“The vaccine does not stop disease spread after a certain number of months,” says Dr. Jay Bhattacharya, a professor of medicine and health policy at Stanford University. Even if children were all vaccinated, COVID-19 would continue to spread among the population.
“We can try to restructure our societies essentially around the prevention of a single infectious disease forever … Or we can live our lives relatively normally, using the technologies we have to protect the vulnerable. Those essentially are the two broad choices we face as a society,” says Dr. Bhattacharya.
Correction: An earlier version of this episode incorrectly identified Dr. Bhattacharya’s role. He is a professor of medicine and health policy at Stanford.
Jan Jekielek: Dr. Jay Bhattacharya, such a pleasure to have you back on American Thought Leaders.
Dr. Jay Bhattacharya: It’s great to be here.
Mr. Jekielek: So the last time we interviewed was last April. I want to kind of look at how the Great Barrington Declaration, which of course you’re one of the authors of, has fared given the new information—given the new data. And maybe we can just kind of recap what it’s all about.
Dr. Bhattacharya: Sure. So the Great Barrington Declaration, the idea is based on two basic scientific facts. First, that there’s a thousand fold difference in the risk of disease. Older people face a much higher risk if they’re infected for severe disease than younger people do—thousand fold difference. At the same time, the lockdowns themselves are incredibly harmful. Harmful to public health, harmful to children, harmful in many ways.
So the Great Barrington Declaration calls for focused protection of the older population, and for the rest of society, essentially as little disruption as possible; as little disruption to schooling and to normal life as possible.
The question of how well it’s fared, you can sort of understand this by looking at the experience of many countries that have experienced these waves since April.
Just to give you an example, Sweden had a massive Spring wave of cases. At the beginning of the wave they’d only vaccinated maybe seven, eight percent of their population, but they’d done it along the principles of the Great Barrington Declaration. Every dose had gone to an older person. That’s focused protection of the vulnerable. And what happened in the Spring wave of Sweden is very interesting. There was a massive wave of cases, but very few deaths relative to the wave of cases.
The same thing happened in the UK. Massive wave of cases and very few deaths, again, because they had protected the vulnerable by using the vaccine preferentially on the old. This sort of decoupling of cases and deaths was sort of characteristic of many countries that had had even limited vaccination as long as it focused on the old.
The American South has had a massive wave of cases, unfortunately, a little more deaths in part because there were still some pockets of older populations that were not vaccinated. Florida is a good example actually. It had a pretty successful vaccine rollout. Something like, by January of 2021, it had offered the vaccine to every nursing home resident where 40 percent of the deaths have happened in the U.S. And by the middle of February, I think almost every older person in Florida had been offered the vaccine, but the uptake was like 80 percent, 90, 85 percent.
There were still substantial fractions of older people in Florida still not vaccinated again, by their own choice. So yeah, I think actually that the premise has held up quite well. Protect the old, and then you let society go on as best you can.
So Florida’s children have had a full year of school whereas my kids in California have not. They’re finally back in school in person for the first time in a year and a half this year or this August. So, the premise of the Great Barrington Declaration, the basic idea of it, protect the vulnerable, let society move on, I think has held up quite well.
Mr. Jekielek: Something that we talked about extensively in our last interview was the sort of fallout of lockdowns. So what about this side of the equation? How has that changed, or what do we know more at this stage?
Dr. Bhattacharya: I mean, we’re starting to count the costs a little bit finally and it’s devastating, right? I think there was a Gates Foundation Report. We found that 30 million people have been thrown into dire poverty worldwide. Tens of millions of poor people around the world [were] thrown into essentially starvation.
A UN report suggested 250,000 children had died of starvation in South Asia, again, as a consequence of the lockdown. So in the developing world, the consequences have been devastating. Tuberculosis deaths have gone up. A huge number of public health priorities in the developing world have gone by the wayside as a consequence of lockdowns.
In the developed world we’re also seeing enormous backlogs of people who did skip their cancer screening, enormous levels of psychological harm, depression, anxiety, suicidality. Interestingly, suicide rates have not gone up in many places, but nevertheless, suicidality, depression, all those things have gone up quite a bit. And a lot of the sort of normal care that we would provide has been slipped by the wayside. So I think this is the kind of thing that has a long tail, right.
It’s when you miss a year and a half of essential preventive care, it doesn’t always appear immediately, although it’s already started to appear. One harm I think we’ll see over the coming decades is that because kids were kept out of school in many places for a full year and a half [exhibit a] huge amount of learning loss. Well, that has consequences on the lives of children that lasts a very long time.
Children that skipped school, it turns out there’s really good research from before the epidemic, live shorter lives and they live less healthy lives and they’re poorer.
They’re like natural experiments based on how some states changed the number of years of mandated schooling. And you compare the states that did it versus states that didn’t. The states that did it had kids that lived longer over a long period of time. So we’re gonna start to see these health effects, but we’ll be counting the cost for a very long time with these lockdowns.
Mr. Jekielek: One of the charges laid against the Great Barrington Declaration, it’s just that it’s kind of a ‘let it rip strategy,’ and I’ve heard this repeated again and again.
Dr. Bhattacharya: When we released it in October of last year, like the three of us were professors, we’re not media personalities, we’re just professors. And what we didn’t understand was that this was in a media environment and actually frankly, a scientific environment that wasn’t really open to this idea.
So both scientists and media essentially used propaganda tools against it, right? So as it was talked about, it is not a let it rip strategy. It is very much a focused protection strategy.
