Part #3 An open letter to Discovery founder and CEO Adrian Gore
Adrian Gore has mandated thousands of people get a specific medical treatment. That demands a bulletproof justification. I’d like to challenge him on that. I argue that his “six-point rationale” is flawed.
Many will follow his ruling by reason of his formal source of power as leader of Discovery. Many will follow it because of the high esteem they justifiably hold him in.
In a series of pieces, I will press Gore on many of his premises. My goal is healthy debate. This is important for the precedent it can set and the impact a vaccine mandate will have on lives. I heartily invite your response and a good-spirited debate.
My Part #3 challenges to Adrian:
- Clear as mud: Adrian’s use of the word “clear” damages his case.
- What he didn’t say matters more than what he did say.
- Vaccine efficacy at preventing transmission is fraught with uncertainty and anomaly.
- Vaccines wane
- The effect of contact on transmission seems a no-brainer. It is not.
- Vaccine mandates and the economy? Not so fast.
You head Part #3 of your rationale for compulsory vaccination of staff, “The public health imperative is clear, given that the Delta variant spreads far more easily and rapidly; and the cost of not vaccinating creates a significant societal burden.”
Two sentences, four flaws
Adrian, I’m going to climb into your first two sentences: “The nature of the pandemic is such that individual behaviour impacts the collective, for better or for worse. The Delta variant compounds the risk with the unvaccinated becoming infected faster and through less contact.”
- Clear as mud
First, you say “clear”. It is not clear. Not by a long shot.
You have set yourself a standard higher than you needed to. I’d suggest you’re better off arguing the case is “strong on balance” or even “convincing”. That would make it more difficult to defeat.
2. “Me. We” – Muhammad Ali
Next, in Covid as in life, everything we do as individuals affects the collective. Always. Everywhere. I argue you have dangerously overstated this in the case of Covid. That is borne out in my argument in general, so I leave it here for now.
3. More haste, less speed
Third, you claim that with Delta the unvaccinated become infected faster. You apply no nuance or reservations. There is some evidence of this. And there is evidence of not just neutrality, but in fact vaccinated people, under some conditions, picking up the virus faster.
I showed this last week using Public Health England data. Since then their Week 37 report has come out. So I’ll update that argument with another week of data. Another successive week showing that for people 40-79 years old, vaccinated people are picking up the virus at a faster rate than the unvaccinated.
Hard to believe? Here’s the evidence:
Public Health England’s Week 36 “Covid-10 vaccine surveillance report”.
In the words of Public Health England: “In individuals aged 40 to 79, the rate of a positive COVID-19 test is higher in vaccinated individuals compared to unvaccinated.”
Week 37’s report finds the same phenomenon.
Here’s the visual:
In sum, in this population and during this time window, vaccinating people aged 40 to 79 increases the likelihood of infection. Note how the distinction is negligible for the 80+ age group.
Repeating a point from last week, gets worse if we consider just one jab. One Dr. Clare Craig has done the maths to extend the table above and work out case rates after just one injection. For every age group people with one jab got Covid at a higher rate than those with no vaccination.
How do you plan to address this potential “chink in the armour” between first and second jab? And, as per above, the chink that continues after the second injection for people aged 40 to 79?
They may have once upon a time sent “Proud Edward’s army” homeward “Tae think again”, but the Scots are partly aligned with the old rivals on this count.
In Scotland, the nation’s public health body has announced that a higher proportion of fully vaccinated people (two jabs) in age group 40 to 49 are getting Covid than are unvaccinated. That finding also applies comparing those with one jab to those with zero jabs in the age group 30 to 49.
I’d suggest these are useful data points. Fallible sources, sure. They all are. They create at least the concern that vaccines might be not just partially effective; not just ineffective; but in circumstances might be actively damaging.
4. Contact: No no brainer
You go on to say that the unvaccinated spread Delta “through less contact”. With no caveats. I’ve seen no evidence of this. You present none.
Where do you get this idea?
Broadly, closeness and duration of contact as drivers of spread are measures that have been sorely badly addressed throughout. Here are two things that show closeness and duration of contact are weak drivers of spread.
First, do you remember the experiment in Liverpool?
