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Harvard Epidemiologist Martin Kulldorff: Hospitals Should Hire Nurses with Natural Immunity, Not Fire Them

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“Since the Athenian plague in 430 B.C. … we have known about natural immunity. So it’s strange that suddenly people are questioning that,” says Dr. Martin Kulldorff.
Nurses and caregivers who have recovered from a COVID-19 infection have “stronger, longer-lasting immunity” than vaccinated individuals who have not been infected before, Dr. Kulldorff says, making these nurses and caregivers actually the “least likely to infect the residents.”
Instead of firing them if they refuse to take the vaccine, hospitals and nursing homes should do the exact opposite: They should actively hire people with natural immunity and assign these individuals to the wards with especially vulnerable patients, he argues.
Dr. Kulldorff is a professor of medicine at Harvard Medical School and a biostatistician and epidemiologist at the Brigham and Women's Hospital. He is also one of the co-authors of the Great Barrington Declaration. We discuss the efficacy of the COVID-19 vaccines, the politicization of science, and the Biden administration’s recent push to mandate vaccines for children.
Jan Jekielek: Dr. Martin Kulldorff, such a pleasure to have you back on American Thought Leaders.
Dr. Martin Kulldorff: Thank you so much. It's a great pleasure.
Mr. Jekielek: Martin, we talked a lot about vaccine mandates the last time. But let's look at the vaccines themselves. There's a lot of, let's just say varied information and misinformation around the vaccines themselves. In your mind today, as we're doing this interview, where are we at? What can the vaccines do? What can't they do? What's their usefulness?
Dr. Kulldorff: They're very good at one thing and not so successful with another.
What they are very good at is to prevent mortalities or death, and also serious disease. We know that the efficacy of these vaccines for preventing death is in the 90s, which means that for a hundred people that would've died, now maybe only five or 10 of those will die because of the vaccine, because they're vaccinated. That's a huge benefit. These vaccines are saving our lives.
Of course, since the mortality is mainly among the older, so anybody can get infected by COVID, but it's really the older people who are at risk for dying here. There's more than a thousand differences in risk between the oldest and the youngest. These vaccines are saving the lives of many older people, and if they haven't had COVID and if they haven't had the vaccine, older people should definitely get it. To me, that's a no brainer. That's the good thing that the vaccine is doing.
Now, one thing that don't perform very well is to prevent transmission and to prevent mildly being infected or prevent symptomatic disease of a more mild version. We now know that it does prevent, it does reduce symptomatic disease for a few months, but that wanes fairly quickly. The vaccine can't stop the transmission of this virus.
For example, we saw in Iceland, which has a very high vaccination rate. They still had the wave of COVID, which was mainly transmitted through people who are vaccinated.
Everybody pretty much are going to eventually get this disease if they survive, if they live long enough, whether they're vaccinated or not. But the risk from dying from COVID is much less if you have the vaccine. Of course, if you're old, then the risk of dying is high. So then, you absolutely want to have the vaccine if you haven't had COVID already.
Mr. Jekielek: You've been a very avid critic of the lockdowns and this was part of The Great Barrington Declaration was a critique of that particular policy. There's still a few places in the world that are actively doing lockdowns, like in Australia, for example. And through the lockdowns, they've managed to keep their cases down and the disease down. They're adamantly staying on that course. What are your thoughts about that?
Dr. Kulldorff: I think they have proved that you can't suppress and eradicate this disease, which we knew already.. But they tried and they failed because they now have many, many cases in Australia.
What lockdowns can do is to push things into the future, but it can't stop it from eventually coming in; eventually spreading. In Australia, as in other places of the world. Most people are eventually going to be infected by COVID.
Of course it's important for all the people to get vaccinated, but this idea that you can eradicate COVID or that you can suppress it and control it, that doesn't work for a disease like COVID.
Smallpox, we have eradicated. That works. We have eradicated rinderpest. Those are the only two diseases that we have eradicated. Polio can be eradicated if you put more effort into it. But a disease like COVID or the flu, or for other coronaviruses. They cannot be eradicated. It's something that we will live with forever.
As we live with other four common coronaviruses like, they give us a common cold, so the pandemic is going to end, but it's going to move into pandemic states where it will be around. People will be infected occasionally as we get infected, that will trigger the immune system again. We're not going to have the serious outcomes as we have had because very few people will be susceptible.
At the same time, there will be some older people in their 80s, for example, the immune system has deteriorated and they might still die from COVID when it becomes endemic, just like people die from the flu or from any other many viruses when the immune system deteriorates and goes down.
Mr. Jekielek: In places like Australia, you're saying it's just basically a matter of time before they have to experience what any other place in the world has experienced, but perhaps hopefully with high vaccination among the vulnerable people.
Dr. Kulldorff: Yeah, that's the key for Australia to make sure that the older people get vaccinated as close to 100 percent as possible. At the same time, children are a minuscule risk from dying from COVID. We don't have to worry about them being vaccinated. It's the old people who have to vaccinate.
But then what happens is if you have these extreme lockdowns, they have negative consequences on public health—the collateral damage. And the longer you extend it, the more severe those problems will be. For example, we have less cancer in 2020 and '21 compared to before, and that's not because it's less cancer, we're not detecting it.
If you're not detecting it, we're not treating them. That's not necessarily going to lead to death this year but somebody who might die now, or three or four years from now who would've lived 20. There's collateral damage on cardiovascular disease, diabetes mistreatment, and of course on  mental health.