Recognize who’s most vulnerable to the disease and move resources there, right. With the vaccine you can do it very well. It’s a little more challenging before the vaccine, but you actually, there’s lots of ideas that we proposed even before the vaccine for protecting older populations.
The reigning narrative in October of 2020 when we wrote it was lockdown. The only way to protect the vulnerable, people were saying, or some people were saying including, for instance, Anthony Fauci, was a lockdown. And he was praising states that locked down and said, look, if you lock down, you will protect the vulnerable, in effect.
And in order to discredit the ideas of the Great Barrington Declaration, addressing the ideas directly, they had to have a counter narrative, though a false one, which is that we were proposing to let the virus rip through the population, which is utterly false.
Dr. Fauci picked this up. A number of other mainstream news sources picked this up, and so, rather than having to grapple with the ideas of the Declaration, they could just dismiss it as, oh, you wanna let it rip. You’re monsters for wanting to let it rip. I think it was a way to dismiss the fact that there were prominent scientists that were dissenting from the lockdown orthodoxy without actually having to cope with the ideas that we were actually saying.
[Narrative]: We reached out to Dr. Anthony Fauci but we did not receive an immediate response.
Mr. Jekielek: Well, and the thing is that the Great Barrington Declaration, it’s not exactly something entirely new, right? That’s what I found very interesting as I started to research this more back many months ago. So, this is really kind of an extension of the existing approach prior to coronavirus, right?
Dr. Bhattacharya: Yeah. That was the approach that I thought we were gonna take in February of 2020. For a hundred years we followed this pandemic plan, and the Great Barrington Declaration’s, as you say, nothing really new. It just seemed shocking at the time because the lockdown narrative just sort of settled in October, 2020.
In February, 2020, it would have been utterly uncontroversial. The ideas actually were implemented in 2009 H1N1. We didn’t disrupt society for H1N1 even though the initial case fatality rate estimates were quite high. We did focus on protection of the vulnerable. In 1957, 1968, 1976, every single pandemic that in modern times, we followed a plan very, very, very close to this.
Mr. Jekielek: Well, and so why don’t you tell me, and I know you look at the data daily, basically, it’s part of your work as a public health scientist. Where do we stand with these vaccines? Basically if you can tell me the state of what they offer and what they don’t offer and the risks. Give me an overview.
Dr. Bhattacharya: Sure. So the vaccines, of course, there’s the mRNA vaccines, and there’s the Johnson and Johnson and the AstraZeneca vaccines, or these adenovirus vector vaccines. They actually have the same, very similar characteristics in a couple of ways.
One is that they appear all of them, to provide very long-lasting protection against severe disease. So if you have the vaccine and you get exposed to COVID, you’re much less likely to die from it, and you’re much less likely to be hospitalized from it. And that protection seems to last at least six months, probably longer. They generate robust B and T cell responses that protect you against severe disease from COVID. So that’s the good news for the vaccines.
The hope I think initially for the vaccines was that they would actually stop cases from happening. The bad news is that it seems like while that happens, that it does protect against cases for a short period of time, eventually it stops protecting against cases.
You can see this most clearly in a place like Iceland, which vaccinated a very large fraction of its population and nevertheless have had an enormous case rise—case surge. The vaccines eventually, for a short time, protect you against any infection, but then eventually stop being able to do that. So you can get a breakthrough infection—that’s very common.
For instance, I had a breakthrough infection. I had the vaccine, the Pfizer vaccine in April, 2nd dose in April and in August I had COVID. Wasn’t hospitalized. It was like three days of fever and fatigue and loss of smell, but I was fine.
Mr. Jekielek: It seems to me that there’s been a lot of messaging, or there seems to be a societal expectation that we can rid ourselves entirely of this disease.
Dr. Bhattacharya: Yeah. We have no technology at all to rid ourselves of this virus. This virus is in permanent circulation in human societies. And just to put a fine point on it, or not too fine a point about it, I think everyone on the face of the earth will face COVID at some point in their life if they don’t die before they get it. Everyone on the earth will face COVID. It’s not possible to rid any human society from COVID.
There are animal reservoirs. Dogs can get it and cats can get it. There was a study that 40 percent of white tail deer apparently have antibodies to COVID. Bats supposedly can get it. So it’s a disease that is in mammals and it’s just not eradicable. We have no technology to eradicate it. The idea that we can protect ourselves from getting COVID forever is just false.
In fact, we kind of face a choice as a society. We can try to restructure our societies essentially around the prevention of a single infectious disease forever. Fail at that with all the consequences that we’ve seen, you know, this sort of lockdown, where we throw away all of the other priorities in life, including public health priorities, or we can live our lives relatively normally using the technology that we have to protect the vulnerable. Those essentially are the two broad choices we face as society.
Mr. Jekielek: Well, where do you see us going right now, I guess is the question?
Dr. Bhattacharya: I don’t know the answer to that. I did an interview with Lord Sumption, who’s the Supreme Court Justice in the UK, former UK Supreme Court Justice and very vocal against lockdowns. And his view is that we are in for a Dark Age. The COVID era has exposed all kinds of weaknesses in our democracies.
This sort of lockdown ideology is more or less, in some sense, some ways permanent. COVID may end, but there’ll be other panics and other things that undermine our liberal social order. I don’t know, I’m not quite so [sure]. He calls it a new Dark Age.
Martin Kulldorff has argued that the Age of Enlightenment is over. I guess I’m not quite so pessimistic. I think that the liberal social order is much more robust than we realize, although it looks like it’s on life support right now. I think it will come back.
