. That is, the things you think are true get a free pass-regardless of how poor the supporting evidence – while only the ideas you disagree with do you apply skepticism.
Ivermectin and HCQ didn’t work, and you were right to explain why in your posts. Yet as noted in footnote [3], you fail to apply that same level of skepticism to the easily debunked claims in the Financial Times articles you cite that high vaccination rates are suppressing the spread of Covid.
A (to me) damning example of one-directional skepticism is your 7/22/20 post “Masked Science: Fact-checking Mask Studies” where you apply rigorous skepticism to a dozen studies claiming cloth masks don’t work, pointing out all the flaws in methodology, rigor, design, and conclusions.
Of course, the consensus on cloth and surgical masks has pivoted back to what we knew 1920-2019 – they don’t work – but you felt inclined to only debunk all the studies suggesting masks didn’t work. Why didn’t you eventually write a blog post admitting “hey we got cloth masks wrong – here is why”?
I wonder, why didn’t you apply that skepticism equally to the hundreds of nonsense studies claiming cloth masks were incredibly effective? Why not tear apart the 2 Stylists in a Missouri salon paper the CDC promulgated? The ridiculous Kansas Mask Study? Abaluck’s RCT in Bangladesh?
Katelyn has made the same mistake – any terrible study showing the wonders of cloth masks got a pass and added to her “Think masks don’t work? Look at the evidence” social media threads [4], while she suddenly became concerned with study design, confounders and p-values when an RCT suggested what we would find out to be true – they are largely worthless after all [5]
It seems to me, as a dispassionate scientist, that you entered the Social Media Covid Blog World with your mind made up – masks work, Covid vaccines work, lockdowns work, etc, and wound up stuck defending these extraordinary and failing theories for reasons I can only guess (Politics? Sunk Cost Fallacy? Availability bias?) using the very pseudoscientific practices you claim to reject.
I apologize if this comes off harsh, I am not trying to be mean spirited – there are just only so many characters we can put in a comment and I don’t know if any of this will be read anyway 😊
(PS 100% agree with your post “don’t censor threads” even if threads is dead – the message is spot on)
_______________________
[1] https://yourlocalepidemiologist.substack.com/p/state-of-affairs-europe-should-we/comments?s=r
[
2] Should be mandatory viewing for everyone, especially social scientists https://www.youtube.com/watch?v=tWr39Q9vBgo
“I might be quite wrong” – my mantra
[3] For example your 7/21/21 piece: “Some vaccinated people are getting COVID. What does this mean?” cites a FT article based on terrible data making a claim that the UK and Portugal are doing great by comparing them to sub-Saharan Africa – and of course right after this article UK and Portugal would explode in cases and deaths, while Africa would shrug and throw out unwanted vaccines.
https://x.com/nathanwpyle/status/1176860147223867393/photo/1
[4] It is fascinating to me to this day how after 100 years of not being able to find much benefit of masking against respiratory viruses, we conjured 35+ studies instantly showing how amazing they are in a few months
https://www.facebook.com/permalink.php?story_fbid=202002698114314&id=101805971467321
[5] https://www.facebook.com/permalink.php?story_fbid=pfbid01SraZhfgd3fvJ969SrsjufxCuWE92DJRTW8dXbYqMFemjX5WYVUwD85GPJbMFVQyl&id=101805971467321
Michael,
Couple points. I do not understand why you struggle with nuance- immunity is not a binary. Your continued point that cases surged after vaccines ignores the fact that vaccinated people (especially initially) had lower rates of infection, and continued lower rates of hospitalization and death. Why do you never address this?
Why do you just post your talking points continually barely addressing the content of the articles you are responding to?
Also I'd recommend some self reflection- I see a lot of projection in your posts. "One directional skepticism" is pretty rich given your propensity to ignore huge swaths of data, and continue to link to literal propaganda. All I see in your posts is continued logical fallacies- false equivalence, straw man arguments, cherry picking data, false dilemmas, and confirmation bias. You're using the same strategies you claim to rail against.
SK,
I would love to see the following questions answered by Katelyn and Kristen:
1) How do you recommend a vaccine in children where there are zero excess deaths? What is the NNT?
