Shortly after COVID-19 was recognized as a worldwide catastrophe, my much better half asked me how long I thought this would this last. Based on my then 45 years of biomedical research experience I replied, “Three years.” I was wrong. That was more than five years ago, when the refrigerated makeshift morgues were parked on the streets of New York City. While the pandemic has slackened considerably, SARS-CoV-2 is still with us and new variants continue to emerge, with the latest causing “razor blade throat.” The scariest development would be a new SARS-CoV-2 that is as lethal as MERS-CoV. MERS had a fatality rate of 35% but it was not very transmissible and cases still occur.
As a comparison, smallpox had a fatality rate of 30%. Those of us of a certain age received the smallpox shot in elementary school and this continued into the 1970s. I remember getting the Sabin polio vaccine about the same time with my family and hundreds of others lined up in my elementary school to eat a sugar cube with a blue or purple spot on it. The medicine went down very well. And it worked. Polio has been eliminated in the United States, and elimination of polio worldwide can be accomplished if vaccination is extended to everyone. The last naturally acquired case of smallpox occurred in 1977 and the disease was declared eradicated in 1980. From the WHO on 8 May 1980:
Having considered the development and results of the global program on smallpox eradication initiated by WHO in 1958 and intensified since 1967…the world and its peoples have won freedom from smallpox, which was a most devastating disease sweeping in epidemic form through many countries since earliest time, leaving death, blindness and disfigurement in its wake and which only a decade ago was rampant in Africa, Asia and South America.
I remember this well. Biomedical science and public health were celebrated, as they should have been because this was truly an astounding accomplishment. But expectations that infectious disease would soon be a thing of the past were premature. The first clinical report of AIDS appeared on 5 June 1981. Forty years later COVID-19 appeared. AIDS is now a manageable chronic condition for the majority of those infected with HIV in the Global North who are treated with HAART. Effective vaccines against HIV remain on the scientific horizon, perhaps beyond it. In the absence of HIV vaccines, we have PrEP, but as with many effective interventions its availability is restricted to those who can pay. Business is business, but this Neoliberal dream is no way to do public health.
Vaccines for COVID-19 are famously available. The stimulus for this essay was a question from a conservative friend who asked me why CDC decided to change the definition of vaccine after the pandemic began. I had read something of this but had not really paid attention to the issue. Still, it is a good question, and I began digging. I did not expect to find much, but I did find something I should have known.
As with most things COVID, this item appeared first in a political context through the actions of Representative Thomas Massie of Kentucky:
Massie shared an image containing three definitions for the word “vaccination” with his 326,000 followers on Sunday. One was labeled “pre-2015” and described vaccination as: “Injection of a killed or weakened infectious organism in order to prevent disease.” Another was dated 2015-2021 and said: “The act of introducing a vaccine into the body to produce immunity to a specific disease.” The third was from September 2021, calling vaccination: “The act of introducing a vaccine into the body to produce protection from a specific disease.”
The basic facts can also be found here and here and in many other contemporary articles. They all agree with the following changes in the official definition of vaccine:
- Pre-2015: Injection of a killed or weakened infectious organism in order to prevent disease.
- 2015-2021: The act of introducing a vaccine into the body to produce immunity to a specific disease.
- September 2021: The act of introducing a vaccine into the body to produce protection from a specific disease.
The King5.com link (Seattle NBC affiliate) states it is true that:
CDC changed its definition of vaccine from “a product that stimulates a person’s immune system to produce immunity to a specific disease, protecting the person from that disease” to “a preparation that is used to stimulate the body’s immune response against diseases.”
Several experts in infectious disease responded that the definition of vaccine has changed at the margin, but these have not “impacted the overall definition…and that the previous definition could be interpreted to mean that vaccines were 100% effective, which has never been the case for any vaccine, so the current definition is more transparent.” The changes were said to be semantic and clarifying instead of substantial.
This is where my colleagues – these scientific experts – miss the point completely. No one has ever believed that vaccines are 100% effective, going back to the ancient practice of variolation that induced immunity to smallpox. Variolation (covered here [1] in our discussion of Simon Schama’s Foreign Bodies: Pandemics, Vaccines and the Health of Nations) would have produced an antibody response in every person scarified with knives and needles dipped into exudate from active smallpox lesions, but in some cases the vaccinated subsequently came down with smallpox anyway. Their immune response did not provide protection – immunity – to the disease. This is not uncommon, both in the clinic and in the laboratory, where an antibody response can be measured but it is not strong enough to prevent disease or for the antibodies to be used in research.
It did occur to me that my flat statement that no one has ever believed that vaccines are 100% effective would be disputed by the experts. This was addressed during the early years of the COVID-19 pandemic in Vaccination terminology: A revised glossary of key terms including lay person’s definitions (paywall). This paper is an academic exercise with utility summarized in these Layperson’s Definitions from their extensive Table 2 of 44 terms associated with vaccinology, including:
- Effectiveness: A measure to describe how good a vaccine is at preventing a disease when distributed for use in the general public.
- Efficacy: A measure to describe how good a vaccine is at preventing a disease under test conditions, for example a clinical trial.
- Herd immunity: This happens when enough people are vaccinated or have immunity from a disease, thereby reducing the chances of someone who is not vaccinated from becoming infected.