Then, all the missed education that kids didn't go to schools have long-term consequences, both for their physical health and of course education, but also for their mental health and a general wellbeing for as long as they live. Education is important.
Mr. Jekielek: Actually, I want to talk a little bit later about this, about what we should be studying in order to assess what the pandemic has really done to us, what treatments work and so forth. Before we go there, I want to talk a bit about the elephant in the room, so to speak.
This is something you've been more recently, very vocal about, which is this whole idea of natural immunity. It just seems like the whole concept of natural immunity is largely being ignored in policy, which seems very odd.
Dr. Kulldorff: It is very strange. We have known about natural immunity since the Athenian plague in 430 BC. I'm not talking about before COVID—I'm talking before Christ. For almost two and a half thousand years, we have known about natural immunity. It's strange that suddenly, people are questioning that.
The purpose of the vaccine is to have a milder disease if you get infected. But if you already have been infected, because maybe you were infected before the vaccine existed, then you already have excellent immunity. You have stronger, longer-lasting immunity than you have from the vaccines.
This idea that you're going to fire a nurse who was working in the COVID ward for many months taking care of COVID patients who got infected, who recovered, and who now have better immunity than those hospital administrators who were sitting at home or doing zoom meetings and who didn't get COVID, but got vaccinated. They have less immunity than this nurse who was at the frontline taking care of patients.
But now, those administrators are firing those nurses, even though they have better immunity. We should do the opposite. Hospitals should hire nurses and other staff with natural immunity. Then, they should assign those to the geriatric wards, where their older people are extra sensitive or frail. Even if they're vaccinated, they might be at risk of dying from COVID. We should utilize them to take care of all the patients who are at risk.
The same with nursing homes. Nursing homes should go out and try to hire people who have natural immunity. They are the ones who are at least likely to infect the residents. And we're doing the opposite. They're being fired.
I don't understand how any hospital president who supposedly should do what's best for the patients in the hospitals and take care of them, and who supposedly should be enlightened and informed about these things, how they can do the very opposite of what is best for their patients.
Same with university presidents. They're supposed to be the beacons of the enlightenment and of knowledge, and they're going contrary to these basic facts that we have known about for a couple of thousand years.
Mr. Jekielek: This is pretty fascinating because you're basically saying that the hospital health workers with natural immunity can be the frontline of the focused protection program going forward, basically.
Dr. Kulldorff: Yes. Actually, that's what we did during the Athenian plague in 430 BC. They used the people who had recovered from the plague to take care of sick patients.
Mr. Jekielek: Fascinating. When it comes to infection, is natural immunity better in preventing infection than vaccination? Is that what you're saying?
Dr. Kulldorff: Yes. One of the best studies was from Israel and they looked at, and they saw that if you are vaccinated, you have 27 times more likely to have symptomatic COVID disease compared to if you have natural immunity with the [inaudible 00:11:20] between, I think it was 13 and 54 or something.
It's a big difference. When looking at the hospitalizations, there was also more protection from natural immunity than from vaccine immunity. When it comes to death, there was zero death in both groups. Both the vaccinated and those with natural immunity were well protected against death. So, that's good.
The immunity is stronger and it's longer lasting than if you have a vaccine. And that's not a surprise. That's what we would expect. The vaccine targeted a specific part of the virus while natural immunity has more broad protection. It just has to do [with] where the body encounters the virus for the first time and if it's a natural infection, you encounter it first in your lungs, typically. If it's the vaccination, you do it in the arms. It also has to do something with comparing the protection from the two.
Mr. Jekielek: Sure. You're talking about symptoms here, but what about just infection itself? A lot of people out there are very concerned about getting infected with COVID.
Dr. Kulldorff: The vaccine works or the immune system works, so that if you get the virus in the body, then that's when the immune system goes into effect. It's not like a Star Trek shield around you that prevents the virus from entering the body. The immune system cannot operate until the virus in your body. When the virus enters, it takes some time for the immune system, sometimes to get up to speed.
It depends on how long ago you had the vaccine or how long ago you had the natural disease. But the fact that somebody tests positive is not really in my mind, very interesting. If we would test for all the viruses and anybody who was asymptomatic, but tested positive because they have been exposed, where we would go nuts, worrying about all these viruses around there. It's really the symptomatic disease that we'd be concerned about as well as of course, hospitalizations and death, which is the most important.
Mr. Jekielek: Fascinating. That's a very interesting way to look at it. You're basically saying at any given point, we have all sorts of infections. It's just that most of them never become symptomatic.
Dr. Kulldorff: Yeah. I won't even call them infections because we don't have any symptoms. It's just that people test positive because there are some viruses in the body.
Mr. Jekielek: Speaking of this natural immunity, it doesn't seem to be showing up in too many of the studies that are being done. Most of the data I'm seeing is just something that's not really considered. There's a question, how much of the vaccine efficacy might be actually attributed to people having had COVID before, given that at this point, probably a very significant portion of the population has had COVID? And how could we even tell?
Dr. Kulldorff: I think it goes both ways when we compare vaccinated and unvaccinated because in both groups, there are people who have had the disease naturally. What we really should do is compare four groups: natural immunity plus vaccine, natural immunity without vaccine, no natural immunity with vaccine, and no natural immunity and no vaccine. Those are really the four groups that are of interest.
