Vaccines Show Surprising Link To Reduced Risk Of Alzheimer’s

Well, the anti-vaccine community is not going to like this one.

A growing body of evidence, buttressed by a new report out last month, shows that people who are vaccinated have a significantly lower risk of Alzheimer’s disease.

Yes, that’s right: in addition to the obvious benefit of protecting you from infections, multiple different vaccines have now been shown, in two large studies, to be associated with fewer cases of Alzheimer’s.

How big is the effect? Well, the earlier study, published about a year ago, looked at the flu vaccine. Scientists from the University of Texas Health Science Center, led by neurologist Paul Schulz, collected data on more than 1.8 million older patients from around the U.S., of whom half had received the flu vaccine and half had not. Their average age was 74 years, and the scientists examined health records for four subsequent years to see how many developed signs of Alzheimer’s in that time.

In the vaccinated group, nearly 48,000 patients (out of 936,000) developed Alzheimer’s during the four-year follow-up period, about 5.1% of all patients. That might sound like a lot, but in the unvaccinated patients, nearly 80,000 developed Alzheimer’s. To put it another way, patients who got the flu vaccine had a 40% lower risk of Alzheimer’s, 5.1% versus 8.5%.

It appears this benefit isn’t specific to the flu vaccine, though. In the newer study published this September, the same group from the University of Texas looked at three more vaccines: the Tdap vaccine (tetanus, diphtheria, and pertussis), the shingles vaccine and the pneumococcus vaccine. They were able to collect records on 1.65 million people, among whom more than 500,000 had received one or more of the vaccines. All of the patients were over 65 years old.

Remarkably, all three of the vaccines showed similar and quite significant benefits against Alzheimer’s disease. In an eight-year follow-up period, the risk of Alzheimer’s was 30% lower (7.2% versus 10.2%) in patients who had the Tdap vaccine versus those who hadn’t. For the shingles vaccine, the reduction in risk was 25%, 8.1% versus 10.7%. And for the pneumococcal vaccine, the risk was 27% lower, 7.9% versus 10.9%.

(Note that this study looked at the older shingles vaccine. The newer one, Shingrix, has only been widely available since 2017. The scientists hypothesize that the newer vaccine, because it’s more effective against shingles, may provide even greater protection against Alzheimer’s.)

So how might this work? Is Alzheimer’s caused by an infection, and the vaccines prevent Alzheimer’s by preventing the infection? Well, the short answer is no, probably not. Although we don’t know the cause of Alzheimer’s, we don’t have any strong evidence that it’s the direct result of an infection.

Furthermore, with data showing that at least four different vaccines offer similar levels of protection against Alzheimer’s, the evidence indicates that the effect cannot be specific to the flu vaccine, or the Tdap vaccine, or with any of the other vaccines or their ingredients.

The University of Texas group that published the study speculated that vaccines might work to protect against Alzheimer’s by “long-term reprogramming of innate immune cells,” also called “trained immunity.” This hypothesis is far too complex to try to explain here–and it involves immunology, which I don’t really understand myself and which is “absurdly intricate” as science writer Ed Yong put it. So let’s just say that this is an intriguing idea that needs more research.

And for anyone who thinks that getting an infection and recovering (instead of getting vaccinated) might offer the same benefit, that doesn’t seem to work: another study looked at precisely this question and found no connection between the number of influenza infections and the risk of Alzheimer’s. So the vaccine seems to confer a benefit that the disease itself does not. (I mention this because a popular–but wrong–claim of anti-vaccine activists is that you get better immunity from infection by catching the disease and then recovering. Not a good idea.)

Also, I have to add that these studies report correlation, not causation. So even though the effects are large and significant, we don’t know for certain that vaccines do something to directly prevent Alzheimer’s. Maybe people who get vaccinated also have other behaviors that help them avoid Alzheimer’s–although the study design tried to minimize this possibility.

Vaccines have enormous, extensively documented benefits: they prevent suffering and disease, and they’ve saved countless millions of lives. And now it appears that they offer something else: a lower risk of Alzheimer’s. So if you haven’t received your boosters, now you have one more reason to get them.

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.