2) Why did some of the worlds most highly vaccinated countries have some of the worst all-cause mortality spikes *after* their populations were fully vaccinated (South Korea and Taiwan for example, given their love of masking)
3) Why didn't countries with low vaccination rates suffer the poor outcomes predicted and instead threw out their unused shots?
SK "(you) ignore the fact that vaccinated people (especially initially) had lower rates of infection, and continued lower rates of hospitalization and death. Why do you never address this?"
I agree that is what the early studies suggested, so I weighed that hypothesis as real time data came in. Two things stuck out:
1) The early studies were fairly weak
2) The predictions the studies made were failing simple tests as time moved on
I suspect your belief that vaccine was working (especially initially) is because you saw all the charts and graphs showing it was a miracle (Kristen shared one such graph in her initial post in this series).
Now I may be projecting as you say, but I suspect you don't have background in statistics, study design, nor probably are abreast of the replication crisis?
Many of these impressive charts often contained biases, errors, and non-transparent methods. Common issues included:
- Included deaths/hospitalizations of people vaccinated but only within last 4 weeks (needed 2 weeks from second shot to be moved to the "Vaccinated Bucket")
- Using incorrect denominator for population estimates which inflated unvaccinated risk
- Automatically assuming anyone they couldn't confirm vaccinations status as unvaccinated. (Imagine you are in NYC on a trip from Virginia, have a heart attack, and brought to morgue where PCR test confirms you also had Covid - you can't tell them your vaccine status so you're considered unvaccinated)
- Early belief that the vaccine was sterilizing, so people who died of but where vaccinated were assumed to have died from something else.
- Not showing cohort breakdown of the unvaccinated dead - why weren't they vaccinated? Was it because they were in Hospice and had a week to live? That's roughly the outcome of 10% of our deaths at any given time. If a fraction of hospice patients decided to skip a vaccine, that would wildly inflate "Unvaccinated Covid Deaths"
Now, I had those concerns early on, but still hoped these would be the miracle promised.
But simple sanity checks as time went on were failing. States with low vaccine rates having identical All Cause Mortality Curves as highly vaccinated states was early indicator. Highly vaccinated countries having explosions of Covid demonstrated there must be something wrong with the studies. Again, South Korea had an enormous amount of deaths in their vaccinated population, and not once has Katelyn or Kristen written about that.
You keep saying "Well it worked early", but the vaccines were administered *while* Covid was plummeting on it's own as it was seasonal. Credit was being given to the vaccine for cases and deaths receding Feb-May 2021, but vaccine uptake was 2%-10% in many places, or not happening at all, and Covid followed the same curve regardless. But you don't know this because it seems you aren't double checking everything you are told - I guess?
Then, when Covid was exploding despite vaccination, the new claim was that "Red Counties are doing worse than Blue Counties". Well guess what? That has been true for 100 years with the flu and common cold. The confounders aren't that Covid hates republicans, it's that Red Counties are older, fatter, suffer from more comorbidities.
SK: "Why do you just post your talking points continually barely addressing the content of the articles you are responding to"
Kristen's asking a great and important question "why is trust in vaccines failing" and I disagree with her premise that it was a just a communication issue. It was a "you got a lot of this wrong and aren't owning up to it" issue why people don't trust Public Health.
Today she is saying "we should have been nicer to the unvaccinated to convince them we were right"
I am pointing out, no, you got so much wrong the last 4 years and don't even seem to know it. The example I used of her telling readers "she was so much less likely to get Covid in New England than Texas" in a 2021 blog was demonstrably false the very day she wrote it, had she decided to quickly check her claim with data. These types of mistakes compounded, and there is an obliviousness to it. She and Katelyn recommend vaccinating children, and seem not to be aware there have been zero excess deaths in children 0-14 the *entire pandemic* in the *entire world*. The NNT is infinity.
I'm not trolling. I am trying to help these young scientists realize they got bamboozled.
SK: "All I see in your posts is continued logical fallacies- false equivalence, straw man arguments, cherry picking data, false dilemmas, and confirmation bias. You're using the same strategies you claim to rail against."
As we discussed yesterday, I am facing an unfalsifiable hypothesis.
We have been struggling to make sterilizing flu vaccines for 80 years, and would openly admit "we don't know why they don't work". We spent 20 years trying and completely failing to make a Coronavirus vaccine.