But of course, in the original clinical trials where we showed the efficacy of the vaccines, it was clean because they excluded those who had natural immunity from those trials—excluded in the analysis, in the main analysis for those trials. And that was to get a more accurate estimate of the vaccine efficacy.
But I think that those are the biases in the observational studies. It can go both directions because those with natural immunity exist both among the vaccinated and among the unvaccinated.
Mr. Jekielek: Then what about, there's also been a bit of talk about people with natural immunity getting the vaccine, and there's been some evidence that says it can help and some evidence, very preliminary stuff that I've seen in some UK data that suggest that it can hurt. Do you have any thoughts on that?
Dr. Kulldorff: There's two sides of the coin. Does it help with COVID and then, what could be the adverse reactions? If you take COVID first then, there's been some studies, there was one CDC study from Kentucky, and then also that same Israel study that shows that if you ... So, they compared two groups.
Both have had natural COVID and one was vaccinated and one was not. Those who were vaccinated were less likely to test positive. That's not surprising because if you then get the vaccines, they boost up the antibodies and therefore, it will more quickly take care of any infections.
The Israel study, the Kentucky study did not, but the Israel study also compared symptomatic disease. It's found that if you're vaccinated, you have a 35 percent reduction in the risk of symptomatic disease. It wasn't statistically significant, so it was a wide confidence interval. We don't know for sure, but it indicates that there might be some protection also for symptomatic disease.
Then, the question is how important is that? Let's say, let's assume it's 35 percent. It might be more or less, but let's assume it's 35 percent. If you tell me that something would reduce my risk of cancer, getting cancer in my lifetime by 35 percent, that would be enormous. That would be hugely important, because we have a fairly high risk of getting cancer at some point in our life. We can reduce that by a third, that would be a medical breakthrough of proportions that we usually don't see.
On the other hand, if you're telling me that I can do this thing to reduce the risk of being hit by lightning by 35 percent, fine. But I'm probably not going to do too much hassles to have that because my risk of being struck by lightning is so minuscule anyhow. Reducing it by 35 percent, doesn't really make a difference.
Here we have people with natural immunity. They already have very strong, long-lasting immunity  better than the vaccines. Reducing it by 35 percent is good, if it is 35 percent. But it's not so critically important because the risk is already at a very, very low level.
Therefore, if you haven't had COVID disease and if you're old, then you have a higher risk of mortality. Then, the reduction of the vaccines is very important. But if you have natural immunity, even if there's a 35 percent lower risk or 50 percent, or whatever, or 25 percent or whatever it might be, it's not a huge benefit because it's already very low because you have strong natural immunity.
Then, we get to the other side of the coin, which is what are the adverse reactions? We know that there are some adverse reactions to these vaccines. For example, myocarditis, especially among young men and there are blood clots. It usually takes two or three years until we actually know the full spectrum of the safety profile of a vaccine or a drug for that matter.
That's just the way it works. It takes a few years. This is not unique to the COVID vaccines. It's just across the board. We still don't know exactly what are the consequences and the adverse reactions to the vaccines.
Now, if you are 78 years old, then it's a no brainer in my view, because the benefits are so great that even if you have a small risk for some adverse reaction, the benefit far outweighs the risk.
On the other hand, if you already have immunity from having had COVID, then the benefits of the vaccines are much, much smaller. Even if you haven't had COVID, if you are a child, the risk of serious disease or death is minuscule. It's less than if you have the influenza, which is already very low for children. It's not at all clear that the benefits outweigh the risks for children. My guess is that it probably doesn't outweigh for children.
Therefore, to put mandates on people who have had COVID, they already have better immunity than the vaccinated and the benefit there might be somewhat a benefit, but they [are] already at very low risk. Any reduction of that is not much of an improvement. They might not be at potential risk from adverse reactions.
Mr. Jekielek: We talked a lot about mandates in our last sit down. Where are you at with respect to mandates in general?
Dr. Kulldorff: I think they are bad because the mandates are based on the fact, on some kind of a questioning of natural immunity. It doesn't matter whether you're a nurse or a truck driver, or a longshoreman or a pilot, or whatever, they know that natural immunity exists. Many know they've had it. To force them to take a vaccine that they don't need, it undermines trust in public health to force people to do things that are not needed.
I'm astonished that the medical community, and CDC, and hospital presidents, and university presidents would impose this. In general, I think that if you want to have trust in public health, it has to be mutual trust.
For example, Sweden doesn't have any ... I'm a native from Sweden. It doesn't have any vaccine mandates of any kind. It has one of the highest vaccination rates in the world. Excellent rollout of the COVID vaccines. Yeah, I think vaccine mandates are very damaging both to public health and the trust in public health.
Mr. Jekielek: It just seems like since we did talk last, there seems to be more of an appetite, not less for the mandates.
Dr. Kulldorff: I don't know why it does. It must be something political because from a public health perspective, it doesn't make any sense at all.
Mr. Jekielek: When we were speaking earlier, we were talking about it's incredibly important to collect basically robust data in a pandemic like this, and basically do as many studies as possible, for example, look at things like the effectiveness of natural immunity, which was done in Israel, but for some reason wasn't done here. What studies do you feel should be being done as we speak, and that they aren't being done? What are the most important ones?
Dr. Kulldorff: There are some studies that really should be done and they're not being done. One is, the CDC should continuously monitor the zero prevalence, the amount of immunity that exists in the population. For example, Spain had a very good randomized study with 60,000 people.
