Coronavirus pandemic prompts increased transparency of drug companies

The unprecedented nature of the SARS-CoV-2 coronavirus pandemic has begun to influence the transparency of drug company trials of potential COVID-19 vaccines.

On September 17th The New York Times reported that Moderna and Pfizer were releasing the protocols that describe the trial process to test a potential COVID-19 vaccine. On September 19th they reported that AstraZeneca had done the same. This heralds a significant change on the part of drug companies. Although in practice complex vaccine trial protocols would need to be interpreted by say, science journalists, in order to be understood by the wider public particularly given the multicultural nature of today’s communities in developed nations.  [See references below for protocols]

As trials have progressed to Phase III in which data on the safety and efficacy of vaccines are collated, the interest of the public has grown significantly. Intense media attention surrounded the recent pause of the Phase III trial of the vaccine being developed by AstraZeneca in partnership with scientists from Oxford University. Not surprisingly public interest has turned to pressure for more transparency as to how trials are conducted.

From July 24th to August 7th Ipsos surveyed respondents from 27 countries [PDF] on attitudes toward a COVID-19 vaccine. 74% of respondents said they would have a vaccine if it was available. The most common reason for rejecting the vaccine was concern over side effects (56%). This was followed by doubt of its effectiveness (29%). The importance of transparency surrounding Phase III trials is confirmed by the weight of these two reasons for rejecting the vaccine.

These vaccines are being developed rapidly under the gaze of a public that expects at some time to be given such a vaccine. It’s understandable that anxiety surrounding both efficacy and safety of COVID-19 vaccines existed long before the specifics of Phase III trials became public. That those specifics have become better understood due to an issue with safety does raise matters of trust within the public.

Of course the increased attention over safety and efficacy would never have arisen during development of the many so-called “alternatives” to regulated vaccines. Alternative products are not subject to reliable scrutiny and as such the acute and chronic effects are in fact undocumented or unknown. The safety and efficacy of such listed (as opposed to regulated) therapeutic products is almost always merely assumed.

Establishing trust between the public and the government and health authorities is important. Increased transparency of vaccine trials will help promote trust. Sustaining trust is significantly reliant on clear information and explanation of complicated issues that raise public concern. This is particularly true in the present environment where changing evidence may come across as inconsistency and if left unacknowledged may lead to suspicion. The proper interpretation and presentation of available information is essential.

Normally data gathered during a trial are published after the trial. However the dynamic nature of COVID-19 vaccine development and the global impact of this pandemic have already changed what may be considered normal. Added to this is information that is leaking out. The Oxford trial has recommenced on the advice of an independent safety committee. AstraZeneca announced that they “had not confirmed a diagnosis” of transverse myelitis in the study volunteer.

What has also recently become apparent is that the study was paused in July after a male volunteer who had received one dose of the vaccine developed transverse myelitis. See page 10 of this participant information sheet. There was a review by independent experts. The trial resumed after it was determined that the individual had a previously undiagnosed case of multiple sclerosis unrelated to the vaccine. Still, there was a persistent concern that AstraZeneca had not revealed in detail what had happened to the woman whose significant neurological symptoms led to the most recent trial pause.

On the September 14th edition of The Health Report Dr. Norman Swan interviewed Professor Bruce Neal, Executive Director of the George Institute Australia. The occasion was to discuss the launch of a project called Join Us. A challenging issue about Phase III trials is that drug or vaccine development may stall or fail due to lack of suitable participants. This isn’t due to drop out or resistance. Rather the cost and administrative difficulty of finding suitable participants is significant. Join Us aims to secure pre-consent to trials of a certain nature.

Whilst that’s interesting information about trials, Swan also asked Professor Neal about his thoughts on the reluctance of AstraZeneca to reveal details about the woman responsible for the second pause of the Phase III trial. Neal considered reasons to release more information. It would give a heads up to other researchers around the globe allowing them to “provide input and information into it”. However he also noted that releasing such information midway through a trial may have negative consequences.

There may be confidentiality issues as such a “severe unusual event” might lead to patient identity being leaked. Perhaps most interestingly was the observation that the trial may well end with a conclusion that the event was not an issue related to the vaccine. By then the damage is done. The public have already internalised the notion of a negative side effect. The media effort to reverse that belief is not likely to be successful.

Professor Neal stated;

And so the media surrounding the announcement of something like that is going to retain much more prominence probably than the media that tries to reel that back in and say, look, actually it wasn’t an issue. And that could have ramifications down the track when you try to get people to take the vaccine.

It’s important to note that the FDA has not allowed the AstraZeneca trial to resume in the US. The National Institutes of Health stated that it remains to be seen if the illnesses are coincidental and that, “pausing to allow for further evaluation is consistent with standard practice”.

Understandably some health professionals in the US remain concerned. Whilst investors were told of the second problem it has become clear that the company did not immediately alert the F.D.A. and advise them of the independent safety board’s recommendation to pause the trial. Virologist Dr. Peter Jay Hotez based at Houston’s Baylor college of Medicine has not been impressed. He claimed communication has been “horrible and unacceptable” citing the failure of UK regulators to provide rationale for resumption of the trial.

The New York Times also reported;

Dr. Paul Offit, a professor at the University of Pennsylvania and a member of the F.D.A.’s advisory committee on vaccines, said that it’s unclear how the company — or the U.K. government — determined that the second case was not related to the vaccine.

Offit has also noted that the rarity of transverse myelitis in the general public has not been reflected in the UK trial population. The extra caution we are seeing in the US is reason for the public to have increased confidence in the influence regulators have over the safety of vaccine trials. Consequently there is reason for the public to be less anxious about the safety of COVID-19 vaccines that are eventually marketed. Given that independent safety experts in the UK have advised it is safe for the Oxford trial to resume it will be very interesting to see what further evaluation by US authorities concludes.

There has been research into immunisation and subsequent development of transverse myelitis (TM) and acute disseminated encephalomyelitis (ADEM). Key points from the 2016 paper Acute Demyelinating Events Following Vaccines: A Case-Centered Analysis are as follows;

Results: Following nearly 64 million vaccine doses, only 7 cases of TM and 8 cases of ADEM were vaccinated during the primary exposure window 5-28 days prior to onset. For TM, there was no statistically significant increased risk of immunization. For ADEM, there was no statistically significant increased risk following any vaccine except for Tdap (adolescent and adult tetanus, reduced diphtheria, acellular pertussis) vaccine. […]

Conclusions: We found no association between TM and prior immunization. There was a possible association of ADEM with Tdap vaccine, but the excess risk is not likely to be more than 1.16 cases of ADEM per million vaccines administered.

Acknowledging vaccine safety concerns as a cause of vaccine hesitancy, in July this year Nicola Principi and Susanna Esposito published a narrative review, Do Vaccines Have a Role as a Cause Of Autoimmune Neurological Syndromes?