The FDA needs to approve the COVID-19 vaccines. Right now.

I’ve spent untold hours fighting bureaucracy during the course of my life. Sometimes the issues are big, sometimes small, but I often get incredibly frustrated when I see organizations–and the people who work for them–enforcing rules without thinking, often to the detriment of everyone involved.

Usually, though, bureaucratic rules are little more than annoying time-wasters. They don’t usually cause actual harm to people. Right now, though, the FDA’s failure to fully approve the Covid-19 vaccines, and its rigid adherence to its own rules, is not just wasting time. It’s killing people, albeit indirectly.

The FDA needs to approve the Covid-19 vaccines, and they need to do it now. They claim to be working hard on doing just that. The vaccines have already been administered to hundreds of millions of people, and the ones used in the U.S. and Europe have proven to be remarkably safe and amazingly effective. So what is the FDA waiting for? Well, according to them, they have to wade through the paperwork.

As nearly everyone knows, here in the U.S. we have three approved vaccines against SARS-CoV-2, from Pfizer-BioNTech, Moderna, and Johnson & Johnson. The first two are messenger RNA (mRNA) vaccines, an innovative design that is strikingly effective, reducing the chance of infection by over 90%.

The U.S. now has an ample supply of vaccines, but we are struggling to get everyone vaccinated, in large part because so many people are either hesitant to get the vaccine or downright opposed. Let’s leave aside the blatant anti-vaxxers for today, many of whom are so deeply misinformed that changing their minds is probably impossible.

A much bigger problem, and one that we can fix, is the far larger number of people who are waiting for the vaccines to get full FDA approval. Not only are many individuals waiting, but many large institutions, including the U.S. Defense Department, have announced that they will mandate vaccines for their personnel once the FDA formally approves them.

Right now, the 3 vaccines in the U.S. are only conditionally approved, under the FDA’s Emergency Use Authorization (EUA). The fact sheet that the FDA provides with these vaccines includes a number of caveats, and states that “there is no FDA approved vaccine to prevent Covid-19.” That statement is not, to put it mildly, very convincing.

Full approval requires the FDA to review “hundreds of thousands of pages of documents,” a process that usually takes 10 months, or maybe six months for a “priority” application. Pfizer only submitted its paperwork on May 7, and Moderna on June 1, so even the FDA’s priority process would leave us without an approved vaccine until the end of 2021. That’s just too long.

I’ve heard the FDA’s excuses. The FDA’s Director of Biologics, Peter Marks, explained in a letter to the NY Times that

“any vaccine approval without completion of the high-quality review and evaluation that Americans expect the agency to perform would undermine the F.D.A.’s statutory responsibilities, affect public trust in the agency and do little to help combat vaccine hesitancy.”

Sorry, Dr. Marks, but these excuses are nonsense. The Covid-19 vaccines have been rolled out with unprecedented speed, it’s true, but we’re now seeing the results of a real-time, real-world experiment on hundreds of millions of people, and–luckily–the results are great! Have you and your colleagues at the FDA not noticed this?

Furthermore, everyone knows that the vaccines will be fully approved in the next few months, and multiple government officials, including the President, have said so quite openly. So why not approve them today? Because you have to follow a set of bureaucratic rules that were not designed for a pandemic?

The virus doesn’t care about the rules. Infections in the U.S. are skyrocketing again, because of the Delta variant, and the only way to end this pandemic is to get nearly everyone vaccinated. Until we have full approval of the vaccines, we’re simply not going to get there. By relying exclusively on the paperwork provided by the vaccine manufacturers, and ignoring the enormous amount of real-world data that everyone can see, the FDA is prioritizing process over results.

The FDA says that it’s now in a “sprint” to approve the vaccines, but with every day that passes, more people get sick, and the virus has more time to mutate and become more deadly.

Listen, FDA: rules are created for a reason. In case you haven’t noticed, the pandemic is a worldwide emergency that cries out for you to bend or break the rules if doing so will save lives. We all want a safe and effective vaccine, but there’s an overwhelming amount of evidence that we already have at least 3 of them (and probably 6 or 7). You can approve the Pfizer-BioNTech and Moderna vaccines today, and if new data emerges, or if you discover something startling and unexpected in those millions of pages of paperwork, you can withdraw approval. There’s nothing preventing this except bureaucracy.

