Vaccines and Therapeutics 2.0 & 3.0 Merge

[Chap]

Here is a recent piece published in the British Medical Journal on the subject of the not very impressive policy approach of the UK government to the pandemic:

Government’s plan recklessly exposes millions in the UK to infection when they could be vaccinated
July 15, 2021
In allowing mass infection, Boris Johnson’s government is pursuing a strategy that will lead to avoidable deaths and long term illness, say this group of authors

Is the US doing any better than this? I would be interested to hear how this looks to posters more familiar with the American situation than I am.

The statement from the prime minister, Boris Johnson, on 12 July leaves little doubt that the government’s latest pandemic plan involves recklessly exposing millions of people to the acute and long term effects of mass infection. We believe this is a terrible mistake. This strategy is already putting intense pressure on struggling healthcare services and will lead to many avoidable deaths and long term illness.

The narrative of “caution, vigilance, and personal responsibility” is an abdication of the government’s fundamental duty to protect public health. “Personal responsibility” does not work in the face of an airborne, highly contagious infectious disease. Infectious diseases are a matter of collective, rather than individual, responsibility. The government’s strategy will place around 48% of the population (children included) who are not yet fully vaccinated, including the clinically vulnerable and immunosuppressed, at unacceptable risk.

More than 1000 scientists have signed a letter to the Lancet setting out why allowing mass infection this summer is a “dangerous and unethical experiment.” The government is following an apparent strategy of achieving herd immunity through mass infection, rather than the much safer (and more predictable) path of vaccination. Mike Ryan, executive director of the WHO Health Emergencies Programme, called a strategy of letting infection spread through a population “moral emptiness and epidemiological stupidity.” The British Medical Association, Association of Directors of Public Health, SAGE, the Academy of Medical Royal Colleges, the Royal College of Nursing, and NHS leaders have all highlighted the dangers inherent in allowing mass infection. If the government is following “data not dates,” it has not made an evidence based case for this, and the scientific consensus is firmly against its approach.

The argument made by the prime minister that it is better to accept mass infection now than to postpone until winter, when “the virus has an advantage,” is deeply flawed and misleading. A strategy that chooses mass infection in the young now over vaccination, in order to achieve greater population immunity to protect the vulnerable in winter, is unethical and unscientific. This strategy, and the modelling it relies on, also completely ignores public health measures, such as mitigation in schools, workplaces, vaccination of adolescents, and booster doses for the vulnerable that could protect our young now and offset increased risks over winter. Getting and keeping transmission low now will give us time to vaccinate more people, rather than exposing them to mass infection. We could offer two doses of vaccine to everyone over 12 by the autumn, providing the best possible protection.

This strategy of mass infection will lead to a significant burden on a health service that is already under immense strain, with some hospitals again cancelling elective surgeries and delaying cancer treatment. The health secretary has warned that this could lead to a backlog of 13 million people waiting for routine care. Ministers have been told to expect 1 to 2 million cases in the coming weeks, with cases reaching 100 000 per day. A significant proportion of these people will go on to develop long covid. Both the CEO of NHS Providers, Chris Hopson, and chief medical officer Chris Whitty have expressed grave concerns over the prospect of hundreds of thousands more cases of long covid among the young during the coming months. Allowing unmitigated transmission in a partially vaccinated population also provides a fertile environment for selection of escape variants, which could have huge consequences for the UK and countries globally.

Opening the UK up further is billed as “freedom day,” but for many people it is anything but. Those living with health conditions that make them more vulnerable to covid (and vaccines less effective against it) fear a return to shielding indoors as they are no longer protected by low case numbers and measures such as others wearing masks, physical distancing, and isolation of contacts. Since vaccinated people can and do transmit the virus, many of their loved ones will need to restrict their activities to protect them. For too many people, removing mandated mitigations restrict, rather than enable, freedom. This is unlikely to bolster public confidence and engagement in economic activity. And if the government strategy leads us into yet another lockdown, this could have an even more devastating impact on the economy.

The public overwhelmingly supports sensible public health measures such as masking indoors. This begs the question why dangerous public health decisions that are neither in the public interest, or in line with public sentiment, have been made in the midst of a raging pandemic. Credible sources suggest that the government is pursuing policies that will appease a political minority of its own backbenchers and lobbyists.

The government messaging is confused. On the one hand we hear some cabinet ministers say masks are restrictive and they can’t wait to cast them off, and on the other hand we are told that it is a public responsibility to continue to wear masks on transport and other indoor places. How does the government expect the public to engage with such confused messaging?

