Covid-19 News

  • PS - if FLCC were arguing that only diabetic under-50 females with renal failure benefited from ivermectin - well that is possible, and could not be picked up by even a large RCT. But it is not what is proposed, nor would such a small use case be worth putting so much effort into.

    • Official Post

    That is very encouraging for a small RCT. Luckily, rather than rely on contentious and fudgable meta-studies we have several studies of IVM in process that will provide definitive answers for its utility in that sort of use case. PRINCIPLE and that US loads'O'dosh study that TSN seems to think is funded by an immoral researcher. Luckily the study results and reception will depend only on quality and size of the trial - not TSN's opinion of the person in charge.

    I forgot to check, but hopefully PRINCIPLE is using IVM +. Not just IVM alone. It seems to have been lost in the contentious debate, but when HCQ, then IVM first became news, they were used in conjunction with Z-packs, and Zinc. HCQ was at the time considered an ionophore to help the Zinc enter the cell so it could do it's thing.Over time Vit D, C and a few others were added to the cocktail.

    Recently Dr. Zelenko reiterated that it takes all working together for the best HCQ efficacy, and the FLCCC said the same thing for their MATH+, and I-MASK IVER protocols.

  • Please explain Slovakia. Uttar Pradesh, Delhi. These are facts not claims as you make....

    No - Slovakia, UP, Dehli are country, province, city, not facts, nor arguments.

    How about you explain them - as any epidemiologist making your point would need to, considering in each case:

    • Quality of information (e.g. when using case numbers availability of testing and how it changes over time)
    • Lockdown and distancing policies, and how they affect social contact
    • Variant prevalence (e.g. when did delta take over)
    • Level of vaccination (relevant only to overall R value, not to sharp changes)
    • Level of natural immunity (probably not relevant)
    • Speed at which your intervention (in this case I guess twice-weekly prophylactic IVM) is pushed out to the whole population. If claiming a very fast change in R value - this must be pretty well instantaneous, and compliance must be a high enough percentage of the population.

    Make your case:

    • What is the effect that you claim is caused by IVM and not any of these other factors?
    • Be precise: is it a sharp change in the value of R, or is it the fact that overall R is lower or higher than expected (that one is difficult because different countries have very different average numbr of contacts).
    • Have you ruled out other factors (e.g. change in lockdown, or change in dominance between alpha and delta, that would have the same effect)
  • I forgot to check, but hopefully PRINCIPLE is using IVM +. Not just IVM alone. It seems to have been lost in the contentious debate, but when HCQ, then IVM first became news, they were used in conjunction with Z-packs, and Zinc. HCQ was at the time considered an ionophore to help the Zinc enter the cell so it could do it's thing.Over time Vit D, C and a few others were added to the cocktail.

    Recently Dr. Zelenko reiterated that it takes all working together for the best efficacy, and the FLCCC said the same thing for their MATH+, and I-MASK protocols.

    PRINCIPLE is just IVM. And you are wrong to hope that trials should be on compound treatments. If IVM + Zn works, then IVM on its own, or Zn on its own, will work. Maybe less well, but that does not matter. AFAIK there is no good evidence that Zn works.

  • Recently Dr. Zelenko reiterated that it takes all working together for the best efficacy, and the FLCCC said the same thing for their MATH+, and I-MASK protocols.

    If that is an excuse for them not working individually - it is not impressive.

    Otherwise, if it is true, it can be established. That will take time. Lots of help will be available to do that if ivermectin is found useful and anything like the level claimed by FLCC.

    There is also the "have your cake and eat it" issue. It is not good science to say, for every positive trial that contains ivermection (without additions) - "that proves ivermection works" but then for every negative trial that contains ivermectin (without additions) say that it does not count.

  • A posthumous victory for Lamarck, Michurin and Lissenko over Darwin, but also a good reason to avoid messenger RNA vaccines like Pfizer and Moderna, and to prefer “old-school” vaccines like AstraZeneca, Johnson & Johnson and Sputnik.

  • Make your case:

    No you should make your case and have to rule out that it is not from giving IVR to all 205 mio. people in Uttar Pradesh >3x size of UK 1000x less cases.

    As I give the facts you have to disprove them! Only children deny facts...

    PRINCIPLE is just IVM.

    No! Only in fake treatment studies you might like to see...At least V-D, Zink is always added to fight a virus etc...