So don’t tell us that you (FDA) have to “complet[e] the high-quality review” or you’ll somehow be shirking your responsibility. That response is equivalent to saying “we can’t look at the overwhelming evidence from the real world, we can only look at the paperwork that the vaccine companies provided to us.” In other words, “nanner nanner we can’t hear you” rather than considering the fact that hundreds of millions of people have taken the vaccine and that it’s working.

And about that comment from the FDA about maintaining public trust? As Dr. Eric Topol pointed out in a recent op-ed, somehow the FDA managed to approve, in the midst of the pandemic, an incredibly expensive new Alzheimer’s drug (aducanumab) for which the evidence of effectiveness is very thin, and the risks of harm are very real. The FDA’s own advisors resigned in protest, and now the FDA’s inspector general is going to take another look at how this happened. And yet the FDA is worried about “public trust in the agency”? Give me a break. Meanwhile, the FDA can’t seem to find the time to approve the mRNA vaccines “despite massive evidence of their benefits.”

The FDA needs to stop hiding behind the mountain of paperwork. Millions of people will remain unvaccinated while the FDA reviews documents that merely tell us what we already know: the vaccines work, and they are safe. Give them full approval, today, and continue to monitor their safety carefully, and many lives will be saved.

We've totally crushed the flu virus this year

 As awful as the Covid-19 pandemic is, it’s given us at least one benefit: we’ve utterly crushed the flu virus.

That’s right–the flu has almost completely disappeared this year. A combination of social distancing, closed schools and businesses, dramatically reduced travel, and high flu vaccination rates has achieved something that most flu experts never thought possible.

Flu levels are so low, in fact, that one has to wonder if the flu will even come back next year. The levels now are far lower than we’ve ever seen in modern history. Let’s take a look at the numbers:

nfluenza cases reported to the CDC by US public health laboratories, 2020-2021 season. Data from the CDC, graph created by the author.

As you can see here, the very worst week had just 24 confirmed cases in the entire U.S. That is truly astonishing. And in 2021 so far, we’ve had 5 or fewer cases in the entire country each week. Basically, the flu is gone. To see how dramatic this is, let’s look at data from last year (the winter of 2019-2020), which was a typical flu season:

Influenza cases reported to the CDC by US public health laboratories, 2019-2020, season. Data from the CDC, graph created by the author.

As you can see above, the U.S. had about 3,000 cases per week in January and February of 2020, with a peak at nearly 4,000 cases.

The rate of influenza this year is over 100 times lower than it’s ever been. Why did this happen? It’s obvious: all of the precautions we’re taking to reduce the spread of Covid-19 have worked wonders to prevent the flu as well. In fact, they’ve worked far better for influenza than for the Covid-19 virus.

No one knows what the flu season will look like next year, but for now, at least we’ve won a clear victory against the influenza virus. That’s a bit of good news.

Why do the Covid-19 vaccine trials take so long?

The whole world is waiting for a Covid-19 vaccine. More than 100 different vaccines are being investigated, and 42 of them are already being tested in humans, which is lightning-fast progress in the world of vaccine development.

11 vaccines are already in Phase 3 trials, which use thousands of volunteer subjects to test whether a vaccine really works. If any of these 11 trials are successful, as many scientists expect them to be, then the world might finally begin the process of opening back up.

By all accounts, though, we’re still a few months away from having an approved vaccine. Why does this take so long? Today I’ll try to answer this question. A little math is involved, but we don’t need much to get the basic idea across.

In a Phase 3 trial, we give the vaccine to large numbers of people to see if it works. Some of the 11 current trials use as many as 40,000 volunteers, so let’s use that number for the sake of discussion. In the trial, we might give the real vaccine to half the volunteers–20,000 people–and give a placebo to the other 20,000. A placebo is a harmless shot, typically just saline solution, that won’t have any effect. The volunteers don’t know if they’re getting the real thing; this is called “blinding.”