We believe that infections both matter and are avoidable. Instead of allowing infections to rise, we urge the government to take urgent actions to inform and protect the public and prepare for autumn:

Inform:
The government must articulate a long term strategy for pandemic control.
We need clear, evidence based information on how to protect ourselves and others.
Protect:
Keep basic preventive measures, such as masks, physical distancing, and outdoor hospitality, until cases return to the levels seen in May. These measures are minor disruptions that increase our freedoms rather than restrict them.
Data not dates: We fully agree with the government’s own slogan here, and they need to hold to what they promised, not set arbitrary dates tied to public expectations or political lobbying. We must wait until cases are low, school and workplace mitigations are in place, and most people aged 12 and above are vaccinated before opening up further.
Make workplaces, schools, and public transport safer: Support resourcing of ventilation or air filtration. Re-introduce masking in secondary schools, and move learning outdoors as much as possible. Allow employees to work from home whenever possible, and ensure that workers can travel to work without being placed at risk.
Prepare:
Test, trace, and isolate. Provide local authorities with the means for extensive testing and support people to isolate if potentially contagious.
Prepare for school re-opening: Invest in making schools safer ahead of autumn.
Signatories and co-authors:

Christina Pagel, professor of operational research (branch of applied mathematics), director of the Clinical Operational Research Unit, & co-director of the UCL CHIMERA hub, University College London. Member of Independent SAGE.

John Drury, director of research and knowledge exchange, School of Psychology, University of Sussex. Participant in the UK’s Scientific Advisory Group for Emergencies and/or its subgroups, and a member of Independent SAGE.

Trish Greenhalgh, professor of primary care health sciences, University of Oxford, UK.

Stephen Griffin, associate professor, University of Leeds.

Deepti Gurdasani, senior lecturer in machine learning, Queen Mary University of London.

Zubaida Haque, member of Independent Sage.

Aris Katzourakis, professor, University of Oxford.

Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine. Member of Independent SAGE.

Susan Michie, Centre for Behaviour Change, University College London. Participant in the UK’s Scientific Advisory Group for Emergencies and its subgroups, and a member of Independent SAGE.

Gabriel Scally, visiting professor of public health, University of Bristol. Member of Independent SAGE.

Robert West, professor of health psychology, University College London. Participant in the Scientific Pandemic Influenza Group on Behavioural Science (SPI-B): 2019 Novel Coronavirus (Covid-19).

Kit Yates, senior lecturer, Department for Mathematical Sciences, University of Bath. Member of Independent SAGE.

Hisham Ziauddeen, consultant psychiatrist, Cambridge and Peterborough NHS Foundation Trust, UK.

Competing interests: nothing further declared.

[Chap]

The question of vaccine hesitancy needs to be addressed on a world scale.

Here is an interesting recent discussion from Nature:

Understanding COVID-19 vaccine hesitancy

Shingai Machingaidze & Charles Shey Wiysonge
Nature Medicine (2021)

Vaccine hesitancy in the UK, while not insignificant, has been lower than many people expected it to be.

How are things in the US? And why are they that way?

As of 29 June 2021, there had been more than 181 million reported infections with SARS-CoV-2 and nearly 4 million reported deaths from COVID-191. In May 2020, the 73rd World Health Assembly issued a resolution recognizing the role of extensive immunization as a global public-health goal for preventing, containing and stopping transmission of SARS-CoV-22. Globally, there are now more than 125 vaccine candidates, 365 vaccine trials ongoing, and 18 vaccines against COVID-19 approved by at least one country3. Published research carried out largely in high-income countries cites concerns about the safety of vaccines against COVID-19, including the rapid pace of vaccine development, as one of the primary reasons for hesitancy4, but data from low- and middle-income countries (LMICs) have been limited. In this issue of Nature Medicine, Solis Arce et al. present data that begin to address this research gap5.


Credit: Majority World CIC / Alamy Live News
The reluctance of people to receive safe and recommended available vaccines, known as ‘vaccine hesitancy’, was already a growing concern before the COVID-19 pandemic6. A framework developed from research done in high-income countries, called ‘the 5C model of the drivers of vaccine hesitancy’, provides five main individual person–level determinants for vaccine hesitancy: confidence, complacency, convenience (or constraints), risk calculation, and collective responsibility7,8. Promoting the uptake of vaccines (particularly those against COVID-19) will require understanding whether people are willing to be vaccinated, the reasons why they are willing or unwilling to do so, and the most trusted sources of information in their decision-making. Solis Arce et al. investigated these questions using a common set of survey items deployed between June 2020 and January 2021, across 15 studies carried out in Africa, South Asia, Latin America, Russia and the United States5.