  • Some real good data

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  • PRINCIPLE is just IVM. And you are wrong to hope that trials should be on compound treatments. If IVM + Zn works, then IVM on its own, or Zn on its own, will work. Maybe less well, but that does not matter. AFAIK there is no good evidence that Zn works.

    " If IVM + Zn works, then IVM on its own, or Zn on its own, will work. "

    I must disagree with this statement quite strongly. This certainly is NOT following science.

    Of course chemistry is absolutely full of interactions.

    Testing if certain chemicals are essential to life such as sodium or chlorine? So if I do an RCT seeing if sodium is essential to life and test only sodium, it will result in a complete negative...that sodium will destroy life. If an RCT tests chlorine is necessary for life by itself, it will show it is deadly.

    Yet as we all know, sodium and chlorine ARE essential life, but only together as sodium chloride... common salt.

    While a simple example, it is quite true. Your statement is simply unfounded that RCT's testing only one variable are full-proof and "will work" is falsifiable and easily disproved.

    While it COULD be that a particular substance could work "some" on it's own and then work much better in conjunction with a complimentary agent, your statement that it "will work" and the RCT will tell us is simply opinion and not founded. I have done many, many design of experiments (DOE) in real life engineering... ignoring interactions is a fools errand.... perhaps not in academic math.... but absolutely in the real world!

    This is the main problem with RCT's. They can easily leave out absolutely critical components (either intentionally or accidently) that result in incorrect results... .and then people will say "RCT rules" this is proof....... except when an RCT shows something positive against the worldview and then "it is a poor design or poorly conducted trial".

    The often quoted saying.... "junk in".... "junk out".... or more scientifically stated .... "bad design in"..... "bad design out".... and the PRINCIPLE trial is NOT immune to this either!

  • Major Medical Journal Editor Raises Concerns about mRNA-based Vaccines

    Major Medical Journal Editor Raises Concerns about mRNA-based Vaccines
    On May 28, TrialSite reported on information regarding mRNA vaccine safety revealed by a freedom of information act (FOIA) request filed by a group of

    On May 28, TrialSite reported on information regarding mRNA vaccine safety revealed by a freedom of information act (FOIA) request filed by a group of Canadian physicians who were concerned about COVID-19 mRNA vaccine safety. The specific safety information related to the FOIA involved the Pfizer mRNA-based vaccine known as BNT162b2 or “Comirnaty.” The FOIA documents revealed results from animal studies demonstrating that some contents of the Pfizer mRNA-based vaccine did not remain at the injection site, but instead appeared to spread widely. According to the documents, pre-clinical studies show that the mRNA-lipid nanoparticles that are wrapped around the mRNA genetic material spread throughout the body with at least a potential to concentrate in various organs. TrialSite also reported on regulatory documents that suggest (at least in their European Medicines Agency submission) Pfizer did not follow industry-standard quality management practices during preclinical toxicology studies during vaccine development, as key studies did not meet good laboratory practice (GLP). The full panel of industry-standard reproductive toxicity and genotoxicity studies were apparently also not performed. But does this matter in light of the risk-benefit analysis associated with regulatory emergency use authorization (EUA) and the raging COVID-19 pandemic? Perhaps not; however, credible sources are asking questions. Dr. Peter Doshi, Associate Editor of the British Medical Journal, went on the record that both Pfizer and Moderna, the two authorized mRNA COVID-19 vaccine makers, failed to respond to questions centering on why biodistribution studies weren’t undertaken before the mass vaccination program. This leaves many doctors concerned that some of the mRNA vaccine ingredients are materializing in unanticipated areas of the body.

    TrialSite’s position on combatting the pandemic is clear for anyone who reads our articles. We are adamant that a comprehensive, holistic approach is required and includes A) safe and effective vaccination, B) branded therapeutics in development, C) generic therapeutics, especially for early, mild-to-moderate scenarios (about 90% of all cases), and D) appropriate public health measures that are contingent on many factors, including underlying health risks, access to care, available resources, and socioeconomic conditions. For example, it’s easy to practice social distancing in the US when compared to an impoverished, crowded place like Uttar Pradesh, where social distancing isn’t possible. Still, the combination of proactive testing and early treatment in the form of affordable medicine kits can still make significant strides. In fact, that’s exactly how Uttar Pradesh pulled ahead of the Delta variant.

