No, Public Health's Agenda wasn't cherry picked, and certainly wasn't nefarious

There was a lot going on in the background; this reflects my experience

I wrote this recently in response to a question (after I posited a position) on Katelyn Jetalina’s Your Local Epidemiologist Substack, which I Highly Recommend. Katelyn, a PhD epidemiologist in several areas, has spent the Pandemic speaking clearly about the public health messages we’re trying to get out. Unlike so many of us, Katelyn was able to speak in a manner that was well-understood by the public, and did, certainly, a better job than I did regarding communicating the science as we knew it on a day-to-day basis to the public. I cannot say enough positive things about her knowledge or communication. I am in awe of her skill, and her ascendency in the Public Health world is well-deserved.

So: The original comment driving this response started like this:

Here's a brief response (busy time of year) about what I mean by the word "agenda." PH made a decision early on that vaccines were the way out of the pandemic. Jab enough arms and the virus would disappear. There were other agendas, too, such as around masks, but let's focus on vaccines.

What this meant is PH emphasized (exaggerated?) every reason to take a vaccine and omitted (censored?) every reason not to. In other words, cherry-picking, manipulation, etc.

There was more, but this gets things rolling. AND, for the record it isn’t a bad question because we had so much misinformation, and frank disinformation, really normal and fairly rational people were confused and didn’t understand the state of the science – and we, overall, didn’t do a great job of communicating what we knew and how often it was changing.

And my response:

The early decision to go with vaccines was based on population immunity naivete to the virus when presented in its original, or wild form. Finding and introducing a mechanism to boost humoral immunity rapidly was seen as the best approach. This decision was a cross-scope result of discussions with virology, vaccinology (including those more familiar with the mRNA technology) and clinical practitioners who, early on, were at their wits' end trying care for the vast number of patients requiring admission. And, recall we had to learn a plethora of new approaches to treatment. In general, there's a threshold where a degree of respite can be achieved if sufficient percentages of the overall population are vaccinated. This calculation is based on the reproductive rate and incubation period. However, we were stymied in several ways, not the least of which was in finally understanding one was contagious with COVID prior to symptoms, something we'd not encountered in a viral illness before. In addition, we had some poor assumptions regarding how this virus was spread, mostly by extrapolating from other upper respiratory viral illnesses. COVID wasn't "other" illnesses, but unique. Finally, reticence by major elected officials to recommend vaccination or even participate started a ground-swell of sentiment to avoid vaccination. IF there ever was a window where we might have pushed COVID back down and seen a LARGE benefit vaccine reluctance ended that option.

In hindsight, I don't think we could achieve that goal, but it wasn't cherry picking, or sole-focus on one target. It was a considered opinion by a range of experts.

I've just read the Nature article regarding N-methyl pseudouridylation of mRNA (https://www.nature.com/articles/s41586-023-06800-3). Their work found that a phenomenon known as frame shifting caused improper protein (antigen) production. I note the hype found in the Telegraph article wasn't in the Nature report nor was it sensationalized in the Cambridge press release (https://www.cam.ac.uk/research/news/researchers-redesign-future-mrna-therapeutics-to-prevent-potentially-harmful-immune-responses). Early trials demonstrated an efficacy in excess of 90% in producing neutralizing antibodies. The frame shifting, even in a worst-case such as the Telegram article would still have resulted in production of appropriate antigen in most cases (it's not like you see a frame shift and all your response goes off the rails, but that's an easy interpretation to come by).

I'm not going to go far down the rabbit hole of Ladapo and DeSantis, but to say that I don't view Ladapo as authoritative in this field and his espoused views are at odds with easily 90% of the experts in the US, as well as WHO. It'd be hard, with the record of hospitalizations and deaths seen in Florida to support Ladapo’s positions or findings. Desantis, trying to separate himself as an innovator, (but without Ladapo, I note) championed use of monoclonal antibodies, often well in excess of recommendations by CDC, and even his own state public health personnel. This was, in some ways, masterful: It did keep people out of the hospital, but it also reduced supplies of monoclonal antibody therapy in other areas across the country. It may also have hastened variant production, and reduced the period where monoclonal therapy worked. ONE element of immune evasion with new variants is an ability to evade protection by monoclonals.