Included in the analysis were seven studies in low-income countries (Burkina Faso, Mozambique, Rwanda, Sierra Leone and Uganda), five studies in lower-middle-income countries (India, Nepal, Nigeria and Pakistan) and one study in an upper-middle-income country (Colombia). The authors compare these findings with those from two countries at the forefront of vaccine research and development: Russia and the United States5. Overall, they found that the average acceptance rate across the full set of studies in LMICs was 80.3%, with lowest acceptance in Burkina Faso (66.5%) and Pakistan (66.5%); moreover, the acceptance rate in every sample from LMICs was higher than that of samples from the United States (64.6%) and Russia (30.4%)5. The data show that vaccine acceptance is explained mainly by an interest in personal protection against COVID-19, whereas concerns about side effects are the most common reasons for hesitancy, and health workers are the most trusted sources of guidance about vaccines against COVID-195. It is, however, important to note that reported intentions may not always translate into vaccine uptake9.

Another survey was conducted by the Africa Centres for Disease Control and Prevention, in partnership with the London School of Hygiene and Tropical Medicine, between August and December 2020, in 15 African countries (Burkina Faso, Côte d’Ivoire, Democratic Republic of the Congo, Ethiopia, Gabon, Kenya, Malawi, Morocco, Niger, Nigeria, Senegal, South Africa, Sudan, Tunisia and Uganda)10. Again, it was found that the majority of respondents in Africa (79%) would be vaccinated against COVID-19 if it were deemed safe and effective10. Perhaps it may be that lived experience in LMICs, where many vaccine-preventable infectious diseases are still causing thousands of deaths annually, results in higher perceived need for or value of vaccines. In contrast, high-income countries have successfully eliminated or eradicated numerous vaccine-preventable diseases and, as a consequence, many people, including medical professionals, have not seen the devastating effects of these diseases in their respective countries. This could lead to complacency, altered risk calculations and limited collective responsibility about vaccination decision-making.

With the wide availability of smartphones, more people can now access the internet and social media in LMICs. Although this can be a great tool for self-education, which is a key component of vaccination decision-making, it also presents several challenges in the form of misinformation (including ‘anti-vaxx’ messaging) and incomplete information, as well as inconsistent and complicated scientific information that may be difficult to understand.

The reasons for COVID-19 vaccine acceptance and hesitancy remain complex. As new SARS-CoV-2 variants emerge, adding further complexity11, and new vaccines come to the market, it will be important to maintain a delicate balance in communicating what is known and acknowledging the uncertainties that remain. Researchers and pharmaceutical manufacturers should be as forthcoming as possible, with research data on vaccines against COVID-19 made readily available. International medical journals should ensure that the use of ‘expedited reviews’ does not compromise the robustness of the peer-review process of key publications on the safety and efficacy of vaccines, or related research findings. Governments should be transparent about their COVID-19 response programs and vaccine availability and should disclose how key decisions are being made. Reporting of adverse events after immunization is a key component of monitoring the implementation of vaccination programs, and although it is important for these events to be documented and reported, intensive media coverage may also discourage people from being vaccinated. The media should therefore report in a responsible and transparent manner, providing clear and unbiased information to its audiences. Finally, people using the internet and social media (including scientists and clinicians) should do so responsibly to avoid spreading falsehoods or using language that could be misinterpreted and could thereby potentially add to vaccine hesitancy.

Although issues of vaccine-distribution equity remain a considerable challenge for LMICs that require urgent intervention12, the lag in the rollout of vaccines against COVID-19 in these regions does present a window of opportunity for addressing issues of hesitancy. The findings from Solis Arce et al.5 suggest that prioritizing distribution of vaccines to LMICs is justified not only on equity grounds but also on the expectation of higher marginal returns in maximizing global coverage at a faster rate4. The world shares a collective responsibility in fighting this pandemic; therefore, continued research on COVID-19 vaccine acceptance and hesitancy should be a priority. Such research should then be used to inform contextualized campaigns and information-sharing that will ultimately result in increased confidence in and uptake of available vaccines.

References
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McGill COVID19 Vaccine Tracker Team. https://covid19.trackvaccines.org/vaccines/ (accessed 27 June 2021).
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Author information
Author notes
These authors contributed equally: Shingai Machingaidze, Charles Shey Wiysonge.

Affiliations
European and Developing Countries Clinical Trials Partnership, Africa Office, Cape Town, South Africa
Shingai Machingaidze

School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Shingai Machingaidze & Charles Shey Wiysonge

Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
Charles Shey Wiysonge

Corresponding author
Correspondence to Shingai Machingaidze.

Ethics declarations
Competing interests
The authors declare no competing interests.