- Immunization: The process where an individual becomes protected against a disease caused by a bacterium/virus.
- Immunity: The ability to fight off an infection caused by a harmful bacterium/virus.
- Pandemic: A disease occurrence worldwide affecting a large number of people.
- Vaccine failure: This occurs when the person develops the disease, even though they have been already vaccinated for it.
- Waning: A decline or weakened immunity over time.
That the public understands these terms should be a surprise to no one. Virtually every parent knows that vaccination will not always work. Breakthrough infections happen, but rarely with vaccines that are effective. Virtually every parent also knows that there is an infinitesimal chance that a vaccine might have deleterious consequences for any given child but that not getting vaccinated against disease is a much bigger risk for their children and society – or they previously “knew,” and therein lies much of our current distemper regarding public health.
To summarize: The biomedical, public health, and political response to COVID-19 was to go virtually all-in on two novel vaccines, but these prevented neither the disease nor its transmission. It has been shown, after the fact, that vaccination reduced mortality and morbidity and saved an indeterminate number of lives. It will be impossible to determine how many have died of COVID-19, but according to The Lancet, as many as 18,000,000 deaths were connected to the pandemic during its first two years.
These facts are inconsistent with the layperson’s conception of an effective vaccine. And for whatever reason, the scientific and medical communities cannot seem to understand the quite natural reaction to promises not kept. This has led to an increasing level of mistrust of the scientific and medical establishments among laypersons, who were told that if you get the vaccine you will not get COVID-19. This was manifestly not true. And at the same time CDC changed the definition of vaccine so that it was at odds with the public conception of and experience with vaccines. [2] You do not have to be a conspiracy theorist to notice the coincidence.
Thus, a major casualty of our response to COVID-19 has been trust in biomedical science, clinical medicine, and public health. It follows that this has given current political leadership an excuse to attack the establishments of each. It did not have to be this way. What is to be done?
The first thing to be done is to revive the public’s trust. This has been covered in an interesting article: Rethinking Trust and Public Health Compliance: Introducing a Trust Continuum for Policy and Practice (open access). This contribution is academic but commonsensical and useful, with one group of academics engaging with another group in a serious manner. From the Abstract, lightly edited:
Trust in government has emerged as one of the strongest predictors of national performance (mostly undefined here) in fighting COVID-19. This commentary aims to take stock of the vast literature on trust and compliance with public health measures that has emerged during the pandemic to synthesize policy-relevant recommendations about: 1) How to conceptualize trust; 2) Whether trust is always deserved; and 3) How governments can earn appropriate levels of trust…we develop a framework that conceptualizes trust as falling along a continuum ranging from extreme distrust to blind trust with the ideal point- “informed” or “basic” trust-falling in the mid-point of the continuum. We illustrate the continuum with examples and provide recommendations regarding how governments can build more nuanced disease responses that account for individuals and sub-groups at different rungs on the continuum while (re)building trust. We conclude that trust-building is a long-term project that must continue in non-crisis times.
This conceptualization of trust is the important point. Whether trust is deserved depends on the behavior of those who believe they should be trusted. And the only mechanism by which any government can earn trust is for it to be honest. I.F. Stone comes to mind here, though. Ditto for scientists, who during the pandemic forfeited trust by not emphasizing that the Operation Warp Speed vaccines were an experiment. As the authors rightly point out, trust is not a binary concept. Rather it exists on a continuum schematized but full of good sense in their Exhibit 1:
| Definition | Impacts on Behaviors | Policy implications | Laymen Terms | |
| Distrust | Suspicion of ill intent | Breeds belief in conspiracy theories | Coercion likely to be ineffective | It’s evil and wrong |
| Mistrust | Skepticism justified by negative experience | Breeds skepticism | Coercion may be effective and deepen suspicion | I’m not sure |
| Informed Trust | Gained through verification & trusted sources | Individual critical judgment & valuation of evidence | Authority should be transparent through public communication | I checked it & so I believe it |
| Basic Trust | Earned through tacit past experiences | Widely accepted societal practice or authority | Authority must build & maintain trust | It’s how it is |
| Uninformed Trust | Uncritical trust, often socially pressured | Socially driven compliance | Collaborate with community-based organizations | My friend said so |
| Blind trust | Overconfident faith in science & elites | Deference to authority and virtue signaling | Avoid saying “Science said so | The authority said so |
We clearly should exist as a polity and society somewhere in the central rows. But we are polarized at either end of the current political divide, with the notional Right and Left [3] sneering at one another through a darkened glass, each filled with ill intent exacerbated by their overconfident faith in their tribal elites. Coercion and corrosion are characteristics at both ends of their spectrum, which is not nearly as broad as they believe.
As noted in Rethinking Trust and Public Health Compliance, trust can and should be viewed as a “virtuous circle in which greater trust leads to better governance and citizens who are more satisfied with the government’s performance, thereby generating increased trust.” Neoliberalism along with the current reprise of the Gilded Age militates against the possibility of this virtuous circle. Biomedical science has followed the same neoliberal path, as described in this remarkable passage that describes our past five years nearly perfectly:
Implicit in the focus on “trust,” however, is the notion that trust in actors and authority figures is deserved. During the COVID-19 pandemic, public health leaders appeared shocked and dismayed that the public would resist efforts aimed at protecting them from an emerging viral threat, perhaps taking compliance to be logical, science-based, or not requiring explanation. If only people trusted their political leaders, scientists, or doctors, millions of lives could have been saved.
