In my five-hour podcast interview with Lex Fridman, released on December 8, 2021, I discussed many issues including the origins of the pandemic and the lab incident hypothesis, China and global geopolitics, interdependence and the OneShared.World movement, the case for vaccination, ultramarathon running, and chocolate shamanism.
Because both Lex and I know and share a great respect for Joe Rogan, our conversation is peppered with positive references to him. We both state, in our different ways, that this affection does not mean we necessarily agree with everything Joe says.
In my interview with Lex, I spoke at some length about Joe’s recent dialogue on his JRE podcast with CNN’s Sanjay Gupta. Sanjay is a close friend of mine and whom I also deeply respect. In the section of my conversation with Lex where I discuss Joe’s dialogue with Sanjay, I make the general points that although I thought Joe won the debate (in that an average person with no background listening to the conversation would, in my view, be more likely to lean toward Joe’s position that only at risk people needed to be vaccinated and that the benefits were less clear for everyone else), I personally find Sanjay’s position (that most everyone should get vaccinated both to protect themselves and the protect the people around them) to be more convincing. I also said that Joe’s arguments in his conversation with Sanjay focused more on anecdotal information and that Sanjay had not sufficiently articulated the difference between anecdotal and statistical arguments (I hope you’ll listen to my interview with Lex rather than rely on my summary of it).
Because I had asserted in my conversation with Lex that I thought Joe had won the “debate” and also outlined the types of arguments I thought Sanjay might have better deployed, I was concerned after my taping with Lex that my words would upset my dear friend Sanjay. The other night, however, I received a very straightforward (euphemism) private message from Joe stating that I had unfairly characterized his arguments as anecdotal, that it was wrong of me to suggest he should get vaccinated, that I had underplayed studies showing the dangers of the vaccine, and that I had not sufficiently referenced an Israeli study suggesting that people who’ve been infected alone are much more protected than people who’ve been fully vaccinated. He stated that his issue was not my disagreeing with him but the “deceptive, simplistic, bullshit version” of his conversation with Sanjay.
Although I’ve responded to Joe privately, this blog post is an attempt both to respond publicly and to leverage this issue in the direction of a deeper and more inclusive conversation about the vaccines – and by inclusive I mean including everyone on all sides of this conversation.
As I say in my conversation with Lex, we live in a world where most of us only communicate meaningfully with people inside our information bubbles. Because of this, most of us end up doing an increasingly worse job of seeing the perspective of people outside of our bubbles. Although I disagree with Joe on the vaccination issue, that last thing I would ever do or want to do is to simply write off or ignore his or anyone’s views because they do not align with my own (which is, in fact, my biggest critique of the mainstream scientists and others who have so flippantly dismissed the pandemic lab incident origin hypothesis).
Because I take Joe’s view so seriously, I decided to listen to my entire podcast interview with Lex, trying to hear my words from the perspective of Joe and people who share his view on the vaccination issue. It’s always hard to step out of ourselves, but I aspired to do my best. When I finally got to the end after five hours of listening (I’m training for an ultramarathon, so most of it was on the run), I came to feel that I had oversimplified two sentences that justifiably upset Joe.
The first was when I characterized Sanjay’s arguments as driven by statistical studies and Joe’s by anecdotal information. This was an unfair characterization and I’m sorry for it. What I should have said was that many, but by no means all, of Joe’s arguments in the conversation with Sanjay were anecdotal and that Sanjay could have done a better job of separating anecdotal and statistical arguments. I was wrong and I apologize. Joe’s references to scientific and other studies deserve a full consideration. That is, in fact, the best way to evaluate whether or not they hold up.
A second critique was that I did an insufficient job of weighing the relative risks and rewards of vaccination, particularly for healthy younger people like Joe. To be clear, I actually do believe that most everyone should be vaccinated, both to protect them and to protect those around them — right now, for example, our hospitals are full of mostly unvaccinated people suffering from COVID-19 and many people are not being treated for other diseases. Although I stand by my assertions, I do feel that I was not sensitive enough to the fact that many people feel the vaccine poses a greater risk to their health and well-being than does the virus. I’m self-critical because we need, now more than ever, an open conversation where people’s arguments, not strawman characterizations of those arguments, can be presented and discussed. If the starting gambit for a conversation is feeling like the person talking is mischaracterizing or belittling your view, the conversation will never happen.
As I mentioned in my dialogue with Lex, the CDC Q&A page on Covid-19 does a terrible job of articulating questions that way real vaccine skeptics might. The most meaningful dialogues happen across differences, particularly when we listen to and respect each other. That’s why I’d love to have a site where vaccine skeptics can raise their concerns in their own words and where scientists and others can respond respectfully. It’s true that some of our divisions are now reaching deep into questions about the legitimacy of science and of expertise more generally, but I strongly feel that most people are just looking for the best answer to protect themselves and their families. Taking down the temperature for these conversations, as Sanjay and Joe did successfully in their dialogue, is a critical first step.