The authors wrote in part in their abstract;

Only well-conducted epidemiological studies with adequate evaluation of results can clarify whether a true association between vaccines and adverse event development truly exists. Autoimmune neurological syndromes that follow vaccine use are among these. […]

Literature analysis showed that most of the associations between vaccines and nervous system autoimmune syndromes that have been reported as severe adverse events following immunization are no longer evidenced when well-conducted epidemiological studies are carried out. Although the rarity of autoimmune diseases makes it difficult to strictly exclude that, albeit exceptionally, some vaccines may induce an autoimmune neurological disease, no definitive demonstration of a potential role of vaccines in causing autoimmune neurological syndromes is presently available. Consequently, the fear of neurological autoimmune disease cannot limit the use of the most important preventive measure presently available against infectious diseases.

Ultimately this research in conjunction with the cautious US approach at present does not support a contention of general recklessness in the production of this vaccine or of other potential COVID-19 vaccines.

This dynamic provides yet another blow to anti-vaccination conspiracies. Namely the contention that there is collusion between drug companies and health regulators to suppress the supposedly inherent dangers of vaccines that anti-vaxxers wrongly insist lead to an abundance of vaccine injuries. More so Dr. Paul Offit has been derided, verbally attacked and threatened by the global anti-vaccine lobby for many years as a callous profiteer of vaccines. Yet he has constantly raised a voice of caution to ensure safe COVID-19 vaccine development.

It is certain that placing the AstraZeneca trial on hold following advice from the F.D.A. is not a unique event. Rather the fact that measures employed to control the current pandemic are being played out before the public in real time has provided insight into events that are usually ignored. In the previous post I listed some other aspects of anti-vaccine conspiracy that simply cannot be sustained following media reports of the AstraZeneca/Oxford Phase III trial pause. Even cursory attention to the details of this trial has exposed the dishonesty of anti-vaxxer claims.

Well before the trial pause led to media attention, public anxiety and now transparency of drug companies, the importance of trust in accepting a COVID-19 vaccine had been raised in Australia. Prime Minister Scott Morrison made a significant mistake with respect to public confidence in vaccine development and uptake. In August he announced that Australia had signed a deal to produce the vaccine being developed at Oxford University if Phase III trials were successful.

His mistake was to add that it would be “as mandatory as you can possibly make it”. Morrison realised the mistake and in under a day had produced the anticipated walk back. Nonetheless the many anti-science and anti-reason groups that are feverishly misrepresenting the motives of governments and health authorities during this pandemic were delighted. Within hours of Morrison’s announcement the AVN published a video mocking the notion of “safe and effective” vaccines whilst contending they “had always known this was coming”.

There were of course no “walk backs” from the AVN when Morrison corrected his position. Pushing fear of mandatory vaccination has always translated to profit for this group and Scott Morrison had done them a favour. Say no to mandatory vaccination read the back of a T-Shirt weeks later in Perth during Australia-wide “solidarity” rallies. Messages on social media continue in the same vein. Still, the reality is that messages and memes on mandatory vaccination would be common had Scott Morrison made no such statement.

Any harm done to the uptake of a COVID-19 vaccine in Australia is likely negligible. A survey conducted in April found that just under 86% of Australians aged over 18 would get a COVID-19 vaccine. 4.9% would not whilst 9.4% were indifferent. These figures are promising but were collated before the widely publicised pause in the AstraZeneca trial and increased public reflection on the safety of a COVID-19 vaccine. Survey responses were to the statement, If a COVID-19 vaccine becomes available, I will get it.

Ipsos published their global attitudes results on September 1st, indicating an 88% uptake of a COVID-19 vaccine in Australia. 59% strongly agree and 28% somewhat agree with the statement, If a vaccine for COVID-19 were available, I would get it. Only China and Brazil were more likely to accept a vaccine. These figures were also collated before the pause in the AstraZeneca trial. Follow this link to read Key Findings for Australia.

Another area that’s causing anxiety is the posturing of Donald Trump toward authorising a COVID-19 vaccine before the upcoming election. Consider the measure of Trump for a moment. He will tempt the voters with the promise of a vaccine in weeks. However it is more realistic to expect a safe and effective COVID-19 vaccine in months. These promises demand a disregard for vaccine safety. Yet in March 2014 Trump was tweeting in support of the mythical vaccine/autism link, a bogus view that bemoans a lack of vaccine safety. After the last election, research fraud and vaccine/autism profiteer Andrew Wakefield attended an inaugural ball from which he posted a social media video calling for an overhaul of the CDC.

Others have long ago considered the measure of Trump in regard to the election and a COVID-19 vaccine promise. In early June University of Pennsylvania professors Dr. Paul Offit and Dr. Ezekiel Emanuel wrote an opinion piece in The New York Times entitled Could Trump turn a vaccine into a campaign stunt?

It included;

In a desperate search for a boost, he could release a coronavirus vaccine that has not been shown to be safe and effective as an October surprise. […]

Given how this president has behaved, this incredibly dangerous scenario is not far-fetched. In a desperate search for a political boost, he could release a coronavirus vaccine before it had been thoroughly tested and shown to be safe and effective. […]

Thousands of Americans have already died as Donald Trump has perpetually postponed effective public health interventions and made poor therapeutic recommendations. We must be on alert to prevent him from corrupting the rigorous assessment of safety and effectiveness of Covid-19 vaccines in order to pull an October vaccine surprise to try to win re-election.

At the beginning of the second week of September the CEOs of nine drug companies, arguably competing in the development of a COVID-19 vaccine, signed a pledge to stand with science and not launch such a vaccine until it met “high ethical standards and sound scientific principles”. The pledge statement as it appears on Pfizers website is in references below. It came at a time when public health specialists and scientists expressed concern that the Trump administration was pressuring regulators to authorise a vaccine before the November 3rd election.

The New York Times reported;

The joint statement by competitors was seen as an effort to restore public trust as President Trump has pushed for a vaccine before the presidential election.

An out-take from the pledge from Pfizer’s website is as follows;

Following guidance from expert regulatory authorities such as FDA regarding the development of COVID-19 vaccines, consistent with existing standards and practices, and in the interest of public health, we pledge to:

  • Always make the safety and well-being of vaccinated individuals our top priority.
  • Continue to adhere to high scientific and ethical standards regarding the conduct of clinical trials and the rigor of manufacturing processes.
  • Only submit for approval or emergency use authorization after demonstrating safety and efficacy through a Phase 3 clinical study that is designed and conducted to meet requirements of expert regulatory authorities such as FDA.
  • Work to ensure a sufficient supply and range of vaccine options, including those suitable for global access.

We believe this pledge will help ensure public confidence in the rigorous scientific and regulatory process by which COVID-19 vaccines are evaluated and may ultimately be approved.