[Doctor CamNC4Me]

I’m posting this for Jersey Girl since she likes to get into the weeds ref Covid:

https://jamiemetzl.com/origins-of-sars-cov-2/

Excerpt:

Let me be clear. While I do believe that a lab incident is the most likely origin of the pandemic, this is only a hypothesis. That this pandemic might stem from a zoonotic jump in the wild is also a hypothesis, even though very little evidence supporting that hypothesis has so far emerged. When comparing the evidence for each possibility, the case for a lab incident origin seems significantly stronger to me. Additional evidence could always change that. That’s why my essential argument is that we need a full and unrestricted international scientific and forensic investigation into all COVID-19 origin hypotheses with full access to all relevant records, samples, and key personnel. It is an affront to all of us that this no such investigation has been carried our or is currently planned. We owe everyone who has died from COVID-19, all the people who have lost their loved ones and livelihoods, and future generations a thorough, unbiased, and unrestricted investigation of how the tragedy began and has unfolded.

And another:

Because there is a lot of material to get through below, let me just summarize what I believe to be the most likely scenario.

- In 2012, six miners working in a bat-infested copper mine in southern China (Yunnan province) were infected with a bat coronavirus. All of them developed symptoms exactly like COVID-19 symptoms. Three of them died.
Viral samples taken from the Yunnan miner were taken to the Wuhan Institute of Virology, the only level 4 biosecurity lab in China that was also studying bat coronaviruses.

- The WIV carried out gain of function research, almost certainly on these and a range of related and other samples (which is different than genetically engineering the viruses). Chimeric viruses were likely developed in this process. There has never been a full and public accounting for what viruses are in the WIV sample set and database, and key elements of the database have been taken off line or deleted.

- Given the close relationship of the Chinese Peoples’ Liberation Army (PLA) in the development and construction of the Wuhan Institute of Virology, it is fair to assume a connection between the PLA and the WIV.

- In late 2019 the SARS-CoV-2 virus appeared in Wuhan. The closest known relative of this virus is the RaTG13 virus sampled from the Yunnan mine where the miners had been infected. (RaTG13 is almost certainly not the backbone virus for SARS-CoV-2.)
The genetic similarity between the RaTG13 virus and SARS-CoV-2 suggest that SARS-CoV-2 or a closely related backbone virus could have been sampled from the Mojiang mine and brought to the WIV (which is why the disappeared WIV databases and lab records are so critical).

- It is also plausible that SARS-CoV-2 could have been among the viruses held in or derived from a different virus in the WIV repository.

- In the earliest known stage of the outbreak, the virus was already very well-adapted to human cells.

- In the critical first weeks after the outbreak, Wuhan authorities worked aggressively to silence the whistleblowers and destroy evidence that could prove incriminating.

- When Beijing authorities got involved a bit later, they likely faced a choice of implicating the Wuhan authorities, and, in effect, taking blame for what was quickly emerging as a major global problem, or turning into the curve and going all in for the coverup. I believe they likely chose the second option.

- The Chinese government then massively lobbied the WHO to prevent the WHO from declaring COVID-19 as an international emergency and prevented WHO investigators from entering China for nearly a month.

- In late January 2020, PLA Major General Chen Wei was put in charge of containment efforts in Wuhan. This role included supervision of the WIV, which had previously been considered a civilian institution. General Chen is China’s top biological weapons expert. Allegations that the PLA was conducting covert dual civilian-military research on bat coronaviruses at WIV have not been proven.

- The Chinese authorities have gone to great lengths to destroy evidence and silence anyone in China who might be in a position to provide evidence on the origins of COVID-19.

- Although nothing can be fully conclusive in light of Chinese obfuscation, the continued absence of any meaningful evidence of a zoonotic chain of transmission and mutation in the wild and the accretion of other evidence is pointing increasingly, in my view, toward an accidental lab leak as the most likely origin of COVID-19. Given the extent to which China would benefit from discovering evidence of a transmission in the wild, we can assume Chinese authorities are doing all they can to find this kind of evidence without success. This failure would explain why Chinese officials have recently begun, with little credible evidence, asserting that the outbreak started outside of China.

- In light of all of this, only a full and unrestricted international forensic investigation into the origins of the pandemic, with complete access to all samples, lab records, scientists, health officials, etc. will suffice.

The site is very extensive and worth some time if you got it. I’ll probably spend some time on it just to get a feel of his ‘investigation’ and whether or not its coherent.

- Doc

[Chap]

This article from the New England Journal of Medicine is interesting by reason of its anecdotal and person-centred approach.

Like the man says:

... people who are determined to undermine confidence in vaccines will always find ways to spread misinformation. But a much larger proportion of the population may be willing to get vaccinated given the proper reassurances, and dismissing their concerns often leaves them seeking someone to validate them. I suspect that’s one reason why correcting misinformation often falls short. Some people, for instance, may truly believe that vaccines cause autism. But for others, this ostensible fear may mask less easily expressed needs such as maintaining one’s identity, belonging to a group, or simply being heard.