    The Summary

    In a recent article in the BMJ titled, “Covid-19 vaccines: In the rush for regulatory approval, do we need more data?”, the author Dr. Peter Doshi shares concerns about the mass COVID-19 vaccine program that is ongoing under emergency use authorization. Doshi was particularly concerned about the biodistribution of the vaccines, because biodistribution investigations were not conducted for the SARS-CoV-2 vaccine candidates. The vaccine sponsors justified this move by stating that a series of comparable studies were conducted that used “mostly unapproved compounds that use the same platform technology” as a proxy. However, biodistribution studies involving the currently authorized vaccines were bypassed.

    The BMJ author wrote that “Pfizer and Moderna did not respond to the BMJ’s questions regarding why no biodistribution studies were conducted on their novel mRNA products, and none of the companies, nor the FDA, would say whether new biodistribution studies will be required prior to licensure.”

    What is a Biodistribution Study?

    Related to the COVID-19 vaccines, biodistribution studies are investigations into what organs or tissues the vaccine ingredients accumulate after the vaccine is injected. In medical research, it is a method of tracking the location of compounds of interest throughout the body of an animal or a human, and it’s considered vital for determining overall safety and toxicity. Radiolabels, specialized imaging, and designated time points are used to determine the biodistribution of an experimental drug, or in this case, a vaccine. Animal biodistribution studies can vary significantly from human ones.

    Pfizer & Moderna’s Position Raises Questions

    Let’s put the overarching concern in context: due to the pandemic and Operation Warp Speed, regulatory timelines were accelerated during the development of the vaccines. Both Pfizer and Moderna have declared that absolutely no compromises in regulatory processes or safety practices were made during this unprecedented speed of vaccine development. But is that even possible? There is always a triple constraint of time, cost, and scope—meaning, if you dramatically speed up the process, something has to give. TrialSite learned that, according to documents from the European Medicines Agency, good laboratory practices (GLP) were waived for at least some of the preclinical research. Some might call that a compromise. And it seems the industry sponsors didn’t conduct biodistribution studies in humans with the actual study products being administered to millions. If that is the case, how can a company say that no compromises were made?


    Throughout the pandemic, TrialSite documented widespread concern over the White House having too much influence over regulators, ranging from the impulsive EUA award for hydroxychloroquine to the same status for convalescent plasma despite opposition from the National Institutes of Health. There were legitimate concerns over timing study results with elections for political gain. Other examples of favoritism include how the NIH’s National Institute of Allergy and Infectious Diseases (NIAID) changed a study endpoint during a pivotal trial on Gilead’s remdesivir, so that Dr. Anthony Fauci could conveniently declare a new standard. Not long after, the World Health Organization’s (WHO) Solidarity study would produce very different outcomes: it not only showed that remdesivir isn’t effective, but that there is also a growing list of safety concerns. Yet in America and other markets, the authorization and approval of remdesivir has allowed Gilead to mint billions of dollars in sales.

    Most regulatory bodies and agencies within the federal government consist of well-intentioned, stand-up professionals, but the pandemic has brought to light serious questions that require honest answers. Do these agencies represent the true interests of the American people or are they dominated by the interest of pharmaceutical companies and an elite cadre of academics? Has the concept of regulatory capture crept into the whole system, and does this help fuel the obvious and expanding distrust in medical and public health organizations? Is reform needed? TrialSite plans to dig into these issues in subsequent articles.

    The Article

    Published back in May, the BMJ’s Peter Doshi asked the sensible question: Only half a year into a mass vaccination initiative under EUA, both Pfizer and Moderna are seeking formal regulatory approval (registration), “but what’s the rush, and is just six months of data from now unblinded trials acceptable?” As Doshi points out, the trials were unblinded and participants in the placebo groups were offered vaccination just weeks after the vaccines received EUA, making it next to impossible to do long-term comparisons between the placebo and vaccine groups.

    Doshi declares that the matter of biodistribution is not trivial. While it’s not popular to raise any concerns about the current vaccines, mounting VAERS entries (over 11,000 deaths and over 4.000,000 adverse events) warrant a closer look. While VAERS is an imperfect surveillance system, the CDC and FDA claim that none of the deaths are caused by the vaccines. Given the numbers, it’s understandable why many people question that stance and demand more transparency. Is it a surprise that there’s some vaccine hesitancy?

    Follow the link to the article.

  • A posthumous victory for Lamarck, Michurin and Lissenko over Darwin, but also a good reason to avoid messenger RNA vaccines like Pfizer and Moderna, and to prefer “old-school” vaccines like AstraZeneca, Johnson & Johnson and Sputnik.