Again, I believe that vaccines save lives, people should get vaccinated to both protect themselves and others, we need to study all approaches, including non-traditional ones, and that science and statistics should be our guide more than anecdote, but it’s just a fact that many people feel otherwise and there’s no amount of preaching from people like me that will change things. I hope things will change and that as many people as possible will be protected, but we need to find the best and most inclusive path from here to here.
With this in mind, I reached out to one of the smartest and most knowledgeable experts on COVID-19 treatment and response, Columbia University’s Dr. Daniel Griffin. Many people know Daniel for his regular updates on the This Week in Virology podcast. No one know everything about this rapidly changing situation, so I don’t take Daniel — or anyone’s — word as gospel, but I very much trust his open-mindedness, seriousness, and compassion.
I asked Daniel to share his thoughts to what I thought were four essential questions raised by Joe:
- What is the best study showing that people in the USA who choose to not be vaccinated are putting others at risk?
- What is the best study showing that people who are naturally infected and then vaccinated are better protected than people who are infected but not vaccinated?
- What is the best study showing that the virus, in general, poses a greater threat to individuals than do the vaccines?
- What is the best study showing that young, healthy people should get vaccinated?
- What is your view of the Israeli study cited by Joe as suggesting “Israeli study that showed that recovering from covid infection is as much as 13 times more effective at preventing covid infection than the vaccine”?
Please find Daniel’s responses in italics below:
What is the best study showing that people in the USA who choose to not be vaccinated are putting others at risk?
One is reduction in getting infected.
Here we are working with what I refer to as the superpower of Vaccine Efficacy versus Infection or VEI. If you cannot get infected you cannot transmit. So first some data that continues to support that vaccines not only protect against severe disease (hospitalization and death but also protect against infection.
SARS-CoV-2 vaccine protection and deaths among US veterans during 2021 was published in Science. Part of what I like about this article was the very clear distinction between what they call VE-I and VE-D. (Vaccine effectiveness against infection and vaccine effectiveness against death) Moderna starts off with a VE-I of 89% and Pfizer-BioNTech starts off with a VE-I of 87% and then they start to decline so will next be looking at boosting.
This publication looked at 780,225 individuals in the VA or veterans in the US system and reported that while VE-I (Vaccine effectiveness against infection) declined but vaccination remained protective against death in persons who became infected during the Delta surge.
Then we get even lower with boosting. Protection against Covid-19 by BNT162b2 Booster across Age Groups The rate of confirmed infection was lower in the booster group than in the non-booster group by a factor of approximately 10, so that is a nice reduction in VEI.
If you die you cannot transmit after death so it is really the VE-I that matters for transmission
The second is the risk of transmission if vaccinated but then get infected.
The preprint The impact of SARS-CoV-2 vaccination on Alpha & Delta variant transmission. This study was performed as public health surveillance and NHS Test and Trace program quality assurance. The authors start by providing the background that Pre-Delta there was evidence that vaccination reduced transmission of SARS-CoV-2 from individuals infected despite vaccination, but while vaccination lowers the risk of infection, they wanted to look at vaccinated and unvaccinated individuals infected with Delta to assess how much vaccination prevents onward transmission.
They performed a retrospective observational cohort study of contacts of SARS-CoV-2-infected index cases using contact testing data from England. In this study 51,798/139,164(37.2%) contacts tested were PCR-positive. Two doses of BNT162b2 or ChAdOx1 vaccines in Alpha variant index cases independently reduced PCR-positivity in contacts (aOR, adjusted odds ratio vs. unvaccinated=0.18 [95%CI 0.12-0.29] and 0.37 [0.22-0.63] respectively). The Delta variant attenuated vaccine-associated reductions in transmission: two BNT162b2 doses reduced Delta transmission (aOR=0.35[0.26-0.48]), more than ChAdOx1 (aOR=0.64 [0.57-0.72]; heterogeneity p<0.001).
There was another interesting finding… They reported that … Transmission reductions declined over time since second vaccination, for Delta reaching similar levels to unvaccinated individuals by 12 weeks for ChAdOx1 and attenuating substantially for BNT162b2. Protection from vaccination in contacts also declined in the 3 months after second vaccination. So we are going to have to again be thinking about boosters.
A couple different studies demonstrating that the period of high RNA copy numbers is shorter in the vaccinated and also that vaccination impacts transmission. Community transmission and viral load kinetics of the SARS-CoV-2 delta (B.1.617.2) variant in vaccinated and unvaccinated individuals in the UK: a prospective, longitudinal, cohort study was published in THE LANCET Infectious Diseases.
In this article there is information on how vaccinated people clear the infection more quickly.
The authors compared viral load trajectories from fully vaccinated individuals with delta infection (n=29) with unvaccinated individuals with delta (n=16), alpha (B.1.1.7; n=39), and pre-alpha (n=49) infections. Primary outcomes for the viral load kinetics analysis were to detect differences in the peak viral load, viral growth rate, and viral decline rate between participants according to SARS-CoV-2 variant and vaccination status. They found that although peak RNA copy number did not differ by vaccination status or variant type, fully vaccinated individuals with delta variant infection had a faster mean rate of RNA copy number decline (0·95 log10 copies per mL per day) than did unvaccinated individuals .