I think the key thing is that we have to, as a society, start addressing the panic and fear that we’ve caused about COVID. And once that recedes, people’s normal values, normal ethics, normal desire for normal life will return. And I think a lot of the pathology we’ve seen has to do with fear, like with the primal fear of infectious disease.
Mr. Jekielek: So when you say the liberal social order is kind of on life support, are you talking about what we’re seeing, for example, in Australia? Are you talking about what we’re seeing here? Like dig into that for me a little bit here.
Dr. Bhattacharya: Sure, well, Australia is an extreme example. They effectively are not a liberal democracy at this point, right. They’re essentially under martial law. And even if they are able to get rid of the case surge that they’re currently experiencing, they will live under the threat of martial law forever if their goal is to rid themselves of COVID, because it’s not possible. The expats can’t return.
Sydney is divided into military zones effectively where you can’t go more than a few miles outside of your house or mile or two outside your house. You can’t even visit your relatives across a fence. You know, same thing with Melbourne. I think they’ve effectively, quarantine camps that they built for forced quarantines of people who happen to turn up positive.
It has the trappings of a liberal social order, but it’s not actually liberal social order, right? It’s structured around the control. All of society is structured around the control of one virus, and that’s it.
The United States, in effect, you know, again, we had an election, which is an amazing thing during a pandemic, but much of American policy has not been conducted by politicians. It’s been conducted by the science class—you know, a class of scientists. And the politicians have essentially said, I’m gonna relegate the powers I have off to these scientists who are advising me, and we’re gonna follow the science, right?
What does it mean other than I’m gonna abdicate my responsibility as a politician to this group of experts and I’m gonna do whatever these experts say? I think that is not a liberal social order. What that is is very different than that. Again, I would call it a biosecurity state aimed at control. Now it has not been as extreme as Australia, but that’s essentially what we’ve had the last 18, 19 months.
Mr. Jekielek: But one would hope that politicians would go to experts, right, and not just make decisions for purely political reasons, so.
Dr. Bhattacharya: It’s funny. There are some politicians like Ron DeSantis [and] I think Pete Ricketts in Nebraska. There’s a few that have looked to other experts. I think in the United States, there’s been some pushback against this. Many states have said, no, that’s enough. We’re not gonna have a lockdown. We’re gonna keep kids in school and have worked very hard toward that end.
But I think a lot of politicians when faced with a crisis like this, where they don’t actually have very much expertise, they need to be able to say that they did everything they could. And you have a certain set of scientists giving them, offering them up for free, essentially, a pass. If you follow this policy, no matter what the outcome is, you’ll have done the right thing, right?
You hear Dr. Fauci saying this all the time; this state did the right thing, the state didn’t do the right thing. That’s catnip for a politician. They can offload the risk of whatever policy choice they make to the expert class. Well, they told me to do it, therefore it’s the right thing to do. No matter whether you have a catastrophic outcome like nursing homes in New York city exposed where you’re overrun with COVID patients because you sent COVID infected patients back there. Well, the experts told me to do it, right?
You have this situation where, I mean, politicians want to offload a responsibility over a risk that they have very little experience dealing with, and a group of scientists giving them ready-made action items that they can then just say, “Oh, look, I’m following what the experts have told me to do.” A politician, their job is to essentially reflect the will of the people, and if they do a good job with that, they get reelected or there’s some check and balance, right.
The advice I would give to politicians is, surround yourself with scientists who disagree with each other and make your own choice because science can help guide; sort of guide like if I do A, B might happen, right? Maybe one scientist says B will happen or another says C will happen. You can say, okay, there’s a range of possibilities. But should I do A? What will the public think if I get B or C? What does the public actually want? Does the public actually want to have kids out of school for a year and a half? Is that a thing that I can go to the public and say, look, I’ve done a good thing. You have to reflect the public will.
The politician, in a sense, engages in trade-offs between goods, right? I want my children to go to school. I want COVID control. I want cancer screening. I want a whole bunch of things. And we can’t always have all of them. And the political system helps navigate those goals. You can’t avoid that, right? I think the nice thing about the liberal social order is there’s checks and balances to it. In a biosecurity state, like we kind of have had, essentially there is no check. Who voted for Dr. Fauci?
Mr. Jekielek: So you and other public health officials that have, let’s say, differed from the establishment perspective or as some people would call it, the orthodoxy, have been criticized quite a bit. Most recently, very, very heavily in this BMJ, “British Medical Journal”, opinion piece. I don’t know what you’d call it. It’s not a scientific paper. I want to give you a chance to kind of respond to this because it’s pretty serious what’s being alleged there.
Dr. Bhattacharya: Yeah. So the “British Medical Journal” is an excellent scientific journal, but it has a blog where apparently the standards are much lower than in the scientific part of the BMJ. They published a piece filled with, I don’t know any other word to say it, but essentially lies about the support for the Great Barrington Declaration—the funding. It was not just lies, but lies designed to excommunicate people who think along the lines of the Great Barrington Declaration from the scientific community.
For instance, the Great Barrington Declaration was signed in Great Barrington, Massachusetts at a think tank called the American Institute for Economic Research. Now, they invited us for a conference there, it actually surprised them that we came up with this, it wasn’t part of the plan. The Great Barrington Declaration is our—my, Senator Gupta and Martin Kulldorff, that’s our plan, not the AIER plan. I think they like it, but that’s neither here nor there.
None of us were paid to do it, to write it. None of us have received any money whatsoever for it. And so this BMJ blog makes allegations about funding, which are utterly false. Like for instance, Scott Atlas actually says he’s an AIER employee, which he’s not. He’s not affiliated with AIER at all, which is again a lie.