Then we wait. Here’s the problem: we don’t infect anyone intentionally, so we have to wait for naturally-occurring infections, and it might take a long time to see those. Subjects just go about their lives, and if they get sick, the study records that fact.

So the question is, how many people in each group of 20,000 will be infected in the first week? The first month? Two months? The answer is that we simply don’t know. To speed things along, scientists running the trials try to select volunteers who are more likely than most people to get infected, but we can’t really control the number of people who get sick.

Let’s suppose that after just one week of a trial, 3 people in the placebo group come down with Covid-19, and no one in the vaccine group gets sick. So far so good, right? But we can’t possibly conclude that a vaccine works based on just 3 cases. Statistics tells us that those 3 cases might have just happened by chance. (More precisely, if 3 cases occur in the 40,000 subjects, and if the vaccine doesn’t work at all, then there’s still a 12.5% chance that all 3 cases will occur in the placebo group.)

Suppose that 2 months roll by, and now we have 100 people in the placebo group who got sick, and only 10 infections in the vaccine arm. This is much, much better: without going into the math, a difference of 100 versus 10 would be highly significant, suggesting that the vaccine reduced cases by 90%.

But what if 2 months roll by and the placebo group only has 10 cases? Even if the vaccine group has zero cases, such a small number is not going to be enough to give us confidence that we have an effective vaccine. We want to see as many cases as possible–but we can’t force the issue. We have to wait.

In the US, the FDA has announced that a vaccine has to protect at least 50% of people in order to be declared effective. This means we need to see enough cases in to be confident that a vaccine confers that degree of protection. 50% is a pretty low bar, but so far none of the trials have announced even preliminary results showing that they’ve met that standard.

(Aside: “blinding” is really important in these trials. If subjects know they’re getting a placebo, they might be extra-careful to avoid exposure to the virus. This would artificially depress the number of cases in the placebo group. Conversely, if they know they’re getting the vaccine, they might be more reckless, increasing the exposures and cases in that group. In order for the results to be valid, we need all the subjects to behave the same.)

A faster option? There is a way to speed up this process: a “challenge” trial, where subjects are intentionally infected with the virus. The UK is preparing to start such a trial in January, first administering vaccines to healthy volunteers, and then exposing them to the SARS-CoV-2 virus about a month later. This is a far faster way to determine if a vaccine is working, but it creates serious ethical quandaries, because we don’t have a cure for the virus. If the world has an effective vaccine in January, I expect that the challenge trial will be cancelled. That wouldn’t be a bad outcome.

Why you should trust the coronavirus vaccine

Let me start by making one thing clear: at the time of this writing, we don't have a scientifically validated vaccine for COVID-19. But more than 150 vaccines are being developed around the world, and many of them are already in advanced stages of testing.

So we'll have a vaccine soon, likely in a matter of months. And everyone should take it. I know I will.

Today I’m going to try to de-mystify vaccines a bit, in the hope that this might help people feel more comfortable with them.

Before explaining what a vaccine actually is, let me point out that vaccines are probably the single greatest medical advance in the history of human civilization. Vaccines have saved hundreds of millions of lives: prior to vaccines, people lived in fear of diseases like smallpox, which killed 300 million people in the 20th century alone. Thanks to the vaccine, we eradicated smallpox from the entire world in 1980. Polio is another dreaded disease that killed or permanently injured millions, until the 1950s, when Hilary Koprowski, Jonas Salk, and Alfred Sabin invented vaccines that protected against it. Today, no one in the U.S. or Europe worries about polio, and it too has nearly been eradicated worldwide.

What exactly is a vaccine? It’s a pretty simple concept. Our immune system has the remarkable ability to “remember” pathogens that we’ve been exposed to. So once you’ve been infected with some viruses or bacteria, you acquire immunity to those diseases that may last the rest of your life. A vaccine is basically a way to teach the immune system to recognize a pathogen without actually making you sick.

The simplest way to do this (conceptually) is to take a batch of viruses or bacteria, kill them so they’re harmless, and then just inject them into a person. The immune system then “sees” the proteins in the dead pathogens (because the proteins are still floating around), and it learns all it needs to know from these. Later on, if a live virus infects that person, her immune system will say “aha, I know you!” and will quickly surround and destroy the invaders.

