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When the COVID-19 pandemic hit, and its full impact was experienced worldwide in terms of loss of lives and livelihoods, I had a naïve expectation. I reasoned that now that the American people got to see the sorry state of the world as a result of the absence of ONE vaccine, they would fully realize the lunacy of the antivaxxer movement that wants a world with NO vaccines. And when the COVID-19 vaccines were produced in record time and became available, I fully expected the American people to flock in droves to get vaccinated and protect their lives and those of their loved ones and friends. Alas, although a majority of Americans received the vaccine and the boosters, a substantial number refused. Not only that, but the antivaccination movement had a resurgence and effectively spread alarmist misinformation and conspiracies about the vaccines far and wide promoting vaccine hesitancy, which hurt and killed many people.  The antivaccination movement, which before the pandemic was mostly a movement among people with left-wing ideology concerned about vaccine safety and effectiveness, expanded during the pandemic into right wing groups rallying around ideas of parental rights and freedom from the imposition of government vaccination, which in turn gained a measure of backing from politicians eager to capitalize on their support. This activism also produced a campaign of harassment of health professionals and scientists promoting and dispensing vaccines. After the pandemic, the antivaccine groups have remained active by organizing and trying to influence vaccination policies such as school vaccination requirements in several states. Regardless of the above, the COVID-19 vaccines performed admirably. The vaccines saved more than 20 million lives worldwide the first year they were introduced, and in the United States they prevented three million deaths. During the height of the pandemic, unvaccinated people were 10 times more likely to be hospitalized and 11 times more likely to die than vaccinated people. As it was during president’s Donald Trump tenure that the Covid-19 vaccines were developed, it is ironic that Republican voters had a higher proportion of deaths than Democratic voters because of their reticence or outright refusal to receive the vaccine. Many notorious vaccine deniers including talk show hosts and social media influencers died as a result of Covid-19. In a move reminiscent of the well-known Darwin Awards, a subreddit forum created the Herman Cain Award, which is bestowed upon people who publicly declare their opposition to the COVID-19 vaccines and then die of the disease. Even though many vaccine scientists have been publicly maligned and harassed, they have soldiered on making our world a better place by producing new vaccines, creating better vaccines or vaccination methods, or molding public policy. The rest of this post is a celebration of their achievements. We start with the COVID-19 vaccines which were made possible by decades of research, during which many problems were identified and solved. The Hungarian-American scientist, Dr. Katalin Karikó, overcame adversity and along with her colleague, American immunologist Drew Wiseman, made key discoveries that allowed mRNA to be stable and not produce an inflammatory response. This in turn made possible the mRNA-based COVID-19 vaccines. They both shared the Nobel Prize in Physiology or Medicine in 2023. The American immunologist, Barney S. Graham, experienced a life-changing event when two children died in a respiratory syncytial virus (RSV) vaccine trial in 1967. He spent the rest of his life trying to figure out what happened. Graham discovered that viral proteins change their shape when they interact with the cells they infect, and that the best vaccine is the one that targets the protein in the shape before it interacts with cells. This discovery was instrumental in developing the COVID-19 vaccine, and also allowed the development of effective vaccines against RSV, a disease which can be lethal for infants and older people. Dr. Graham and his collaborators received the 2020 Golden Goose Award, which recognizes federally-funded basic research that leads to discoveries with significant impact on humanity. Now we move on to the remarkable case of the prevention of a cancer by a vaccine! In the 1980s it was discovered that some types of human papilloma virus (HPV) could cause cervical cancer. Several researchers, among them American immunologists Doug Lowy and John Schiller, and Australian Immunologist Ian Frazer, took up the study of the genes and proteins in HPV that were responsible for making human cells cancerous. They discovered that when several copies of an HPV viral protein are mixed together, they assemble into a virus-like-particle that can elicit a strong immune response. This approach was then employed by pharmaceutical companies to produce vaccines that are effective against the virus and which have been found to significantly reduce the risk of cervical cancer in women, anal cancer in men, and genital warts in both sexes. Lowy and Schiller received the prestigious Lasker-DeBakey Clinical Medical Research Award for this achievement, and Frazer received the Prime Minister's Prize for Science in 2008 and was voted a “National Living Treasure” in 2012 by the National Trust of Australia. Finally, there is malaria, which kills more than 500,000 people (80% children under 5) each year, and which is a fiendishly complicated disease to tackle due to the many stages of development that its parasite goes though, and its capacity to evade the human immune system. However, after more than 60 years of research and trials by many scientists and clinicians, the first malaria vaccine was approved for use by the World Health Organization (WHO) in 2021 and another vaccine two years later. In clinical trials, the vaccines reduced the number of cases of malaria and mortality, and their evaluation is ongoing. Vaccines are a success story and a tangible example of what science has done for us. Vaccines have decreased infant mortality in the world by 40% in the last 50 years, and the future of vaccines with new technologies to develop more effective vaccines seems promising. In the meantime, antivaxxers are causing real harm by promoting vaccine hesitancy. The obstacle to greatly diminishing the burden of disease on humanity is not lack of tools anymore, but overcoming misinformation. The photo of the COVID-19 vaccine by Lisa Ferdinando (DOD) was taken from the Flickr photostream of the US Secretary of Defense and is used here under an Attribution 2.0 Generic (CC BY 2.0) license.