    So the paper is:

    Polθ reverse transcribes RNA and promotes RNA-templated DNA repair

    And this is not relevant to mRNA vaccines, where the RNA can't get into the cell nucleus. But in any case, if you worry about RNA in cells getting turned into DNA you should worry much more about COVID infections, which result in millions of times more foreign RNA introduced into potentially any cell in the body, with much more RNA. The vaccine mRNA can generate spike protions and do nothing else, whereas the virus RNA can to all sorts of nasty things.

    How do mRNA vaccines work?
    mRNA vaccines deliver information to our cells that allows them to make viral or bacterial proteins. Our immune system reacts to the proteins and builds up…

    There is misinformation implying that mRNA vaccines could alter DNA in the nucleus.[14] mRNA in the cytosol is very rapidly degraded before it would have time to gain entry into the cell nucleus. (mRNA vaccines must be stored at very low temperature to prevent mRNA degradation.)

    Like most anti-vax misinformation this is an interesting factoid which taken on its own sounds alarming, and in context is not a feasible risk.

    it is a shame; COVID vaccines have real risks - but what has traction on the internet is the scary-seeming not real risks.

  • Peter Doshi has a track record of bashing COVID vaccines with scientific-sounding, but actually highly misleading, arguments.

    Here is a previous one debunked by Hilda Bastian - who has now become one of my fave cartoonists. Note that in spte (or because) of its innacuracy it gained a LOT of internet traction.

    Note her careful consideration of his claims, and how they fall short.

    Hilda Bastian - Scientist, Blogger, Cartoonist


  • Unpacking Peter Doshi's non-scientific (that is political) arguments

    Hilda does a wonderful job analysing the scientific basis for Doshi's comments about COVID vaccines - I recommend the above link - with cartoons - to everyone.

    I thought her view of the political part of these comments (argument 5) would be interesting here as well:

    Argument 5:

    [U]blinding and primary event adjudication committees...what criteria did they employ, and why...was such a committee even necessary? It’s also important to understand who was on these committees.

    This section was odd. The committees were necessary for just the reasons Doshi raises: there were inevitably subjective decisions here, and so multiple blinded adjudicators assessed the information. You can see that from the criteria detailed in the protocol. Take determining whether it was severe illness for example: most of the criteria were objective, but there was also this "Significant acute renal, hepatic, or neurologic dysfunction". So, plenty of potential for different judgment calls there. And as already mentioned, there isn't strong evidence that blinding makes a difference.

    Doshi, though, seems to think we should all be suspicious of who was on the Tozinameran committee in this context:

    "While Moderna has named its four-member adjudication committee – all university-affiliated physicians – Pfizer’s protocol says three Pfizer employees did the work. Yes, Pfizer staff members."

    I think this gets to a critical underlying issue about Doshi's bias and the buttons he's pushing on, intentionally or not. Considering Big Pharma untrustworthy plays a foundational role in conspiracist thinking, not just about drugs and in anti-vaccine literature and lobbying, but in general. The mentions of data being buried or hard to find push those buttons, too: they are keeping the truth from you. Of course, if they actually were, then it wouldn't be a theory. But making it free to view on the FDA website and at medical journals is pretty transparent, even if the documents are large and dense.

    I don't accept that "university-affiliated" necessarily means less bias in an outcome assessor, or for other members of the trial teams. The Moderna vaccine was a partnership with the NIH, after all, and that could introduce bias too. Very rigorous methods are meant to minimize the influence that individuals' biases can have. In this particular instance, I think there are actually more signs of bias in the reporting of the Moderna trial than the Pfizer one for Tozinameran. Why?

    The trial for Tozinameran reports there was 1 person with severe Covid-19 in the vaccine group. That person was classified as having severe illness even though they never needed medical care: most of us wouldn't consider what they had "severe" at all. But they were classified as severe because of the blood oxygenation level at one visit.

    The Moderna group report 0 people with severe Covid-19. But the FDA analysis for their trial reports this:

    One participant in the mRNA-1273 group, a participant >65 years of age who had risk factors for severe COVID-19, was hospitalized due to oxygen saturation of 88% on room air 2 months after receiving the second dose of vaccine. There was a verbal report of a positive SARS-CoV-2 RTPCR test 3 days prior to hospitalization; however, NP swab collected during hospitalization was negative for SARS-CoV-2. Due to absence of a confirmed RT-PCR result at the time of data snapshot, this case was not referred for adjudication and not captured. The pre-hospitalization RT-PCR result was later reported to be positive from an external CLIA-certified laboratory and may represent a severe COVID-19 case with hospitalization in the vaccine group.