As for Poland and Romania refusing to buy Pfizer appears, with only a little research, to be political in nature and not based on failures of the vaccine. According to Politico, the conflict in Ukraine was cited by both countries as reason to not pay for doses they'd already received.

As for the Moderna vs Pfizer vs Novavax debate, from what I've learned of the mRNA science, both Pfizer and Moderna are competent vaccines, but the variants have changed which makes them less effective. Reformulation with XBB strain spike has made them more relevant but the rapidity of deletion/substitution changes in the S1 protein doesn't make this a sure thing, and people have become infected even after successful vaccination. Novavax had a longer delay getting product tested and out the door, but today there's a group in strong favor of using Novavax for the next booster due to fewer post-injection effects. Personally, I support the idea of using several different vaccines to improve diversity in the initial humeral and eventual cellular immune responses.

Although I've almost exclusively had Moderna, I am of the opinion that getting an initial series with one company's product and a subsequent booster using the other product offers at least an acceptable if not improved approach. That's the path I took, but I didn't opt for Novavax for my last booster because it wasn't available at the time. Had it been available, I might have gone that route.

The history of masks, lockdowns (or restriction on gatherings), and better referred to as isolation and quarantine, has historical precedent, and was supported in numerical modeling work under a working group in the George W Bush White House on pandemic H5N1 influenza. I did similar modeling with a variety of initial condition variations and potential mitigating factors and reached similar conclusion, but never published my work. One of the tenets of Public Health is incorporating non-pharmaceutical Interventions early on to attempt to slow the spread of an illness. Those same arguments against vaccinating were raised about the widespread recommendations for use of NPI's (non-pharmaceutical interventions) often with a claim we were advocating to infringe on personal freedoms (if we were, it was to promote a greater public good/public health protections.

I'm backtracking for a moment.. Overall, the number of cases of pericarditis and myocarditis were markedly elevated in young men age 15-25 following vaccination with Pfizer (and to some lesser extent Moderna). That number was dwarfed, however, by the numbers in the same age group who acquired COVID. In addition, the vast majority of those with post-vaccination myo/pericarditis were hospitalized as a precaution and their disease process was shortened and much milder than those who acquired myocarditis/pericarditis secondary to infection. Statistical analysis to this day demonstrates that vaccination has greater positive effect and fewer adverse effects compared to acquiring the viral disease.

Early, in the Feb/March timeframe, there was a call for evaluation of any drugs that exhibited, in vitro or in silico, a potential antiviral effect. This was where hydroxychloroquine and ivermectin, as well as vitamin C and D, and azithromycin therapy thoughts originated from. A lot of these agents were tried, and often not with any rigid clinical trial guidelines, which made things more difficult to interpret. Other countries engaged in formal clinical trials. In the US, we read their reports and used their experience as a guide where possible, but we also discussed our findings online in restricted chats. I was introduced to these (introduction was required, at least in the ones I'd become involved in, by former colleagues. These were not your typical public health discussion but round tables of therapeutic experiences, a way to debrief and decompress at the end of the day, but for the 3 groups I was involved in, they could be practice changing. I learned about the failures of HCQ and ivermectin in these discussions long before they were made public (that said, my sources might have heard about, say, the early termination of studies in the VA system earlier than they were leaked to the media.

Over time, there have been small, and subsequently larger trials that continue to fail to show either non-inferiority (they're no worse that today's standard of care), or outright patient harm. Use of azithromycin was strongly discouraged because it is a broad-spectrum antibiotic, and its use for a viral disease plays havoc with antimicrobial stewardship and all the things we have tried to do to prevent drug-resistant bacteria. And, it didn't do a great job against viruses. These were therapeutics. We'd have loved to have therapeutic agents we could use, and one of the first emerged from work in Britain: Use of relatively low dose decadron reduced ICU admissions and length of stay, and it was CHEAP.

We had other challenges, too: When do we have to intubate? How do we set the ventilators, does "proning" work (a very recent study upended the prevailing "wisdom": No, it doesn't, always, especially when patients are on ECMO. Once again: Those were therapeutic approaches and would be used along side preventive measures (we hoped!). Vaccines and therapeutics, and non-pharmacologic interventions were what we had to work with. With no agenda of trying to limit one in favor of another.