Yes to the cynical eye this may seem to present the pharmaceutical CEOs as really great guys. However I recommend reading the entire Biopharma Leaders Unite pledge. More to the point with increased transparency the public and the media have an invested interest to see a suitable outcome here. This pledge is certainly a step up from Fauci saying he has “confidence and some faith” that the COVID-19 vaccine approval won’t be political.

Earlier in the year it was reported that a significant number of Americans are likely to refuse a COVID-19 vaccine. A robust anti-vaccination lobby and rising numbers of the vaccine hesitant mean that the number of Americans who accept the vaccine may be insufficient to sustain herd immunity, which may require between 50 – 70% of the population to be immune. The more recent Ipsos survey found 67% of US citizens would have the vaccine.

Exactly how many must be vaccinated to achieve herd immunity is still uncertain. The WHO suggest 95%. Mathematical modelling reflecting age and social activity level produces a herd immunity “illustration” as low as 43%. Other reports suggest a vaccine uptake of over 70% is needed. The Mayo clinic point out that reaching this level of immunity through infection and not vaccination would overwhelm the health system and cause millions of deaths.

Thus there is ample reason to hope greater transparency of vaccine trials leads to justified improved confidence in the safety and efficacy of COVID-19 vaccines and increased uptake. Of course given the speed of current COVID-19 vaccine trials let us also hope that the vaccines that make it to market are extremely safe and splendidly effective. The fewer challenges that accompany immunisation on a global scale the better.

Another area that is getting more scrutiny if not exactly transparency is that of vaccine nationalism. This term refers to agreements between governments and vaccine manufacturers that ensure developed nations have secure access to vaccines for their entire population before they are available for other nations. With COVID-19 this may result in a delay in vaccinating health workers in developing nations, individuals at high risk of severe disease or death and those living in a region of a sudden dangerous cluster.

COVID-19 is a global pandemic. Yet we are faced with a situation where wealthy nations will be able to vaccinate their populations whilst countries that rely on aid organisations will be unable to vaccinate health workers and at-risk populations without organised help. A recent Science Friction podcast looks at the ways in which this problem can be combated. Australia’s Friends of Science in Medicine actively support equitable access to “COVID-19 vaccines and related health technologies”.

No doubt the anti-vaccine lobby will use information in the trial protocols in the same way they use vaccine package inserts. Thanks to exceptional cognitive dissonance they will list reasons as to why information from vaccine manufacturers can’t be trusted whilst using that same information to defend these reasons. The good news is that as we’ve seen, increased transparency and media attention has exposed tenets of anti-vaccine conspiracy and beliefs as vacuous and fallacious. On these points it’s a case of watch this space.

In conclusion it can be seen that the increase in transparency of COVID-19 vaccine development should indeed serve to increase public trust and confidence in the quality of eligible vaccines. I cannot finish without stressing again that the safety and efficacy elements of Phase III trials do not apply to the raft of concoctions marketed as alternatives to medicine. All consumers should seek reputable sources of information and beware of the many hoax “cures” of COVID-19. Discuss any novel plans to manage or prevent COVID-19 with a registered medical practitioner.

Finally whilst the importance of transparency with respect to vaccine trials has become clear, it was also confirmed by the Ipsos global survey on attitudes to a COVID-19 vaccine. The most common reasons for intending to refuse a vaccine are safety followed by efficacy. The establishment of which is the very aim of Phase III trials.

 


REFERENCES

Phase 3 clinical trial of investigational vaccine for COVID-19 begins

Moderna Clinical Trial Protocol – SARS-CoV-2 vaccine

Pfizer Clinical Trial Protocol – SARS-CoV-2 RNA vaccine

AstraZeneca Clinical Trial Protocol – COVID-19 vaccine

Oxford Vaccine Trials – Participant Information Sheet: COV002 (July 2020)

Oxford Vaccine Trials – Participant Information Sheet: COV002 (Sept. 2020)

Willingness to vaccinate against COVID-19 in Australia

9 in 10 Australians say they would get vaccinated for COVID-19 – Ipsos

Global attitudes on a COVID-19 vaccine – Ipsos [PDF]

A future vaccination campaign against COVID-19 at risk of vaccine hesitancy and politicisation

Biopharma Leaders Unite To Stand With Science – Pfizer

Moderna and Pfizer reveal secret blueprints for coronavirus vaccine trials – NYT

AstraZeneca under fire for vaccine safety releases trial blueprints – NYT

Acute demyelinating events following vaccines: a case-centered analysis
– DOI: 10.1093/cid/ciw607

Do vaccines have a role as a cause of autoimmune neurological syndromes?
– DOI: 10.3389/fpubh.2020.00361

FSM supports equitable access to COVID-19 vaccines

Vaccine nationalism threatens global plan to distribute COVID-19 shots fairly

The rise of vaccine nationalism – should we be worried? – ABC Podcast

Herd Immunity: Understanding COVID-19 – DOI: 10.1016/j.immuni.2020.04.012

 

 

 

 

 

 

How the Oxford trial pause challenges anti-vaccine conspiracies

Recently the Oxford COVID-19 vaccine trial was paused due to a possible case of transverse myelitis in one of the subjects. Today (Saturday UK time) it was announced that the trial would resume following advice from from safety experts.

Confirmation Update: Transverse myelitis has not been diagnosed in the subject [1], [2], [3], [4].

The news of the pause had the anti-vaccine lobby reacting with as much composure as dozing picnickers who have awoken to find they are laying atop a large nest of very active fire ants.

There is the urge to proclaim we told you so. Yet this includes the realisation that forfeiture of key pegs in anti-vaccine conspiracy is required. What has followed as we see below appears to be confusion, the inability to comprehend events, fabrication of fallacy and bogus reinforcement of elements of the Big Pharma conspiracy.

It’s important not to underestimate how disturbing genuine challenges to an individuals world view can be. In the case of the Oxford trial announcement, the anti-vaccine conspiratorial view of the world is threatened by a distressing reality. For the dedicated anti-vaxxer this leads to uncomfortable cognitive dissonance. In fact anti-vaccine conspiracies must exist in the first place to resolve the cognitive dissonance that arises when scientific evidence and epidemiology overwhelmingly refute the myth of dangerous vaccines and manufactured claims of vaccine injury and death.

In this case there are three main challenges to current anti-vaccine beliefs.

  1. The MSM (mainstream media) presented a transparent account of the Oxford trial pause.
  2. The pause in the trial itself shows that the safety aspect of Phase III clinical trials is working well.
  3. Cursory reading of the situation confirms the efficacy component of Phase III clinical trials and the use of a placebo.