But in the U.S., there was the Santa Clara study which was done by Stanford, which was excellent. But there was one county in the U.S., and CDC should continuously do this on a monthly basis for all geographical areas, and for all age groups to see how immunity has developed over time and how it varies by different groups—different locations and so on.
That's basic to see surveillance information that you need to have, if you want to optimally deal with the pandemic, and they never stepped up to the plate and did that. Individual scientists can do the Santa Clara study in one place and one time, but they don't have the resources to do this in a more systematic way. That's the CDC's responsibility to do those things.
What also CDC should have done is, we know there are 700,000 plus now reported COVID deaths in the U.S.. But some of those died because of COVID, others died because they had something else, but COVID contributed and helped push them over the edge, unfortunately.
But then, there were others who had COVID when they died, but they didn't die from anything [that] had to do with COVID. It was something else. That's something that CDC should have figured out a long time ago to monitor to what extent the people who are reported from COVID actually died from COVID.
You don't have to do that for everybody. For children where there's maybe about 400 now, they should do it across the board. But for older, they should just do a random sample and go through their health records and see what did actually die from. So, what percentage of them died from COVID versus with COVID? That's another thing that CDC should have done.
Mr. Jekielek: But presumably, they could start today, right?
Dr. Kulldorff: They could and they should. The other thing, which is also a different thing enough for CDC, but that NIH have done specifically in the National Institute of Allergy and Infectious Diseases who was responsible for the infectious disease research is to look at treatments.
There's a lot of information going around about that this treatment works and this does not work. We know that monoclonal antibodies work very well, so that's an important treatment if you take it early enough. But we should have tried all these other things. If they work, we have to have a large randomized placebo controlled trial to show that they work.
Mr. Jekielek: You're saying, for example, ivermectin, it's shown in some smaller studies that it works.
Dr. Kulldorff: Yes. There are smaller studies that have some conflicting results, but you have to have one large randomized placebo controlled trial to actually know. If it works, it will prove it works. If it doesn't work, it'll prove it doesn't work. Then, we can put that treatment to rest—one way or the other. We should have done that with many different treatments. That's something that NIH should've done because an individual scientist doesn't have the money to certainly do this.
When they initiate a project, they were used to write a grant application. After a year, if you're lucky, you'll be funded. But in the pandemic, we don't have a year because it's a year to be funded and then, another year to do the study, maybe. It's really the NIH who has the capacity to quickly launch these studies on treatments, and they didn't do that. That's a huge failure of the government and NIH not doing that.
What also should have been done and I proposed it very early on in the epidemic, but it didn't go anywhere was to do what's called data mining to see if there are any of the existing drugs that people have used for whatever purposes that actually happen to help with COVID.
So, the people that do it for cardiovascular diseases, or they take some eye drug for eye problems or whatever, maybe one of those would work for COVID. You should go in there and just look and do what's called data mining to see if any of them actually pops up as a beneficial drug. That wasn't done either. Again, that's really the NIH who has the capacity and the resources to quickly launch such studies, and they didn't do it.
Mr. Jekielek: We've heard a lot about ivermectin and we've heard a lot about hydroxychloroquine, obviously drugs that are used by millions of people for other purposes. At this point, do you think that this is the time to look at these specific ones and expand beyond them.
Dr. Kulldorff: Yeah, we should still do those studies and probably should have done them a year and a half ago. That's when they should have started.
Mr. Jekielek: We've been talking about vaccination of children a little bit already, and you've been mentioning how the risk is minuscule. It appears that the White House is setting up to do basically large scale vaccination of children. I think it's five to 12. That was the recent memo from the White House. What are your thoughts about that?
Dr. Kulldorff: I don't think children should be vaccinated for COVID. I'm a huge fan of vaccinating children for measles, for mumps, for polio, from rotavirus, and many other diseases because that's very critical. But COVID is not a huge threat to children. They can be infected just as they can get the common cold, but they're not a big threat.
They don't die from this except in various circumstances. If you want to talk about protecting children or keeping children safe, I think we can talk about traffic accidents, for example, where there are some risks and there are other things that we should make sure to keep children safe. But COVID is not a big risk factor for children.
One example is from Sweden, during the first wave, in the spring of 2020, which affected Sweden quite strongly. Sweden decided to keep daycare and schools open for all kids ages one to 15. There are 1.8 million such children who lived through the first wave without vaccines, of course, without masks, without any social distancing in schools. If a child was sick, they were told to stay home. But that was basically it. Do you know how many of those 1.8 million children died from COVID?
Mr. Jekielek: I think I remember the number because it's zero, right?
Dr. Kulldorff: Yes, zero.
Mr. Jekielek: Okay, yeah.
Dr. Kulldorff: And only a few hospitalizations. This is not a risky disease for children, and children have had much higher risk from not going to school, from not being outside exercising, playing baseball or soccer, or ice hockey or whatever. They're at a higher risk for not having a good social relationship with other children.
If you want to worry about the risk of children, we shouldn't worry about COVID. We should worry about all of those things, making sure they're in school, that they get to participate in sport activities, in cultural activities like music, concerts, theater, and all of those things. That's where we should worry about the children.
Mr. Jekielek: There's also, of course, been this discussion around masking and there have been studies, so I think even since we talked that have come out about the effectiveness or lack of effectiveness of masking.