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I have dealt with antivaxxers several times in my blog, and I have made my position clear. All the evidence we have indicates that vaccines work and have saved many lives, including the COVID-19 vaccines. I consider that by promoting vaccine hesitancy or avoidance, antivaxxers are harming and even killing people who delay or forfeit potentially life-saving vaccines. Some of the antivaxxers I’ve butted heads with in social media seem to be individuals that, no matter how misguided, are convinced of their position. These individuals respond to my criticism and engage in debates. However, others are nothing but opportunists who are not interested in countering rebuttals of their position. These characters just traffic in likes and shares of what they post, and in the number of comments they receive regardless of their nature. They don’t necessarily believe in antivaxxer arguments, they just use them to grow their accounts, which have tens to hundreds of thousands of followers. In between these two types of antivaxxers is a third kind who is halfway between the previous two. The accounts of these characters have a few hundreds to thousands of followers, and they are very active posting, liking, and sharing vaccine misinformation. They will occasionally respond to criticism, but they will seldom carry on an argument for more than one or two posts. Most importantly, I’ve noticed that they coordinate to like and share each other’s posts, and what they write at times seems to have an odd grammatical structure and choice of words, as though their first language were not English. I have been told that these accounts belong to foreign operatives who are promoting antivaxxer sentiment in the United States and other things to disrupt our society. The concept is not so farfetched as we know for a fact that Russian operatives posted on social media to influence our elections and create chaos. But without specific proof, this is just another conspiracy theory. As many of those who follow my posts know, I have also criticized those who spread conspiracy theories, but what is often lost in the heat of the arguments is that I am talking about unfounded conspiracy theories. I accept the fact that there have been conspiracies promoted by the government or other organizations, and I accept that there may be such activities currently going on, but I have always stressed that you need to have evidence to correctly identify them as such before claiming that there is a conspiracy. Acting otherwise is irresponsible. It is with this in mind that I was surprised to learn about a conspiracy by the US government to spread antivaxxer messages!  At the start of the COVID-19 pandemic, China engaged in the spreading of propaganda claiming that the COVID-19 virus came from the United States. Then, in order to increase their influence in other countries, China supplied the COVID-19 vaccine they developed and other things to the Philippines and nations in central Asia and the Middle East that still did not have access to the vaccines made in the United States (a move known as “vaccine diplomacy”). To retaliate for this and counter Chinese influence, the Trump administration authorized a clandestine psychological operation to be carried out by the military in which, using hundreds of fake social media accounts that ended up accumulating altogether tens of thousands of followers, they fanned antivaxxer sentiment in those countries and spread misinformation about the Chinese vaccine. The accounts posted suggestive things such as that the virus came from China and the vaccine too, that the vaccine from China was fake, that it might be a rat killer, and that it contained pork gelatin (this was targeted to Muslim countries). This was at the time that tens of thousands of people were dying each day as a result of COVID-19. After the Biden administration came into power, this particular disinformation program was shut down. The above is not an unfounded conspiracy. We know it is true because the news organization Reuters which broke the story conducted interviews with contractors working for the US army, retired and active US officials, academic researchers and social media analysts, and reviewed data regarding fake social media accounts used by the U.S. military. I have been actively countering antivaxxers and promoting vaccines for years, so I am appalled that our own government participated in spreading these messages. Now, let me make it clear that I am not ignorant about the cutthroat environment of international politics. China is a dictatorship where there is no freedom of the press. People in China who try to investigate any alleged foreign psychological operations carried out by Chinese military operatives will end up in jail. The reason why Reuters was able to discover what the U.S. military was doing, and the reason we learned about it, is because of the freedoms we enjoy in this country. I could not have written this post if it were not for those freedoms. Therefore, I understand that the United States has to fight against governments such as the Chinese in several fronts, including the psychological realm, to counter its influence. However, I don’t think the way to do it is to spread antivaxxer messages or misinformation about a vaccine. And in thinking like this I am not alone. Top U.S. diplomats in Southeast Asia strongly objected to the anti-vax campaign, but they were overruled. Reuters quotes one American military official saying, “We weren’t looking at this from a public health perspective. We were looking at how we could drag China through the mud.” In the end, China’s vaccine diplomacy was not as successful as they expected, although probably not due to the psychological operation carried out by the U.S. government, but rather due to hard power tactics that China employed in many countries where they came across as an aggressor. Whether the U.S. caused damage due to its antivaxxer campaign is difficult to discern. The evidence we have indicates that the Chinese vaccine worked reasonably well against the initial variants of the COVID-19 virus. In places where only the Chinese vaccine was available, it saved lives. Therefore, anyone foregoing receiving the Chinese vaccine could have placed themselves in danger. I am not a military operative specialized in conducting psychological operations. But I would venture that any way of countering the influence of China or other countries or organizations has to take into account the well-being of foreign nationals. Instead of conducting this antivaxxer campaign, the US government could have, for example, been more proactive in sharing the COVID-19 vaccines developed in the United States with other countries from the beginning to build up goodwill towards the United States. That’s just my two cents. The unmodified image by Christian Emmer is used under an Attribution Noncomercial 4.0 international Deed (CC BY-NC 4.0).  Antivaxxers are people who deny the need for or the efficacy of vaccines and their role in controlling some of the most dreadful diseases in the history of humanity. Not only this, but antivaxxers also claim that vaccines have huge side effects that actually harm more people than they benefit, and they have been particularly vocal about the COVID-19 vaccines. All this is, of course, not true. The COVID-19 vaccines have saved millions of lives by decreasing the proportion of hospitalizations and deaths among the vaccinated to a much greater extent compared to the unvaccinated. Antivaxxers have also spread misinformation and lies about the COVID-19 vaccines that have been repeatedly debunked over and over and over. Nevertheless, they ignore this while expressing outrage at pro-vaccine people, at best calling them “sheep” (sheeple), or at worst claiming that they are being manipulated by or are part of an immoral and unethical alliance of the government, pharmaceutical companies, and other organizations bent on profit and societal control. So what should be my approach to dealing with antivaxxers? I see two alternatives: the inflammatory approach and the conciliatory approach. INFLAMMATORY APPROACH