The anti-vaccine lobby contend that mainstream media are biased against the “truth” of vaccine horror because what is reported is not anti-vaccine. If the mistake of giving anti-vaccine identities air-time to push unsubstantiated disinformation is made, criticism swiftly follows. Yet primarily it is the industry requirement to fact check that keeps anti-vaccination views from being presented unchallenged.

It’s more likely that their antics make tabloid or news segments because they are dishonest and at times vindictive. This attracts regular criticism of the Australian Vaccination-risks Network. A scheme by anti-vaxxer Kyia Clayton to interview AVN president Aneeta Hafemeister on ABC Hobart was met with outrage. It was justly criticised on Media Watch which yet again led to Meryl Dorey urging members to bombard the ABC and ACMA with complaints.

Rather than rise to the occasion and present evidence that meets the standard of scientific consensus the AVN has instead accused the media of being part of the larger conspiracy. Attacking mainstream media and articles that are based on vaccine fact is a substantial activity for Australian anti-vaxxers.

A constant claim of anti-vaxxers is that vaccines are never tested adequately for safety. This is partly due to the erroneous belief that vaccines are so full of dangerous chemicals and biological matter that they cannot possibly be safe. Ergo, any genuine monitoring for adverse reactions in large samples would reveal that a high percentage present with such reactions. As this is not the case their only conclusion is the biased testing conspiracy.

Another claim is that vaccines are never tested for efficacy. They don’t work and we have all been deceived. Herd immunity is a fake concept. Vaccines were introduced after improved sanitation and hygiene eliminated most disease and thus deserve no credit. This claim is made with the help of deceitfully crafted graphs plotting mortality, not morbidity, in such small numbers it appears that vaccines had no impact. The two claims specific to Phase III clinical trials are often made together.

This was clear when the AVN responded to an August 2019 SMH article by Liam Mannix, Anti-vaxxers live in an online bubble this scientist wants to burst. Their response is a strange collection of “propositions” the author angrily contends must exist, whilst citing pseudoscience and articles relating to medication, not vaccines.

The AVN piece included this under “Proposition 4”;

…there have never been double-blind, placebo-controlled prospective studies done on either the safety or efficacy of vaccines, not even when a new vaccine is introduced.

Oh my. This persists despite accessible evidence to the contrary and available WHO recommendations. More so, in line with all anti-vaxxers the AVN argue their definition of a placebo (such as saline) is what should be used in vaccine trials. In fact it is used in many trials but the AVN choose to ignore this. This may include shifting the goal posts. Virology Down Under discuss this no true Scotsman anti-vax fallacy related to placebos.

In some vaccine trials a saline placebo is not ethically suitable and the placebo used is not inert. With respect to the urgency COVID-19 presents this article argues that placebos aren’t needed for vaccine challenge trials. In the Oxford trial a non-saline placebo functions as a more effective control as Dr. Norman Swan explains below. The AVN have always objected to Gardasil studies which used AAHS (the amorphous aluminium hydroxyphosphate sulphate adjuvant) as a placebo.

Without citing any reference the AVN offer their definition of a vaccine trial placebo;

By definition, a placebo must be a totally inert substance which will never provoke a response.

In a recent Coronacast episodeThe Oxford vaccine’s troubles. Why it’s not doomed (yet) Norman Swan talked about efficacy and safety in this vaccine trial. Whilst the USA are using a saline placebo, the other participant countries are not. Swan explains;

A few weeks ago, phase 2, phase 3 studies, that’s dose finding and whether or not the vaccine works in large numbers of people and whether it safe, started in Brazil, South Africa and the UK, and they were aiming to recruit 17,000 people. There was also a phase 3 study just beginning in the United States in about 80 sites, trying to recruit about 30,000-odd people. The aim is to have a trial of about 50,000 people.

And interestingly it’s a placebo-controlled trial but the placebo is not saline. It is in the United States, but in Brazil, South Africa and the UK it’s actually not a dummy drug, it’s not saline, it’s a meningococcal vaccine, and they are doing that so that people don’t recognise whether or not they’ve had a placebo. It’s very important in a placebo-controlled trial that you don’t know that you are in the placebo arm. And if you get a shot in your arm and nothing happens and it’s pretty mild you think, well, maybe I’m in the placebo group.

The presenters talk about the seriousness of transverse myelitis and Norman Swan offers this context;

However, there was a study not so long ago which looked at 64 million vaccine doses and really found very little evidence, if any, that transverse myelitis is caused by immunisation. Out of 64 million doses they found seven cases or eight cases that may be associated with it. And they look really widely. They didn’t just look at the week after you’ve had the immunisation or the month after, they looked at almost any time after you’ve had the immunisation, and they conclude that transverse myelitis, unless in very rare circumstances, is not caused by a vaccine. […]

So what they’ve got to find out with this person is are they in the placebo arm, are they in the active arm, is it really transverse myelitis, what are the antibodies that have actually been shown? Are there any other symptoms? And did the person actually get infected with real COVID-19 after the trial had started…

I recommend reading the transcript or listening to this episode of Coronacast. Tegan Taylor and Swan talk more on Phase III trials and discuss the specifics of the Oxford vaccine. It’s an adenovirus carrying genetic material into cells to instruct the cells to produce fragments of COVID-19 virus. It is these fragments that induce an immune response. With respect to the use of placebos in vaccine trials a July 27th episode examines the ethics associated with the fact that subjects in the placebo arm of Phase III trials are not receiving a vaccine.

By the time the Oxford podcast was published on Thursday the AVN was already suggesting on Facebook that there may be more adverse reactions hidden from the public.

AVN Facebook post

Dubious message on AVN Facebook

“It does raise questions”? The problem with the above post is the apparent interpretation by an AVN Facebook administrator that one of the “close friend daughters” who took part in the Oxford trial “is in the Royal” [London Hospital], “diagnosed with Transverse Mylytis” (sic). There is an unverified claim that, “they have asked to keep this quite (sic) as they don’t want the public to know”. The AVN admit the information may not be true.

Yet is this really evidence of a covert case of transverse myelitis? Perhaps Karen McNab is referring to a) her friend’s daughter and also b) the “volunteer” mentioned in the WhatsApp message. The trial subject who had the presumed adverse reaction is a woman who is in hospital.

Of course my interpretation could be wrong. There is however no clear statement that one of the friend’s daughters has transverse myelitis.

Some AVN members were justifiably suspicious.

AVN FB members question source

Rixta Francis, a long term AVN member prone to simply inventing disinformation published her predictably outrageous fallacy of the Oxford trial. This is an excellent example of an immediate, and  feverish attempt to slap at the fire ants of cognitive dissonance. Fellow members are supportive.

Facebook: Rixta Francis misleads over Oxford COVID vaccine trial
Self published author of The Fiction of Science Rixta is prone to reinterpret reality in the manner above. To appreciate this we need to explore her approach more fully. In an interesting example of how things come round in circles Francis is infamous for her abuse of the memory and parents of baby Riley Hughes, who featured in the SMH article I mentioned above.