Dr. Kulldorff: Yeah. First of all, for children, there has been no good studies. We have no evidence that masks work in children. But there have been two randomized studies—that's the gold standard in science, to have the randomized trials. There's been two studies on masks in adults, one from Denmark and one that was done in Bangladesh.
The Danish studies show that the mask could either be slightly protective or slightly making things worse. It was not statistically significant. But that only evaluated masks protecting the person wearing the mask. The Danish study didn't evaluate whether if me wearing a mask would protect other people.
The study from Bangladesh did both because they randomized not individuals, but they randomized communities or villages. Some villages was randomized to wearing masks and others, to not being encouraged to wear a mask if they could. If they wanted to, of course, anybody could. Nobody was prevented from doing it.
There, we found that the masks reduce COVID somewhere between zero and 18 percent. It means that there was either no effect from mask or very small effect from masks. This idea that has been going around that masks will save us or protect us, they might do a tiny bit from these randomized studies, but they're surely not a game changer.
Even if they do prevent a little bit, that might just reduce or prolong the time until somebody gets infected. All this emphasis on masks I think has been very unfortunate because it means that the other things that we don't emphasize, things that actually would help. Like for example, of course, vaccine is one example, to vaccinate older people, and that has been emphasized.
But reducing staff rotation in nursing homes, for example, or testing nursing home staff more or using people with natural immunity in nursing homes, reducing intergenerational myths during the height of the pandemics, making sure that older people don't have to go to the supermarket, but can get delivered their foods before they were vaccinated.
Now, when they're vaccinated, I don't think, it's not a big issue for them to go. There were a lot of things that could have been done. In schools, for example, increasing ventilation in schools. Some schools have very bad ventilation. Now, we don't know exactly how much better ventilation in schools would reduce COVID because kids are at very low risk. It might not do very much, but at least it's something that we know as benefits for other things like asthma or allergies and stuff like that.
Improving ventilation in schools is something that's good, no matter what, for other things. It's a good thing to do, even if we didn't have COVID. It would've been better to emphasize things that actually do make a difference than things that are, have no, or only very small benefits.
Mr. Jekielek: As you're speaking. I can't help think about how there seems to be almost like a stigma developing against the "unvaccinated." I say that in quotes and this idea of denying medical service to people who are unvaccinated.
I was thinking about this because I was thinking about people with natural immunity and how people with natural immunity could actually be a great benefit to society in these scenarios of focus. For example, helping as the frontline, or focus protection, and so forth. But it's almost like, instead of say, celebrating the people who do have natural immunity, there's this movement instead of demonizing unvaccinated people.
Dr. Kulldorff: Yes, that form of segregation, I think is very scary. That's not how civilized society operates. It's trying to distinguish the unclean, the untouchables versus those who have the vaccines. It's especially tragic, because again, you have these people who worked from home and they did the Zoom class, or the pajamas class, or the laptop class who stayed away from the virus.
But somebody was delivering food to them, somebody was taking care of the power supplies, somebody picked up the garbage, somebody was working in the fire departments and the police departments. Somebody was driving the trucks with the food, some of them are working in the factories. Somebody was working in the ports to unload the products coming from abroad or load things. You have all these essential workers who had to work and who made sure that the society was running while a certain group of people, professionals were hiding at home.
Now, when those people hiding at home have been vaccinated, they are now somehow deeming those essential workers who were working and got infected, and now have superior immunity, they have somehow been deemed uncleaned—unclean. I saw notes on the windows or in the yard, a sign that's saying "Support essential workers. We love you," and all that kind of stuff. There was not much to that was there? Because now they're being demonized, even though their immunity is better than what the vaccinated have. Some of them are being fired now. That's not how just society operates.
Mr. Jekielek: It's really interesting to think about what the end game of all of this is. It seems like natural immunity is something that should be considered seriously. It seems like demonizing people for being unvaccinated is not the right way to go. Why don't I ask this? Is being unvaccinated, does that pose a threat to anybody in society?
Dr. Kulldorff: A person who is not vaccinated, but with natural immunity are much less a threat to society than a person who is vaccinated, because we know that the vaccinated, while protection for mortality is good, the protection to a symptomatic disease wanes rather quickly. So, they can spread it much more easily than those who have natural immunity.
I'm not in favor of any vaccine passports, but if you're going to have any, we should give the passport to those with natural immunity. I'm not in favor of that, but there will be at least some logic to it because there's no logic right now to have vaccine passports where those with vaccines who have less immunity than those with natural immunity are allowed to go to the restaurant. But those people who worked as essential workers and who got COVID, and now have superior natural immunity, they're not allowed to go to the restaurant. That's crazy.
Mr. Jekielek: But what about people who don't have natural immunity or don't know? Are they a threat to anybody?
Dr. Kulldorff: I don't think so. For example, children are certainly not because we know that children are not big at transmitting this disease. We know that from studies. Most children get it from adults, and there's much less transmission from child to adults. Now, as long as the old people are vaccinated, other people are not a threat to them.
Mr. Jekielek: Is there anything that would suggest that vaccinated people transmit the virus less, or how do they transmit the virus in comparison to unvaccinated non-natural immunity people?
Dr. Kulldorff: We don't really know the answer to that question. I think they can go both ways. If you have the vaccine, it reduces transmission for a while for a few months before it starts waning. At least it reduces symptomatic infection, symptomatic disease for a while before it wanes. But presumably, that means that also transmission goes down.