MEDICINE AND SOCIETY
Escaping Catch-22 — Overcoming Covid Vaccine Hesitancy
List of authors.
Lisa Rosenbaum, M.D.

On September 8, 2020, AstraZeneca announced that it was pausing its late-phase SARS-CoV-2 vaccine trial because of a serious adverse event in a U.K. participant. The next day, my hairdresser, Ms. J., asked me what I thought about the news. I said the halting of the trial to investigate the adverse event was reassuring — an example of science doing its job. “What do you think?” I asked.

“There’s no effing way I’m getting a vaccine,” she said.

Ms. J., who lives in New York City, had Covid-19 in April. Though she didn’t require hospitalization, the virus incapacitated her for weeks, leaving her weak and unable to tolerate solid foods; for months, she continued to become dyspneic with exertion. She was terrified of getting the virus again and derived little comfort from the possibility that she had enduring immunity. Yet the prospect of getting a Covid-19 vaccine was even scarier. Emphasizing the haste of vaccine development, the need for long-term safety data, and concern that side effects could “make everything worse than it already is,” Ms. J. added that most of her friends and relatives were similarly “really suspicious” of the vaccines.

And they are not alone. Though many people initially believed a vaccine was the magic bullet that would save us from a devastating pandemic and return our lives to normalcy, we now find ourselves contemplating simultaneously how to ethically allocate a limited number of vaccine doses to the many people who want them and how to increase vaccine uptake among those who don’t. Though estimates vary, public health officials suggest that about 80 to 85% of Americans would need to be vaccinated for the country to achieve herd immunity. Vaccine confidence seems to be rising, but recent polling suggests that about 31% of Americans wish to take a wait-and-see approach, and about 20% remain quite reluctant.1 The behavioral obstacles to widespread vaccination are thus as important to understand as the scientific and logistic hurdles.

Accordingly, since September, I have been talking with people about their perceptions and concerns about Covid-19 vaccination. Before the election, people often mentioned the prospect that a vaccine would be approved prematurely by a desperate Trump administration, but concerns about long-term safety are common, persistent, and not unfounded. Even though adverse events tend to occur within the first 6 to 8 weeks after vaccination, vaccines are typically not approved until 2 years of follow-up data have been gathered. In addition, some SARS-CoV-2 vaccines, such as those based on messenger RNA, use new technologies for which long-term data are lacking. We also don’t yet know the durability of immunity, the degree to which vaccines prevent asymptomatic infections, or whether boosters will be necessary, especially given the emergence of viral variants. In the midst of a pandemic that is taking thousands of lives daily and devastating society, many people will find these uncertainties acceptable. But for others, as with many trade-offs in medicine, the magnitude of benefit may have less emotional resonance than the possibility, no matter how minimal, of risk.

More Than Messaging

For those with intent to be vaccinated, interventions such as default appointments and onsite vaccination effectively increase uptake.2,3 Less is known, however, about how to increase uptake by modifying the beliefs of the hesitant. In one randomized trial targeting parents with children eligible for the measles–mumps–rubella (MMR) vaccine, researchers tested various messaging strategies that either corrected misinformation or had emotional appeal. One strategy refuted the claim that vaccines cause autism, while others featured pictures of children with the diseases the MMR vaccine prevents or a dramatic narrative about an infant who nearly died of measles.4

These strategies not only failed to increase intent to vaccinate, but among vaccine skeptics, they actually did the opposite. Graphic pictures of a child with measles increased fears of vaccine-related side effects rather than fear of the disease itself. And though accurate information reduced the misperception that vaccines cause autism, intent to vaccinate still decreased among the most hesitant parents. Extrapolating these findings to a paralyzing pandemic comes with countless caveats, foremost among them that vaccination will initially target adults. Nevertheless, as we embark on far-reaching messaging campaigns, some humility about our intuitions about human behavior is in order.

We do know that the confidence of physicians and public health officials can be instrumental in allaying people’s fears.2 One elderly couple I spoke with in October, for instance, after expressing reservations about a vaccine being approved prematurely for strictly political reasons, concluded, “If Anthony Fauci approves it, we will go for it.” This sentiment is consistent with what we know about vaccine uptake in general: the seemingly most effective way to increase vaccination rates is with clinician recommendations.2,5 As Robert Jacobson, a Mayo Clinic pediatrician who studies vaccine hesitancy, pointed out, since health care workers are among the first groups to be vaccinated, they will be able to speak to their patients with authority and confidence: “I got this vaccine, and I want you to have it, too.”