As Kristen notes in her blog "Medical research is a loooooooooong process. Like, really long." [1]
So it was extraordinary that we could solve an 80 year old problem in 6 months back in 2020. We should have been skeptical, and initially PH Social Media Influencers were skeptical [2] but it seems mainly because they were worried Trump would get credit.
Bottom line SK, the burden of evidence is on those making the claim. If you claim that tying an Onion to your Belt wards off the Flu, and I show you that countries who don't tie Onions on their Belts (as was the style at the time) have identical or better rates of Flu, don't come at me with claims of "Cherry Picking" or "False Dilemmas".
You are welcome to email me further if you don't want to explain the following major challenges to the Covid Vaccine I started with above:
1) How do you mandate a vaccine in children where there are zero excess deaths?
2) Why did some of the worlds most highly vaccinated countries have some of the worst all cause mortality spikes *after* their populations were fully vaccinated (South Korea and Taiwan for example).
3) Why didn't countries with low vaccination rates suffer outcomes predicted?
Bonus: 4) Claims were made that without boosters, hospitalizations and deaths would soar, yet the opposite happened as the public moved on from Covid.
_______________
[1] https://youcanknowthings.com/2020/06/17/why-does-it-take-so-long-to-develop-medical-treatments/
[2] Charltan Eric Topol for example:
"We were on a path for a vaccine emergency authorization (EUA) before November 3rd. Thanks to the FDA, Trump's plan was disrupted. That won't happen. First real sign of the independence of FDA since the pandemic started. And that's important."
https://twitter.com/EricTopol/status/1314979190555340800
Michael,
I really wish you could focus your arguments and points, but I suspect this approach to gish gallop has worked for you.
You have so many claims, and so little sources.
Let's address a couple.
1. COVID-19 was causing hospitalizations and deaths in kids at a higher rate than any other infectious disease (yes a comparatively low rate to adults, but kids aren't supposed to die), and we had an effective vaccine to lower the risk of that. Also I'm not aware of any pediatric vaccine "mandates." California thought about it, but never did it. We don't have many excess deaths from measles right now in the US, should we not vaccinate? When has excess deaths ever been used as a metric for deciding to vaccinate?
2. No country was 100% vaccinated, and the vaccine didn't prevent every death. But it substantially lowered the risk. New variants, waning immunity and easing of restrictions explain the spikes to me.
3. First of all: https://www.sciencedirect.com/science/article/pii/S2772707623000115 Second, this keeps bugging me. You seem to expect the same results everywhere no matter what, ignoring all context. I'm not a global health expert, but I know countries that struggled with the administrative burdens of vaccination (or cost) also struggle with accurate reporting.
I do have some epi background and no I don't think I've been fooled by fancy graphs. I'm talking about multiple, large prospective and retrospective cohort studies that repeatedly and continue to demonstrate reduced risk of serious illness, hospitalization and death due to COVID-19 with vaccination. I'm happy to list them if you like.
One last point, since you brought up a background in statistics. Let's do a thought experiment. I think it is likely the majority of those working in biostatistics, epidemiology, public health and medicine would disagree with your view that the COVID-19 vaccines did not prevent serious illness and death. What seems more likely, that they, with all their knowledge and expertise are wrong, or that you (and a small minority of other scientists in this field) have cracked the code and they were all duped? This is not an appeal to authority, majorities of scientists have obviously been wrong in the past, but rather a thought experiment. How likely is it that you have figured it all out?
"SK: You have so many claims, and so little sources"
I encourage you to point out specific claims I failed to source, and I will do so, just as I did yesterday. A lot of the things I am saying I am taking for granted are common knowledge at this point (e.g., zero excess deaths ages 0-14 worldwide) so for a bit of brevity move quickly. Again, my email is in my profile and you are welcome to have side conversations through email where you might be more comfortable. I have had wonderful discussions with several readers of this blog and others the last 4 years this way.
SK: " Let's do a thought experiment. I think it is likely the majority of those working in (science) would disagree with your view that the COVID-19 vaccines did not prevent serious illness and death. What seems more likely..."
To be clear, I'm open to the vaccine having benefit to the elderly. I scheduled my parents shots in 2021.
Now, you are proposing that I am on the losing side of the "no, you are all wrong" meme (https://knowyourmeme.com/photos/2368486-yes-you-all-are-wrong) , which I agree, if I were saying these things in 2021, would have been the case.