More than 13,000 people attended two nightclub events, a music festival and a business conference in April and May 2021. They did not need to socially distance or wear face coverings. They were asked to take both a PCR and a lateral flow test on the day of the event and five days later.
Eleven people tested positive after this spell of what I’d call helluva close contact.
Many of these people danced, drank, sweated and presumably enjoyed a variety of other sorts of close and sustained contact that I imagine people do at raves. I trust a work day at Discovery involves far less contact than this.
Liverpool public health director Matt Ashton said there were “definitely groups of people who were infected afterwards”, but the people “were known to each other, so it is also possible that those people got it after the events”.
Indeed, home and hospital are huge drivers of spread. Offices with ventilation, space and outdoor areas far less so. Likewise, schools are not drivers of spread.
Lockdowns, and their limitation of contact in public had no perceptible effect on spread. Sweden didn’t lock down. The UK locked down hard.
American states took very different approaches to lockdown. Florida and Texas famously opened up very early. New York and California locked down hard and are yet to open up to nearly the extent of Florida and Texas. The Dakotas took opposing stances in latter stages.
There is no meaningful signal that these differences in strategy ever existed.
On the above, I’ll highlight that the 2021 Super Bowl (“Go Chiefs!”) was held in Tampa, Florida in February. Nothing happened re. Covid. Spring Break hit Miami, Florida just as hard as ever in March/April. No signal, again.
If lockdowns don’t work, why would letting those who choose not to vaccinate return to work be a problem?
These eyeball tests hold mathematically, too. Stringency of lockdown measures do not correlate with better outcomes. In the words of a November 2020 study in Frontiers in Public Health Economics, “Stringency of the measures settled to fight pandemia, including lockdown, did not appear to be linked with death rate” (Covid-19 Mortality: A Matter of Vulnerability Among Nations Facing Limited Margins of Adaptation).
What you didn’t say
In part #3 of your rationale, you say, “We know that vaccines significantly reduce the chance of contracting COVID-19. In addition to this, vaccines result in a 50% to 80% lower transmission risk for vaccinated individuals should they inadvertently contract COVID-19, despite having been vaccinated”, citing Impact of Delta on viral burden and vaccine effectiveness against new SARS-CoV-2 infections in the UK.
“Inadvertently”? Does anyone contact any virus advertently?
As above, there is evidence of equivocality on reduction of chances of contracting the virus when vaccinated.
You cite 50-80%. This is within the spectrum we are seeing in some studies. You make no mention that this fades over weeks and months (see “Time doesn’t heal all wounds” section below).
Why? Do you not find that dishonest?
This study says a few critical things that you don’t:
- “With Delta, those infections occurring despite either vaccine have similar peak viral burden to those in unvaccinated individuals. The impact on infectivity to others is unknown, but requires urgent investigation.”
And later “Peak viral load therefore now appears similar in infected vaccinated and unvaccinated individuals, with potential implications for onward transmission risk, given the strong association between peak Ct and infectivity”.
I understand this to mean that people who get the virus, whether they have been vaccinated or not, carry just as much virus in the back of the snoot. This indicates similar capacity to pass on the virus.
They do theorise on this: “However, the degree to which this might translate into new infections is unclear; a greater percentage of virus may be non-viable in those vaccinated, and/or their viral loads may also decline faster as suggested by a recent study of patients hospitalised with Delta.”
- “Real-world data on vaccine effectiveness against Delta infections are currently limited.”
“A test-negative case-control study using data to 16 May 2021 from the English symptomatic testing program suggested that the effectiveness after one BNT162b2 [Pfizer-BioNTech] or ChAdOx1 [Astrazeneca-Oxford] vaccination was lower against symptomatic infection with Delta (31%) than Alpha (49%)”. On this they cite Effectiveness of Covid-19 Vaccines against the B.1.617.2 (Delta) Variant in the New England Journal of Medicine.
“A further contributor may be waning immunity, with two recent studies from Israel finding higher infection rates in those vaccinated earliest”, citing Correlation of SARS-CoV-2 Breakthrough Infections to Time-from-vaccine; Preliminary Study…
I suggest it is important to discuss the portion of this study you cited alongside the ones I have added above.
Why did you leave those parts out?
Part of the problem?
Vaccine mandates are backfiring in some populations.