Simple as it sounds, there are many complications with this process. One is that it’s often very hard to isolate and grow enough of the virus (or bacteria) for large-scale production. The viruses then need to be isolated, killed, and purified, which can be complicated and costly. For COVID-19, though, any cost is worth it.

Another, much newer way to make vaccines uses modern molecular technology to make RNA. There’s no need to isolate or grow the virus at all! This is how Moderna’s new mRNA vaccine works (see their whitepaper here).

The mRNA vaccine relies on the fact that we already know which protein in the SARS-CoV-2 virus is the most important one. It’s called the spike protein, so I’ll just call it Spike. Spike is what attaches to human cells and lets the virus infect them. We also know the sequence of the Spike gene: the sequence of the entire SARS-CoV-2 virus was released in early January, and we’ve now sequenced thousands of these viruses.

An mRNA vaccine simply uses the RNA itself, rather than dead viruses. Today we can synthesize RNA in large quantities, so if you take some of this RNA and inject it into a person, what happens? Well, our own cells will translate this RNA to produce the Spike protein. All by itself, the protein cannot possibly cause an infection. It’s analogous to having a motor without a car: you can’t go anywhere without the whole package.

But here’s the good part: our immune system will recognize Spike anyway, even without the virus, and it will remember this invader. So the RNA vaccine is, in theory at least, even safer than traditional vaccines, because live pathogens are never used in the production process. (Before the anti-vaxxers jump on me here, let me emphasize that traditional vaccines are incredibly safe.)

This is just one example: there are 23 vaccines already in human trials, and over 150 in development, using mRNA, proteins, and other approaches.

There are other ingredients in vaccines too: preservatives and adjuvants. Anti-vaxxers like to read vaccine ingredients and then claim that all sorts of harmful stuff is in there, but their claims are mostly just gross ignorance. Preservatives are there to prevent the growth of things like bacteria, so they make vaccines safer. And adjuvants like aluminum salts (the most common adjuvant) are ingredients that enhance the effectiveness of vaccines, meaning you can use a lower dose. Aluminum salts have a very long safety record.

So why don’t people trust vaccines? Largely because the anti-vaccine movement has spent years spreading misinformation and fear, and it is already pronouncing strong opposition to any coronavirus vaccine, regardless of the evidence. The New York Times reported this week that mistrust of future coronavirus vaccines could imperil public health, especially in the United States. Polls have shown that large proportions of Americans say they won't take a vaccine even when it's available, which is, frankly, kind of crazy. (It didn’t help when tennis player Novak Djokovic expressed doubts about whether he’d be willing to take any future coronavirus vaccine.) Last month, NIH’s Anthony Fauci said that the “general anti-science, anti-authority, anti-vaccine feeling” in the U.S. may seriously undermine the effectiveness of any future vaccine. Of course, this could change once we really do have a vaccine, and we should all hope it does. But the anti-vaxxers never let up.

It also doesn't help build trust when the Trump administration calls their vaccine program "Operation Warp Speed." This might have sounded exciting to some sci-fi fans in the White House, but to many people it sounds more like a devil-may-care approach that emphasizes speed over safety. 

So how do we establish trust in the new vaccines, which are probably coming just a few months from now? One way to reassure people is to publish all the numbers from the vaccine trials. A just-published study in NEJM on the Moderna vaccine (the RNA vaccine) provides exactly these numbers, and they look very good in terms of both safety and effectiveness. 

In that study, all 45 participants had a robust antibody response–a stronger response, in fact, than in many people who’d been infected with the virus itself. There were some side effects, including fever and chills, but all were graded as mild or moderate. The scientists looked at 3 different dosage levels, and the side effects were greatest in the highest dose–but the antibody response was perfectly adequate in the lower dosage levels. So the next phase of testing, already under way, is using the lower dosages.

This was a phase 1 study, but it's very encouraging. If these results hold up in a large group–a question that is being tested now, in a phase 3 study–we'll have a working vaccine. 

And if you want to know more about this trial, you can read about it at the public NIH site, ClinicalTrials.gov.