Paxlovid was recommended for use once it'd seen clinical trials (and after it'd demonstrated its capabilities in the lab. Prior to Paxlovid, several variants of monoclonal antibody were used with varying success. but their success was fleeting, as new variants arose. After it was approved under EUA, it remained in short supply. It has a rather problematic drug interaction profile, which made some physicians reluctant to prescribe it in patients, especially older patients more subject to polypharmacy; other docs were just plain reluctant to prescribe it what meant the antiviral was underutilized, despite having a somewhat broad recommended panel of patients. Personally, I'd have liked to see it available to patients of all ages, but its short supply meant that wasn't destined to happen.

Public Health, and pandemic planning in general, had a playbook developed under George W Bush, and further refined under Obama. The Trump administration assumed they'd just deal with things as they came up, dispersed the working group and shelved the plan. Note that the plan was for an influenza pandemic, so some of the details were wrong anyway, but a number of the things you heard and saw were straight out of a prepared plan many of us had read and internalized. Our "agenda" was to learn as much as we could about this virus and outbreak, and in the interim to fall back on what was in a preexisting plan, even if the administration didn't want to admit there was a problem, OR that the plan existed. Said plan called for closing schools, limiting multi-person gatherings, quarantine and isolation of potentially infected persons, strict emphasis on hand washing, encouraging of masks (the early confusion was related to not understanding the aerosol nature of spread (rather than large droplet and fomite spread), the fact this was a coronavirus (and we were immunologically naive) rather than influenza, and the speed of entry to community spread confounded the response. We also had serious communication problems. I've addressed these on my own page, as well as here, but YLE was a bright spot in communication. She and I often said the same things but she was communicating while I was merely transferring information, and lots of people didn't understand the difference and thought their interpretation of my data was equivalent to a professional training curriculum, or even a rather advanced on-job program. In too many cases, our use of jargon to communicate rapidly worked fine with peers, but failed us when the public tried to interpret our statements. I was at least as guilty of this as my peers.

In the world of public health law, it's been common in the past to restrict freedoms. The poster-case for this is restriction of tuberculosis patients from free movement, isolating them at home, and requiring them to be observed taking their daily medications. Another example is "Typhoid Mary" who was twice isolated for long periods (years) to restrict her as a vector for disease spread. In science, it's hard to allow everyone to have an opinion and express their desire for autonomy because the playing field is unlevel to start, and it doesn't get better when someone says, "I've got MY facts", but those are "alternative" facts, and not rooted in the same processes we used to determine efficacy of therapeutic processes and drugs. Too many people, on both sides of the political spectrum obtained their opinions and facts second-hand from social media or online sources. There have been several cases where I'm reasonably certain material presented was from malign actors who were sowing incorrect material (actual disinformation) rather than misinformation, or misinterpreting the data as presented. While both misinformation and disinformation are bad, of the two, disinformation is often worse, because the purveyors are more skilled at appearing authoritative, and often employ better writers than those offering mere misinformation. This includes, unfortunately, several recognized, and now popular physicians whose arbitrary and antithetical positions have gathered a following. I can't speak to their purpose but they're not helping overall, because they're presenting as authoritative opinion, material that has not been adequately researched and cannot be supported by existing data and analysis.

Finally, CDC was effectively gutted when Redfield came to power, as many of the most senior, and experienced scientists left. Others who stayed were subjected to censorship or having their material rewritten by political appointees. Experts such as Deborah Birx were initially listened to but sidelined when their experience-based recommendations didn't parallel administration officials' preferred narratives. Fauci was demonized for doing what he's done for 5 decades: Speaking his mind, with opinions based on the best information available at the time. The sound-bites omitted him frequently saying, "We've now learned [xyz] and have changed our position...". Hahn was not particularly outspoken until he realized that, as a scientist, his reputation among peers was more important than staying quiet to hew a political path. Redfield and Azar were essentially useless. The work of the White House Task Force, several of whom I know fairly well, was overall excellent but meted out by political soundbites. There's a lot more to this story. Despite its length, this is the short-story.