I’ll let this study speak for itself:
“Our findings suggest that control measures, such as domestic vaccine passports, may have detrimental effects on people’s autonomy, motivation, and willingness to get vaccinated. Policies should strive to achieve a highly vaccinated population by supporting individuals’ autonomous motivation to get vaccinated and using messages of autonomy and relatedness, rather than applying pressure and external controls.”
Have you factored in the likelihood that mandating vaccines will contribute to vaccine hesitancy, and even, dare I suggest it, “antivax” sentiment?
Time doesn’t heal all wounds
In Waning of BNT162b2 vaccine protection against SARS-CoV-2 infection in Qatar, researchers conclude, “BNT162b2-induced [Pfizer-BioNTech] protection against infection appears to wane rapidly after its peak right after the second dose, but it persists at a robust level against hospitalization and death for at least six months following the second dose.”
Effectiveness against infection “reached its peak at 72.1% (95% CI: 70.9-73.2) in the first five weeks after the second dose. Effectiveness declined gradually thereafter, with the decline accelerating ≥15 weeks after the second dose, reaching diminished levels of protection by the 20th week.”
What is your long-term plan? Vaccines every few months in perpetuity?
Here’s another demonstration of the rate of decline of effectiveness: Waning of BNT162b2 vaccine protection against SARS-CoV-2 infection in Qatar. This further demonstrates the wonky effectiveness of vaccines at limiting spread.
“Estimated BNT162b2 [Pfizer-BioNTech] effectiveness against any infection, asymptomatic or symptomatic, was negligible for the first two weeks after the first dose, increased to 36.5%… in the third week after the first dose, and reached its peak at 72.1%… in the first five weeks after the second dose”.
First observation: vaccinating people with Pfizer-BioNTech needs to come with a warning that for the next two weeks the vaccine will do nothing at all to prevent infection. Then it gradually builds to about 72% as second dose arrives on the scene.
But after 20 weeks… well, see chart below.
You’ll note that this waning of effectiveness is far smaller in relation to hospitalisation. Good news!
How will you deal with this? In particular, will you require people with immunity via prior infection to keep taking shots interminably?
Everything has a cost
Nothing is free of risk. For people who have already had the virus and recovered, the risk of adverse effects of the vaccine are higher than for those who have not. Consider Previous COVID-19 infection but not Long-COVID is associated with increased adverse events following BNT162b2/Pfizer vaccination: “Prior COVID-19 infection… associated with an increase in the risk of self-reported adverse events following BNT162b2/Pfizer… including lymphadenopathy post-vaccination.”
That said, the added risk is small: “The proportion reporting one moderate/severe symptom was higher in the previous COVID-19 group… 56% v 47%…with fever, fatigue, myalgia-arthralgia and lymphadenopathy significantly more common”.
Why won’t you trust staff to return to work without a vaccination if they have had the virus already? Otherwise, will you demand they take the vaccine with little and little downside upside?
Natural is best
Evidence that prior infection beats vaccines for both power to prevent infection and endurance thereof, as well as for capacity to limit symptoms and reduce death rates.
Picking just one good example, a study from Israel shows natural immunity is many times better than vaccines: Comparing SARS-CoV-2 natural immunity to vaccine-induced immunity: reinfections versus breakthrough infections.
This study finds: “SARS-CoV-2-naïve vaccinees [i.e. vaccinated without having had the virus previously] had a 13.06-fold … increased risk for breakthrough infection with the Delta variant compared to those previously infected.”
Their conclusion: “ This study demonstrated that natural immunity confers longer lasting and stronger protection against infection, symptomatic disease and hospitalization caused by the Delta variant of SARS-CoV-2, compared to the BNT162b2 [Pfizer-BioNTech] two-dose vaccine-induced immunity.”
It seems this should surprise nobody. Charlotte Thålin, a physician and immunology researcher at Danderyd Hospital and the Karolinska Institute who studies the immune responses to SARS-CoV-2, reviewed this paper and concluded, according to Science, “It’s a textbook example of how natural immunity is really better than vaccination”.
In fairness, they also find that “Individuals who were both previously infected with SARS-CoV-2 and given a single dose of the vaccine gained additional protection against the Delta variant.” So there is upside to vaccination on top of prior immunity. But we’re talking percentages on tiny percentages.