Considering the high effectiveness of the COVID vaccines at decreasing the hospitalizations and deaths from COVID-19, considering that antivaxxers have been waging an aggressive campaign of spreading misinformation about the COVID-19 vaccines on social media, and considering that online misinformation is linked to COVID vaccination hesitancy and refusal, it is not surprising that many people were harmed or killed by the misinformation spread by antivaxxers. During the peak of the Delta variant the daily consequences of spreading misinformation have been estimated at 300 deaths, 1,200 hospitalizations, and 20,000 COVID-19 cases with a cost of 50 to 300 million dollars. I am appalled and outraged at how many lives antivaxxers have damaged. So my question is: should antivaxxers pay for their crimes? This is not a far-fetched concept. Alex Jones, the talking head from Infowars, spread misinformation and disinformation about the shooting at Sandy Hook Elementary School where 20 children and 6 adults were killed. He said that the shooting was a false flag operation carried out by anti-gun groups, that no one died, and that the children were actors. As a result of this, the families of the murdered children experienced years of harassment by the followers of Alex Jones. Thankfully, he was brought to court and tried and found guilty, and now he has to pay the Sandy Hook families millions of dollars. Alex Jones tried several defenses including his right to free speech, but the judges didn’t buy it. He spread falsehoods and this hurt people. That was the bottom line. So, if anything, the case against antivaxxers should be even more clear cut, because many people who followed their ideas were harmed or died. Although in the case of Alex Jones the Sandy Hook families sued him for slander, a person or the family of a person harmed by antivaxxers could sue them for fraud. They would have to prove that the antivaxxer spread the misinformation while knowing that it was false. They would have to prove that the person who was harmed relied on the antivaxxer in their decision to forgo vaccination. And they would have to prove that there was economic loss (hospital bills, lost wages, funeral expenses, etc.). There are, of course, additional subtleties that have to be taken into account depending on the specific antivaxxer entity or person being sued, but this is a possible approach. Following this rationale, I think that at the very least, any antivaxxer that fulfils the conditions outlined above should be sued for the medical and funeral expenses incurred by the people (or their relatives) who followed their advice in good faith and were harmed or died. The above is the inflammatory approach. It’s the sort of thing you say/write to scandalize and infuriate people and increase their engagement, drive traffic to your blog, website, or podcast, and grow your brand. This approach makes tempers flare and generates a lot of heat and ill will as invectives fly back and forth and hatred is spewed everywhere. But there is another way to do this. It’s probably not as successful for getting engagement, but it may be more useful to society, civil discourse, and the psychological well-being of the public. CONCILIATORY APPROACH Every time two groups of people have strong disagreements on some things, the recommended course of action is to find areas of agreement. Antivaxxers are concerned about the side effects of COVID-19 vaccines. The evidence we have indicates that the frequency of serious side effects as a result of these vaccines is very low, which makes the vaccines much safer than having the disease. However, even if rare, when hundreds of millions are vaccinated, the number of net cases start to accumulate. And some of these cases are severe enough that exceptionally susceptible people may end up impaired and saddled with huge debts due to their medical bills. Shouldn’t these people be compensated? I would venture that most people, whether pro or anti-vaccine, would agree with this. Unfortunately, this is not what is happening. There is a federal program known as the Vaccine Injury Compensation Program (VICP) that is available to people who have been injured by the routine vaccines that are administered in the United States. This program in its lifetime has awarded $4.7 billion in compensation for vaccine injuries to cover 36% of the claims it has received. But this program does not cover the COVID-19 vaccines. Compensation for harm from the COVID-19 vaccines is handled by a program called the Countermeasures Injury Compensation Program (CICP). The CICP program was designed to handle compensation for people injured by treatment for rare events such as an Anthrax attack, but this program is now handling compensation claims for a treatment dispensed to hundreds of millions of Americans. The CICP program is underfunded, understaffed, and overwhelmed with claims, which it is resolving at a glacial pace, and so far congress has not done anything about this. So here is the chance for antivaxxers to make a difference and actually achieve something positive. If they stop their attacks on vaccines and pro-vaccine people and focus on lobbying congress to, for example, expand and fund the CICP program or move the COVID-19 claimants to the VICP program, that would be a major achievement that would help people affected by the side effects of vaccines. At the same time many pro-vaccine individuals and organizations that advocate for the rights of patients could join ranks with them to work together towards a common goal and actually benefit people. The alternative, of course, is to keep engaging in the usual cycle of claims, counterclaims, insults, counterinsults, and endless vitriol, which may help increase engagement but which does not accomplish anything meaningful to benefit society. So my question to antivaxxers is, what is it going to be: inflammatory or conciliatory? Image from pixabay by Gerd Altmann is free for commercial use and was modified from the original. 8/13/2021 How to Deal with Opposition to Vaccination: Lessons from Addressing Climate Change DenialRead NowI came across an interview that journalist Bill Moyers did with Christian climate scientist Katherine Hayhoe back in 2014. The topic of their conversation is about the particular situation of Evangelical Christians in the United States as it relates to denial of climate change, but I believe the interview is remarkable because of the broader applicability of Dr. Hayhoe’s ideas as to why denial of many issues has been embraced by various communities and what can be done about it. You can watch the interview in the video above, but I will provide a recap of the major points of the interview. Dr. Hayhoe’s argument is that climate change is a hot button issue for many people because they feel it threatens all that they hold dear. However, what people reject about climate change is not so much the science but the solutions. Climate change is something that affects the community, and as such, efforts to deal with climate change require large numbers of people to work together, which means that the government has to be involved. But opposition to government is deeply rooted in the American psyche, and any legislation to limit what people can do or use is viewed with mistrust. Thus, climate change has become a casualty of much larger societal issues. This has been compounded by the fact that people have been lied to by those in whom they deposited their trust. On the one hand, the leaders who many of these people trust because they share their values, have told them that climate change is a hoax, or that it’s real but it’s not a big deal and nothing has to be done about it. Or in the absence of clear leaders, political and media personalities who don’t like the solutions to climate change have stepped in. And because these individuals say the same things that people believe with regards to many other issues, the people put their trust in them. On the other hand, the spokespeople for the opposite point of view have often been scientists who do not share the values of the communities they are addressing. People will not believe messengers whom they do not trust because they perceive them as not sharing their values. The remedy to this situation will not come from more information and more science, but rather from dealing with who we are as humans and how we function politically. Dr. Hayhoe says that, although caring about the climate is consistent with who people are as Christians, we have increasingly confounded our politics with out faith. Instead of allowing faith to determine our attitudes to political and social issues, we are allowing our political party to dictate our attitude towards issues that are clearly consistent with who we are. Finally, Dr. Hayhoe says that everyone has a list of things they care about such as the health of their kids, job security, the cost of living, faith etc., and climate change should not be viewed as one more thing to put on the list that competes with the others because climate change is already affecting the top things on everyone’s list. Climate change is affecting the things most people care about, love, and hold dear.  There are other aspects to the interview, but the ones I’ve mentioned above are those that I think are more generalizable to other situations where misinformation and social dynamics are getting in the way of people accepting and acting on a reality. One possible such situation is COVID-19 vaccine denial.