Riley died from pertussis in March 2015 before he was old enough to be vaccinated. Feeling a need to educate parents about immunisation Catherine Hughes began the Light For Riley campaign. She now runs the Immunisation Foundation of Australia. Ten months after the death of Riley, Francis falsely claimed Catherine was a member of Stop the AVN, suggested Riley and his pertussis had never existed or that the parents killed infant Riley themselves.

The post below suggests the Oxford adverse reaction has been staged. It includes dismissal of genuine media intention, dismissal of safety and dismissal of efficacy helped by quoting Australia’s CSIRO. Again this is textbook management and minimisation of cognitive dissonance.

AVN Facebook post

Other comments in the thread follow a similar theme and manage to reveal quite ridiculous thought processes. The reason people placed themselves at such risk is because they were offered “a small fortune… it all comes down to money”. Vaccines always cause “horrific injuries”. We “can’t cure cancer but we can make a vaccine in six months for a disease we don’t understand?”.

It will be interesting, but not surprising, to see how this group reacts to the news that the trial has resumed.


Further reading:

Oxford Vaccine Group

Oxford vaccine trial – University of Oxford

How Vaccine hesitancy could undermine Australia’s COVID response – The Guardian, September 12th 2020

Fact Check: Mastercard partnership on vaccination records is unrelated to finances – USA Today, September 9th 2020

Halting the Oxford vaccine trial doesn’t mean it’s not safe – The Conversation, September 9th 2020

Vaccine testing and approval process – CDC

 

 

Meryl Dorey suddenly believes viruses can only be transmitted by injection

The driving force behind the Australian Vaccination-risks Network is Meryl Dorey who is tagged on this blog, and was highly active at the time of the HCCC Public Health Warning about this group.

Thanks to a tweet by a highly effective critic of the AVN my attention was drawn to a post Meryl made on her Facebook page during a live video broadcast on April 11th this year. What I found compelling was that suddenly – and I do mean suddenly as Dorey had never made this claim before – she announced that her “personal opinion is that viruses can only be transmitted by injection”. As we’ll see this causes problems for one particular anti-vaccine position Meryl has promoted.

The comment below was posted in the context of discussing viral testing and the strange notion of buying “a private test”, presumably to avoid the COVID conspiracy pitfalls. The last sentence contains Meryl’s view about viral transmission by injection. This pattern of adopting stand out themes of conspiracy theories is one Meryl Dorey has followed for years.

Meryl Dorey: viruses only transmitted by injection

Source: Comment 32

The compelling aspect to Dorey’s sudden revelation is that this claim had already been made 12 days earlier by anti-vaxxer and erstwhile Involuntary Medication Objectors Party candidate, Tom Barnett. The video in which he made his claims was removed from Facebook and YouTube.

Barnett claimed in the video;

You can’t catch a virus; it’s impossible. The only way you can catch a virus is by having it injected into your bloodstream.

I say. Meryl apparently decided this sounded pretty good to however she is planning to profit from the COVID-19 crisis. Feel free to search her online material prior to Tom Barnett’s comments for a statement suggesting Meryl Dorey believes viruses can only be transmitted by injection. I for one am having trouble finding such a reference.

Claiming to hold such a position enables one to reject the need for immunisation and to argue that vaccination against viral disease may in fact be the cause of the disease.

Meryl is clearly spinning more plates than is wise with this latest addition of evidence denial. To be specific, her claim that viruses can only be transmitted by injection is a form of germ theory denial |Wikipedia|. Denial of germ theory |Wikipedia| is as old as germ theory itself. Thanks to germ theory significant advances in personal hygiene and public sanitation have brought about improvements in health and reduction in the spread of disease.

Which brings us to a real problem for Meryl Dorey. She claims that vaccinations have done almost nothing, if not absolutely nothing, to prevent disease. She has fallaciously argued before that the documented fall in vaccine-preventable disease is in fact due to better hygiene, diet and sanitation and occurred before the introduction of vaccines. This is very common misinformation pushed by anti-vaxxers usually with heavily doctored graphs that chart disease mortality as opposed to morbidity and are falsely attributed to official sources.

It fails utterly to explain the success of vaccines introduced in the later half of the 20th century such as measles (1963) and haemophilus influenzae type b (1993). The WHO do a good job of dispelling this misinformation here. At the beginning of 2012 I looked at the AVN’s use of this myth and included an explanatory video with audio from both Meryl Dorey and Judy Wilyman.

In it we hear Dorey during a radio interview with Helen Lobato on Melbourne’s 3CR in December 2011 make the familiar claim;

Meryl Dorey: A lot of the credit that’s been given to vaccines for the decline in deaths and infectious diseases has nothing to do with vaccines. Because it all happened before the shots were even introduced.

Helen Lobato: Mmmm… and it was more the diet and the sanitation?

Meryl Dorey: That’s right. Engineers did more to improve the health of Australians than doctors ever have.

You might like to listen to Meryl on the audio player below;

 

Looking back at Dorey’s frequent promotion of this misinformation on the AVN website, social media and other media it is impossible to find any clarification specific to viral infection being only possible by injection. Nor is there any delineation between bacterial infection and viral infection being controlled by sanitation.

Thus in one foul swoop Dorey has removed the logic behind her claim that sanitation, not vaccination, brought about the control of specific viral infections. If viruses can only be transmitted by injection then improved sanitation must only be responsible for reducing infectious diseases caused by bacteria.

This also removes her concerns over “vaccine shedding” [1], [2] with respect to vaccines designed to prevent viral infection. This is highly significant concerning Dorey’s new claim as material presented to defend the notion of unbridled “vaccine shedding” refers exclusively to viral shedding in stools or in the case of LAIV nasal spray, in nostrils.

As Meryl Dorey and the AVN have challenged health ministers and authorities to accept being injected with a body weight adjusted equivalent of the entire childhood vaccine schedule, I do hope there is no intent to demonstrate strength of conviction by ingesting or inhaling any viral material associated with disease.

Therefore as it now stands I would be fascinated to know how Meryl Dorey intends to justify believing that sanitation, not vaccination, reduced the spread of viral disease given her claim that viruses can only be transmitted by injection.

 

Government cuts to ABC harm quality journalism

Sky News Australia, owned by News Corp, has a well earned reputation for denying the evidence of climate change and the need for reducing carbon emissions, which host Chris Kenny recently referred to as “leftist climate policies”.

The occasion was indulgence in what has earned the outlet another, equally concerning reputation. Regular attacks directed at the Australian Broadcasting Corporation based on the contention that they promote biased leftist ideology. That the ABC leads unwarranted leftist media campaigns, the most significant recently being an apparent “attack” on Cardinal George Pell, although it was News Corp which first reported charges brought against Pell. Since Pell’s High court acquittal of historical child sexual abuse charges the tone and pace from Sky News seem to have increased.