As critical as recommendations from trusted authorities will be, in an environment rife with misinformation and distrust of expertise, disseminating evidence-based information may be insufficient to persuade some people. That’s partly why Heidi Larson, an anthropologist at the London School of Hygiene and Tropical Medicine whose recent book, Stuck, summarizes her decades of research on vaccine hesitancy, sees Covid-19 as an opportunity to rethink our approach to vaccine uptake. Larson, who studies rumors, cautions against the impulse to merely correct misinformation and assume our work is complete. Writing before the pandemic, Larson observed that “Vaccine reluctance and refusal are not issues that can be addressed by merely changing the message or giving ‘more’ or ‘better’ information.”6 Though the pandemic has cast the dangers of misinformation into stark, soul-crushing relief, the gravity of a falsehood’s consequences doesn’t render it more correctable with truth.

Larson’s own thinking was transformed in 2003, when, while overseeing vaccine strategy and communication at UNICEF, she was called to Nigeria, where a government-led boycott of the polio vaccine was under way. There, Larson discovered that resistance reflected not specific concerns about the vaccine but rather a convergence of broader social factors, including rumors that Western vaccines were intended to sterilize children; a fear, in the aftermath of 9/11, that the United States was at war with Muslims; and ongoing conflict between the local and central governments. Quashing the rumors seemed to matter less than addressing the nexus of questions, concerns, beliefs, and historical forces that gave rise to them. Though the reasons for skepticism may vary among communities, Larson’s approach to vaccine hesitancy is universally relevant: before you attempt to persuade, try to understand.

The Undecideds

Mr. K. is a 56-year-old man who avoids vaccines and decided with his wife not to vaccinate their children. “People disregard you as a conspiracy theorist,” he told me, “but we put a lot of thought into making that decision.” Many of Mr. K.’s beliefs were informed by his father-in-law, a pediatrician who has concerns about the safety of vaccines. “He is not a pharma-driven doctor,” Mr. K. explained. “He’s not part of the medical establishment.” The problem with that establishment, as Mr. K. sees it, is not just its drug pushing and profiteering, but its censoring of people who disagree. For instance, in July, when social media companies removed a viral video of physicians suggesting (misleadingly) that hydroxychloroquine was an effective treatment for Covid-19, Mr. K. saw a parallel to attempts to quash antivaccine sentiment. “What is going on with this country where people can’t make their own decisions?” he asked. “I try to find the scientists out there who aren’t afraid of losing a grant — people who have nothing to lose if they speak the truth.”7,8
In both his aversion to mainstream medicine and his perception that people questioning medical dogma are censored, Mr. K. highlights a Catch-22 of vaccine hesitancy: by challenging untruths, we may inadvertently feed the perception that the “real” truth is being suppressed. Larson describes in her book the fallout after pressure from the scientific community resulted in removal of the antivaccination film “Vaxxed” from the Tribeca Film Festival in 2016. The pulling of the film confirmed the belief of vaccine doubters that physicians and scientists are unwilling to engage with any dissent. Moreover, notes Larson, these instances of so-called censorship attract people who, while not necessarily antivaccine, identify with broader rights agendas promoting “freedom” and “a fundamental democratic right to choose.”6

Indeed, while people firmly opposed to all vaccines may be relatively few in number, they wield outsized influence, particularly on social media, over the undecideds. A recent study of expressions of vaccine-related sentiments by 100 million Facebook users found that antivaccine clusters of people, though less numerous than provaccine clusters, have a more central presence in large networks and interact with more undecided clusters.9 Provaccine clusters, meanwhile, engage predominantly in smaller networks, so even though they exert less influence, they often have the “wrong impression that they are winning.” Provaccine clusters are also disadvantaged by the tendency toward “monothematic” messaging, whereas antivaccine pages deploy multithemed narratives to broaden their appeal, touching on safety concerns, alternative medicine, Covid-19 (both causes and cures), and various conspiracy theories. In response to these dangerous disinformation campaigns, social media companies have intensified efforts to label falsehoods and eliminate them. But as Neil Johnson, a physicist and the study’s first author, explained to me, such efforts can backfire.
One of the most widely shared Covid conspiracy theories, for example, is that the vaccines contain microchips that will be used by elites (Bill Gates is often mentioned) or by the government to track people’s behaviors. People propagating the rumor often point to a study of a new technology that delivers microparticles intradermally during vaccination, creating a digital vaccine record.10 The research, funded by the Gates Foundation before Covid, aims to address the challenge of vaccine record keeping, particularly in low-resource countries. Although this technology is not present in any Covid vaccine, Johnson, who has been monitoring vaccine sentiment online throughout the pandemic, cautioned against dismissing the rumor as mere misinformation. “We can hope that Bill Gates won’t eventually use it to track Covid vaccine behavior, just like we hope our neighbors won’t one day wake up and plow their car into our house,” Johnson said. “They could in principle, but it’s highly unreasonable to think that they would.” If the vaccine hesitant feel that they’ve been unfairly accused of spreading misinformation, Johnson explained, they become further emboldened in their doubts. Even ideologically disparate groups unify around such shared skepticism.