It has all kinds of allegations about how AIER has support for climate change denial or tobacco, all of which, the folks at the AIER are telling me is false. It has allegations about connections with shadowy right-wing groups. I mean, it frankly reads like a conspiracy theory to me.
The whole thing, it’s a farrago of lies. And, frankly, you know, like people when they don’t have a good argument against the merits, they resort to things like this. And I think that’s essentially what’s happened here.
The only shocking thing is the BMJ, the “British Medical Journal,” which is a very respectable journal, published it. And from which I can only infer that there’s something about the scientific orthodoxy that’s nervous about the ideas of the Great Barrington Declaration and these other alternative approaches.
Put it this way, it is very clear that the lockdowns have failed. They’ve utterly failed to control the viral spread. You cannot look at lockdown as a successful policy. We haven’t even begun to talk about the collateral harms from that which are enormous, catastrophically bad. That was the scientific orthodox. I don’t think it was actually a majority of scientists, but a small number of scientists who took control of the mouthpiece of science said, “Look, this is what we must do.”
And they got their way in almost every country, in almost every state, and it’s utterly failed. And now they need some excuse for why it didn’t work. They need some scapegoat to say, well— And they’re trying to make us into the scapegoat for why the policy recommendations that they gave failed because they don’t have any actual substantive argument they’re instead using these ad hominem smears, straight up lies to try to make their case.
[Narration]: 10 Days after the BMJ article was published, it was updated with several revisions. Instead of saying billionaires funded them, the article now says [they] provided support. Instead of saying the Great Barrington Declaration was sponsored by AIER, which is described as a climate denialist think tank receiving money from the fossil fuel and tobacco industries, it now says the Declaration quote “arose out of a conference hosted by AIER.” And finally, instead of saying Dr. Scott Atlas worked for AIER, it now says he was a contributor. When we reached out to BMJ, they told us it stands by the piece, but acknowledged it had made a small number of clarifications to the article, which BMJ argues do not materially change its arguments.
Mr. Jekielek: So, I mean, what are you hoping for? Are you hoping to be able to have a robust exchange, intellectual exchange on these issues? Are you unable to do that? And what is the reality of this?
Dr. Bhattacharya: Yeah, I think there has been robust, some—like one of the main goals of the Great Barrington Declaration actually was, in addition to changing the policy, was to open up the range of scientific discussion and to show people, the public at large, that science had not reached a consensus that the lockdowns are the only thing we could do.
In fact, there were a lot of scientists I knew who were deeply uncomfortable with the lockdowns even before the Great Barrington Declaration. And in that I think we succeeded, we opened up the discussion. Many scientists have spoken up. Tens of thousands signed the Great Barrington Declaration itself; doctor or scientist arguing that they had reservations about the lockdowns.
So I think that hope has happened, like we’ve started… And, you know, I also wanted engagement with the other side, right? So, for instance, we wrote in October, before the vaccines, what I had hoped for was engagement with people in public health to help think about how to protect the vulnerable, because that’s a very local thing, right?
Depends on the living circumstance of the vulnerable elderly, which may differ in Peru than it might be in the United States. Most generational homes, nursing homes, care homes have a very different set of policies. And you really need the engagement of local public health in order to be able to do that. That’s what I was actually hoping for.
Instead, we got this ideology, this let it rip nonsense where the idea was the only thing that could protect the vulnerable is lockdown, and of course, it failed.
So I think what you’re seeing now with this BMJ piece and some other things is an attempt to rewrite the historical record to make people somehow think that the people that actually control the policy weren’t to blame for the failure of the policy. It’s like a general who loses a war trying to say, well, it wasn’t me, it was the president who didn’t give me enough troops.
Mr. Jekielek: So what is the way forward here? I mean, so you’ve said a zero COVID policy doesn’t make sense for a whole variety of reasons. The lockdown policies have failed, and actually it might be worth kind of recounting exactly how and why. And then there’s this whole, if we would call it like an idea of vaccine mandates that’s being floated in various ways and actually being instituted in some places like say New York City where I live. And so the question is, why don’t we just kind of explore these realities and then try to [find a] way forward here?
Dr. Bhattacharya: I mean, I think we have a fantastic tool to protect the vulnerable—the vaccines. We should work very hard to convince vulnerable people that it’s worthwhile for them to get it. And that involves, for instance, not doing a mandate. A mandate, essentially what it’s done is it created a class of people like the vaccine. The anti-vax movement used to be a small fringe movement on the edge of society. And you know, scientists would obsess over it, or how can they exist x percent, less than 1 percent of people that don’t agree that MMR vaccine is a good idea.
What the vaccine mandates have done, what this entire policy environment has done, including like the denial of natural immunity, for instance, immunity that’s provided by recovery after COVID is it has created a deep distrust over this vaccine. And now that this anti-vax movement, if you will, is 20 percent of the population, 30 percent or it’s some much larger fraction. It’s mainstreamed it.
It’s because people have lost trust in the science. Scientists have made all kinds of promises about the lockdowns, about the vaccines that have not come to pass, right. So, for instance, the promise was that the vaccines will get us to a place where we can more or less not worry about the spread of the disease. Well, of course, that turned out not to be true. Like the vaccine does not stop the disease from spreading. You highly vaccinate a population and still have the disease spread, that’s clear now, right.