Here’s an intriguing and worrying take on the need to vaccinate on top of prior infection from good old Anthony Fauci:
“America’s Doctor” doesn’t really have a firm answer.
It’s the economy, stupid (James Carville, 1992)
Adrian, you argue that “there is an economic argument: the cost of treating illness brought on by COVID-19, as well as the compounding cost due to missed workdays and business closures, is a cost borne by society and not the individual.”
I’ll start this one by simply referring to the messy and contradictory information on effectiveness of vaccines on transmission of Covid. If their effectiveness is dubious, your argument fails.
Yes, vaccines clearly reduce symptoms, hospitalisation and death. All of that is good for productivity. But I ask again, does this justify a mandate? The principle will be that a corporate can mandate the risks that an employee takes to their health without any bearing on other employees or the company.
What if I go skydiving every other week, do long hikes in big mountains, drink and smoke too much, volunteer at a tuberculosis clinic, drive 50,000km a year and drive a motorcycle?
None of your business, I’d suggest.
This also needs the question: Compared to what? We are comparing vaccine uptake with a mandate to vaccine uptake without a mandate. Ideally both accompanied by quality information and easy vaccine availability.
We also need to ask again, “Part of the problem?” Already we are seeing examples overseas of unions refusing vaccine mandates wholesale. These include the likes of Chicago’s Fraternal Order of Police; Health Professionals and Allied Employees union in New Jersey; Britain’s Trade Union Congress
In the England, care home workers have been mandated by government to get the vaccine. More than 60,000 have signed a petition to fight this. Rachel Harrison, speaking for the GMB union said, “This looks like another potential avoidable mess. We’ve told Ministers that more than a third of our members in social care would consider packing their jobs in if vaccines were mandated. They can’t now say they weren’t warned.” The organisation claims the “sector [is] already facing a 170,000 staffing black hole.”
On my reading, every one of these unions has been either neutral or very supportive of vaccines by choice.
In the US, states are already suing the Biden federal administration on his vaccine mandates. Arizona is hitting Joe hard.
This is all a drain on the economy. And it is the mandate-maker’s burden to prove, if you’re going to argue that mandates are good for the economy, that this cost is less than the costs of the virus we’ve mentioned above.
Don’t forget the other costs: direct, indirect and opportunity. Direct costs are the financial cost of the vaccine. And, as seems necessary, the additional boosters that may be needed for a long time. Indirect costs are things like the way mandates can fuel a reflexive suspicion of vaccines. Opportunity costs are harder to put a finger on. To start with, factor in all the things we could do with our time, money and energy rather than implementing medical mandates?
In Part #3, I introduce my idea on a solution to this mess.
Science is about ruthlessly and bravely questioning everything. Discovery is a place that I have long thought to be scientific. This provides what I reckon is an irresistible way forward:
- Review the science and the arguments;
- I suggest you should reach the conclusion that a vaccine mandate is wrong;
- Scrap your mandate;
- Be bold about it. You are not conceding defeat. Far from it. You are affirming and advertising your credentials as a quality organisation that studies heath issues hard, sticks to moral principles and has the guts to change course when it is the right thing to do;
- Reap the rewards of brave leadership.
Next: Faulty Fiat #4
Later this week I’ll publish my challenge to Part #4 of your rationale: overcoming hesitancy. I argue you’re going about that badly.
John Ioannidis is Professor of Medicine and Professor of Epidemiology and Population Health, as well as Professor (by courtesy) of Biomedical Science and Statistics, at Stanford University. He argues in How the Pandemic Is Changing the Norms of Science regarding the response to Covid-19, “Even the best peer-reviewed journals often presented results with bias and spin. Broader public and media dissemination of scientific discoveries was largely focused on what could be exaggerated about the research, rather than the rigour of its methods and the inherent uncertainty of the results.”
If you are mandating thousands of people get a specific medical treatment, your argument should be bulletproof. On my analysis, yours has meaningful faults that deserve fuller consideration before the rule takes effect on many lives.
Adrian, I would hugely appreciate your engagement on this. Despite my strong conviction one way, I endeavour to be open-minded and ready to change my mind if persuaded. Despite your decision, and I imagine an equally potent yet polar conviction to mine, I do hope you’ll do the same.