But it could also be the opposite because maybe if you're vaccinated, you have such mild disease that you still walk around. You're not at home in bed, you still walk around. And therefore, you're more likely to transmit it than somebody who wasn't vaccinated, who has a more serious disease. So therefore, they're going to stay home because they feel sick.
I'm not saying that that is the case, but it can go both ways. I haven't seen any clear data. I don't think there exists clear data where which of those two things plays out the most.
Mr. Jekielek: Aside from the ethical question, basically about whether it's reasonable to call someone unclean for being labeled and for being unvaccinated, basically you're saying it is not clear that people are in any way a threat to society by being unvaccinated in the first place?
Dr. Kulldorff: Yes, it's not at all clear that one of them are more or less likely to transmit them to another group. We don't know that yet. You asked about the end game. I just saw this post on Twitter of a painting where this person goes up the stairs, but it always goes up. Somebody joked that that was the end game of this vaccine medicine and so on. But I hope that's not the case.
Mr. Jekielek: As you're describing this M.C. Escher drawing, I can't help thinking of this idea. There's this waning immunity from the vaccines within a few months, to infection. There's the first booster shot, second booster shot. You can imagine a situation where a booster shot every three months becomes what it means to be fully vaccinated. There's even this discussion of changing the definitions. I think the CDC director was just talking about that the other day. Is this a scenario that is in any way viable?
Dr. Kulldorff: I don't think that's going to happen. I hope it's not going to happen. We have to distinguish between what the purpose of the vaccine is. The vaccine does a good job preventing death, and we should be very grateful for that. But to try to rely on vaccines to suppress the spread of the disease, or to suppress it or eradicate it, that's not feasible. Any such attempts are doomed to fail. We have seen that.
People tried to do it with lockdowns and it failed. We know that now. The pandemic will end and it'll become endemic. The pandemic will end when enough people have natural immunity. People who are vaccinated are still going to get the disease, most of them.
Then, once they have had the disease, they will have stronger immunity. Everybody will be reinfected now and then, just like with existing coronaviruses. But because they have immunity, it's not going to be serious for most people. Every time you get reinfected, it improves your response of your immune system.
Then, there will come a time maybe when I'm 87 years old, if I'm lucky to live that long, where my immune system is weak and I might be infected by COVID, or by any other coronavirus or by the flu or something other virus, and my immune system is no longer strong enough. Then, that will be the end of it.
There will always be people, older people with more frail and with a weakening immune system that they're going to die from COVID or from other viruses that's been happening for a long time. That's just part of our life. We can't vaccinate ourself out of that situation.
Now, maybe people who are old and frail should get a booster shot at some point. There has been depressing little data on it. They should have started those trials in May to know exactly what the benefits are, but it could ever be that older people will benefit from a booster shot either now or later to reduce the mortality. But so far, the vaccines are holding up very well for mortality. It's in the 90s, at least for six months. Obviously, we don't know what is going to be two years after the vaccine or five years after.
Mr. Jekielek: And just to clarify for the benefit of our viewership, pandemic and endemic, you say it becomes endemic like there's some sort of magical change. What does that mean exactly?
Dr. Kulldorff: Pandemic is when we have a new disease and it's worldwide. We have waves of mortality and infections, which we have seen in the last almost two years now. That's the pandemic stage.
But at some point, when we have enough immunity in the population, and so it's herd immunity, we are not going to have these waves anymore. Herd immunity, by the way, is the scientific phenomenon that we know about. It's not a strategy or anything like that. It's just something just like gravity that's well-established.
When enough people have been infected, the virus cannot spread as much as before, but it will still be around. It will still be lurking around. It will be affecting a few people here and there, and there will probably be a winter wave because that's how this virus seems to operate. A few people will get sick.
Most people probably just fight off very naturally. Less people will be infected, but those are most who will fight it off much more easily. But if you will get more sick and some older people will die every year from it. That's the endemic stage.
For example, the other four common coronaviruses are in the endemic stage. We don't even think very much about them. We do get a cold sometimes from them, but we don't think very much of them. But that is the endemic stage. We will reach that. The pandemic will end.
The way we have dealt with this pandemic, we have sort of prolonged the pandemic stage. In some countries, I think, they're closer to endemic stage. In some countries, they are not like Australia, for example. They have hardly started. But in a place like New York, for example, which was very hard hit, we are much closer to the endemic stage. We don't know exactly when that will arrive.
We talked about the studies that hadn't been done, but there's actually the opposite. There are the studies that shouldn't have been done, but they were done. Those are all these prediction models, predicting how many people will get COVID, how many people will die.
If you know enough about infectious disease technology, you'll know that those models cannot accurately predict what's going to happen. People who predict numbers or those things for the future, they don't know enough about infectious disease signals to realize that those predictions shouldn't be made and cannot be made accurately.
Mr. Jekielek: The other thing which was, very quickly seemed an odd thing to be doing, with respect to coronavirus was the contact tracing. Does that have any meaning here?
Dr. Kulldorff: Yes. First of all, contact tracing is a very important tool that acknowledges half or some diseases, for example, sexually transmitted diseases. You do contact tracing if somebody has syphilis, you ask about their sexual partners, then you go and test them. In that way, you can limit the spread by doing this contact tracing.
Ebola is another example of a disease where we have a few cases of Ebola in the U.S. which they try to find out who they were in contact with.
But you can't do it for a disease like COVID, which is widespread or for influenza. That's nonsensical. This idea that some people who had that, they're now going to do contact tracing for COVID and test people, and ask them who they had been in contact with is nonsensical from a public health and a public perspective. I'm not quite sure who came up with those idiotic ideas.