The promise was that the lockdowns would protect the vulnerable. Well, that’s turned out to be false. And then the idea was like the reason for the vaccine mandate is there’s not enough people cooperating with us to get vaccinated together. If we have a sufficiently large fraction of the population vaccinated, we would stop the thing.
Now that we’ve created this, essentially, an outclass of people, these unvaccinated people, for whom we can blame for all kinds of things. Remove them from normal life. You know, a lot of them are poor. A lot of them are minorities. A lot of them are working class people who worked through the epidemic. They were the heroes of the epidemic up until the moment they decided, I’ve already got COVID, I don’t know if the vaccine is for me.
I mean, you can argue about whether it is right or wrong from a medical point of view for them, but instead of respecting them, they said, well, you must get it or you lose your job. That’s essentially where we are.
So I think we’ve created this deep distrust in science and in medicine through these coercive policies and these set of failed promises. And I think what needs to happen is we need to work to heal that.
I mean, public health is actually quite an important thing. And having a public health that people can trust is actually important for people’s health. And I think we just, we have to reverse course. I mean, I, frankly, if I were in charge of the CDC, I would just apologize for the enormous mistakes that public health has made over the last 18 months and seek to start anew—seek to get trust of the public.
And I think that has to be the beginning of it, like some acknowledgement that things have gone deeply wrong rather than trying to scapegoat, to take responsibility, that the orthodoxy that promoted these lockdowns, that oversold the vaccines, instead of using them for focused protection, promising, essentially, zero COVID with them. They should acknowledge that immunity after infection actually exists, acknowledge their errors, and then try to start over.
Mr. Jekielek: And, just okay, for the record, with respect to lockdown policies, you said they’ve unequivocally failed. It’s abundantly clear. Explain that.
Dr. Bhattacharya: Well, take the nations and states. I’ll just give you a very, very simple example, right. So Florida has essentially opened up entirely in September of 2020; mostly opened up in May of 2020. Have not followed a lockdown policy. Didn’t close businesses. Didn’t close schools. Many places in Florida didn’t mandate masks.
So in schools in Florida, actually, like half the schools in Florida, more than half schools in Florida didn’t require a mask during the year or allowed parents to opt out or whatever, right.
So what you had is essentially like an AB test. You have Florida which followed a much more… Well, at the same time they also followed a focused protection plan, protecting nursing homes; before the vaccine, moving resources into nursing homes, to test staff, reducing staff rotations, working to provide resources so that the older people that live in Florida could avoid being infected during high seasons of COVID.
On the other hand, you have New York, New Jersey, Pennsylvania and California that followed lockdown policies. Well, which had better COVID outcomes? Well, it turns out Florida did. Florida had lower risk adjusted death rates from COVID than California did. Even now, even after the recent summer surge in Florida in cases and deaths which is shocking, right, but it’s true.
You also had more equal outcomes. For instance, in California, it’s the Hispanic population that has borne the brunt of COVID. A disproportionate number of deaths in COVID in California have come in the Hispanic population. In New York, it’s the black population that had disproportionate number of deaths from COVID—the working class people in each of these states.
In Florida, there is no discordance between the deaths from COVID by race and the population representation. COVID was an equal opportunity killer in Florida. There were less age-adjusted death rates in Florida, whereas in a lockdown state, you had this incredibly unequal outcome by race and income and also the worst outcome in terms of deaths.
Mr. Jekielek: Fascinating. I mean, it’s— You’re basically saying that Florida, because of its policies, has the more equitable outcome, to use that term. So something that has been talked about a lot, but I don’t think is terribly well understood is this idea of herd immunity. And it seems like with any virus that’s circulating, the population will get to herd immunity at some point. But tell me about herd immunity with respect to COVID.
Dr. Bhattacharya: Sure. It’s actually not true that every virus… Well any virus that induces immunity at all. You recover from it and you’re immune will have herd immunity at some point, right? So [with] HIV, you don’t get herd immunity. But COVID, if you’re infected with and recover from it it produces immunity that is actually quite durable. So the estimates are one year, something like 0.3 percent of people are reinfected after they’ve recovered from COVID. Okay.
So herd immunity is a very simple idea. It’s that at time T right now, every person who gets COVID infects one or fewer additional people. So if I get COVID, I only infect one person or fewer than one person on average. What that means is that the disease will decrease in prevalence and it’ll decrease in incidence. So whenever the case counts are coming down, you’re actually in herd immunity.
Herd immunity is not a synonym for zero COVID. I think that is the problem many people have had in thinking about herd immunity. It’s not a synonym for the disease has gone away, we never have to think about it again.
A society can go in and out of herd immunity. During the high COVID season, the winter, you actually, a smaller fraction of the population. You start getting cases that are going up because the herd immunity threshold actually goes up. You need a larger fraction of the population actually immune in order for the cases to start coming down again and vice versa.
During low COVID season, even a small fraction of the population is immune means that the disease won’t spread very much because you’re above the herd immunity threshold very quickly. So what you have is a situation where when the disease first entered the population, no one was immune, and it spread very, very rapidly because every person that got it spread it to two, three other people, right.
You can have variants that are more transmissible. Supposedly Delta’s more transmissible, which makes it so that even when you have a certain fraction of the population immune, you get a new variant. Well, because it’s more transmissible, you need a larger fraction immune for the disease not to grow.
But what’s happened over time is a larger and larger fraction of the population of different countries have become immune by dent of natural infection and recovery. And so it will become more and more difficult for the disease to spread very rapidly and widely to be an epidemic the same way it was in 2020.