Despite overwhelming evidence that the COVID-19 vaccines are safe, effective, and necessary, there is a certain proportion of the population of the United States that refuses to accept the vaccine. In parallels with climate change deniers, the sector of the population opposed to vaccination tends to be conservative and distrusting of government. In another parallel to climate change denial, this group of people tends to listen to media that reinforce their fears feeding them misinformation about vaccines. At the same time, this group of people is distrusting of what scientists say about vaccines, and especially of those scientists associated with the government. Like the evangelicals who have allowed their politics to replace their faith in guiding them with regards to climate change, the vaccine deniers have allowed their politics to replace their common sense and instinct of self-preservation when it comes to vaccines. And like climate change deniers, vaccine deniers have a list of things they hold dear and care about, and COVID-19 has probably affected every single item on the top of their lists, from the health of people they admire, acquaintances, friends, and family, to the impact on the economy. Dr. Hayhoe advocates finding trusted messengers within the evangelical community (people who are like them, such as she is) to spread the message that we need to act on climate change. This is indeed a strategy that is currently being pursued in the case of vaccine denial. The government is trying to recruit media personalities and local respected leaders to talk in favor of vaccination. But I think we can go about finding these trusted messengers in an additional way which relies on another parallel between COVID-19 and climate change. Much like climate change, COVID-19 affects everyone, and there is a growing list of vaccines deniers, who have been seriously ill or died due to the virus. The people who listened to these vaccine deniers have now been knocked back to their senses in the most brutal of ways. And I think that their stories should be used to snap vaccine deniers from the stranglehold that their politics have on their common sense and instinct of self-preservation. And unlike climate change, there is no ambiguity as to the cause of the harm. If someone loses their property, a friend, or a loved one to rising sea levels or a fire or a hurricane, they can always be told that there is no direct proof that climate change caused it. But if someone dies due to COVID-19, that reality cannot be denied. So, find out who are those vaccine deniers that were harmed by COVID-19 and seek out their audiences, their acquaintances, their friends, and their families, and ask them to tell their story to those in their communities and to champion vaccination. Every serious vaccine-preventable COVID-19 illness or death among the community of vaccine deniers is a tragedy. But the silver lining is that these illnesses and deaths will generate a group of people willing to open their minds to vaccination and promote it. I think these people have an important role to play in stopping vaccine denial. Image from pixabay by Gerd Altmann is free for commercial use and was modified from the original.  COVID-19 Vaccine Those opposed to vaccines (antivaxxers) are fond of quoting government figures to argue that there have been many adverse events due to COVID vaccines. They then proceed to state that because the government figures underreport these adverse events this means that the problem is much, much, worse. They also argue that there is a conspiracy to keep this information from the American public, and they demand that COVID vaccination should stop.