Quite so. But all scientists in good standing should have cringed every time a leader of the scientific establishment said, “Trust the science” and its corollary “I represent science” during the early phase of COVID-19. Instead, most of us nodded in assent. No one should accept an argument from authority from anyone. Legitimate scientists who asked questions such as “Whose science and for what purpose?” were ignored, or worse. As it happened, vaccines that were produced under an Emergency Use Authorization did not work as the people have come to rightfully expect. The imperative for Big Pharma to be first with the latest technology (which was not experimental) and make a lot of money in the process won out over approaches that would have worked in the emergency, and did work until countries such as China and New Zealand fell into line with the rest of the world.
When I was asked how long I thought the pandemic would last – three years – I expected the scientific establishment to get to work as they had from the very beginning of the HIV/AIDS epidemic. It took more than ten years for HAART to become widely available, but the spread of HIV was contained rapidly among those who followed authoritative guidelines that were initially resisted by some in the community and in the establishment. There was every reason to believe that given the advances in modern molecular biology and virology in the forty years (at least four or five generations as progress in biomedical science is reckoned) between AIDS and COVID-19, a concentrated effort would lead to successful management of the pandemic, if not a cure of or treatment for the disease. In any case cure/treatment would come later, after the world’s public health establishment figured out how to control the spread of SARS-CoV-2.
We have discussed this before, and there is no need to revisit the details. But one fact about coronaviruses has bothered me from the early days of the pandemic. When talk of the mRNA vaccines for COVID-19 had reached critical mass in 2020, my colleague and friend who died of complications of long COVID last November told me in no uncertain terms that vaccines would never be the solution to the pandemic. I asked her why. She was a veterinarian with whom I had worked for fifteen years. She was right about everything and this time it was the nature of coronavirus pathobiology. According to the scheme from Exhibit 1 above, I gave her my complete informed trust. As she explained, avian biologists have known of deadly infectious coronaviruses for more than ninety (90!) years. For nearly as long, veterinarians and poultry scientists have known that vaccines against coronaviruses have a short half-life. They simply do not work very well for very long. Therefore, infection control is essential, especially for chickens raised in CAFOs (another matter altogether).
So, why was it assumed by the biomedical establishment that human coronaviruses would be any different? I have no answer other than ignorance suffused with hubris. This establishment seems to have forgotten what is true for one animal and one type of virus is likely to be true for another closely related animal and similar virus (the first retroviral human oncogene was discovered in research on chicken cancer more than one hundred years ago). A review recently published in the out-of-the-way but very good journal Avian Pathology (1972) covers the relevant pathobiology of vertebrate coronaviruses through the lens of the avian biology: Lessons learnt on infectious bronchitis virus lineage GI-23 (paywall). From the Abstract:
Infectious bronchitis virus (IBV) is the first coronavirus discovered in the world in the early 1930s and despite decades of extensive immunoprophylaxis efforts, it remains a major health concern to poultry producers worldwide. Rapid evolution due to large poultry population sizes coupled with high mutation and recombination events and the reliance of the antiviral immune response on specific antibodies against the epitopes of the S1 glycoprotein, render the control of IBV extremely challenging. The numerous and rapidly evolving genetic and antigenic IBV types are currently classified based on the whole S1 gene sequence, into 36 lineages clustered in eight genotypes…The hallmarks of IBV Variant 2-like strain infections are high virulence and remarkable nephrotropism and nephropathogenicity; however, the molecular mechanisms of these traits remain to be elucidated.
Let us modify/paraphrase this as follows:
Despite decades of extensive immunoprophylaxis efforts, this human coronavirus remains a major health concern. Rapid evolution due to large human population sizes coupled with high mutation and recombination events and the reliance of the antiviral immune response on specific antibodies against the epitopes of the S1 glycoprotein, render the control of this coronavirus extremely challenging.
This settled knowledge should have been in the forefront of the response to COVID-19. As an aside, so much for the herd immunity understood by laypersons and championed by the current Director of the National Institutes of Health and a member of the completely new Advisory Committee on Immunization Practices (ACIP). Without durable immunity to the pathogen, it is difficult to imagine how accelerating herd immunity through mass infection of those for whom COVID-19 was merely an inconvenience (untrue as it turns out) would work.
Although Avian Pathology will not be high on the list of journals read by most physicians and biomedical scientists, a quick search of PubMed using “coronavirus” as the query returns much of the early IBV literature, but not the original report from 1931: “An apparently new respiratory disease of baby chicks” in the Journal of the American Veterinary Medical Association, 78: 413-422. Nevertheless, this paper is not difficult to find. The Summary is visible at the link:
The very sudden and almost precipitous occurrence of an acute and quite fatal respiratory disease among baby chicks furnished the occasion for a brief though special study of the condition, the results of which supply the information given in this discussion. We have refrained from specifically naming the disease under discussion. It materially differs, in one phase or another, from any of the established respiratory diseases of poultry. On the other hand, it has some characteristics of catarrhal roup, laryngotracheitis, and perhaps more things in common with infectious bronchitis of adult fowls. Therefore, if we were pressed for a definite name we would be inclined to entitle it: infectious bronchitis of baby chicks.