    Well, that was some diplomatic wording from the FDA. The FDA didn't conclude there were any possible false-negatives of concern for the Tozinameran trial, but this seems pretty clear.

    Secondly, BioNTech/Pfizer determined more of the serious adverse events they adjudicated to be possibly or definitely vaccine-related than the FDA did; Moderna determined fewer to be possibly or definitely vaccine-related. From the start on, there's been less hype in public and in published materials from the BNT/Pfizer group than from Moderna. And the trials run by Oxford University for their vaccine have raised far more, and more serious concerns, than Doshi raises here. So he may want me to sell me on the idea of being more suspicious of the Tozinameran trial because its assessors weren't from a university, but I'm not buying it. I haven't seen evidence to justify a concern about this specific trial.

    To me the bottom line here is this: these are both impressive clinical trials, with impressive results. I think the Pfizer trial is particularly scrupulously reported, but with the serious scrutiny they're getting from the FDA and the EMA, we're getting extensive and reliable information about both. Yes, it would be great if the trials had been powered to give us highly certain answers on severe Covid-19 and other key questions. But it's an emergency. And we couldn't afford to wait for months longer to start using high-efficacy vaccines. Perfect information is wonderful, but it comes at a cost, and the cost of still not having any vaccines at all right now would have been horrendous.

  • What is a Biodistribution Study?

    This is one:: Pfizer report_Japanese government.pdf Pfizer gave the Japanese government.

    Let’s put the overarching concern in context: due to the pandemic and Operation Warp Speed, regulatory timelines were accelerated ... for generating maximum profit for Pfizer .. & ... 33 billion added as of today

    Hilda Bastian - Scientist, Blogger, Cartoonist

    Is that your preferred comedian?

  • More Hilda reporting on future COVID vaccine developments.

    With a very extensive analysis of 15 or so vaccine trials, and the safety evidence

    New Vaccine Hopes, Adverse Reactions, & a Developer Clashing With Regulators: A Month of Highs & Lows - Absolutely Maybe
    We’ve well and truly reached cherry-picking season on Covid vaccine data! It’s definitely easier to fall into the trap of claims based…

    Her analysis in the above link of relative adverse event risk and efficacy (subject to the fact that it will change as new data comes in) is a good deal more detailed than that given here by W. Only caveat - it is 2 months old.

  • Hilda's stuff is so nicely written - with cartoons as a bonus - it deserves several posts

    I like and respect Hilda's deconstruction of these two systematic reviews. Even though my opinion - informed mainly by the longitudinal random sample infection survey evidence or the UK, which I consider to be higher quality than almost anything else, leads to an IFR closer to that of M&M, Hilda's critique of Ioannides (a lot) and M&M (even more) is accurate.

    Take home: don't believe systematic reviews just because they are called systematic reviews - realise that these things (specifically COVID IFR) are difficult.

    NB - my comment - there is no one figure for IFR because it depends on population demographics, and also treatment. My best guestimate (for current treatment) would be from ~0.2% for young countries, to ~0.8% for old countries. And maybe double that for delta.

    Here is her take on the knotty subject of working out COVID IFR

    Peering Through the Smoke at a Duel Over Covid's Infection Fatality Rate - Absolutely Maybe
    This is one of my older cartoons. Unfortunately, the problem it’s depicting hasn’t gone out of style. But now it strikes me…

    I think this counts as a full-on feud between these 2 scientists, and it seems to be expanding beyond IFR. But I don’t want to discuss their behavior here. I want to discuss the science side of all this, and what issues this episode raises for the quality of science.

    Major cheer and jeer squads formed around both reviews, often praising one review and heaping disdain on the other. It wasn’t just about a difference in interpretation of data: these were fundamental issues about what counts as reliable science in systematic reviewing – and that’s a highly specialized area. So what should we make of these respective claims? Is one, the other, or both of these systematic reviews excellent – or as diabolically bad as detractors say? And what are the implications of scientists’ conflicting claims if the answer is actually cut and dried?

    It would take far too long to dig into all the detail about these 2 reviews, and every claim made about them. But there’s no need to. The picture gets very clear, very quickly. (Note: I criticized both these reviews heavily when they were in preprint, but never followed up to see what was in the published versions, and how much of the pre-publication critique the authors attended to.)