What are antivaxxers talking about? What are these government figures? Are they quoting them correctly? What do the numbers mean? By the time vaccines are allowed to be used on the US population, they have gone through multiple clinical trials and other evaluations that have certified they are safe. But this vaccine safety is based on data gathered from at most a few tens of thousands of people. Therefore, it is understood that when vaccines are applied to a population of tens or hundreds of millions there may be some low frequency adverse events that may have not been detected in the clinical trials with a smaller group of people. To account for this, the government in 1990 created a federal database called VAERS (Vaccine Adverse Event Reporting System) that is meant to act as an early warning system to detect possible safety problems with vaccines. However, VAERS is a passive reporting system. This means that anyone can file a VAERS report regardless of its nature, and that report is entered into the database and cannot be removed without the permission of the person who reported it. Although knowingly filing a false VAERS report is a violation of Federal law, if you are convinced that the adverse event you are describing, no matter how outlandish, is tied to a vaccine, it will be incorporated into the database. For example, Dr. James Laidter mentioned in the neurodiversity weblog that back in 2005 he entered a VAERS report claiming that an influenza vaccine had turned him into the incredible Hulk, and the claim was accepted into the database. However, due to its unusual nature, a VAERS representative did contact him, and after an amicable discussion about the limitations of VAERS, the representative requested his permission to remove the claim to which he agreed. If he had not agreed to that, the claim would have remained in the database. Another example, Kevin Leitch writing for the Left Brain Right Brain science blog mentions that he submitted a VAERS report claiming that a vaccine had turned his baby girl into Wonder Woman, and he is not even a US resident! However, even when considering reasonable adverse events, it must be understood that VAERS reports do not stablish that there is a link between the adverse events reported and vaccination. Each day thousands of people develop a health problem and/or die in the United States in a manner unrelated to vaccines. If any of these people received a vaccine around the time they developed the health problem or died, they could be reported to VAERS thus constituting a false positive. The experts understand that the VAERS database has a high number of these false positives, and they use the database as a very preliminary step to perform more research, gather more data, and establish for sure whether a given event being reported is a real adverse event due to vaccines or not. These experts know that quoting numbers directly from the VAERS system is meaningless insofar as learning anything about the safety of vaccines is concerned. But this is exactly what antivaxxers do! And while some antivaxxers may be ignorant about the nature of VAERS, many of the leading antivaxxer influencers know the shortcomings of VAERS and nevertheless choose to continue reporting or quoting the raw numbers to advance their platforms and promote their agendas. Antivaxxers are also prone to saying that VAERS vastly underestimates the number of vaccine adverse events by as much as 99%, so in some of their alarmist literature they suggest that VAERS numbers should be increased by large multiples. However, although reporting to VAERS of non-serious adverse events such as soreness at the injection site is indeed very low, estimates of the sensitivity of VAERS to serious adverse events, while variable, is much higher than antivaxxers would like us to think. For example, for anaphylaxis due to seven different vaccines, estimates of VAERS reporting sensitivity ranged from 13% to 76%, while for Guillain-Barre Syndrome after three different vaccines the sensitivity ranged from 12% to 64%. Despite its shortcomings, the VAERS system has been useful for detecting rare side effects of the COVID-19 vaccines. For example, an elevated risk of myocarditis and pericarditis has been detected in males 12-29 years of age who have received mostly two doses of the Moderna or Pfizer mRNA COVID-19 vaccines. This is a treatable disease that involves inflammation of the heart or its surrounding membranes. The CDC convened a meeting of experts (the Advisory Committee on Immunization Practices: ACIP) to analyze these cases. The analysis involved weighing any harm caused by the vaccine against its benefits. The committee concluded that the benefits of vaccination outweighed the risks. However, now that we know that this age group is at an elevated risk of myocarditis/pericarditis, vaccine providers and healthcare professionals have been alerted to this side effect and its treatment. This is the way VAERS and science are supposed to work. Rare adverse events of a vaccine are detected, and the risk/benefit is determined after a thorough evaluation of the data available. Then a rational course of action is pursued to achieve the greatest benefit with the least harm. The irresponsible use of VAERS by antivaxxers’s to concoct alarmist articles and memes promotes vaccine hesitancy which in turn prolongs the pandemic, leading to more hospitalizations and deaths and may give rise to new variants of the virus that are more resistant to the vaccine. Photo of the Pfizer-BioNTech vaccine from Max Pixel is in the public domain.  My First Shot of the COVID-19 Vaccine I got my first shot of the COVID-19 (Moderna) vaccine, and to celebrate this event I thought I would write about the vaccine and how societies in general reacted to vaccines in the past. Before COVID-19 we were spoiled. The massive success of vaccination in eradicating or diminishing disease had made it possible for people to enjoy the luxury of dabbling in antivaxxer pseudoscience and indulging in vaccine hesitancy. Until COVID-19 hit us, many people had not experienced the fear for their loved ones that people had experienced in the times before vaccines were available during epidemics of diseases such as polio. Nowadays few people remember the peace of mind and hope that vaccines brought to humanity. The bliss experienced by people finally rid of the scourge of certain diseases such as smallpox, which periodically decimated entire communities, is difficult to describe today. To give you an idea, let me just present below a translation of a stanza of the poem Oda a La Vacuna (Ode to the Vaccine) by the Venezuelan poet Andres Bello written in 1804 (he mentions Jenner, the discoverer of the smallpox vaccine, and Carlos, the King of Spain who promoted the distribution of the vaccine). “Supreme Providence, the tearful echoes of the disheartened man at last arrived to your abode, and you raised your righteous arm from his neck; admirable and amazing in your resources, you gave the man medicine, wounding the herds with contagious plague; you opened for us new springs of health in the sores, and you stamped upon our flesh a miraculous seal that the black pox respected. Jenner is the one who discovered under the roof of the shepherds such a precious find. He joyfully published to the universe the happy news, and Carlos distributes to earth the gift of heaven.”