There is a lot about SARS-CoV-2 that we still do not understand, including its origin as spillover from a zoonotic source or as an escape from the virology laboratory in Wuhan. The Proximal Origin of SARS-CoV-2 was published in March 2020 in Nature Medicine. This letter has an interesting history, as recounted by Ryan Grim (informed trust again). I remain agnostic about the origin of SARS-CoV-2, but nearly fifty years in the laboratory makes me believe that it could have escaped from one. This is not to say the virus was manufactured in the laboratory! On the other hand, scientists have known at least since the early 1950s that durable immunity to coronaviruses is “problematic” at best. Therefore, the most logical approach to controlling a pathogenic human coronavirus is anything but a vaccine, wherever the virus originated.
So, where do we go from here regarding “trust”? For scientists, the road will be long. We should remember that much of the current distrust is our doing over the past forty years, at least. But “science for the sake of useful knowledge” got us to the point where we understand how life works and much of what goes wrong when it doesn’t. We must return to this work-in-progress view of disinterested science during a reconstruction that I will not live to see.
For our political predicament, we should remember that a week is a long time in politics. But until the decision in Citizens United is rendered null and void, I see little hope. Money is not speech. And contrary to a fundamental tenet of Neoliberalism, consumer is not the same as citizen. Still, the American political world is full of surprises on occasion when it is not just one thing after another courtesy of the Uniparty.
Notes
In memory of MAK, DVM.
[1] The origin of vaccination lies in variolation, which is a simple procedure in which pus or encrusted “pocks” from a smallpox lesion are introduced into the lightly incised skin of the patient after which the wound is bandaged. This usually results in a mild form of the disease (fever and a relative few pustules localized near the site of variolation) after which the patient is generally immune to smallpox.
[2] The public knows that a vaccine eradicated smallpox and current vaccines prevent, with necessary caveats well understood by the people, the following serious illnesses: polio, measles, mumps, rubella, whooping cough, tetanus, bacterial meningitis, cervical and other cancers caused by human papilloma virus (HPV), rotavirus infection, respiratory syncytial virus infection, chicken pox and recurrent shingles in adults. I would rather have not had five of the illnesses on this list. Periodic vaccine denialism that culminated in the MMR-autism hoax has been covered well and is not considered here. That the current leadership of the US Department of Health and Services is reviving vaccine denialism through the several means at its disposal is a fact. This will continue until it is stopped, however that can be done. However, the damage to scientific research and public health is likely to endure.
[3] “Notional” is the keyword in the distinction here between Right and Left. Precise definitions of each are not possible here. Suffice it to say there is often nothing conservative behind the exertions of the current Right, and at the same time there is nothing socialist, much less social democratic, behind the bleatings of the current performative, self-reverential Left. Left Is Not Woke and never will be. A different, more expansive version is We Have Never Been Woke: The Cultural Contradictions of a New Elite. And contrary to the reigning Uniparty trope, aside from the 1920 Presidential campaign of Eugene V. Debs, who received 3.4% of the vote while serving a sentence in the Atlanta federal prison for seditious speeches against President Woodrow Wilson and The Great War, there has never existed in the United States something called a serious “radical left” that hides in the shadows of the hive mind of the Uniparty.
KLG: Ahhh, the info that slips out in notes (which is why I read almost all notes in history books, where the authors have to name manuscripts and sources).
To wit, note 3: “Suffice it to say there is often nothing conservative behind the exertions of the current Right, and at the same time there is nothing socialist, much less social democratic, behind the bleatings of the current performative, self-reverential Left.”
What happened to scientists? Like so many other groups now suffering from severe loss of moral authority (I will stick just with scientists here), scientists didn’t realize that they had to resist neoliberalism to remain scientists.
Your essay put me in mind of the vaccine that was being developed in Italy, by the ReiThera research group. It gave good initial results. Then the ReiThera group lost a case in the Italian court that supervises public expenditures and money ran out.
https://www.nature.com/articles/d43978-021-00090-x
Eventually, as we know, contracts for vaccines in the EU were given to Pfizer, less so Moderna, and less so Astra-Zeneca (whose crappy vaccine had to be pulled). The other dozens of vaccines being tested were never heard from again. (Except for Novavax.) The U S of A refused to consider Russian vaccines. Ursula von der Leyen still owes us those missing text messages about her single-handed negotiations with Pfizer.
So neoliberalism made the decision for scientists. And as the saying goes, Absolute power corrupts absolutely. Money, the expression of power in the neoliberal world, corrupts scientific endeavor. Your excellent colleague, the veterinarian, knew that things had gone wrong, but Covid, like war, was a gold rush for certain corporations. (And in war we see people who believe that the West can bomb Iran into democracy.)
And that promising Italian vaccine? It no longer even has an entry at Italian Wikipedia. I checked.
I’m not saying that scientists have to become discalced Franciscans. But scientists (and still other groups I won’t name) have to get out from under the money somehow. Or learn to hold themselves in noncooperation with money.
As it is, scientists have followed the same path as the Democratic Party. And look where the Party of Wasserman-Schultz is — many ironies, because you have Democrats who were against Operation Warp Speed because Trump favored it, who are cozy with Big Pharma, and who are making money in spite of / or / because of their lack of moral authority.