More so a specific amount is levelled at ABC Media Watch and its host, Paul Barry. Yet they fail to mention it was Paul Barry on Media Watch who tackled the claims that Pell was not innocent because he had been found not guilty due to reasonable doubt. Barry insisted that Pell was innocent until proven guilty. As he was now not guilty, has was innocent.

The brazenness combined with the shoddiness of these attacks has been percolating for years. Accusations in the main are made with no real evidence, simply opinion. This is doubly true when it comes to attributing motivation to the ABC or its journalists. The present environment that allows the confidence for Sky to present what is often junk journalism often with the aim of smearing the ABC exists in very large part thanks to successive Coalition governments.

Australian Government criticism of the ABC has a long history and its tone reflects what party is in power at the time. Yet moves to manipulate the ABC through budget cuts and misleading verbal attacks about “ideological bias” have proven to be from the game book of the Coalition. Despite a pre-election promise to maintain budgets of both the SBS and the ABC, the Howard government targetted both. His governments 1996 budget included a 2% ($55 million) annual cut to ABC funding beginning in 1997-98. And an independent review of the ABC was commissioned to be led by Bob Manfield.

Howard continued to verbally attack the ABC over his four terms. His former Chief-of-Staff Graeme Morris described the ABC as “our enemies talking to our friends”. Dennis Muller (Senior Research Fellow in the Centre for Advancing Journalism, University of Melbourne) noted in The Conversation in February last year that Howard himself labelled the ABC nightly news as “Labors home video”.

And that;

Howard’s communications minister, Richard Alston, kept up an unremitting barrage of complaints that the ABC was biased. This culminated in 2003 with 68 complaints about the coverage of the second Gulf War. An independent review panel upheld 17 of these but found no systematic bias.

I could not agree more with Muller that;

This playbook – repeated funding cuts, relentless allegations of bias, and recurring inquiries into the ABC’s efficiency and scope – has been followed to the letter by the Abbott-Turnbull-Morrison administrations.

Interesting then that The Howard Years, in which he worked at shaping his legacy, was a successful ABC-TV event.

But I really wonder if Howard could have foreseen what he’d put in motion. Yes Howard was conservative. Morally, socially and politically. His fawning to the Australian Christian Lobby left behind inestimable damage in that it swung the gates wide for organised bigoted fundamentalism. His record of demonstrable apathy in response to climate change and his capitulation to the Greenhouse Mafia was inescapable. Less than eight months ago in a keynote speech to mining industry representatives he criticised “climate change zealots” and perhaps foolishly said he was “agnostic” when it came to climate change.

But John Winston Howard was not anti-science as were those around him. Of course, when we look at the evidence of climate change there is really no room for agnosticism. Yet Howard was defending his legacy and the contribution Australia’s mining industry had made to economic stability during the GFC of 2008. He didn’t deny the existence of climate change or label it a leftist conspiracy without foundation.

Certainly he was not an enemy of reason. Climate change aside he understood the importance of evidence and the risk of turning ones back on it. Perhaps he wondered at the wisdom of the Liberal Party Council. On June 16th 2018 they voted to privatise the ABC, despite this going against the very pursuit of journalistic independence that led to the founding of the ABC. The Institute of Public Affairs was delighted with the prospect of privatising the ABC. Two members of the IPA had published a book on “how to do it” just a month before.

This wasn’t a sudden decision in conservative politics. By then the Abbott-Turnbull administrations had already cut $338 million from ABC funding since 2014. The 2018 Budget handed down by then Treasurer Scott Morrison included a three year freeze on ABC funding beginning in June 2019. He said at the time, “everyone has to live within their means”. The tied funding of $43.7 million will cost the broadcaster $83.7 million in budget cuts over three years, on top of the cumulative $254 million in cuts since 2014. There was no better news in the 2019 budget.

It was reported in The Conversation in April last year;

This has resulted in an accumulated reduction in available funding of A$393 million over a five-year period, starting from May 2014. According to current budget forecasts, this also means the ABC stands to lose A$783 million in funding by 2022, unless steps are taken to remedy the situation.

Earlier this month Opposition leader Anthony Albanese asked the PM to reconsider the ABC budget freeze in respect of their essential role over the bushfire season and now the coronavirus pandemic. SBS reported;

“Will the Prime Minister restore funding so the ABC can keep doing its job so effectively?” [asked Albanese]

Mr Morrison responded: “The ABC is doing an excellent job and they’ll continue doing that job with the resources that have been provided to them.”

“Like all agencies, like all Australians, they will all do the best job they can with the resources they have available to them.”

The funding cuts are brutal and are a clear sign of the federal government’s aim to restrict the journalistic vision of the ABC. The ABC was clear in stressing that the most recent cuts threaten delivery of the ABC Charter requirements. More so 800 staff have lost their jobs. As I noted above, I wonder if Howard would be comfortable with this. Leading up to the last Federal election Labor promised to reverse the budget freeze and ensure the $83.7 million the ABC stood to lose. They also promised $60 million to the ABC and SBS.

Writing about the Young Liberals call in late June 2018 to sell the ABC, Vincent O’Donnell noted;

But most members of the conservative movement are hostile to the ABC because it is said to be biased. Accusations of bias are useful tools to undermine confidence and support for the ABC…

[…]

…there are folk whose political beliefs are so far to the right that just about all of Australia, and most of the world, is to the left. Any media that reflects this reality is necessarily left wing and biased.

Intermingling of the Coalition government and right wing conservative journalists criticising the ABC goes back some time. In August 2014 a parliamentary library research paper noted (part 4: Disbanding the network);

Following its victory in the 2013 election, the Abbott Government became increasingly critical of the Australian Network for what it argued [were] overly negative representations of Australia. In addition, Prime Minister Abbott was critical of the ABC’s overall reporting stances; the Prime Minister claiming the ABC took everyone’s side but Australia’s.

The same paper reported in Box 5: Spy scandal and the role of the media that the ABC had reported on Edward Snowden’s leaked information that Australian intelligence officials tried to tap the phones of Indonesian president Susilo Bambang Yudhoyono and his wife. The ABC also reported on asylum seeker claims that they had been abused by members of the Australian Navy. In respect of the Indonesian phone tapping incident Chris Kenny, “accused the broadcaster of embarrassing Australia and Indonesia, undermining co-operative relations and diminishing national security”.

Andrew Bolt contended that the ABC, “was ‘not just biased. It is a massive organ of state media, strangling private voices and imposing a Leftist orthodoxy that thinks it fine to publish security secrets’.” The ABC apologised with respect to the asylum seeker claims, saying it was sorry if the report had led people to assume they believed the claims. Their intention was to present the material “as claims worthy of further investigation”.