Although many individuals today are too far gone down the rabbit hole of antivaxxer irrationality to be redeemed, now that science has delivered for humanity an effective vaccine against COVID-19 in record time, I hope that many people will regain a measure of gratefulness and respect for vaccines and for scientists. The COVID-19 vaccine has an amazing history involving failure, tragedy, perseverance, and triumph that is worth reading about. This vaccine was made possible by a remarkable confluence of several technologies produced by numerous discoveries in basic and applied science. Others have already reported in depth on these stories, so here I will provide a summary of the most salient points with references. A couple of decades ago, the scientific establishment was skeptical of the concept on which the Moderna and Pfizer vaccines are based: using mRNA to direct the production of a viral protein and generate an immune response. This was mostly due to the fact that the mRNA triggered an immune response against itself that interfered with its effectiveness. A Hungarian born scientist in the United States, Dr. Katalin Karikó, spent many years fighting against this skepticism and paying dearly for it in terms of stress, remuneration, and career advancement. Finally in 2005, Dr. Karikó and a collaborator, Dr. Drew Weissman, succeeded in modifying the molecule to make it more stable. Two emerging biotech companies, Moderna (founded in 2010) and BioNTech (founded in 2008) licensed the technology from Karikó and Weissman and began working on a series of applications for the modified mRNA. When the COVID-19 pandemic broke out, they were ready to hit the ground running with the technology. In 1966, a trial of a vaccine against a virus called respiratory syncytial virus (RSV) went horribly wrong. The vaccine not only was unsuccessful in protecting immunized children, but it actually worsened their response to the virus with 21 children being hospitalized and 2 dying. Dr. Barney Graham, an American virologist, devoted his career to finding out what had happened. Finally, he and his colleagues figured out that the protein the viruses use to fuse with human cells changes shape in the process. Antibodies against the pre-fusion protein were effective against the virus, whereas antibodies against the post-fusion form were not and actually made things worse. Dr. Graham and his colleagues applied this knowledge to develop a vaccine against a type of coronavirus that appeared back in 2012 called Middle East Respiratory Syndrome (MERS) which could not be tested because the disease did not reach epidemic levels. However, by 2017 they had figured out how to develop a vaccine against coronaviruses in general. Graham teamed up with Moderna to incorporate his research into the design of mRNA vaccines. When the COVID-19 pandemic began, Graham’s research and experience with coronaviruses allowed Moderna and other companies to design a vaccine for the right form of the protein. A seldom mentioned issue is that the mRNA in the vaccines is a large and fragile molecule that is easily degraded once inside the body and which does not cross cell membranes. The reason the vaccine mRNA is effective, is that the molecule is packed into vesicles called lipid nanoparticles (LNPs) which protect the molecule and allow its efficient delivery into cells. When Moderna and BioNTech began their work to find the right LNPs to deliver their vaccine mRNA, they benefited from the experience of decades of hit and miss research conducted by multiple labs that painstakingly combined different lipid components, tweaked their proportions, and tested them in cell, animal, and humans studies for effectiveness and toxicity. When the pandemic started, both companies had already produced working LNPs to deliver mRNA. And finally, there are multiple discoveries that resulted in technologies that made possible the day to day practical and theoretical work of scientists. Among these are the advances in genetic sequencing technology, which allowed the quick elucidation of the genome of the virus, and the advances in computing and bioinformatics, which allowed the visualization and analysis of sequences and molecular structures, and the quick sharing of information among scientists worldwide. A lot of things have improved in our societies since Andres Bello published his poem back in 1804. Science has spearheaded a revolution that has increased human lifespan and quality of life, and vaccines such as the COVID-19 vaccine have been an essential part of this process. Sadly, one of the things that has changed for the worst is that today poetry is no longer an art cultivated by the younger generations which consider it something old fashioned. But I am grateful for this gift that science has given to us, and I hope somebody considers composing an ode to the COVID-19 vaccine! The photograph is property of the author and can only be sued with permission.  COVID-19 Vaccine We have begun to detect early signs that COVID-19 vaccination is having a dramatic effect in reducing the number of new cases and deaths. This data comes from studies performed in nursing homes where the vaccine was made available first. Despite this good news, there is a substantial amount of misinformation about the COVID-19 vaccine that is stoking doubt among people that would otherwise elect to be vaccinated. In this post I will address some of these claims.
Vaccine development is a process that takes a decade or more. The COVID-19 vaccines were developed in a year (Operation Warp Speed), so they were rushed, therefore there is no way they can be safe. This claim reveals a misunderstanding of what Operation Warp Speed did. This vaccine development operation was not fast because they cut corners. There are several reasons vaccine development was fast, but one of the most important ones was that the government funded multiple stages of the vaccine development process at once. For example, the vaccine was produced at the same time the clinical trials were ongoing. A pharmaceutical company normally waits for the results of the trials before producing the vaccine, because if the trial fails, then it would lose all the investment in producing a vaccine that wouldn’t be approved. In Operation Warp Speed it was the government that assumed this economic risk, and this accelerated the pace of vaccine production. No corners were cut in the development process. The vaccines were tested in regular clinical trials and they were found to be effective and safe. The coronavirus is a new virus and the Moderna and Pfizer messenger RNA (mRNA) vaccines are a new technology. There is no way that a new technology can be applied to a new virus and result in a safe vaccine in such a short time. This claim ignores the history of both the involvement of scientists with coronaviruses and the history of the development of the mRNA technology. Scientists had been researching coronaviruses such as SARS (2003) and MERS (2012) for many years. By studying these and other viruses they discovered how the proteins in the surface of the virus change when attacking a cell, and they figured out how to make antibodies to the right proteins to avoid problems that can compromise a vaccine. The mRNA technology they used had