Thank you, DJG. This is super important. Few people I have spoken to recognize the significance that everyone has now learned that science has shown itself utterly untrustworthy. This is an enormous loss. (At least it seems so in the West, not sure if it’s also true in China or elsewhere.)
But I do not accept this: “So neoliberalism made the decision for scientists. And as the saying goes, Absolute power corrupts absolutely.” Scientists and medics were in fact free to express themselves. Many of them would have faced negative consequences had they done so and for some these would have been severe. I accept that but I do not accept that they did not have a choice in the matter. And I think they still have the opportunity to acknowledge what happened, what they did, and explain their choices.
The PMC, where scientists and medics in the West seem to be mostly at home, appears to be characterized (among other things) by conformism and cowardice. Individuals chose to protect their careers and themselves socially, understandably, but the social outcome is lost of trust in science and expertise in general.
.Tom. Thanks. I will let others and their experiences and assessments guide me with regard to your second and third paragraphs.
With regard to the first paragraph, I will be much more forgiving about “science.” I understand that scientific research has been structured into institutions with lots of money sloshing around — and there is hardly anyone left as wild and remarkable as Paracelsus (half-mystic / half-researcher).
Yet most “science” is just stumbling around. I won’t speak for KLG (too much), but I’d say that his being a mentor and teacher of doctors, who are treating an endless variety of human beings, has led to his ability to perceive the “fuzziness” of scientific research and its provisional conclusions.
As a writer, and as someone who has written for the stage and been on stage, I can assure you that my perception of the scientific endeavor is much like stagecraft. One does what works. One discards what doesn’t work. And yet atomic theory is now almost three thousand years old.
Galileo once wrote a wonderful essay about how grapes are concentrated sunlight, which helps to explain why wine is somehow luminous. Well, Galileo was Italian. Do I accept this “findings”? Yes, as science and as poetry. A biochemist may now contradict me….
DJG, Reality Czar:
> With regard to the first paragraph, I will be much more forgiving about “science.” I understand that scientific research has been structured into institutions with lots of money sloshing around — and there is hardly anyone left as wild and remarkable as Paracelsus (half-mystic / half-researcher).
I was about to comment the same. My quarrels are not with science, but with some of the so-called “scientists”.
The science around COVID-19 has been clear from the start:
It’s a blood disease.
It causes micro-clotting which makes it a systemic disease that can incapacitate and damage every organ in the human body.
It is a vascular disease due the interaction of its spike protein with blood vessels.
It is an auto-immune disease because of the deleterious effects it can have on T-Cells.
All of the above have been at one point or another been reported by the mainstream press – NYT, WaPo et al. However, once again, compromised “scientists”, fetid NGO, and government leadership have never been interested in protecting the populace, but with shielding the sacred economy from decreased consumption. We were all left on our own with non-sterilizing vaccines that were only ever designed to decrease hospitalization and ventilator numbers. Not that those weren’t noble goals in and of themselves, but that bare minimum turned out to be the absolute maximum that anyone in a position of power and/or leadership ever wanted to do. Where is the US nasal vaccine? Where are the follow ups on non-pharmaceutical methods? Where are the free tests? Nowhere to be seen. When the Long-COVID mother-lode hits, and the rancid insurance and drug industries start to deny claims and more extract exorbitant amounts of money from the increasing numbers of the afflicted, I hope there are enough fire-arms-trained body guards to go around.
ChrisRUEcon. I agree with all of what you write. Except the last sentence.
You’ll note that none of the bounty hunters now terrorizing the U.S. populace has been harmed. There is a rumor that one of them had his masked ripped off. One.
Lotsa tough talk. The Second Amendment fundamentalists don’t want to kneecap a bounty hunter dragging away someone in a wheelchair. No, they want open carry in a grocery store.
I can’t tell you how many times it has been necessary for me to use my repeating blunderbuss over the potato bin….
In short, though, science is a bumbling effort because we are individually and collectively such crooked timber.
DJG, Reality Czar:
:)
My insertion of that last sentence was based less on the eventuality of another beatification (à la San Luigi Di Manhattan), and more on the current pluto-kleptocrat realization that their impunity is increasingly shorter-lived. Specifically, this article from Links yesterday caught my attention:
Can’t wait for the Vegas betting lines to open on who gets guarded next …
I see that my comment was unclear, which I regret. I, personally, “believe in” and am committed to science in itself, as a way of learning and describing. This disposition is as solid as ever for me. But science doesn’t have a PR department. Science as a thing overall, like it or not, gets stuck with the reputational damage done by its most public practitioners.
Science is foundational to so much that we want to do in fields such as pollution, climate, health, education, medicine. I want these matters to be scientifically informed and for scientists to participate. But owing to the history KLG set out above, the contributions of scientists are now trusted less. This is important.
A wonderful read, thank you very much for this.
I’m a physician, general practitioner, one of the few who still practices infection control.
The breakdown in trust in Public Health makes my job much harder, but how could it be otherwise when most healthcare workers lead by (bad) example? To regain trust there needs to be a minimum consensus on the risks of infection but right now there is everything but. Meanwhile, being ill is the new accepted normal and I am treated as a heretic from still enforcing two way masking in my consults. This chaos is what neoliberal forces wanted and they got it.