Johnson’s observations remind us why teaching the public to “understand science,” the seemingly obvious way to mitigate antiscientific sentiment, may fall short. Many discussions about science denialism conclude with some version of “We just need to get the public to understand science.” But evidence suggests otherwise. Sociologist Gordon Gauchat, for instance, in describing temporal trends in distrust in science, has shown that at least among conservatives, it’s the most educated subgroup who have become increasingly skeptical.11 One possible explanation is that highly educated people are more facile at finding evidence to support their views or in poking holes in evidence that doesn’t. Accordingly, in a 2019 essay on the so-called crisis in truth, in which antivaccine sentiment features prominently, history-of-science professor Steve Shapin makes the surprising argument that there isn’t “too little science in public culture,” but “too much.”12 That’s partly because people who deny climate change or reject vaccines co-opt the language of science to bolster the legitimacy of their views. Their arguments, Shapin writes, are often “garnished with the supposed facts, theories, approved methods, and postures of objectivity and disinterestedness associated with genuine science.”

Where do these bleak observations leave us as we seek to raise confidence in Covid vaccines?

From Stigma to Empathy

As the pandemic has sharpened the polarization over science, disdain for science denialism has made it easy to conflate true antiscientific sentiment with simple fear of the unknown. In my many conversations about vaccines, what struck me most was the shame that often preceded any expression of doubt. Some people simply refused to talk to me; others, particularly those who work in health care, were skittish about being identifiable. And those who had questions often prefaced them with “I’m not an antivaxxer but….” One common question, for instance, was whether people who are young and unlikely to die of Covid should get a vaccine whose long-term side effects are unknown.

My instinctive response to this sort of question is to emphasize the population benefits of vaccination and the reality that some young people do die from Covid and that even survivors may have long-term sequelae we don’t fully understand. But why not simply acknowledge the legitimacy of the concern? For many of us in the medical community who are haunted by the consequences of science denialism, validating any aspect of vaccine skepticism may feel like ripping your mask off in a crowded elevator. But it isn’t “antiscience” to admit that we still don’t know some things. It’s just truth.

Nevertheless, among people who take no solace in rigorous science, more than transparency will be needed to build trust. Larson notes how quick the scientific community is to justify medical recommendations by saying, essentially, “Science said so.”13 Referring to the pausing of the AstraZeneca trial due to an adverse event, for instance, Larson notes how much of the media coverage featured scientists noting the “normality” of pausing a trial to investigate any adverse events. To Larson, though, this response lacked expressed empathy for the person(s) who experienced an unexpected reaction. “It’s not normal for the person who was hurt,” she said. In our rush to defend the vaccine and the evaluation process, the scientific community may fail to convey how the participant’s symptoms were addressed, though it’s the latter — more than fidelity to science — that may be foremost on people’s minds. After speaking on the radio about this oversight, Larson was contacted by a trial participant who’d experienced an adverse event and wanted Larson to know how well she’d been cared for by the trial’s clinicians. “The scientists were doing the right thing,” Larson told me, “but they weren’t communicating it.”

Of course, people who are determined to undermine confidence in vaccines will always find ways to spread misinformation. But a much larger proportion of the population may be willing to get vaccinated given the proper reassurances, and dismissing their concerns often leaves them seeking someone to validate them. I suspect that’s one reason why correcting misinformation often falls short. Some people, for instance, may truly believe that vaccines cause autism. But for others, this ostensible fear may mask less easily expressed needs such as maintaining one’s identity, belonging to a group, or simply being heard. And yet respecting these more basic instincts also raises an uncomfortable question: At what point does empathy sacrifice scientific truth?

Or perhaps this is a false dichotomy. One of my best friends practices in a region where many people, including some health care workers and patients in her practice, are hesitant to get vaccinated. Even my friend — whose brilliance and rationality I have always admired — has reservations about vaccination, though she knows that expressing them is taboo. But I think that it’s only because she understands why people are scared that she’s effective not just at allaying fears, but at convincing people who don’t know anyone who’s willing to get vaccinated that what is known about the vaccine is more important than what isn’t. Indeed, the staff members who were initially reluctant to be vaccinated, changed their minds after speaking with her.