also been researched for decades and had reached its full potential by the time COVID-19 came around. Finally the Johnson and Johnson vaccine is also as effective and safe as the others and is not based on mRNA technology. The mRNA vaccines will change your DNA, and can give you COVID-19. This is not how mRNA works. DNA produces mRNA, and mRNA carries the instructions for the production of proteins. However, mRNA cannot go back to DNA and alter it. If I asked you whether you are concerned that while you are walking on the sidewalk the concrete under your feet will turn into quicksand and swallow you up, you would probably reply that is silly because it’s not in the nature of concrete to do that. Similarly, it is not in the nature of mRNA to alter DNA. The SARS-Cov-2 virus that produces COVID-19 has a total of 29 proteins. The vaccines contain an mRNA molecule that carries the information to produce ONLY ONE viral protein (the spike protein that the virus uses to enter the cells). The body then produces antibodies against this protein, and the mRNA is degraded after a few hours. The mRNA does not carry the information to produce the rest of the proteins of the virus, thus it is impossible for the mRNA vaccine to give you COVID-19. They tell us that after we get vaccinated, we still need to wear a mask and social distance, so why get vaccinated at all? It is not known if the vaccine can prevent you from being infected with the virus. What we know is that the vaccine will help you fight the virus and protect you against moderate and severe COVID-19 disease. However, scientists don’t know if vaccinated people are still capable of carrying the virus and transmitting it to other people. Thus, scientists are just being careful and recommending that vaccinated people still use masks and social distance while in the presence of others that may not yet be vaccinated until they can answer this question. The COVID-19 vaccines have side effects and have caused severe allergic reactions. The side effects of the COVID-19 vaccines are an indication that the immune system is working. These side effects, such as pain at the site of injection, fatigue, headache, and muscle pain, normally last 24 hours and are an acceptable tradeoff for gaining immunity against a disease that can potentially be lethal or debilitating to you and others you may transmit it to. In rare cases an allergic reaction to the vaccine has been documented which mostly occurs within 30 minutes of vaccination and can be treated by the medical personnel administering the vaccine. This is why it is recommended that people who have a history of allergic reactions should consult with their doctors before getting the vaccine. The COVID-19 vaccines have caused several deaths. This piece of misinformation is straight out of the antivaxxer playbook, and it is based on claims that people who died or had a problem after receiving a vaccine died or had the problem because of the vaccine. In a population of millions of individuals, thousands of people naturally die or have health issues every day. If millions of people get a vaccine, some of them will naturally die or have health issues around the time they received the vaccine, but in a manner unrelated to the vaccine. In other words: correlation does not imply causation. So far the alleged vaccine deaths that have been investigated have not been linked to the vaccine. More than 500,000 American have died as a result of COVID-19 and tens of thousands have been left with long-lasting side effects. All this could have been avoided if we had had a vaccine for the disease at the begining. Well, now we have 3 vaccines against the disease (not counting the Russian, Indian, and Chinese vaccines). There are still tens of millions of people in the US who have not yet had COVID-19, and therefore there is potential for additional morbidity and mortality from the disease. It is important for everyone to get vaccinated to protect both themselves and those around them, so please don’t fall for the vaccine misinformation. Get vaccinated. The photo of the COVID-19 vaccine by Lisa Ferdinando (DOD) was taken from the Flickr photostream of the US Secretary of Defense and is used here under an Attribution 2.0 Generic (CC BY 2.0) license. For years those opposed to vaccination (antivaxxers) have peen plastering social media with their claims that vaccines are harmful, unnecessary, and ineffective. I had addressed the antivaxxer’s claims before, but I recently had a harsh exchange with some of these people on Twitter. These individuals bombarded me with links to articles and other evidence that “proved” their position was true. After I spent several days going over all this evidence, I found that the vast majority of it was nothing more than a mishmash of mediocre science, innuendo, exaggeration, distortion, and lies. So I organized all the evidence to address their claims. I started writing what I expected to be a two or three part blog post exposing the inaccuracy of the antivaxxer’s claims. However, besides getting me into another fight, I realized my effort wouldn’t really convince anyone that antivaxxers where wrong. I sensed the vaccine issue for most people hinged on more emotional rather than rational variables, and antivaxxers had proven particularly adept at stoking the fears of people and manipulating their emotions.  For years antivaxxers had thrived due to the fact that our society had become complacent. Today’ parents have never had to live with the horrors of smallpox, polio, diphtheria, whooping cough, tetanus, and other diseases. Even though antivaxxers are a minority, they were vocal and organized. They generated enough doubt in our society to give rise to vaccine hesitancy where parents delay or even refuse to administer some vaccines to their children. Predictably, some of the most contagious diseases like measles started coming back. A few antivaxxers thought that the possibility of a world without vaccines was within their reach, and they sought to articulate for others how that world would look. As it turns out, that was unnecessary. If anybody ever wondered how the world would look without vaccines, the COVID19 pandemic has made it abundantly clear how the world looks without ONE vaccine. As I write this, the worldwide confirmed cases of COVID19 exceed two million with more than 169,000 deaths, and more than 700,000 of those cases and 41,000 of those deaths are in the United States alone. Cities, states, and entire countries on lockdown, health care systems overwhelmed, and economies devastated. If anyone harbored any type of misgiving about the need for vaccines, that doubt has been vanquished. And COVID19 is not going to go away anytime soon. There are likely to be waves of the virus as a result of reintroduction when social distancing measures are eased. If sufficiently high numbers of people become infected and recover, a degree of what is called herd immunity may be able to protect those who have not been infected. However, only a vaccine will confer total immunity against the virus. There are currently around 41 research groups and companies in the race for a vaccine, and the hope is that one of these will prove sufficiently safe and effective to neutralize the COVID19 threat for the long-term.