Based on the events of the great Flu Pandemic of a century ago I would have expected this pandemic to last about three or four years. But then in a comment about the nature of Coronaviruses years ago, IM Doc pointed to one that came out of Russia back about the 1890s and took about 12 years to burn itself out. Ummm, yeah. And I learned that you cannot vaccinate against a coronavirus as it is, like the flu, a moving target. That is when I knew that all the talk of herd immunity was just so much bs whether it came from Boris Johnson or the Great Carrington Declaration. It was just political expediency so as to not inconvenience the economy, no matter how many plebs had to be sacrificed.
Not surprised at the how the CDC decided to change the definition of vaccine after the pandemic began. When it was roaring into gear, it quickly fulfilled the check-boxes on the WHO list for what a pandemic is meaning that they would have to declare it to be one. But if people remember, the WHO removed the word ‘pandemic’ from their lexicon for about two months so that they did not have to do this and by the time they restored it, it was everywhere. But yeah, trust the WHO.
Speaking of trust. As far as I am concerned, the medical establishment blew trust away right from the start when they sided with governments, especially when they went the way of herd immunity. And look at masks. They came up short at the beginning of the pandemic but instead of giving the straight truth, different governments started to say that not only were they unnecessary but they could be dangerous. And when they admitted the truth months later, they thought nothing of it. ‘Yeah, we lie – but so what?’ Turns out that you cannot buy trust. Ordinary doctors were not that much better, especially the ones that were interviewed on TV. Trust you say? Sorry but with modern medicine that boat has sailed.
“Trust you say? Sorry but with modern medicine that boat has sailed.”
Not only has it sailed, but it was named the Titanic.
I appreciate the Exhibit 1 matrix and have applied it to many other situations well beyond the scope of this post. Examples: “financial advisor”, “insurance agent”, “car mechanic”, “business executive”, “plumber”, “politician”, “car salesman” , “media reporter”, “high school guidance counselor”, “police”, and so forth.
Ironically, the absence of robust data on transmission or infection was in the press releases when the vaccines first came out. Press releases are regulated and cannot make unsupported claims. Political speech is not.
Not a quibble with this excellent post, at all, but I still don’t understand vaccines. Prior to 2015, medical researchers were very excited about vaccines for cancer. Not the recent vaccines given prior to diagnosis to prevent a cancer from occurring, such as HPV. Not sure any are actually working and in use, but these “vaccines” would be given after a cancer was diagnosed.
I still cannot understand why these are called vaccines like vaccines for Rabies or Lepto.
That said, as a complete bone head, when one of my fundie relatives or a Goop Goon has been nattering on about the different types of water or injecting unproven toxins into infants, I really would like to scream something absolute like “Trust the science.” If I was a trained medical professional dealing with someone who was at risk of losing all their teeth if they kept doing the stupid thing they were paying cash to do, I would want to scream it very loudly and then laugh and laugh when they started losing teeth.
Thanks for this. Scientists, caregivers and public health workers all rely on paychecks and/or customers, which are largely controlled by oligarchs via private/public monopolies (at least in the US). Most also need functional labs, pharmacies and public health/medical/research systems, in order to work in their field. A few, mostly in primary and alternative care, can work more independently and may well provide core knowledge and smart adaptations down the road. Long term effects are accumulating and inconsistently recognized – long covid, ultra-processed foods, pollution, addictive tech protocols, biased scientific interpretations….Dentists, regularly exposed to aerosols, routinely use HEPA filters in our area.
Is trust built on a foundation of honesty or of competence?
The inability of the CDC to produce a diagnostic test and a rational screening protocol for using it and the failure to reduce the time to process results quickly enough, pretty much precluded the practicality of test-and-trace and isolation to curtail the epidemic. The epidemic in the U.S. scaled up past the threshold at which it would be economically feasible to contain it by quarantines of finite length early on due to public health shortcomings in basic competence.
Much of the political rebellion resulted from the insistence of authority on coercive measures that were condemned to be ineffective and prolonged by the incompetence of authority. And, then authority backed coercion with misleading claims and (this is important to acknowledge if we are to reclaim democracy as well as legitimate authority) respect for the autonomy of the individual. Many of the loosely cobbled together recommendations for voluntary quarantine and self-isolation were inadequately rationalized and exacerbated social class divisions.
The crisis of public health authority did not begin with mis-marketing of a “vaccine” as a solution to the pandemic. It began with fumbling the test and quarantine response. Overselling the “vaccine” was a desperation play to recover authority and coercive power whose legitimacy was already undermined by poor performance.
Yes and actively censoring and suppressing information on effective treatments against COVID also utterly disgraced the public health authorities. Collins and Fauci should be in jail for their totalitarian actions in support of pharma cartel profits.
Just one simple question, does the medical industrial complex believe and follow the mantra ” do no harm’?
I am 77, I did not get the shot (don’t take the flu shot either) I did not get sick, I did not get the flu.
People get sick when they mix socially in large groups and closed quarters. Explain why the flu basically disappeared during the Covid pandemic. Explain all the sudden heart attacks on otherwise heathy and athletic people. Explain all the reports of strange blood clots in cadavers, etc.
I no longer trust the medical profession at all, I will never visit a hospital again, I will never visit a doctor again, most have become just “pill pushers”.
Just follow the money, it’s now all about the money.