This was a household contact study so there was a significant amount of exposure so despite confirming the ‘Singapore study’ showing a faster drop in RNA copy number and a faster clearance of viral RNA, there was also significant reduction in transmission in vaccinated individuals only getting infected 25% of time compared to the unvaccinated contacts at 38%. So here there is more on VE-I.
What is the best study showing that people who are naturally infected and then vaccinated are better protected than people who are infected but not vaccinated?
Now this is a moving target and has multiple layers. I first start by pointing out that we are discussing post viral infection survivor immunity. This is not something you pick up in the natural food isle and millions have died, been hospitalized and ended up with long COVID so we are talking perhaps about the ones that survived without serious consequences. Part of the moving target here is the new variants and now third doses of the mRNA vaccines. I think there are a couple of issues here. Despite the suggestion that post viral infection survivor immunity is variable and we are already seeing tens of thousands of second infections, some third infections and even fourth infections there is evidence that vaccination of these individuals reduces their chances of reinfection. So good data on VE-I for benefit with vaccinating those with post viral infection survivor immunity. Also, good evidence that it could help with PASC or Long COVID even with post viral infection survivor immunity What we are lacking though is the really good data on VE-D.
What is the best study showing that the virus, in general, poses a greater threat to individuals than do the vaccines?
I do not think there is one good article here. There are hundreds. We are closing in on a million deaths here in the US alone, a striking number of hospitalizations, millions with Long COVID and incredibly safe and effective vaccines.
What is the best study showing that young, healthy people should get vaccinated?
This is really a repeat of #3. This is also being supported by a lack of safety concerns as we are now vaccinating those under 12 and not seeing concerns. This is really a choice between two options with not vaccinating being the more dangerous choice.
In the words of RBG, “It is possible to disagree without being disagreeable.”
What is your view of the Israeli study cited by Joe as suggesting “Israeli study that showed that recovering from covid infection is as much as 13 times more effective at preventing covid infection than the vaccine”?
We have a local infectious disease physician who has been obsessed since the beginning and is musing whenever possible about how any vaccine could ever be more protective than viral infection induced survivor immunity. They jumped on this Israeli preprint and used their health systems weekly clinical update to talk about this preprint. https://www.medrxiv.org/content/10.1101/2021.08.24.21262415v1. I think with third doses of the mRNA vaccines he is crying foul!
Take the fact that this preprint is not peer reviewed. It is a retrospective observational study, applies to double vaccinated, un vaccinated, and vaccinated with only one dose post infection and has no triple vaccinated folks. Also, no double or triple post infection. And the follow up is months not years. And they lack numbers for model 3 that we will address.
One take away is that one or two doses of vaccine seems not to be enough. After a bit of time goes by and this study supports getting that booster. I always worry about talk of long lasting when we are discussing months after infection and not years. So we are back to the idea that after a number of months with only a two dose mRNA series it is looking like getting that third dose in the primary series is supported.
The real question this paper is getting at which is the one I focus on is… if someone was infected can they reduce their risk by getting vaccinated like the MMWR study demonstrated. This gets us to model 3. Those previously infected and no vaccine versus those previously infected now getting just one dose of vaccine. Go right to table 4a and it looks like just one dose of vaccine drops the risk about in hal OR=0.53 with a nice p value=0.024. Or then to table 4b where we hone down on symptomatic infection and then we get about a 35% reduction down to an OR of 0.65. Not enough numbers here to get statistical significance. No model 3 data on hospitalizations which is really critical information.
I think the data we are still missing is severity. I certainly do not want people getting infected and spreading virus but I really do not want people getting really sick, going to hospital, dying or ending up with Long COVID.
The second topic is the study shared by Joe Rogan. Maybe I am a bit insensitive but by adverse effects they seem to be discussing reactogenicity. I got my vaccine which might reduce my risk of getting infected, spreading it to friends and family, and I got muscle and joint pain, fever, a headache and felt poorly for a day. Reminds me of David Hume who talked a bit about a hang nail and all of humanity. We certainly see more reactogenicity with vaccinations in those previously infected so consistent and perhaps that day of feeling poorly is not worth it for some folks. With over a thousand people dying a day here in the US I kind of wish more people were willing to take the jab and the associated discomfort.
My goal for this post is to foster a respectful, open dialogue across difference so we can build a safer future for all. If you’ve read this blog to the end, you are already part of the solution.
If you disagree, great. Please share your thoughts on Twitter and elsewhere. Please also challenge yourself by reading studies and other information with views other than your own.
None of us possessed a monopoly on knowledge but we all share a common humanity.
One final point: We are in the middle of a pandemic that is constantly changing, where we’ll continually need to update our perspectives as new facts and coditions emerge. Thinking dynamically and challenging our assumptions, whatever they are, must be part of our process for wisely navigating these rapids.