Actually, there’s another sort of irony in this. The World Health Organization, when we wrote the Great Barrington Declaration, changed the definition of herd immunity on their website. They said that it’s immunity in a population, if I’m trying to get it exact, but essentially it’s an immunity in the population created by vaccines. They erased the natural immunity part of the definition.
After protests, they put it back. They said both vaccines and natural immunity can contribute to herd immunity.
Ironically, the vaccines seem to protect against transmission for only a short time, and certainly incompletely. So that means natural immunity is going to be the more important contributor to herd immunity when it happens.
Now, let me just tell you what it’ll look like. It won’t look like the disease is gone. During high COVID season the disease will return. During low COVID seasons it’ll go back down again. And disease will continue to spread in the population over and over. People are likely to get COVID more than once in their lifetime, just like they’re likely to get other colds more than once in their lifetime. The good news is that the second, third, fourth times you get it your body remembers how to deal with it, and it’s likely to be much milder than the first time you got it.
So learning to live with COVID is not as scary as you might think. It’s better the first time you get it to be protected with the vaccine because the vaccine blunts the worst of the disease, you know, death and hospitalization. But I don’t envision a future where you have to get boosters over and over and over again because such a large fraction of the population has already had it, and therefore has pretty effective protection against severe disease if they get reinfected.
Mr. Jekielek: Well, so this is exactly what I was just about to ask. Is this idea of a booster is an attempt to compensate for the vaccines being not as effective as they were supposed to be? I don’t know if that’s the right way to put it, and now we have this situation where a couple of FDA officials have actually resigned as a result of, sort of—directly as a result of the interest in introducing boosters, right.
Dr. Bhattacharya: Yeah. Normally if you’re going to recommend a vaccine or a booster at population scale, you need excellent randomized trial data. With the vaccines, we got them actually, pretty good trials, not perfect, but pretty good trials conducted in record time last year.
With the boosters, we have nothing like that. There is no trial data whatsoever that I’m aware of in support of a booster. And so that is why you had a lot of reluctance at the FDA, who’s responsible for safety and efficacy saying, well, where’s the data that shows that we need it, that it will be effective, that it’s safe. What dosing should there be? How much interval should there be between the last time you got a dose? What about people who’ve already got COVID in between getting a breakthrough infection, do they still need a booster? Are there contra-indications?
All kinds of questions you would want answered, because doctors are going to get those questions. They should have data to be able to answer for patients. So it’s not surprisingly the FDA balked at it because we don’t have answers to those questions yet.
Mr. Jekielek: Well, it seemed like these resignations actually led to a change in policy. It’s interesting, isn’t it?
Dr. Bhattacharya: Yeah. Well, I think the folks who resigned in essentially, protest over the political pressure the FDA was facing—they’re people of very high integrity. And I mean, I am incredibly proud to count myself among these scientists. If that’s what scientists are like then I’m proud to count myself as a scientist.
I think they have a job of protecting the public by only saying yes to drugs and therapies that have a lot of solid evidence behind them— safety and efficacy.
And I think it’s appropriate that the FDA be careful about this. The vaccines, I actually am very strongly in favor of them because the data behind them, when the FDA approved them, was so strong. Like we had excellent trials, large ones conducted in record time.
That is not true for these boosters. I don’t know if the boosters are necessary. They may be necessary, but let’s see the data. Let’s develop the data before we launch it at population scale.
Mr. Jekielek: Well, okay. It’s really clear that you’re an advocate for the use of the vaccines around the vulnerable, but there’s also risks around the vaccines. There’s also all sorts of unknown risks because they’ve only been around for so little time. There was just a headline recently about Pfizer basically saying that it has completed some trials that show efficacy in children, is it five to 12? I can’t remember right now, but something in this vein. We haven’t talked about this side of the equation, right—the risks.
Dr. Bhattacharya: Yeah, so there are risks just like with any medical treatment. They’re always benefits and side effects, right? So in any medicine, medical treatment, you’re always balancing and asking whether the benefits are worth the risks. And what we’ve seen from the safety data for the vaccine thus far, is that for certain groups of people, certain ones of the vaccines have some risks associated.
For instance, the mRNA vaccines, the Pfizer and Moderna vaccines for young men and boys, there is a risk of myocarditis. Myocarditis is inflammation of the heart, and it can be severe; maybe somewhere between one and 3000 and one in 10,000, I’ve seen estimates, boys and young men who get the mRNA vaccine will have myocarditis. A 12 year old shouldn’t be getting myocarditis. I mean, that should never happen, right? So that’s a severe outcome, but it’s rare.
I can see a parent saying, I don’t wanna take that risk because the risk of COVID in a young child is actually quite low, right? The death rates are incredibly low from COVID. I mean, thank God, right? And at the same time, the myocarditis risk is very low. The hospitalization risk from the vaccine may actually be higher for the child from myocarditis than from COVID.
But we’re talking about risks that are very low on both sides of the equation with a great amount of uncertainty around both. So it’s a very challenging choice to make. And I think it should be something left to the doctor and the parents talking about what’s in the best interest of the child.
We don’t need to vaccinate children in order to get to the end state of COVID. By vaccinating the old, by protecting the old, children don’t pose any risk any longer to grandma, because grandma’s already protected as best as she can be by the vaccination that she had.
Mr. Jekielek: So why are there vaccine trials being done with children?
Dr. Bhattacharya: I mean, I’ve wondered that. I think initially the idea was we need to vaccinate the entire population to stop the disease from spreading. I think that was, in effect, what the policy was. If we vaccinate a sufficiently large number, the disease will stop spreading in the population. The vaccine does not stop disease spread after a certain number of months, a small number of months, and so that’s gonna fail.