Many if not all of the vaccines being developed in Europe and the U.S. are going through the same kind of scrutiny, and we’ll be able to see the results of those tests too. This is how we generate trust in the results: share them openly. I’m very re-assured by what I’ve seen so far.

The bottom line: vaccines work, and our methods for testing them are rigorous and thorough. With a little luck, the world will have multiple COVID-19 vaccines by the end of 2020. Once we have enough people vaccinated, our long nightmare with the coronavirus pandemic will come to an end.

Let the 2010s be the end of the post-truth era

The 2010s are over, and the double-20s are about to begin. One phrase that I'd like to never hear again is "post-truth era," an idea that has gained prominence during the past decade, especially the last few years.

One dominant theme of post-truthery is that every person has a right to his/her own interpretation of the facts, and that these alternative interpretations–or "alternative facts," as Trump adviser Kellyanne Conway famously called them–deserve to be taken seriously. They don't.

And yet, like most of the pseudoscience that I've been writing about for years now, we have to continue calling out nonsense for what it is, because some of it is harmful, and even deadly. Politics is a never-ending font of post-truthery (or truthiness, as Stephen Colbert defined it in 2005), but here I'm concerned about science. Today I'll highlight three anti-truth campaigns that have caused great harm over the past decades, in the hope that they will soon fade away.

Among serious scientists, truth is not being questioned. Indeed, the essence of science is the search for objective truth. Sometimes, though, a scientific discovery threatens to undermine the power or profits of an influential industry, and that's when industry resorts to denialism (which is essentially the same thing as post-truthiness).

Perhaps the most well-documented example of organized science denialism dates back to the 1950s, when accumulating evidence made it clear that smoking causes cancer. The tobacco industry didn't want to admit this, even though their own internal research supported it, because it meant that their main product was killing their customers, which in turn was terrible news for their business. In response,

"the tobacco companies helped manufacture the smoking controversy by funding scientific research that was intended to obfuscate and prolong the debate about smoking and health." (Cummings et al. 2007).

Eventually, after decades of lawsuits and literally millions of smoking-related deaths, the industry was forced to admit the truth and pay out billions of dollars in settlements in the U.S. Nonetheless, many people still smoke, and even as recently as 2016, the largest tobacco company in the U.S., Philip Morris, was still trying to deny the science about cigarettes.

My second example is more recent, and potentially even more harmful to the human species. You might have already guessed it: I'm talking about climate change denialism. For several decades, the evidence has been building that the planet is getting warmer. A series of reports from the Intergovernmental Panel on Climate Change (IPCC) warned, in increasingly confident terms, that humans were the primary cause of recent warming, mostly due to our use of fossil fuels and the carbon they emit into the atmosphere.

The current IPCC report states unequivocally that humans have already caused 1° C of warming, and that the warming will increase rapidly over the next several decades.

Scientifically, these facts are not in dispute. The world is already experiencing more severe storms, unprecedented floods and droughts, and die-offs due to warming oceans (such as the massive and tragic die-off of coral in Great Barrier Reef).

However, the fossil fuel industry sees global warming as a threat to their profits. Rather than invest in new, cleaner forms of energy, large companies such as Exxon-Mobil and billionaire coal magnates such as the Koch brothers have poured countless millions of dollars into disinformation campaigns to cast doubt on the science of climate change. Prominent among these efforts is The Heartland Institute, a fossil-fuel-funded organization whose main mission is to cast doubt on the science of climate change. (Heartland has also worked to cast doubt on the link between smoking and cancer.)

Climate change denialists learned from the tobacco companies that it was possible to delay government action by decades, simply by casting doubt on the science. Unfortunately, their campaigns have been working. For years, many U.S. politicians denied that the planet was getting warmer. As that argument has become increasingly harder to make with a straight face, they've changed their strategy, and now they might admit that the planet is heating up, but deny that human activities are responsible. They're still wrong.

The goal of this denialism is, simply put, to protect the profits of fossil fuel industries. However, truth doesn't care if you believe it or not. The world is getting hotter. Australia just had its four hottest days in recorded history. The unprecedented heat wave has led to hundreds of fires through much of the country, threatening every major city on the continent. There's no reason to think this won't keep happening.