Now that everyone has had a first-hand emotional experience of what a disease can do without a vaccine, I fully expect the antivaxxer influence to wane in our society. I am also planning not to write those blog posts rebutting the antivaxxer’s arguments, as they have become moot and are now a waste of my time. But there is one thing that I do have to point out, and that is the damage that antivaxxers have caused, but not just the one related to vaccine hesitancy or the wasting of resources investigating nonexistent connections between things like vaccination and autism. Vaccines are safe, but they are not risk-free. While being vaccinated is safer than risking having the disease, there are a very small percentage of individuals that will exhibit serious adverse side effects as a result of a vaccine. As vaccines are applied to hundreds of thousands, there will always be a chance that someone with an unknown susceptibility or condition will experience a serious reaction to a vaccine. Here is where antivaxxers could have made a difference for the greater good of society. They could have accepted the effectiveness and safety of vaccines and the need for them, while at the same time advocating for researching vaccine side effects and defining the characteristics of the susceptibility of individuals to developing adverse effects to vaccination. But instead of becoming advocates, they chose to become opponents. Antivaxxers sought out every possible side effect of a vaccine to paint it in the worst possible light. The interest that should exist in the side effects of vaccines has become linked to the antivaxxer position giving it a social stigma. Many people who accept the need for vaccines, but who are genuinely interested in studying and defining the side effects of vaccines, have found out to their chagrin that what they do is often associated with opposition to vaccination. How many people have antivaxxers impacted negatively by creating this stigma may never be known. It is unlikely however, that the antivaxxers will let up anytime soon. As the world anxiously awaits a COVID19 vaccine, antivaxxers may not have the influence that they once had. But if there is anything I have learned from arguing with climate change deniers, creationists, and proponents of 911 conspiracies, chemtrails, the flat Earth and other irrational skeptics is that they will move the goalposts. They will rationalize their failure, rework their arguments around any new evidence or situation, and fan new conspiracies. However, now that the sheer lunacy of the antivaxxer’s dream of a world without vaccines has been exposed, I am hopeful that society will not be as receptive to their arguments. The image by TheDigitalArtist from pixabay is free for public use.  Anti-vaccination groups have put out many arguments against vaccines which have been rebutted by scientific and health organizations in many publications. I don’t want to cover all these arguments because I want to address the most important and irrefutable argument against vaccines, but before I do that, I want to mention some of the most salient of the lesser arguments. Scientists and Clinicians have sold out to pharmaceutical companies which make a lot of money from unnecessary and dangerous vaccinations.
The vast majority of scientists and clinicians vaccinate their children. If these scientists and clinicians are dishonest people who sell out to pharmaceutical companies to peddle and support harmful vaccinations, why would they do that to their kids? Do you think all these people with doctorate degrees are evil, ignorant, or stupid? Also, pharmaceutical companies would make a lot more money from selling the medicines required to treat the onslaught of diseases that would roar back into our societies if we stopped vaccination than they make from vaccination itself. Vaccines cause autism and sudden infant death syndrome (SIDS). No they don’t. Well-designed studies with large numbers of children have found that vaccines are not linked to autism or SIDS. If a child is all right and develops autism after he gets his vaccines doesn’t that mean vaccines cause autism? The age at which most children are diagnosed with autism coincides with the age at which many vaccines are administered. Considering that millions of children are vaccinated, it is very likely a vaccination and an autism diagnosis will take place sufficiently close together that a parent may be tempted to infer a causal relationship between them. But there is no such relationship. Vaccines contain chemicals that cause health problems. Vaccines contain small amounts of chemicals that fulfill different functions during the production of a vaccine or in the final product. Many of these chemicals are already present in other medicines, in the food we eat, and even around our houses. At the doses used in vaccines, none of these chemicals has been found to be harmful. All the vaccines children receive can overwhelm their immune system. From the moment a child is born they are exposed to the myriad of bacteria, viruses, fungi, and other microorganisms present in the environment. The challenge to a child’s immune system posed by vaccines is a small fraction of what the immune system normally handles and no studies have found that too many vaccines can overwhelm the immune system. Vaccination is unnatural. It is better for children to get diseases and develop a natural immunity. The process by which a child’s immune system responds to a vaccine or to an infection is the same. The difference is that with vaccines the child doesn’t have to get sick, or face the risk of dying or developing complications from the disease. There are risks involved in getting vaccinated. Yes, and there are also risks involved in driving a car. Everything has a risk associated with it, and vaccines are no exception. However, the risks of getting vaccinated are extremely small compared to the risks of not being vaccinated. The safety of vaccines and adverse effects due to vaccines are continuously monitored and compiled by government agencies, and they are the object of scientific research. There are individuals who should not get vaccinated if they, for example, are prone to strong allergic reactions or have weak immune systems. So now that we have disposed of some of the lesser arguments against vaccination, let’s get down to the real argument against vaccines. This is in fact the most important argument of them all, and it permeates the whole of the anti-vaccine movement and the anti-vaccine literature, although it is seldom expressed in verbal or written form. This argument is the following: Vaccines HAVE to cause disease. Vaccines HAVE to be dangerous. Vaccines ARE unnecessary. Doctors and scientists ARE lying to us. ACCEPTING ANYTHING DIFFERENT IS UNACCEPTABLE, period, end of the discussion. In the majority of cases, this is the real argument against vaccines, and it is, of course, irrefutable. The truth is that by and large most of those vehemently opposed to vaccination are too emotionally invested in their cause to consider the evidence. The reasons for this are complex and may differ from one person to another, but they are probably related to the general reasons why human beings uncritically believe in conspiracy theories. In any case, this argument creates a challenge for scientists and health professionals. But the challenge is not to convince those that are against vaccination, which are a minority. The real challenge is vaccine hesitancy. This involves many parents who are open to vaccinating their kids but have concerns because of things they have read or heard. These are the individuals that pose the real risk to society because of the possibility that they will delay the vaccination of their children or choose only to vaccinate them against some diseases, or not to vaccinate at all. Health professionals must get to these parents before the anti-vaccination activists win their hearts and minds, and this cannot be achieved by coldly reciting the results of studies, or by pressuring or shaming them. In this modern era, not only have parents been exposed to a lot of alarmist misinformation regarding vaccines, but they also do not have the experience of earlier generations that lived at a time when many diseases such as polio ran rampant. When explaining to parents the need for vaccination, health professional must avoid judging and contradicting the parents. The parents’ concerns must be addressed sympathetically within the framework of a dialog that helps them examine their own uncertainties, and this must be done beginning at the time of a baby’s birth. Only in this way we will meet the challenge. The vaccine photograph by the US army is in the public domain. |
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