But it's 2024. The crowd has thinned, many moved to the other side. Now we know:
The data is overwhelming that the vaccine did not slow transmission. https://imgur.com/a/9ueSF21 (I know you will say "cherry picking" but I could repeat this for any state, any country - they are all "cherries")
The data is overwhelming there were never any excess deaths in children, before covid, during covid, after covid
https://docs.google.com/spreadsheets/d/1WLCmgaOJSd0m-lXAw6-rTEaJiiTC9F3c452-J-3t1NI/edit?usp=sharing
**There are enough counterfactuals of the highest vaccinated countries having excess mortality surges not seen in lower vaccinated countries to call into the question the hypothesis the vaccine prevented serious illness and death.** Again, and I await your explanation, what happened in Taiwan and South Korea? These two countries were constantly promoted as shining examples of "doing it right" throughout the pandemic by public health until deaths exploded. Then they stopped talking about them. Understanding how South Korea could have all cause mortality doubled (this is literally without precedent) Spring 2022 in an entirely vaccinated population (yes, all people over 65 in SK were vaccinated, and this is the cohort where all the deaths occurred) should one of the most highly studied topics of the pandemic as literally, the exact opposite of what we would expected happened to them.
I can't stress how big a problem the South Korea mortality data poses to you, but you seem incurious, which isn't surprising, as the people you follow are also incurious.
I am not the man shouting the crowd of experts "you are all wrong", because there is no crowd anymore. What is left is a handful of Social Science Media Influencers stuck "holding the bag" on the vaccine hype. Covid as a problem exists entirely now on Social Media. It's talked about on Twitter and r/ZeroCovid, and some SubStack blogs, but doctors with patients have moved on. They are largely not recommending the vaccine anymore to anyone except the elderly (and even that is hit or miss).
Every country but the US and Canada halted the vaccine being administered to anyone under 55-65 age depends on country, (though as of last year Austria still went as low as 30) am I wrong? Perhaps, I haven't updated my notes found here since last year: https://docs.google.com/spreadsheets/d/1oJusZ0yAve1cCCSS5MGjp1XYjNc7qJffqJsz7ARlnLg/edit?usp=sharing
The vaccine passport and mandates were overturned and many who advocated for them have distanced themselves.
Covid Boosters and Vaccine uptake have cratered. Not among Republicans, but Democrats too. And politicians, and doctors, and nearly everyone. It's anecdotal, but my friend group largely consists of physicians in the Cleveland area, I am not aware of any who have bothered boosters since 2021. I am sure there are, but they are the outliers.
Not just Africa, but Europe is trashing millions of vaccines. Yet the public health influencers you are following predicted that without boosters things would get worse, yet the oppositive happened. As our hysteria and disinterest in Covid subsided, so did excess deaths. Why?
Quick address of your 3 counters to my questions though:
1) The measles vaccine worked. The predictions materialized. Cases disappeared, overall mortality reduced. And we see (unfortunately) "tests" of this hypothesis anytime some population decides to stop being vaccinated against measles - cases surge and deaths increase.
But just because one medical treatment works doesn't mean another one does. We have had plenty of vaccines we thought would work, but when they didn't, we shelved it and went back to try again (Rotavirus in 90's for example). Difference is they weren't politicized.
The covid vaccines were determined after careful consideration by the rest of the world not outweigh their negatives in children, which is why the rest of the world rejected them (either initially or after it became clear the evidence wasn't there). Again, I am not the "man shouting you are wrong" to the crowd. "The Crowd" agrees.
2) There are enough examples of countries having a near 100% vaccinated cohort population (i.e., 65+) yet still experiencing incredibly high mortality spikes. I strongly encourage you to dig into Taiwan and South Korea data tables, and if you don't know how to do this, I would be more than happy to walk you through so you can see for yourself. It does not make sense.
As for your possible confounder explanations, let run through them:
a) "New variants" - low vaccinated countries had the same variants
b) "waning immunity" - If a vaccine only provides 2-3 durability, does it work? Or is it "kicking the can down the road"? Would it be realistic to get 4 shots a year? 6? Can that claim be tested?
c) "easing of restrictions" - In the case of Taiwan and South Korea, they were still wearing masks. Their lockdowns were ended over a year earlier (almost two). South Korea children back in school Spring 2020. This doesn't explain it. And corolllary, if the easing of restrictions was the reason, why did the countries wth the shortest lockdowns, earliest return to school, lowest mask use, etc, have the best outcomes? (Nordic Countries: Sweden, Norway, Finland, Denmark).
