On November 10, 2021 (I think), the Brownstone Institute posted an article entitled “20 Essential Studies that Raise Grave Doubts about COVID-19 Vaccine Mandates” by Paul Elias Alexander. Alexander’s essay featured selective quotations, misleading spin, and (arguably) fabrication. I wrote up a lengthy response to Alexander’s article, but never finalized my take. Then today I was trying to decide what to do with my piece, which is long and frankly somewhat tedious, and I noticed that the original study is no longer available on the Brownstone Institute website. If you follow the link above, you will be redirected to a different article by Alexander on the same topic. The new article appears to be somewhat less mendacious than the old one,
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On November 10, 2021 (I think), the Brownstone Institute posted an article entitled “20 Essential Studies that Raise Grave Doubts about COVID-19 Vaccine Mandates” by Paul Elias Alexander. Alexander’s essay featured selective quotations, misleading spin, and (arguably) fabrication.
I wrote up a lengthy response to Alexander’s article, but never finalized my take. Then today I was trying to decide what to do with my piece, which is long and frankly somewhat tedious, and I noticed that the original study is no longer available on the Brownstone Institute website. If you follow the link above, you will be redirected to a different article by Alexander on the same topic. The new article appears to be somewhat less mendacious than the old one, although not all the errors and misdirection I originally identified have been corrected. And the Brownstone Institute never acknowledged the correction, or explained how the original article made it through their review process. Which is fine, I guess . . . if your business model is propaganda.
Here is the conclusion of my original essay, for those who understandably do not want to wade through the details:
Reasonable people can argue about the ethics of vaccine mandates. We can debate exactly how effective vaccines are at preventing infection, serious disease, and transmission. We should acknowledge that vaccines are not perfect and seem to wane in efficacy against infection and – at least for some groups – against serious disease. But to publish an article that appears to be a review of the literature, that uses selective quotation and even fabricates quotes to exaggerate the limitations of vaccines, and that fails to state clearly and unequivocally that vaccines are very effective at reducing serious disease and death is not just advocacy or even propaganda. It’s potentially deadly to people who become vaccine hesitant. And it contributes to polarization by creating an overblown sense of moral outrage over vaccines and mandates and an environment in which it is difficult for non-experts to know who to trust.
You can find Alexander’s original piece in the internet archive here. Below is my full critique. Warning: this is long and detailed, and, yes, tiresome.
Alexander begins as follows (my bold throughout):
The following research papers and studies raise doubts that Covid vaccine mandates are backed by science and good public-health practice. Anyone seeking to challenge these mandates should consult these carefully. They demonstrate that these mandates provide no overall health benefit to the community and can even be harmful. Instead, the decision to accept the vaccine should be made by individuals according to their own assessment of risks in consultation with informed medical professionals.
. . .
Below you can see the scientific evidence that call into question COVID-19 vaccine mandates.
Alexander then gives us a list of links to 20 articles, coupled with a sentence or two of commentary and quotes from the articles. Far from “demonstrating” that mandates have no benefits, the articles say nothing directly about the value of mandates. Instead, they raise doubts about the benefits of vaccines. This is troubling, but it makes some sense if your goal is to make the case against mandates: if vaccines are ineffective or harmful, it’s hard to see the point of a vaccine mandate.
The standard view
Let’s begin with the big picture. As I understand it – and I am not an epidemiologist – the standard view on the effectiveness of vaccines as of the date of Alexander’s essay goes something like this:
Vaccines remain highly effective against severe illness and death, with some waning of protection especially for more vulnerable groups (hence the need for booster shots).
Vaccines seem to be at least modestly effective at preventing infection and transmission, but this protection may wane more quickly than protection against severe disease. However, for various reasons it is difficult to measure these effects with confidence.
Many of the papers Alexander cites support this standard view, but you would not get that impression from his capsule summaries. Instead, Alexander leads his readers to doubt the efficacy of vaccines, and even to worry that vaccination may be harmful. He does this by selectively quoting from articles in a way that emphasizes the limitations of vaccines and understates their value. He uses phrases that conflate protection against infection with protection against severe disease. As we will see, it is not always clear where quotes end and Alexander’s spin and misdirection begins. To see how mendacious his article is let’s look at a few of his summaries.
COVID-19 vaccine surveillance report – week 42
Here is how Alexander describes this study from the UK Health Security Agency:
Information on page 23 raises serious concerns when it reported that “waning of the N antibody response over time and (iii) recent observations from UK Health Security Agency (UKHSA) surveillance data that N antibody levels appear to be lower in individuals who acquire infection following 2 doses of vaccination.” Also shows a pronounced and very troubling trend, which is that the “double vaccinated persons are showing greater infection (per 100,000) than the unvaccinated, and especially in the older age groups e.g. 30 years and above.”
Let’s begin with the claim that vaccinated people over 30 are “showing greater infection” than the unvaccinated. Note that the phrase “showing greater infection” is Alexander’s, it is not from the study, despite the quotation marks, and it is ambiguous – it could mean “getting sicker” or “getting infected more often”. In some raw data provided by the report it turns out that vaccinated people are getting infected at higher rates than the unvaccinated, but as the report notes:
The vaccination status of cases, inpatients and deaths is not the most appropriate method to assess vaccine effectiveness and there is a high risk of misinterpretation. Vaccine effectiveness has been formally estimated from a number of different sources and is described earlier in this report. . . .
The case rates in the vaccinated and unvaccinated populations are crude rates that do not take into account underlying statistical biases in the data. There are likely to be systematic differences in who chooses to be tested and the COVID risk of people who are vaccinated.
These biases become more evident as more people are vaccinated and the differences between the vaccinated and unvaccinated population become systematically different in ways that are not accounted for without undertaken formal analysis of vaccine effectiveness as is made clear.