(first) Do no harm is part of the Hippocratic oath taken by doctors. These days the spirit of the oath is still reflected in the ethical framework that governs doctors practice. So really nobody actually takes the ‘real’ (likely written centuries afteyr Hippocrates) oath. And there is not much of an ethical framework for most types of business.
The disappearance of flu during covid (and a few other communicable diseases) show just how effective isolation can be. Imagine if people (children and adult) would not show up to work and school sick. To make it feasible would require changes to the system that no one with money wants to spend (up in Canada the federal government mandated that everyone now needs at least 5 paid sick days per year. That is what the covid pandemic won for the worker).
There’s a lot of data showing that covid proteins are VERY pro inflammatory. I have little doubt that covid itself is causing a lot of the cardiac events (long covid seems be involved a lot of autoimmune (proinflammatory) processes). I’m unsure whether the protein(s) codes by the vaccinations are also pro inflammatory.
It is not a big stretch to imagine that the same proteins the vaccine exposes you to in order to teach your body to recognize covid could cause reaction. But it’s also not a big stretch to imagine most of these cardiac events happen from an infection that shows very few symptoms.
I agree with your sentiment but there are still useful and non-corrupted (by the pharma cartel) aspects of medicine – notably surgery, and anesthesiology. I’m very suspicious of pharmaceutical drugs and seek out plant medicines first. But if I have a partially blocked heart artery, I’m going to see a cardiologist for surgical treatment. But I’m not taking any flipping statin drugs ever.
I remember the light going on above my head when I read, I no longer remember where, that there has never been a true vaccine for a coronavirus. That’s when I began taking protective measures seriously.
I also refused the Covid-19 “vaccines” whenever they were pushed at me. In the beginning, these “vaccines” were strongly “suggested.” I was told that if I did not “get the jab,” I would die an agonizing death, and deserve it. Later, wearing my mask in public places, I came to be accustomed to having the “suspicious glare” sent my way on occasion. Now, it is as if I am not there for most people. I have become a non-person.
Nonetheless, I still advocated for the old fashioned and proven vaccines; the ones that had been shown to work. This was spun to show that I was an uninformed rube. All or nothing was the narrative frame I encountered.
Then a second lightbulb flickered into life above my head. There was a Narrative in play concerning Public Health. To the best that I can figure out, the modern Narrative is a revival of Eugenicism. The “worthy” thrive and prosper while the “unworthy” wither and die. It is framed as a Natural Law. The truly absurd aspect of this philosophy is that it gives ‘agency’ to natural forces: time, chance, and accident.
The final aspect of “The Covid Experience” I have noticed is that it has plainly and clearly laid out the degree to which the “average” person in the society has absolutely no effectiveness in changing the policy. This “learned helplessness” is a primary driving force behind the mass rejection of “Official Science” and “Official Public Health.”
Stay safe.
The average person cannot change policy but they can change their own behavior – just don’t buy their BS. Don’t buy their drugs. Turn your back on them. And when they get intolerably bad, another Luigi will emerge. Count on it.
The whole Covid 19!vaccine push was medical malpractice. At the beginning of the process it was obvious that you would not have any long term safety data on a treatment that you wanted everyone to take. Then the choice to use mRNA showed that safety was not a priority. An idea that has a horrible testing history but enormous potential.
It is clear to me and many others that the American Medical Community sees a patient cured as a customer lost. With a goal of never ending ‘treatment’.
On a related note then I’d say that the vaccine mandates reduced my trust in the legal system and the legal protections that I thought I had.
There are some cases here and there in the world were the legality of the vaccine mandates are being challenged but since powerful people/interests were behind the mandates then I have little confidence that courts will find that the mandates were illegal.
I’ve come across some defenders of the mandates who are claiming that nobody was forced to take the vaccine, people had the option to refuse. Conveniently they ignore that refusal might and did lead to loss of job and without job then there would be no income and without income there would be no shelter or food. If that kind of pressure is found to be legal then people have few if any legal protections. What next? Robbery at gunpoint to be legal as people were given a choice – give up their money or give up their life. So they were not really forced to give up their money.
In 1980 Congress legislated the transfer of patent rights from federally funded research to the universities doing the research. This well-meaning change introduced the profit motive into previous “ivory tower” or “knowledge for knowledge’s sake” research. I think that this would degrade the quality of the research was inevitable. We’ve read about the plethora of poor if not fraudulent scientific papers flooding scientific journals. That people are skeptical of science is a tragedy, but not surprising.
Government officials as well profit from patents on pharmaceuticals they regulate. A large share of Fauci’s income is from drug patents. It’s a massive conflict of interest which has naturally created a corrupt and oppressive public health regulatory structure.
I’m not seeing that.
https://www.forbes.com/sites/adamandrzejewski/2022/01/15/disclosures-released-dr-fauci-household-profits-exceeded-17-million-in-2020–included-income-royalties-travel-perks-and-investment-gains/
https://pmc.ncbi.nlm.nih.gov/articles/PMC545012/
Thanks for this. Very helpful. Just to add that it wasn’t only the claim that the vaccine was more effective than it was. It was also:
– the insistence that Covid wasn’t an aerosol, even though it clearly was (and I think the WHO is still claiming this to this day)
– the unwarranted attacks on Ivermectin, which (whether it was effective or not) was effectively harmless and should have been tested rather than dismissed with a sneer
– the failure to defend against the attacks on masks, which then led to the acceptance of the claim that masks were ineffective (even N95 masks and up)
– the failure to advocate for air circulation and multi-level filtering
and so on and so forth. One of these might have reduced trust, but the seemingly endless cascade of un- or anti-scientific statements added up to destruction of trust. I suppose this ties into the chart, in that repeated, consistent (such as obviously political) untrustworthy behavior tends to drive people into the less-trust categories.