Climate change denialists are only fooling themselves–after being duped by oil and coal companies.

My third and final example is one that has frustrated me for 15 years now, and it's one that just won't go away: the anti-vaccination movement. This is one of the most frustrating examples of post-truth wrongheadedness, in part it seems so unnecessary, and because so many children have been harmed as a result.

First, let's be clear about the facts: vaccines are one of the greatest boons to human health in the history of science and medicine. People used to die by the millions from smallpox, polio, and a dozen other infections that are now almost completely preventable by vaccines.

Smallpox was 100% eliminated from the planet in 1980, in one of humankind's greatest public health triumphs. Polio has now been eradicated from nearly all countries, and a campaign that started in 1988 has now reduced polio to just a few countries and fewer than 100 cases worldwide. Both of these successes are due to vaccines.

Many other diseases, including measles, chicken pox, and bacterial meningitis, have been reduced so dramatically by vaccines that physicians in the U.S. and Europe almost never see a case. This graph shows the dramatic effect of the measles vaccine, which was introduced in the U.S. in the early 1960s:

Measles cases in the United States by year, 1954-2008. Source: CDC.

The graph shows the number of reported cases, but actual cases were much higher, likely around 4 million cases per year by one estimate. These are the facts.

So what happened? The modern anti-vax movement, led by a small number of extremely vocal, extremely self-confident individuals, began in 1998 with the publication of a fraudulent study (later retracted when the fraud was uncovered) claiming that vaccines caused autism. The study was led by former physician Andrew Wakefield, who later lost his medical license because of his fraud, which included misleading his co-authors and mistreating patients.

Nonetheless, this study was picked up and amplified by several celebrities with large followings, including former Playboy model and MTV host Jenny McCarthy and political activist Robert F. Kennedy Jr, the nephew of former US President John Kennedy. RFK Jr.

Anti-vax activism is all over the web today, despite many efforts to quash it. Countless claims of "my child got sick after his vaccine jab" are presented as proof that vaccines cause harm, and under post-truthism, we're supposed to take such claims seriously.

These stories can be especially difficult to respond to, because many parents are dealing with children who have genuine health problems–including autism–and the parents often truly believe what they are saying. Thus it won't do to tell them to be quiet and go away: their children really do need medical care. They're simply wrong in believing that vaccines have anything to do with their childrens' problems. Their beliefs are amplified by Facebook groups and websites whose sole purpose is to echo and amplify the mistaken claims of anti-vaxxers.

Even though there was never any good evidence that vaccines cause autism, scientists have conducted dozens of studies involving literally millions of children to answer precisely that question, and the evidence is very, very clear: vaccines do not cause autism, nor do they cause any other systematic neurological or behavioral problems. Vaccines do prevent diseases, though, and unvaccinated children can and will get sick. Recent experience has also given us, tragically, many examples of children who died from entirely preventable infections, because their parents didn't vaccinate them. These tragedies didn't have to happen.

Every era is the age of truth. The idea that we're in a "post-truth era," despite being repeated thousands of times in articles, essays, and op-eds over the past decade, is a commentary on people's ability to fool themselves, not on the state of the world. Truth describes the world as it is, and those who choose to deny it might win a short-term argument, but in the long term, they will always lose.

Finally, on a more positive note, I'm somewhat heartened by efforts to educate college students on how to recognize and counter bogus ideas, such as the University of Washington course, Calling Bullshit, created by Carl Bergstrom and Jevin West. (Yes, that really is its title.) As the professors wrote,

"The world is awash in bullshit.... We're sick of it. It's time to do something, and as educators, one constructive thing we know how to do is to teach people." 

If you're interested, they've made the lectures available as free videos on YouTube.

Labelling an era as post-anything has always, to me, suggested a lack of substance, as if the era is defined only by what came before it. The use of "post-" also ignores that fact that the next era will need a name too. Should we expect "post-post-truth" to come next, and what would that look like? Let's hope that the 2020s will give us a return to simple respect for truth. The future of civilization might very well depend on it.