It was very expensive for taxpayers and those efforts should have been used on other things, when I know actually, there were some public health officials who privately were begging the federal government so that they should be able to use the money that they were assigned for contact tracing should be used for vaccinations instead.
Very wisely so. We knew early on that contract tracing would not work. Now, we have proof that it was basically a huge waste of resources. Both financial resources, but also the resources of public health officials who should have done things that would have helped instead of these things that had no benefit on this pandemic.
Mr. Jekielek: We were talking about the collateral damage earlier of lockdowns. Do you feel like the data in order to be able to assess the cost of that, do you feel like that data is being gathered as we speak sufficiently?
Dr. Kulldorff: Yes. One good thing to look at is excess mortality, where we compare mortality from 2020 and 2021 from the previous year—the average over the last five years or so. I haven't seen all that data yet, but it's being collected and it's being analyzed. One thing I've seen is that in the U.S. for 2020, I think it was or at least part of that year, there was excess mortality among older people. A lot of that was driven by COVID.
There was also some excess mortality among the working-age adults, those people in the 20s, 30s, 40s, and 50s and so on, or in that age group. Their COVID death only explained a very small part of the excess mortality.
Most of the excess mortality was with other things, including for example, opioid overdoses, cardiovascular outcomes, and so on. We already know that among certain ages, collateral damage from the lockdowns had a higher impact on the mortality and what the COVID had-
Mr. Jekielek: And a great effect.
Dr. Kulldorff: Yeah, there was more death to the collateral damage from the lockdowns than from actual COVID cases among certain age groups. But that doesn't even count all of them, because for example, as I mentioned cancer, they won't show up in the statistics yet. They won't show up until later. If it doesn't show up until five years from now it's so hard to measure exactly that in terms of our cost of mortality. But we will of course look at cancer mortality and see how cancer mortality changes over time.
Mr. Jekielek: This is people basically not getting their mammograms because they're in lockdown, for example.
Dr. Kulldorff: Yeah. The cervical cancer screenings, for example, which is important, or they didn't go to the doctor when they should have, because they were afraid of catching COVID in the hospital. So, yes. And of course, mental health has been deteriorating and we don't know what the... We know the short-term consequences of that, but we don't know the long-term consequences of it yet.
Those are things that people in science, in public health will be studying now for several years, now that we know more and more about it.
Mr. Jekielek: Do you feel like there's enough? We were talking about how there's certain data related to studying coronavirus and its impacts on society that just hasn't been gathered. Do you feel like there's sufficient data to see these effects?
Dr. Kulldorff: I think that there will be, and I think there will be studied because those are things that are not so critical in time. I think there will be scientists who will collect the data or analyze the data. They will be published in the years to come. That's different from the more acute needs of monitoring the surveillance of antibodies in the population or finding a treatment quickly.
These are after the fact evaluations of the collateral damage just not as temporal and urgent. The normal procedures of science I think was kick in and people will maybe be studying them in different countries.
Mr. Jekielek: We were  talking about these earlier. You're not as convinced about the success of the normal procedures of science at the moment. You yourself have been censored—other people that you work with. There's frankly scientists all over the place, not just in this discipline at the moment that have, let's say voices that are different from the main narrative, so to speak that are being censored. That seems to be very antithetical to the idea of science in the first place.
Dr. Kulldorff: It is. It's concerning obviously for censoring or silencing, or in some cases, slandering scientists. It's so concerning for those scientists. I've been on the receiving end of that. But it's also the biggest damage, I think it means that a lot of scientists don't speak up because they don't want to be at the receiving end of those attacks.
To me, that's dangerous. I know there are many people who don't want to speak up because they see what happens to those who do. You're not allowed to disagree with what a small group have decided is their orthodoxy of the pandemic.
We saw one example from the British Medical Journal even, who published this piece with massive errors about The Great Barrington Declaration and slander, and harm and attacks. It was complete nonsense, like you would expect from a tabloid newspaper, and now it has creeped into what was a respectable scientific journal. That doesn't belong there at all.
Then, of course other people will say, "I can't say those things because for my scientific career, I need to publish in these journals. I need to get these grants. So, I better be quiet."
Mr. Jekielek: Money is obviously a big issue, for example. I don't know what percentage of the grants NIH provides. Certainly for these large scale studies, probably all of them or some huge proportion of them. Money is a big issue here, isn't it?
Dr. Kulldorff: Yeah, if you are a scientist, and you have your lab, and several people are dependent on you bringing in the grants so you can pay them. If you're an infectious disease technologist, you write your grants to the National Institute of Allergy and Infectious Diseases. They have the biggest chunk of infectious disease research money in the world and that's headed by Anthony Fauci. Anthony Fauci has very clear ideas about how to deal with this pandemic.
If you have different ideas than he does, then you may be concerned about not getting the grants. Whether that is true, that they wouldn't get it because they voice a different opinion, that's irrelevant because as long as people think that they might be the case. I think it's actually  dangerous for a country to have the same people in charge of the pandemic response as well as the funding of science.
Those things should be separate so that the people feel free to discuss the pandemic strategies or without having to worry about their research funding. Those things should be separate with different people in charge of those two things.
Mr. Jekielek: There's also this whole talking about collateral damage. But we just keep hearing people say, just trust the science. Trust the science. But very often, what is being attached to the trust of science has nothing to do with science. The broader impact on society of this is something I've been thinking about. Do you have any thoughts on this?