    I’ve spent a few decades analyzing multiple systematic reviews on the same question, and I’ve studied reviews with conflicting conclusions, too. Over the years, I narrowed down to a list of 5 questions to save time by knocking out most of the worst and unreliable systematic reviews quickly. One isn’t relevant to this debate – it’s about whether the review is up-to-date. But let’s go through the other 4 questions for these 2 reviews. From here on, I call Ioannidis (October 2020) the “I” review, and the one by Meyerowitz-Katz and Merone (December 2020) the M&M review.

  • Hilda on Vax for Kids

    An interesting take on the topic.

    A Worrying Drift Towards Exceptionalism In the Covid Vax For Kids Debate

    While it’s clear that most healthy children and adolescents – like most healthy young and middle-aged adults – aren’t a global priority, the rich world’s decisions and priorities around vaccine R&D for the very young have repercussions for other countries, too. And it’s only a matter of time till this isn’t just a pressing debate for rich countries. For perspective: there are just under 200 countries. In high income ones, the average proportion of the population that’s aged under 15 is only 16%. In low income countries, it’s 42%. There are around 60 countries where the proportion of the population under 15 is between 30 and 50%, and many others aren’t far off – Israel, for example, is at 28%. That’s a profoundly different context for discussions about how you get a high enough rate of immunity in a community, and stemming the evolution of the coronavirus and the pandemic.

    To explain my concern about some current debate, let’s start with what I mean about anti-vax movement framing of vaccines for children, and why that propels its reach so far and wide. Many people’s perception of anti-vaccine argument could be skewed because wild conspiracy theories and disinformation campaigns get a lot of attention. In fact, rhetorical argument about children is deeply at the heart of this phenomenon – even in Covid-19 debates, where “Think of the children!” is the most common rhetorical strategy. And it’s spread by social media globally. Anoop Nair and colleagues conclude social media is a key factor driving vaccine hesitancy in Kerala, India, for example, and that getting better at tackling that communication medium could be a constructive strategy. The conversation matters.

    I agree here with Hilda about how indirect and direct personal benefits need to be considered together

    Proponents of vaccination and communicators need to understand this context, Broniatowski and his colleagues argue, and I agree. This individualistic framing, they point out, has enabled enormously successful local activism and influence in the US. It paired up easily with old staples – like, you don’t need to vaccinate, because the diseases are disappearing already.

    The individualism that is the beating heart of so much current anti-vax campaigning drags the emphasis away from the public health ethos of vaccination, to focusing purely on what’s in it for the person getting vaccinated – coupled with exaggeration of vaccine risks and downplaying those of the disease. I think that needs to be countered: now is the time to reinforce community-spirited values, not let them be sidelined or misrepresented.

    In the public health ethos, direct risk and benefits to individuals are utterly critical, of course – but the benefits column is much wider than that. There are the widespread indirect benefits that come from reducing a pathogen’s ability to circulate freely and widely, as well as the protection of those who are both vulnerable to the disease and less-protected by vaccines. There’s still personal interest at play even with the societal benefits: a pathogen’s success blows back consequences on everyone – just think of the impact of increased healthcare costs alone – and there’s a benefit of being spared the distress of having endangered someone vulnerable around us. And that’s a very big group of people.

  • Why we vaccinate (Hilda style)

    In the US, for example, over 5% of the population is estimated to be immune-suppressed, and for them, vaccine protection from Covid-19 is often inadequate. Those for whom vaccination protection may be weaker is a very wide swathe – people with transplants, people trying to recover from cancer, people on some arthritis medications, and so much more. They’re frontline workers in hospitals and everywhere else, they have children, grandchildren, friends – and of course, there are immunocompromised children and adolescents, too. The circles of concern around those millions of people ripple out widely across the community. We should all care, and not let “but they had co-morbidities” become the new “but they were very old”.

    particularly relevant to the discussion here?

    That we only protect the most vulnerable among us if we vaccinate en masse is one of the basic tenets of vaccination, of course. And while you might get a different impression from some of the current debate, that doesn’t apply only to adults. Wider values for infectious diseases are part of why the under-18s get vaccinated, too, and we shouldn’t make an exception out of Covid-19 vaccination. In the case of the rubella vaccine in the routine childhood immunization program, it’s explicitly the point. That’s the “R” in the MMR vaccine. It’s not there to protect children from a very mild disease that was eliminated in many communities years ago. It’s to protect against the risks to fetal development should pregnant women become infected if the virus were to circulate again. Protection against getting sick if rubella does circulate is a bonus, but it’s not the reason infants were vaccinated. Another example: in the US, most adolescent boys might be getting vaccinated against HPV, though the main direct benefit is for women.