3) I expect reproducible results. That is the foundation of science. The hypothesis must pass rigorous scrutiny and exceptions must be faced head on. In the case of Sub Saharan Africa, yes, the administrative burden was high. Testing was spotty. Mortality data is almost nonexistent. These countries face challenges much higher than Covid, and that's the point - they face challenges bigger than Covid. Throughout 2020 and into 2021 there was so much hand wringing by Public Health about how much Africa would suffer from Covid, how we needed to pay for their vaccines, and in the end, the New York Times was puzzled why Covid didn't seem to be a problem there and their Public Health trashed the shots. Actions speak loudly on this.
I do love that you bring up the "Gish Gallop", as that is the challenge I face when discussion this.
I say "please explain how a completely vaccinated and masked 65+ population in South Korea had explosion of deaths", and I'm met with 100 old studies, models, preprints showing how much worse they would have fared without the vaccine.
Why not consider instead that the fastest vaccine developed in human history, by an order of a magnitude, against a virus we tried and failed to vaccinate for 20 years, against a family of viruses we have struggled to develop effective vaccines for 80 years, simply didn't work once we saw everyone get stick anyway and death regularly increase or stay unchanged?
I think we made assumptions, that everyone would see us as SMEs and that they would "understand" and comply with our advice. No one expected that the POTUS would openly challenge our expertise. No one expected that several Red State Governors would openly challenge our expertise. I don't have a counterargument for politicians who have little or no respect for science. I don't have any counterarguments for politicians who do not have the health, safety, and welfare of their citizens as their primary motivation during a pandemic. I know that we did the best, we could do, given the circumstances. But nothing changes the fact that (maybe) 3M Americans died needlessly during the pandemic, mostly because they either choose to ignore us, because they believed politicians over the "expertise" or politicians muddy the water enough, to confuse a significant number of Americans; that they decided that no action was their best option.
You hit the key points of our Covid years.
Nice column. A lot to consider. But if one side continually devalues fact, reason and patience in favor of fiction and outright lies - and engages in threats of violence - how can the attempt to focus on shared values gain any traction? You hit a wall at some point. I do my research and get the vaccinations I deem safe and appropriate. Too many others, though, go straight to the disinformation and take up permanent residence there with no thought of ever dislodging their minds from such a perch. I'll take care of myself first and foremost. I find it's fruitless to converse with the other side. I guess you can fault me for giving up, but that's where I am at age 68.
I'm with you. I'm exhausted from receiving only derision and outright lie-based responses to my years of attempting to engage positively from an empathy & data driven place. I can't approach people with reason anymore if they are behaving & speaking in dangerous, disrespectful, and thoughtless ways.
When a position becomes tribal, an argument against that position is taken as an affront to the tribe. and reason is no longer relevant.
A couple of points.
1. Public health is PUBLIC. It depends on government funding with the usual government oversight. And in the early days of the pandemic, in the US, it became highly politicized. Orders from on high as to who was allowed to say what depending on the perceived political costs.
2. I cannot recall another event where we were all watching science happen in real time. We had to figure out if this was trasmited by fomites, droplets, or something else. We made a (reasonable in my view) guess that social distancing, masks, various closures, etc. would stop the spread or at least provide some limited personal protection. In hindsight, a lot of that advice was not great. But given what we knew and when we knew it, we did the best we could in the face of imperfect knowledge and government meddling.
3. Too many of us are scientifically illiterate. As a consequence, we want to be told ONCE what to do, that it works, and how to do it. The advice on Covid was not consistent (see point 2 above). And that drove a lot of people nuts because they just wanted to know what to do and got frustrated and angry when the advice kept changing. Ideally, science is self-correcting. Good advice WILL change. But when it changes fast and often, we just get frustrated.
I only hope to heaven we have learned from the mistakes we made with Covid and do not repeat them whenever the next virus from hell rears its ugly head.
And Drs Fauci and Hotez deserve a Nobel Prize, not the firing squad so many are calling for.