The government continued to criticise the ABC, accusing it of “maligning Navy personnel”. Defence Minister at the time, David Johnston claimed the ABC had “maliciously maligned” the Navy and contended that their reporting justified an investigation. In March 2014 the ABC reported evidence supporting abuse of asylum seekers in Indonesian detention centres. The then Immigration Minister, Scott Morrison, argued the claims had no credibility and that the ABC should “move on”.

The same research paper includes in Box 1 – One man’s satire another man’s distress, which covers a 2013 Chaser segment wherein a photoshopped image of News Corp journalist Chris Kenny having sex with a dog was shown. Initially the ABC refused to apologise arguing that viewers were, “adequately warned by an onscreen classification symbol and accompanying voice over of the likelihood of seeing potentially offensive content”.

The point I wish to make here is relevant to the opening paragraphs. Kenny did have a defender. On Media Watch Paul Barry firmly disagreed with the ABC and The Chaser view of satire, arguing it was neither satirical nor clever. The saga rolled on for a time with further developments, some serious, some frivolous. Ultimately the ABC did apologise to Kenny.

These examples deal almost exclusively with TV journalism. Of course Media Watch ranges across radio, internet, social media, printed news and TV. Ongoing criticism and bullying of the ABC by the Coalition government is quite telling. As Muller wrote in Constant attacks on the ABC will come back to haunt the Coalition government;

The bipartisan political vision for the ABC was that it should not be vulnerable to sectional interests or commercial pressures, but should exist to serve the public interest in the widest sense

The ABC cannot do this without financial and factual support from governments. More so attacks on the ABC from unapologetic right wing ideological bastions such as Sky News are indicative of a wider social problem. A lack of critical thought and an inability to understand and respect the impact of evidence.

It may well be worth looking more closely at that soon.

 


 

In 2015 Bill Gates advised on the need to prepare for a global pandemic

In 2015 Bill Gates gave a TED Talk on the importance of preparedness for a global pandemic caused by “a highly infectious virus”.

An Ebola epidemic that began in December 2013, and continued until 2016, had by that time killed around 10,000 people in West Africa. Gates cites three reasons as to why there weren’t more deaths. 1.) The selfless work by front line health workers including locating infected persons and preventing further spread (see Contact Tracing below). 2.) Ebola is not an airborne virus and by the time those who are infected become contagious, most are so ill as to be bedridden. 3.) The virus did not reach many urban areas and this directly kept the number of cases lower than had Ebola spread throughout urban communities.

Yet he also refers to what he calls “a global failure”. Noting the slowness of response. The failure to study treatment approaches, diagnostics and the application of epidemiological and medical tools.

In what has been shown to be an uncomfortably prescient statement Gates notes;

So next time, we might not be so lucky. You can have a virus where people feel well enough while they’re infectious that they get on a plane or they go to a market.

Gates uses the Spanish Flu of 1918 to demonstrate how quickly an airborne virus can spread. He observes that the World Bank have estimated that a global flu epidemic will cause a drop in global wealth of “over three trillion dollars” and there would be “millions and millions of deaths”.

It’s important to note that the present reality with COVID-19 is not absolutely reflected in Gates’ TED Talk. Trends of global financial impact have not yet played out. Total fatalities will be disturbing and many may lose friends and loved ones, yet the prediction of “millions and millions” of deaths is not a current reality.

Nonetheless the reason that the capacity to reduce morbidity and mortality – to flatten the curve – is in our hands is indeed touched on by Gates. Just after the five minute mark he speaks of our ability to use certain tools to create an effective response system. Science and technology. The use of cell phones to inform the public. Satellite maps to inform on the movement of people. Advances in biology and research that will support rapid turnaround of drugs and vaccines to fit the pathogen responsible for the pandemic.

As I touched on above another factor discussed but not labelled as such by Gates, that is presently more robustly employed to reduce the spread of COVID-19 is Contact Tracing. Gates talks about locating infected persons and preventing further spread. In May 2017 African Health Sciences published a review of contact tracing in containing the 2014 Ebola outbreak. However with an airborne coronavirus this has proven, as expected, to be enormously more complicated.

At the time of writing there exists a spectrum of tactics in various countries, with some considered invasive to privacy. Israel has passed emergency laws to allow its security agency, Shin Bet to tap peoples phones without a warrant.

According to the Computational Privacy Group in the case of Singapore (using TraceTogether), Taiwan and South Korea this involves using cell phones and dedicated software in the;

…recording [of] close proximity between people using Bluetooth, WiFi, or GPS data, [which] could help efficiently notify people that they have earlier been in contact with someone now diagnosed with coronavirus and should self-isolate

The CPG have published Can we fight COVID-19 without resorting to mass surveillance? which looks at both location data and contact tracing in different regions, and the technology used.

Reports in Australia have suggested that tracking the public through their phones has been considered and that the federal government is “looking to Singapore” and the TraceTogether app. Victoria’s Department of Health and Human Services has expanded contact tracing to include use of the messaging platform Whispir.

IT News reports;

The department will begin using the cloud-based platform from Thursday to regularly interact with those that have come into close contact with someone who has contracted COVID-19.

The platform, which will automate interactions between the department and select individuals, will also be used to enforce self-isolation for Victorians who have confirmed cases of the virus.

Gates was more than reasonably accurate in predicting our response. Presented without exact figures from the epidemiology and pathology of the infectious agent Gates’ description of how we could and would respond deserves high marks.

Presently we are witnessing the application of the tools at our disposal to flatten the curve of morbidity and mortality. We know that only an effective vaccine can break the back of the pandemic as it now exists. Drugs that target specific symptoms and slow or prevent the impact on COVID-19 comorbidity are greatly needed. The use of cell phone apps to both inform and trace the public is well underway.

Most importantly we have accepted that staying at home, social distancing and increasingly reducing the number of people together in public, together with effective hand washing and smothering of coughs or sneezes are vitally effective measures. Some of these measures should be employed every flu season and it’s hoped we will continue to do just that.

One imagines we will be better prepared in future for the emergence of another pandemic. Gates was right in that we needed to prepare. We see that clearly now in the need for hospital beds, ventilators and other medical equipment. He also noted the necessity of strong health systems in poor countries and presently the need for increased funding in developing nations is a reality. [AlJazeera news video]

To finish off perhaps we should focus on what Gates observed at the end of his talk;

So I think this should absolutely be a priority. There’s no need to panic. We don’t have to hoard cans of spaghetti or go down into the basement. But we need to get going, because time is not on our side.

In fact, if there’s one positive thing that can come out of the Ebola epidemic, it’s that it can serve as an early warning, a wake-up call, to get ready. If we start now, we can be ready for the next epidemic.