Even if you vaccinate the young, if you vaccinate children, you’re still going to get the disease spreading through the population as the vaccine is not good at stopping disease spread.
So to me, the only question on children is, is it good for children to be vaccinated for themselves because the effect on others is much less important because it doesn’t do that. In a sense, the vaccine, because eventually, very quickly becomes something that stops serious disease, but doesn’t really stop infection and probably not transmission.
After a certain amount of time, it becomes a private matter rather than a public matter. So that’s how I’m thinking about vaccinating children. It’s not essential to stop the spread of COVID to vaccinate children because the vaccine just doesn’t do that very well after a certain amount of time.
So the only question is, [is] it good for children? And that’s, you know, you have to have good data. When you have a disease that is as mild as it is for children, almost any side-effects whatsoever would militate against giving it to children, I think. Whereas for older people, you have a disease that’s quite deadly, and you’re willing to accept some more side effects, right? That’s always the balancing act in medicine.
Mr. Jekielek: Well, and then there’s also all sorts of other side effects that are being reported, especially in the VAERS system. And at the same time, there’s also risks that we simply don’t know about because of the very short amount of time that these vaccines have existed. They just haven’t been studied, right?
Dr. Bhattacharya: So first let me say, I think these choices about whether to be vaccinated or not should be an individual choice. It shouldn’t be coerced or forced. I mean, this is a new vaccine. There are uncertainties about what the long-term effects are because we just haven’t had them for so long. There are also uncertainties about what other side effects that happen even in the short run because the time it takes to evaluate them is actually—it’s not an immediate thing.
As we just talked about, there are some side effects in young people for myocarditis, and actually for the adenovirus vaccines there was a rare but serious side effect of blood clots, especially in women, older women and middle-aged women that was a cause for some concern.
So I think the systems are set up. The FDA and the CDC have systems set up to try to detect these kinds of side effects. And I think they’re working very hard to try to do this. The VAERS system is only one system, and it’s the most public facing system. It’s the system that happens when, if I take the vaccine and I get some side effect, I can report it to VAERS. My doctor can report it to VAERS that I had this side effect. Usually it captures side effects that are immediate right after the vaccine because seven months later you’re not gonna report a side effect.
The VAERS system is used to generate hypotheses that then are looked at more carefully by other systems both the CDC and the FDA cooperate in using. And the technical challenge is you need control groups. You need to know what would have happened if the person hadn’t got the vaccine, and so that’s much more challenging.
You can’t use just reports in VAERS to do that because the VAERS doesn’t tell you what the expected number of myocarditis cases would be if you didn’t have the vaccine. In children, it would be pretty close to zero, right.
On the other hand, you take the vaccine, you’re 70 years old, you have a heart attack. Well, a lot of 70 year olds have heart attacks. Just because you had a heart attack right after the vaccine doesn’t mean the vaccine caused it necessarily. So you have to do very careful work.
When you have a common condition, like a heart attack in a 70 year old, you have to do a lot more careful statistics work to tease out the signal of increased heart attacks from the noise, if there is—we don’t know. And it just takes more time and care to do that than you can do just with a very simple analysis of the VAERS data.
I’ve worked with vaccine safety for a decade with the FDA. They have very careful scientists that care very much about not harming the public at work at the FDA to try to find these things, and it’s a technically challenging thing. To the public I would say that it is possible that there are side effects that we don’t know about. It’s absolutely possible. You have to balance that uncertainty against getting COVID and the harm from getting COVID if you’re older.
I would recommend that you talk with your doctor about it to help balance it. That’s how we normally deal with this. And I would recommend to policymakers and epidemiologists, don’t force people to get something against their will because they’ll end up distrusting you, and they’ll end up distrusting public health at large, and they’ll have very good reason to do that.
Let’s return to normal order. Let’s have people discuss with their doctors the risks and benefits and make decisions for themselves about the vaccine and so much else. And for public health, stop using coercion when persuasion is the more appropriate tactic.
Mr. Jekielek: So, well, let’s talk a little bit about therapeutics because this is one of these areas [of concern]. There’s been at least one that has been shown very kind of robustly to be effective—the monoclonal antibodies. And there’s also others which have shown some effectiveness in isolated cases, but certainly not in any broad studies that I’m aware of.
Dr. Bhattacharya: So this has become like a poisonous area to talk about weirdly, right? I mean, like therapeutics are supposed to, that’s what doctors do is like we have good vaccines, but we need better vaccines. But we have pretty good vaccines, amazingly enough, after a year and a half of the thing. But we also have developed a suite of tools that are not controversial that are quite effective, actually.
So you mentioned monoclonal antibodies, right? So somewhere on the order of if you get it within the first five days of symptoms, it can cut hospitalization rates by 70 percent, 60 percent, 80 percent somewhere in there depending. And even if you’re hospitalized, it can actually save your life under certain circumstances.
President Trump actually got them. I suspect it might have saved his life. So you have monoclonal antibodies. You have vitamin D which actually has a lot of solid evidence, not particularly controversial, as a way to sort of prevent [and] to blunt the worst of COVID if you should get it. If you’re hospitalized, there’s things like dexamethasone, a steroid, that can reduce the likelihood of severe pneumonia and sort of immune dysfunction. It’s to sort of blunt the immune response, the over-reactive immune response that can kill you.