Since 2022, when my oldest was diagnosed with cancer at 19 months old and I had a 3 month old baby who clearly wasn’t fully vaccinated I have struggled with effective ways to counter antivaxxers in any sense. Appealing to emotion doesn’t work “why should I potentially harm MY kid in order to keep yours safe?!” (the most common come back I see) or “if you are so worried about it just stay home!!” (As if my kids don’t deserve the ability to be in the outside world at all because they don’t have the appropriate immune systems to fend off vaccine preventable diseases due to the lack of vaccines and chemo effects - they are already fairly isolated but they deserve to be able to exist in a society too!) it’s been a rough 2.5 years and isn’t over for us yet. Luckily my youngest is fully vaccinated up to date but my son still isn’t able to receive his re-vaccines.
I understand your points sure!! But in some ways maybe not that simple!! I think the issue of online misinformation & disinformation is so rampant that how that is countered is the bigger question. When there are still daily death threats against docs like Hotez & Fauci, political ones like Rand Paul calling for Fauci to be jailed, etc. etc. Yes, empathy is vital but not sure it's enough to counter all the stuff coming the way of public health professionals. Public health messengers never said they were perfect or got everything right in '20 or after.
Totally agree.
The question that I have - who, or what, profits from the dis-informed world? And I remember that a sage from long ago said that politics is the highest science of man......
I just think everything has gotten so polarized & entwined especially with Fox, ones like RFK Jr, large segments of the GOP now that it will take a least a generation & likely longer to get back to most of the public listening to public health establishment. Yes, there might be some at the individual level that can be swayed away from the anti vax/science mentality which is fine, but any big changes will take a while.
Love the bottom line here: “We must use science to figure out how to regain trust in science. And the science is clear: shaming isn’t helpful.” A wonderful object lesson there, so clever. I also think the wise words in this piece are useful for every interaction we have, whether in person or online. Too often, ad hominem attacks and name-calling take the place of any civilized, respectful exchange of views. The suggestions here offer great ways to get past that problem. (I particularly enjoyed, in that regard, the advice to rant in private😎.)
This is a really important and difficult topic; thank you for writing about it. I’m an MD/PhD (immunology) and work in Neurocritical care, and now & then will see a family which makes decisions based on a data set entirely different from mine. I also use values-based discussion, and I lead with “We all have the same goal: to do as well by [the patient] as we can. Let’s start there.” The situation is so complex (ventilator, pressors, stroke, ICH, TBI, cerebral edema, etc) that we talk a lot (almost a mini med school course on what is happening and why) which helps people come to grips with how we look at cause and effect relationships and helps overcome distrust.
It’s all about the shared goal. I want the same thing you want, you can see the work being done, I’ll answer all of the questions you have, and we’ll both see results as they happen.
I think this kind of practical discussion might work in many different spheres.
"It [is] fundamentally about believing that evidence-based medicine actually works—that systematically collecting data and analyzing it will give us a clearer picture of reality than anecdotes. That we don’t have to go back to the days of basing medical decisions on hunches, fears, and vibes. We have a better way of figuring out what’s real and true.
The rejection of carefully collected, peer-reviewed data in favor of rumors and memes is understandably infuriating. If universally adopted, this would make our society collapse. For people who have devoted their lives to science, medicine, and public health, it makes sense that this gets under our skin and infuriates us."
I love reading this and strongly agree. This is one of the reasons I am so frustrated with gender medicine in our country. Medical organizations and political leaders are doing exactly what anti-vaxxers say that progressives do - use their authority and "science" to support purely political goals without regard to evidence. A different topic, of course, but I think the perception that the left is willing to promote non-evidence based policy and twist the facts for ideological purposes is absolutely true in the field of gender medicine. It is going to (justifiably) harm the public's faith in experts and science, which will make public health that much more challenging in the future. If we want to promote science and evidenced based decision making, we have to be consistent - that's kind of what science is.
“I so agree with your statement that “If we want to promote science and evidenced based decision making, we have to be consistent - that's kind of what science is,” and your example is right on point. It is particularly distressing to see the rejection of science persist in the area of gender medicine despite the publication of the Final Cass Report. (If of interest to anyone here, this is a link: https://cass.independent-review.uk/home/publications/final-report/)
Thank you.