Of course we were not utterly unprepared for a pandemic. Far from it. There are global and national agencies throughout the world that focus on both the risk of a viral pandemic and how we can best prepare. Developing nations are closely monitored by organisations such as the WHO and the UN. Still the lack of any treatment or vaccine to prevent COVID-19 has proven to be an enormous hurdle.

Developed nations are in a better position to fund and respond to recommendations. Australia has a Health Management Plan for Pandemic Influenza, last updated in August 2019. The UK has its Pandemic Contingency/Major Infectious Diseases Outbreak Plan. Similar plans exist around the world.

An interesting dynamic in the USA at present is whilst President Trump has criticised the CDC for its response to coronavirus, he had from 2018 cut their budget for global disease management and closed government units dedicated to preventing pandemics.

Trump’s administration has also cut similar funding for the National Security Council (NSC), Department of Homeland Security (DHS), and Health and Human Services (HHS). Other cuts to CDC funding used to manage chronic disease are scheduled for 2021 and as yet have not been approved by Congress. Perhaps justifiably Trump has come under scorn for his approach to the coronavirus outbreak.

Funding for the prevention of pandemics is an essential part of a solid public health budget. Without a doubt these budgets should be designed with input from scientists. By shirking reason and evidence in their pursuit of “alternative facts” and a post truth world, the Trump administration had maneuvered itself into an increasingly perilous position.

One hopes that as we move toward the future and find ourselves past the COVID-19 pandemic that we aim to listen to the evidence, learn from the past and prepare for pandemics we cannot yet predict.


 

————————————

 

TRANSCRIPT

00:17
When I was a kid, the disaster we worried about most was a nuclear war. That’s why we had a barrel like this down in our basement, filled with cans of food and water. When the nuclear attack came, we were supposed to go downstairs, hunker down, and eat out of that barrel.

00:37
Today the greatest risk of global catastrophe doesn’t look like this. Instead, it looks like this. If anything kills over 10 million people in the next few decades, it’s most likely to be a highly infectious virus rather than a war. Not missiles, but microbes. Now, part of the reason for this is that we’ve invested a huge amount in nuclear deterrents. But we’ve actually invested very little in a system to stop an epidemic. We’re not ready for the next epidemic.

01:20
Let’s look at Ebola. I’m sure all of you read about it in the newspaper, lots of tough challenges. I followed it carefully through the case analysis tools we use to track polio eradication. And as you look at what went on, the problem wasn’t that there was a system that didn’t work well enough, the problem was that we didn’t have a system at all. In fact, there’s some pretty obvious key missing pieces.

01:51
We didn’t have a group of epidemiologists ready to go, who would have gone, seen what the disease was, seen how far it had spread. The case reports came in on paper. It was very delayed before they were put online and they were extremely inaccurate. We didn’t have a medical team ready to go. We didn’t have a way of preparing people. Now, Médecins Sans Frontières did a great job orchestrating volunteers. But even so, we were far slower than we should have been getting the thousands of workers into these countries. And a large epidemic would require us to have hundreds of thousands of workers. There was no one there to look at treatment approaches. No one to look at the diagnostics. No one to figure out what tools should be used. As an example, we could have taken the blood of survivors, processed it, and put that plasma back in people to protect them. But that was never tried.

02:53
So there was a lot that was missing. And these things are really a global failure. The WHO is funded to monitor epidemics, but not to do these things I talked about. Now, in the movies it’s quite different. There’s a group of handsome epidemiologists ready to go, they move in, they save the day, but that’s just pure Hollywood.

03:22
The failure to prepare could allow the next epidemic to be dramatically more devastating than Ebola. Let’s look at the progression of Ebola over this year. About 10,000 people died, and nearly all were in the three West African countries. There’s three reasons why it didn’t spread more. The first is that there was a lot of heroic work by the health workers. They found the people and they prevented more infections. The second is the nature of the virus. Ebola does not spread through the air. And by the time you’re contagious, most people are so sick that they’re bedridden. Third, it didn’t get into many urban areas. And that was just luck. If it had gotten into a lot more urban areas, the case numbers would have been much larger.

04:17
So next time, we might not be so lucky. You can have a virus where people feel well enough while they’re infectious that they get on a plane or they go to a market. The source of the virus could be a natural epidemic like Ebola, or it could be bioterrorism. So there are things that would literally make things a thousand times worse.

04:39
In fact, let’s look at a model of a virus spread through the air, like the Spanish Flu back in 1918. So here’s what would happen: It would spread throughout the world very, very quickly. And you can see over 30 million people died from that epidemic. So this is a serious problem. We should be concerned.

05:04
But in fact, we can build a really good response system. We have the benefits of all the science and technology that we talk about here. We’ve got cell phones to get information from the public and get information out to them. We have satellite maps where we can see where people are and where they’re moving. We have advances in biology that should dramatically change the turnaround time to look at a pathogen and be able to make drugs and vaccines that fit for that pathogen. So we can have tools, but those tools need to be put into an overall global health system. And we need preparedness.

05:41

The best lessons, I think, on how to get prepared are again, what we do for war. For soldiers, we have full-time, waiting to go. We have reserves that can scale us up to large numbers. NATO has a mobile unit that can deploy very rapidly. NATO does a lot of war games to check, are people well trained? Do they understand about fuel and logistics and the same radio frequencies? So they are absolutely ready to go. So those are the kinds of things we need to deal with an epidemic.

06:13
What are the key pieces? First, we need strong health systems in poor countries. That’s where mothers can give birth safely, kids can get all their vaccines. But, also where we’ll see the outbreak very early on. We need a medical reserve corps: lots of people who’ve got the training and background who are ready to go, with the expertise. And then we need to pair those medical people with the military. Taking advantage of the military’s ability to move fast, do logistics and secure areas. We need to do simulations, germ games, not war games, so that we see where the holes are. The last time a germ game was done in the United States was back in 2001, and it didn’t go so well. So far the score is germs: 1, people: 0. Finally, we need lots of advanced R&D in areas of vaccines and diagnostics. There are some big breakthroughs, like the Adeno-associated virus, that could work very, very quickly.

07:21
Now I don’t have an exact budget for what this would cost, but I’m quite sure it’s very modest compared to the potential harm. The World Bank estimates that if we have a worldwide flu epidemic, global wealth will go down by over three trillion dollars and we’d have millions and millions of deaths. These investments offer significant benefits beyond just being ready for the epidemic. The primary healthcare, the R&D, those things would reduce global health equity and make the world more just as well as more safe.

07:55
So I think this should absolutely be a priority. There’s no need to panic. We don’t have to hoard cans of spaghetti or go down into the basement. But we need to get going, because time is not on our side.

08:09
In fact, if there’s one positive thing that can come out of the Ebola epidemic, it’s that it can serve as an early warning, a wake-up call, to get ready. If we start now, we can be ready for the next epidemic.

08:26
Thank you.