Dr. Kulldorff: Yeah, I think the trust both in public health as well as science more broadly has received a lot of damage during this pandemic, and for good reasons. I don't trust the whole scientific process as I used to do. I think it's a very natural skepticism to have. I think it would be strange that people didn't distrust public health and science at this point.
Mr. Jekielek: Can this trust be regained?
Dr. Kulldorff: We have to try. We have to work at it, but I don't know. I think the pandemic will end, we know that and we'll go into an endemic stage. But whether we can restore all the damage to science, I don't know. We have to try. I'm involved in one initiative called the Brownstone Institute to try to work on that in the realm of public health.
I was always optimistic that we will eventually sort out the pandemic and there won't be more lockdowns. I don't think there's going to be vaccine mandates and passport in the long run. I'm optimistic on those things, but restoring the trust in public health, I'm less optimistic about it, but we still have to try because it's very important.
Mr. Jekielek: To this small group of people and Dr. Anthony Fauci that are setting policy, what would be your advice at this point, given everything that we know?
Dr. Kulldorff: Two things. One thing that is done wrong now, if there's a huge emphasis on vaccinating children or vaccinating people who have natural immunity, that's not going to benefit public health. But there are still older people in this country who have not been vaccinated and have not had COVID. Those are the people that we need to reach.
All these vaccine mandates are for children, students and working age adults. There are no mandates for retirees. I don't think there should be, but there should be an enormous effort to reach those retirees who have not yet been vaccinated or haven't had a COVID. And there are still many of them who are not vaccinated. That's where the public health effort should be.
By mandating vaccines for people who don't need it, a lot of people are going to say, "They don't need it. So, they're telling me to get it. Do I need it?" By lying about natural immunity, for example, or misrepresenting them or questioning natural immunity, they're actually making it harder to reach those older people who still really need this vaccine. That's one part that is very, very important.
The other one is for children, let them live their lives. They're not at risk here. Don't test them in schools. Let them just play with their friends. Don't put masks on them in school. Let them go back to normal life right now. It's brutal what we have done to the children in this country during this pandemic.
They are the least at risk from this disease and they have carried a huge burden. With masks now, a lot of adults are not wearing masks anymore, but they're still forcing children to wear masks in schools, even though there's no evidence that it works. It is obviously harmful aspects to wearing a mask. Those are the two things that would be the most important things to do.
Mr. Jekielek: Anything else that you would add as a secondary advice?
Dr. Kulldorff: We have to repair the collateral public health damage. Intensify efforts to catch up with all the missed preventive care. We have a huge issue with trying to deal with the mental health issues, both the mental health issues due to the lockdowns and the isolations, and no schools and so on.
But also the fear that's been spreading around, people who are very fearful of COVID. We know that while some older people are not fearful enough, they underestimate the risk that a lot of younger people and working class, working age adults who overestimate the risk.
We have to help these people as other people who have the mental health issues from the lockdowns to recover. And I know that the psychologist and the psychiatrists, they are overburdened. But it's not enough with them. It's really something that we have to do as a nation, helping neighbors, family members, work colleagues, and even the random person we just meet on the street to be compassionate and try to help everybody to recover from the mental health issues that have been too common right now.
Mr. Jekielek: We touched on this already, but how about listening to the dissenting voices as being an important part of the scientific process?
Dr. Kulldorff: Yeah. I think if you want to be a scientist, you have to listen with open ears to all voices, both scientific voices, but you also have to listen to voices from the public. I think that's one thing that public health has forgotten, to actually listen to how the public is suffering from all the collateral damage, for example. You can't just ignore that.
But if you go back to the science as a scientist, if somebody who I usually agree with, if they write something, I might read it and so on, but it's when somebody who I respect, but who have often a different view, who expresses something that is different for me, they're the one I really have to read and understand. That's the most important people to read.
It's more important as a scientist to read the people who have different opinions than I do, and to read the ones who agree with me, because I already know the arguments that they have, those who agree with me. I will have to understand the arguments with those who disagree with me.
On the personal level, one of the most useful things I did was my colleague Jay Bhattacharya had a debate that he was going to do and he wanted to do a practice session. I was his sort of opponent. I had to come up with the arguments from the other side and I had to do it as good as possible because that's how he would. That was a very useful thing because I had to try to find out, if I'm going to argue for lockdowns, what are the arguments for it? What are the best arguments for it?
I didn't quite able to convince myself, but that's a useful exercise. I think they were obviously lockdowns. We now know that the lockdowns didn't prevent all the mortality. They were not effective and there was a lot of damage from it. They asked us to push things into the future a little bit, but it is very useful and important for scientists to listen to those who have different views. Because sometimes I'm right, sometimes I'm wrong.
Mr. Jekielek: Any final thoughts as we finish up?
Dr. Kulldorff: I hope we can all treat each other with compassion and understanding in these trying times, and to not treat anybody else as less valuable or less clean, to treat each other as human beings. I think we have to do that to reestablish the social fabric of society. That's part of making sure that we resolve the mental health issues that have been exposed and have been caused by this pandemic and the lockdowns and our response to it.
Mr. Jekielek: Dr. Martin Kulldorff, it's such a pleasure to have you on again.
Dr. Kulldorff: Thank you so much. It was a delight. Thank you.
This interview has been edited for clarity and brevity.
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