Although the scientific community’s obligation will always begin with championing truth, the pandemic has shown that society’s health also depends on understanding why so many people reject it. While some trust scientific experts, Larson notes that others seek “truth” elsewhere — their experiences, perhaps, or “heard truths” from their social networks. The pandemic, then, has reminded Larson why getting the public to understand science may be insufficient.14 Maybe, she suggests, it’s also time for science to understand the public.

[Doctor CamNC4Me]

Going back to my post for Jersey Girl, this:

A study by the South China University of Technology concluded that Covid-19 'probably' originated in the Centre for Disease Control – although shortly after its publication, the research paper was removed from a social networking site for scientists and researchers.

Intriguingly, when the wildlife market was closed in January, a report appeared in the Beijing News identifying Huang Yanling, a researcher at the Institute of Virology, as 'patient zero' – the first person to be infected.

Huang Yanling went missing:

https://www.dailymail.co.uk/news/articl ... er-up.html

and from a cursory Google search I can’t seem to find anything that shows she’s been found.

- Doc

[Doctor CamNC4Me]

Ctrl+F this and then read the bulletized list:

“China has taken a series of steps since the beginning of this crisis which seem consistent with a coverup.”

- Doc

[Chap]

Going back to my post for Jersey Girl, this:

A study by the South China University of Technology concluded that Covid-19 'probably' originated in the Centre for Disease Control – although shortly after its publication, the research paper was removed from a social networking site for scientists and researchers.

Intriguingly, when the wildlife market was closed in January, a report appeared in the Beijing News identifying Huang Yanling, a researcher at the Institute of Virology, as 'patient zero' – the first person to be infected.

Huang Yanling went missing:

https://www.dailymail.co.uk/news/articl ... er-up.html

and from a cursory Google search I can’t seem to find anything that shows she’s been found.

- Doc

Anyone who follows events in China more than superficially will be aware that such 'disappearances' of those who cause inconvenience to the government have often taken place in the past, and have grown more and more normal in recent years. So this would be no surprise.

[canpakes]

Pastor Greg Locke is really afraid of masks -

Right-wing pastor Greg Locke used his Sunday morning sermon to ridicule any attempt by the government to vaccinate Americans or impose a “second round” of pandemic containment. He also said he would kick out anyone wearing a mask.

The Tennessee-based Baptist pastor offered his latest tirade against “ungodly Democrats” and the Biden administration, saying the federal government only wants “compliance” and not improved public health for Americans. Locke praised his own “narrow” perspective on the COVID-19 pandemic and pledged to fight any effort to shut down his Bible church Global Vision. Locke said Democrats “haven’t hurt the economy enough” during the pandemic and are now trying to fabricate a second lockdown.

Locke warned health officials not to knock on his door and ask if he had received a COVID-19 vaccine, saying they would “serve ice cubes in hell” before considering shutting down his church following recent spikes in the so-called Delta variant of the virus.

“Don’t believe this Delta variant nonsense. Stop it! Stop it! If they get through the second round and you start showing up with all this masks and nonsense, I’ll ask you to leave, ”Locke told the enthusiastic audience. “I’ll ask you to leave. I don’t play these democratic games in this church. “

“I don’t need to be a jerk to Jesus, but… I’m not going to bow down to a wicked atheist culture,” Locke continued, eliciting loud applause. “Here’s what the left told us: ‘If you comply you compromise, if you comply you will end up being in our good graces.’ But no, you can never comply enough! “

Locke used several New Testament stories about Jesus to convey his general point that adults today must be prepared to offend their friends and family in order to stand up for their values. The ardently pro-Trump pastor urged attendees to “stir the pot” when they feel too many people agree with them in Facebook posts.

The Conservative Pastor’s accusations against the Biden administration and Democratic lawmakers include his claims that Vice President Kamala Harris is a “Jezebel demon” and that the administration oversees “child trafficking tunnels” under Washington, DC

Gotta love that last paragraph, too. : D

https://www.fr24news.com/a/2021/07/past ... crats.html

[Res Ipsa]

Ctrl+F this and then read the bulletized list:

“China has taken a series of steps since the beginning of this crisis which seem consistent with a coverup.”

- Doc

Why is pfizer protected from any liability if this drug makes me grow horns and look like a Mormon?

Because, under American capitalism, profits are capitalized [ETA, “privatized” is a better word choice] but losses are socialized.

[Chap]

Because, under American capitalism, profits are capitalized [ETA, “privatized” is a better word choice] but losses are socialized.

The US is not the only country where that happens.

Of course, we all (unless we are top bankers) bear the scars of the huge application of this rule at the time of the banking crisis. The banks were said to be 'too big to fail' so taxpayers took on the costs and risks of rescuing them.

Since then, the top executives of banks have got richer than they ever were before, and the average taxpayer in the US and the UK is on the whole no better or somewhat worse off than they were.

Great system!