There’ve been, and I can go on with some others, but the point is that there are now a suite of well-tested interventions that will reduce the likelihood of you dying if you were to get COVID. Much better than in March of 2020, right. That’s actually really good news. The shocking thing to me is that we don’t have more.
What happened with hydroxychloroquine was terrible. Essentially, President Trump says, “This is a drug that’s going to work.” And as a result, the entire community of scientists closed its mind to it, to test it. Now, I think there’s been some studies now which have convinced me that it probably doesn’t work, but it deserved a trial, like an open trial.
Another drug like this is ivermectin. There’s now two competing meta-analyses. There’s a whole bunch of randomized trials that have been conducted outside the United States. And you know, it might be that it works in some situations. It doesn’t work in others. I don’t know, but it’s a scandal that I don’t know.
The NIH should have been funding large scale studies of these small molecules, small off-patent molecules that looked promising so that we can answer the question of whether they work or don’t work rather than demonizing them. I think the FDA had a tweet where it called ivermectin, which is actually a great drug for onchocerciasis cases. We rely on this for all kinds of human diseases. They called it horse medicine.
Mr. Jekielek: Which it also is.
Dr. Bhattacharya: Like it’s essentially, it’s again, is a propaganda tool to discourage people from using it rather than encouraging a large-scale trial evaluation of it because it looks so promising in certain such situations. I don’t really understand this resistance to develop therapeutics.
Like one theory I’ve seen is that people are discouraging it because they don’t want people to think that they don’t need the vaccine, but that doesn’t make sense to me. The people who didn’t get the vaccine, well, they deserve good treatment if they can get it. And people with the vaccine can also have cases, and they also may need early therapy.
Mr. Jekielek: Like yourself.
Dr. Bhattacharya: Yeah, right, so everyone benefits from good information about what early therapeutics work and which ones don’t. So I think it should be an all of the above approach.
You know, one of the shocking things to me, it’s like I have been sort of an unofficial advisor to Governor DeSantis in Florida. Early in the summer, he called me up and asked me what I thought about these monoclonal antibodies. And, you know, I told him what I just told you. That there was very promising trial data that worked really well, and I was surprised they weren’t being used more.
So he actively sought to promote the use of monoclonals. Blunted a lot of the harm that the Florida surge would have had. Developed strike teams so that if you call and say, “Look, I just got my day three of my symptoms,” they’ll send someone to your house and give you monoclonals. In California, it’s hard to. You have to call. You have to find a one 800 number. I get all these emails from people not knowing where to get it. It’s difficult to get.
The federal government bought them. People don’t have to pay anything for them out of pocket in most places. We should be promoting them as a way to address breakthrough cases and also cases that happen when you’re unvaccinated. I think you save a lot of lives that way.
Instead, what happened is that the White House cut the allocation of monoclonals to Florida by 50 percent this past week citing something called, what they said, temporal equity. They want to save the doses for the surge that they’re anticipating in the Northern states this winter.
Well, that’s ridiculous. It’s needed in the South now, why not just order more? Manufacture more, so that when the Northern surge hits, which it might hit, we’ve produced more by then. It makes no ethical sense to me, right. We should not, as a matter of policy, be withholding drugs from the people that need them most.
Mr. Jekielek: So, I want to go back to talking a little bit about the future here, as we finish up, and your sort of optimistic vision of it. You know, I can imagine based on everything you’ve told me that some combination of vaccines and therapeutics is the way forward.
Dr. Bhattacharya: I’m actually optimistic. I think if you look at what’s happened in terms of scientific advances in the last 19 months. It’s actually absolutely extraordinary, right? We’ve taken a disease we knew nothing about, and we’ve produced several great vaccines for it. They’re not perfect. They don’t do exactly what that promise, but they’re quite good. And I believe that we’ll have more advances on that front.
We produced a few good therapeutics for it. So it’s no longer the deadly disease that it once was. And I think again, on that front, we’ll have quite a bit more advances in coming days. So I think on the one side, the scientific facts, the medical facts suggest that the disease is no longer the threat that it once was. It’s still a serious disease we should take seriously, and especially for the older population, but it’s not the March 2020 threat that everyone panicked around.
At the same time, we have this restructuring of our society around infection control that I just don’t believe can last, right. People don’t really wanna live like this. The only thing sustaining it is fear. It’s fear and recollection of the panic of March 2020 that’s lingered on and created this ridiculous political dysfunction.
And the other side of that, if we get to the other side of that, after we’ve addressed the fear, and we can talk about how we might do that is the liberal social order. We can get back to arguing about the deficit or with one another. I mean, that’ll be great fun for everyone, right?
I think that return of normal politics will happen once the fear is addressed, and actually it’s interesting, because I think I actually see a reshuffling of the political, the normal political order. Alliances made between groups of people that otherwise wouldn’t have aligned. They found themselves sharing values they didn’t understand that they shared. And I think that that will be really interesting to see once we’re on the other side of the fear.
You’re looking at me like I’m crazy, but I don’t think so. I think that fear can be addressed. I think it can be addressed, but it has to take a conscious choice by public health to tell people the good news about the efficacy of the vaccine against severe disease, the availability of therapeutics, and to remind people that living in fear can actually make your life much less healthy, right?
So sending your kids to school is a healthy thing, not an unhealthy thing, right. I think that public health and politicians together need, and the media, all together telling people the good news will address that fear. We just have to make a decision together that that’s the right thing to do.
Mr. Jekielek: Well, Dr. Jay Bhattachrya, it’s such a pleasure to have you on again.
Dr. Bhattacharya: Thank you.
This interview has been edited for clarity and brevity.
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