What are you saying? It sounds like what you’re doing is dismissing the evidence-based science behind gender affirming care without citing which data you’re challenging or providing any of your own… almost as if your personal biases are getting in the way of making a logical argument.
There is no evidence behind gender affirming care. See the link regarding the Cass Review above.
I love this series! I’ve been able to be this way and have shared it with others. But not as clearly and articulately as you have here. Excellent. As an example, I saw that when I wasn’t well-informed about a subject, e.g., race, politics, and history, I couldn’t really “weigh in” effectively. So, over time, I started absorbing more and more information from my weaker areas, especially politics and history, because the topic became clearly important. Oh yeah, and systemic racism and repression. Now when I talk to people in the neighborhood, family gatherings, the grocery store, the clinic, workers fixing my house or yard, I can figure out their values and only respond to what they’ve already said with a suggestion like, “I recently read that Biden’s build back better program means …” this or that. You know you’re on the right track when the other person says, “I didn’t know that.” And you can say what relief or joy or amazement you felt when that happened, too. It opens the door of their mind even if you never see them again. It’s even better when you do see them again and haven’t offended them or put them on their guard against you.
Did you notice how JD Vance was speaking lies in the debate, but was doing so in a way that sounded friendly, kind, polite? It scared me more than Trump, because I can see that people will respond to him positively. It's an example of your point in action.
On reflection, just about everything CDC recommended turned out to be wrong.
At the same a number of countries in Europe got most of it right. Europes input was based on input from practicing physicians and some input from epidemiologists. US came primarily from epidemiologists which is largely using statistical input. All these decisions need a good douse of input from practicing physicians
I absolutely get what you are laying out here, and the goal of helping people see how science helps us is spot on. I will say that in this current climate trying to, even very politely, have a conversation on such topics is extremely difficult. I volunteer at Planned Parenthood as an escort helping clients get into the clinic while protesters yell horrible things at them. Since the spring I have made it my mission to talk to the protesters not about the issue of abortion or all of the other services going on at the clinic, as we of course don't agree, but to try and humanize each other, to try and not "other" each other, talking about regular life stuff. I will continue to participate in trying to humanizing each of us, but I honestly don't see any sign of these people seeing any reason to try and think differently, to try and learn from getting to know the "other" person. I know my example is different than what the article is about, but the challenge of what I'm trying to do seems similar to me.
One of the problems that I see is that folks are being forced into binary camps on this position: either for or against, and that doesn't necessarily reflect reality. As I have said previously, I am not "anti vax", but neither do I blindly swallow the current recommendations, which to me seem like a load of bullshit with a dose "I'm an expert trust the science" to try to mask the flavor. To put things in perspective, I was born in 1971. From what I can find it looks like at that time, the vaccinations I received would have been: DTP, Polio and MMR. There was no vaccine for chicken pox, which I contracted in first grade.
Now, let's compare that to the current recommendations:
RSV, Hep B, Rotavirus, DTP, HIB, Pnemonacoccal, Covid, Influenza, MMR, Chicken Pox, and Hep A.
Not mentioned would be HPV administered as a teenager.
I look at this and say, WHOA! And God forbid I should question any of this. Hepatitis? The first time I recall someone getting a hepatitis vaccine was it being offered to the person who cleaned the bathrooms at the first place I worked after graduating from college.
This is easily double the number of vaccines I was given and most of these are three and four doses. I didn't get three or four doses of anything as a kid. You're damn right I question this, especially when juxtaposed against some of the supposed "misinformation", which has become a buzzword to try to stop the conversation as a put down, about the effects. And don't give me crap about being a health expert or even a damned doctor. As an engineer I am quite capable of understanding and interpreting "the science" and even have more college education than most doctors. Calling yourself an "expert" doesn't cut it.
If you'd like some fun reading, here is some great background on how the ACIP decides what gets put on the vaccine schedule. It is fascinating and comprehensive stuff!:
https://www.cdc.gov/acip/media/pdfs/2024/09/ACIP-Evidence-to-Recommendations-Framework-cdc.pdf
https://www.cdc.gov/acip/media/pdfs/2024/09/ACIP-EtR-Users-Guide_October-1-2020.pdf
Good words and perspective to share.
I fear that our society is indeed in danger of collapse- and not just from disregard of public health measures.