Reviewing the official definitions of vaccine:
Pre-2015: Injection of a killed or weakened infectious organism in order to prevent disease.
2015-2021: The act of introducing a vaccine into the body to produce immunity to a specific disease.
September 2021: The act of introducing a vaccine into the body to produce protection from a specific disease.
I am troubled by the use of the word ‘vaccine’ to define the word ‘vaccine’ in the last two definitions. I do not think it is a stretch to suggest that by the last definition of vaccine a live virus available in the air from someone infected and deliberately spread to the healthy could be construed a vaccine. Suffering a case of covid and recovering does produce some protection from infection by that same covid virus. By the last definition of a vaccine the public health authorities in the u.s. began vaccinating the public before the mRNA ‘vaccines’ by tossing out centuries old practices for limiting the spread of infectious disease. I remember how parents in the 1950s tried to get their children infected with measles and chicken pox to protect them from getting those viruses later in life when they could cause greater harm. Of course the protections from a childhood infection and recovery by measles and chicken pox did provide more durable protection from the viruses [ignoring shingles].
I doubt that anyone at the CDC seriously believed covid did not spread through the air. The handwashing fixation impressed me as a comic hangover from the days of Typhoid Mary. Though at a cost, the classic methods for limiting the spread of an infectious disease could have been greatly augmented simply by introducing better filters in air filtration systems. Such introduction, especially in schools, would also reduce the spread of colds and flues and reduce allergic reactions in addition to reducing the spread of covid. The CDC policy regarding masking really angered me. The quibbles over medical standards for masks versus industrial standards for masks was also very annoying. Long before the pandemic, the limitations on sick days and leave from work was a beautifully avaricious way for corporations to assure the spread of sickness in u.s. workplaces.
I still trust Science. The problem is that Science departed from the u.s. with the neoliberal surge of science shackled as a servant to money.
Those fomite people sold a hell of a lot of plexiglass to the hospital I was spending a lot of time in. And even funnier, it’s a teaching and research hospital. I’ll give them credit though. Whenever I check in for an appointment, they ask me if I’ve had Covid.
My sense is that many scientists and physicians thought (think?) that any attempt at nuance about covid vaccines would play into the hands of “anti-vaxers”, and that it was better to assert the effectiveness of all vaccines even if in the case of covid ones this was questionable.
This was my understanding as well that it was a sort of a PR battle. There was a lot of power minimizing the risk of the disease itself that I think led to a sort of coercion to get people to take it seriously, in a sense. The table of impacts on behavior and policy relates to this.
I think it was also partly that this was a worldwide event and there’s only a handful of experts in each jurisdiction so most public leaders truly had no idea what what going on and had to rely on expert advice. So what ended up happening was a scaled up SARS 1 response where the idea that everyone got on board with was to lockdown and make it die out like in 2003. Then when that didn’t work the idea it could be killed off was still alive through the concept of herd immunity to stop transmission while opening up society.
Really great essay, thank you. I assumed early on that given the history of HIV an effective treatment would appear but that hasn’t happened yet – is it even being investigated with any effort?
“ignorance suffused with hubris”
Oh yes. Understandably, the essay didn’t get to airborne transmission. I was following the pandemic when both NC and other sources reported on the studies which proved airborne transmission in 2020. But they were often from Asia so of course they were deprecated. One example which is an impressive investigation, the kind of thing the US CDC did once upon a time.
Sure wish the Novavax alternative weren’t so suppressed. Appreciate the mention of other countries’ efforts the area, that idea has completely disappeared from view in the US.
Thank you, KLG.
A question — given the current Distrust and Mistrust toward public health authorities, and the certainty that Sars-COV-2 is not the last airborne virus pandemic the US will experience (well, assuming that the diplomats can stave off a nuclear winter, after which pandemics would not be as big a concern as they formerly were), …
How bad does the case fatality rate of a future epidemic or pandemic have to get before the public will become willing to employ non-pharmaceutical interventions to interrupt / slow transmission?
Current attitudes have for me a bit of the feel of a “Don’t Look Up” scenario.
If trust is ever to be rebuilt, there will have to be added protection against science being invaded by politics, tribalism, and big money. Even now a huge number of people believe RFK Jr and even Dr Bhattacharya have no credibility, partly because they were appointed by Trump. For years saying even a minor qualification mentioning possible vaccine harms could get you cut off from a friend.
I read up about the reproducibility crisis and Dr Ioannidis’ work. I remember hearing that the biggest predictor of research results is funding. How can people trust science when this is the case, that most papers cannot really be trusted until verified without the profit motive?
I honestly think we need a Truth and reconciliation commission around COVID. There has been too much division and just hoping to magically get back to the way things were cannot happen. There needs to be acknowledgment of mistakes and how we will prevent them.
a commission of Truth and reconciliation
yes of course… but who gets that anymore?