The 5 Stages of Anti-Vax Angst: A guide

Last week the Biden administration was criticized for making some harsh statements about those who refuse to be vaccinated. “For the unvaccinated, we are looking at a winter of severe illness and death — for themselves, their families and the hospitals they'll soon overwhelm. But there's good news: If you're vaccinated and you have your booster shot, you're protected from severe illness and death,” said Biden.

That statement came in for much criticism on social media, especially by those who took the statement out of context. “You’re not going to convince anyone to get vaccinated with such harsh language,” some scientists complained.

Well, true. But as someone who’s been fighting the anti-vaxxers for years, I recognized the Biden team’s statements as Stage 3 of what I’m calling the Five Stages of Anti-Vax Angst. I understand their frustration, because I’ve been there myself. Let’s go through these stages, shall we?

Stage 1: Disbelief. I first encountered the anti-vax movement, in the early 2000s, when I was leading a research project on sequencing the flu virus (here’s one of our papers), and a reporter asked me, quite seriously, if the flu vaccine could cause autism. Huh? I thought. “Well no,” I reassured him, “where’d you get that idea?” I soon traced the source of his concern back to a now-notorious Lancet paper by Andrew Wakefield, which turned out to be fraudulent and was eventually retracted.

Surely, I thought, the solution is simply to educate people better, and to explain that vaccines are the single greatest medical advance in the history of medicine. With better education, the anti-vax movement will quickly fade.

In Stage 1, vaccine advocates simply can’t believe that significant numbers of people believe stuff about vaccines that simply isn’t true. Alas, though, they do.

Stage 2: Frustration. Unfortunately, merely writing articles explaining the benefits of vaccines is not nearly enough. Officialdom (government agencies like the CDC and NIH) constantly issues statements about the benefits and safety of vaccines, such as this CDC website. Scientists and physicians have written hundreds of articles and countless books explaining how beneficial vaccines are, to no avail. For example, renowned vaccine expert Paul Offit wrote an outstanding book warning of the dangers posed by the anti-vaccine movement, called “Deadly Choices: How the Anti-Vaccine Movement Threatens Us All.” That book appeared all the way back in 2010, and yet look where we are now.

Just a year after Offit’s book, journalist Seth Mnookin published “The Panic Virus,” an excellent exposé of the fraud behind Wakefield’s original paper, and on how the anti-vax movement has been aided (often unwittingly) by popular media personalities.

What these books and others reveal is that the anti-vaccine movement is loud, committed, and (unfortunately) highly influential. For every article or book written by a clear-headed vaccine advocate (and there are many!), there are multiple articles and books promoting wildly inaccurate claims that vaccines cause harm. Trying to refute these claims is like playing whack-a-mole.

Scientific bloggers have learned that no amount of patient explanation can get through to some people, and the anti-vaxxers just won’t quit. Eventually, some of them move on to Stage 3.

Stage 3: Anger. This is where the Biden administration finds itself. After months or years of explaining, pleading, and even begging people to get vaccinated, the crazy, irrational, and often angry opposition of anti-vaxxers (or the “vaccine hesitant,” to use a kinder term) can be just too much.

Some people take a long time to reach this stage. Dr. Anthony Fauci, director of NIH’s infectious disease institute (NIAID), has been the public face of the government effort to get people vaccinated for all of the past year. He’s been subjected to inexcusable vitriol, including death threats towards him and his family, and he continues to try to convince people that vaccines are safe and effective. It’s a tough and thankless job. Dr. Peter Hotez, a vaccine expert at Baylor College of Medicine, has been tirelessly explaining the benefits of vaccines throughout the pandemic, and he too has been subjected to awful, hateful attacks. (Dr. Hotez also wrote a highly personal book a few years ago, explaining why vaccines didn’t cause his daughter’s autism.)

Neither Dr. Fauci nor Dr. Hotez has reached Stage 3, but I wouldn’t blame them if they did. Some public-health experts have, though, and one can see why: after trying for months to get people to do something that reduces their own risk of deadly disease, only to meet defiance, one might say “I’m done. You all can just go ahead and get sick.”

Or, as the FDA’s Twitter account responded in exasperation a few months ago, to the never-ending insistence that ivermectin, can cure Covid-19: “You are not a horse. You are not a cow. Seriously, y'all. Stop it.” (Ivermectin is a de-worming agent for horses. It does not work against any virus, including the one that causes Covid-19.)

The comments on Twitter can be far, far harsher. So when Biden warned that the unvaccinated “are looking at a winter of severe illness and death,” I can’t blame him. After all, he’s right.

Stage 4. Persistence. For those who get past Stage 3 (or skip it entirely), there’s a realization that even though some anti-vaxxers are simply beyond reasoning with (I’m looking at you, Robert F. Kennedy Jr. and Joseph Mercola), that doesn’t mean we can’t fight back. We have to recognize that misinformation is out there, and that some people will continue to spread it no matter what we might say. But there are strategies that work to convince others to get vaccinated, and we have to keep trying. That’s persistence.

For example, a study early this year showed that just a dozen people were responsible for a large majority of the vaccine misinformation across most of social media, including Facebook, Twitter, YouTube, and Instagram. I and others have called for social media companies to de-platform these harmful individuals, which could go a long way towards slowing down anti-vax propaganda. Let’s keep trying.

Another strategy, illustrated by Paul Offit’s 2010 book, is to reveal how anti-vaxxers often profit from their misinformation. Some anti-vaxxers have gotten wealthy selling supplements and “alternative” medicines, promoting them with bogus claims that the supplements can substitute for vaccines. If we raise awareness that these quacks are profiting from the spread of misinformation, that can help raise skepticism about their claims. Getting someone to ask questions themselves–to think critically, in other words–is often the best way to get them to reject the arguments of anti-vaxxers.

And even though I might seem critical of the efforts by government agencies to educate the public, I still think they should do it. Indeed, they should do far more than they are doing: in addition to providing facts about vaccine safety and effectiveness, the CDC and NIH could work harder to directly counter the myths and misinformation that are constantly circulating.

I’ve been blogging about the anti-vax movement since 2008, even before I started writing for Forbes in 2010 (see here and here, for example). I’ve long ago lost count of how many articles I’ve written, trying to point out the harm caused by anti-vaccine misinformation, and I’ll keep trying. So I’d say I’m still in Stage 4.

Stage 5. Surrender. In the face of stubborn opposition, and sometimes virulent and personal attacks, some people eventually just give up. It’s easier, of course, to stop fighting people who just don’t want your help, and I can’t blame anyone who does. When I call this stage “surrender,” I don’t mean to suggest that pro-vaccination and pro-science advocates ever accept the wildly misinformed views of the anti-vaccine movement. Of course not. It’s just that some people decide they can no longer spend time on what seems an endless battle.

I’m not advocating that we should ever give up. We can’t, because infectious diseases don’t care if we stop vaccinating ourselves.

So those are the 5 stages of anti-vax angst, as experienced by countless medical and scientific professionals who are fighting misinformation.

And here we are, in the midst of another huge peak in Covid-19 infections, with a significant portion of the U.S.–and of other countries as well–refusing to get vaccinated. The unvaccinated may indeed be facing a “winter of severe illness and death,” even though no one wants that. I don’t blame anyone for pointing out what is very likely to happen. And if the winter ahead is indeed bad, then I place much of the blame on a small number of very loud voices, such as the Disinformation Dozen, who irresponsibly continue to promote harmful untruths about vaccines.

Vaccines are the single greatest public health advance in the history of medicine. Vaccines have eliminated smallpox from the planet, nearly eliminated polio, and made many other previously-feared childhood illnesses a thing of the past. We can do the same to Covid-19, if everyone will just get vaccinated.

DNA is safe to eat. RNA isn't bad either.

Have you eaten any DNA lately? My bet is that you’ve eaten lots of it. DNA is not only safe to eat, it’s present in many truly delicious foods.

For example, chocolate has loads of DNA. Ice cream also has DNA, plenty of it. And lest you think DNA is only in desserts, it’s also found in hamburgers, cheese, bread, all kinds of sushi, and a very long list of other foods. Want to know which foods are DNA-free? Keep reading.

(Aside: why am I explaining that DNA is safe? Scientists reading this might say of course it is, what’s the big deal? If you’re among those, you don’t need to read any further. But many people are afraid to eat DNA because they don’t know what it is, and the name sounds a bit scary. In fact, a study in 2016 found that 80% of Americans thought that foods containing DNA should have a warning label.)

DNA contributes pretty much nothing to the taste of your food, which is sort of obvious given that it’s found in so many different-tasting foods. That’s because flavors are a very complex combination of many, many ingredients, and DNA is just one small part of most foods. If you were to purify DNA and taste it all by itself, it would taste slightly salty. If you want to watch someone trying this for himself, check out this video:

So how do we know that DNA is present in so many different foods? The explanation goes like this: all living things–plants, animals, fungi, bacteria, and others–are composed of cells. Almost every cell in a plant or animal contains a copy of its genetic code, and that code is captured by DNA molecules. Think of DNA as a very, very long string of chemicals, or “bases.”

In rice, to choose just one example, each cell contains 12 chromosomes, and each chromosome is a long DNA molecule. The DNA strings in rice add up to about 430 million bases. So when you’re eating rice, you’re eating all of this DNA in every bite.

The wheat we use to make bread has even more DNA: every cell has about 16 billion bases. That’s 5 times more DNA than human cells have! But interestingly, the wheat we use to make pasta, called semolina or durum wheat, has only about two-thirds as much DNA as bread wheat (and only 14 chromosomes instead of 21). But I digress.

Thus any food that is derived from a plant or animal is almost certain to contain DNA, unless the food is processed so much that every cell from the original plant is removed or pulverized to bits, and the DNA is somehow removed (which normal food processing or cooking does not do). There’s no reason to remove the DNA, though, because it’s completely safe.

Pretty much every food that has DNA in it will also have RNA. RNA is safe to eat too! Some people have been concerned lately about RNA, which has been in the news frequently because it is used in two of the most effective Covid-19 vaccines, the ones from Pfizer/BioNTech and Moderna. Of course, injecting RNA into your arm is different from eating it, but both are very safe. (For more about RNA vaccines, see the article I wrote just a month ago, here.)

Now let’s answer a question I posed at the top: what foods don’t have DNA? The list is remarkably short:

  1. Salt
  2. Sugar*

Yep, that’s it. Salt is a mineral, so it doesn’t come from living things. And sugar is a simple molecule, C12H22O11, produced by plants such as sugar cane and sugar beets. The asterisk (*) next to sugar is there because unless the sugar is very pure, some DNA from the original plants is probably present, so even "pure" sugar might not be DNA-free.

And if you want to wash down that salt and sugar with a DNA-free drink, you can’t use coffee, tea, wine, beer, or fruit juice. All of them contain DNA.

Before I close, I should add that DNA stands for deoxyribonucleic acid. To some, the name is cause for concern: after all, “acid” can’t be good, right? Maybe we should call it “nuclein” instead; that was the name given to it by Friedrich Miescher, the Swiss scientist who first discovered DNA, in 1871.

Bottom line: DNA is in almost everything you eat, you’ve been eating it all your life, and there’s nothing to worry about.