The report itself is clear that vaccines are highly protective against serious disease and also concludes (with low confidence) that the vaccines are protective against infection and transmission. If Alexander believes that the report authors have misinterpreted their own data and the studies they cite, he is free to explain why, but instead he just leaves his readers with the impression that they are more likely to get infected – and possibly to get sicker – if they get vaccinated. (Even in the raw data you are more likely to die if unvaccinated, a point Alexander omits.)
What about the waning of N antibody response over time? Alexander never explains why this is a “serious concern”, and this is not self-evident. (As the report explains, N antibody testing measures prior infection with covid but not vaccination. One might speculate that waning N antibody levels suggest that people with natural immunity should get vaccinated, but naturally this is not Alexander’s point.) The authors of the report do not say this is a problem. Alexander is free to argue that this is a problem, but he needs to actually provide an argument, not just leave readers with the impression that the authors of this report regard this as a problem.
Effectiveness of Covid-19 vaccination against risk of symptomatic infection, hospitalization, and death up to 9 months: a Swedish total-population cohort study
Next consider how Alexander covers this study. Here is the brief takeaway Alexander includes in his report:
“Report on their study which shows that (cohort comprised 842,974 pairs (N=1,684,958), including individuals vaccinated with 2 doses of ChAdOx1 nCoV-19, mRNA-1273, or BNT162b2, and matched unvaccinated individuals) “vaccine effectiveness of BNT162b2 against infection waned progressively from 92% (95% CI, 92-93, P<0·001) at day 15-30 to 47% (95% CI, 39-55, P<0·001) at day 121-180, and from day 211 and onwards no effectiveness could be detected (23%; 95% CI, -2-41, P=0·07)” …while the vaccine provides temporary protection against infection, the efficacy declines below zero and then to negative efficacy territory at approximately 7 months, underscoring that the vaccinated are highly susceptible to infection and eventually become highly infected (more so than the unvaccinated).
The result from the study that Alexander highlights (the part not in bold) is that protection against infection after vaccination with the Pfizer vaccine wanes significantly and is positive but not different than zero according to standard tests of statistical significance. The highlighted part (my bold) is not from the study, it is Alexander’s spin. It leaves the impression that getting vaccinated is bad for you after 7 months: the vaccinated become more highly infected than the unvaccinated. (Note how vague this is. What does it mean to become “highly infected”? It could easily be taken to mean “sicker”, not “more likely to get sick”. The study does not support either of these conclusions.)
Anyway, here is the full abstract:
Vaccine effectiveness of BNT162b2 against infection waned progressively from 92% (95% CI, 92-93, P<0·001) at day 15-30 to 47% (95% CI, 39-55, P<0·001) at day 121-180, and from day 211 and onwards no effectiveness could be detected (23%; 95% CI, -2-41, P=0·07). The effectiveness waned slightly slower for mRNA-1273, being estimated to 59% (95% CI, 18-79) from day 181 and onwards. In contrast, effectiveness of ChAdOx1 nCoV-19 was generally lower and waned faster, with no effectiveness detected from day 121 and onwards (-19%, 95% CI, -97-28), whereas effectiveness from heterologous ChAdOx1 nCoV-19 / mRNA was maintained from 121 days and onwards (66%; 95% CI, 41-80). Overall, vaccine effectiveness was lower and waned faster among men and older individuals. For the outcome severe Covid-19, effectiveness waned from 89% (95% CI, 82-93, P<0·001) at day 15-30 to 42% (95% CI, -35-75, P=0·21) from day 181 and onwards, with sensitivity analyses showing notable waning among men, older frail individuals, and individuals with comorbidities.
So here is what Alexander leaves out: the Moderna vaccine remains effective against infection after 6 months, as does mix-and-match with the Oxford/AstraZeneca vaccine and one of the mRNA vaccines. Furthermore, vaccines waned in effectiveness against severe disease but still remained moderately effective after six months.
Here is the authors’ interpretation of their results:
Vaccine effectiveness against symptomatic Covid-19 infection wanes progressively over time across all subgroups, but at different rate according to type of vaccine, and faster for men and older frail individuals. The effectiveness against severe illness seems to remain high through 9 months, although not for men, older frail individuals, and individuals with comorbidities. This strengthens the evidence-based rationale for administration of a third booster dose.
In short: vaccines remain effective against severe illness even after 6 months, except for certain vulnerable groups, and as the authors say, this strengthens the case for booster shots; it does not undermine the rationale for vaccine mandates.
Waning of BNT162b2 vaccine protection against SARS-CoV-2 infection in Qatar
Next consider how Alexander summarizes this study:
“Qatar study which showed that the vaccine efficacy (Pfizer) declined to near zero by 5 to 6-months and even immediate protection after one to two months were largely exaggerated… BNT162b2-induced protection against infection appears to wane rapidly after its peak right after the second dose.”
The sentence I have bolded is Alexander’s interpretation, it is not a quote from the study, although his use of quotation marks suggest that it is . . . a quotation. (That’s how quotation marks work. You put something inside quotation marks when it is quotation.) Alexander’s spin suggests that Pfizer stops working completely after 6 months. That’s what the phrase “vaccine efficacy” suggests. But the second part of Alexander’s summary suggests the study only shows that protection against infection wanes. So, which is it? Let’s look at the full abstract:
RESULTS: Estimated BNT162b2 effectiveness against any infection, asymptomatic or symptomatic, was negligible for the first two weeks after the first dose, increased to 36.5% (95% CI: 33.1-39.8) in the third week after the first dose, and reached its peak at 72.1% (95% CI: 70.9-73.2) in the first five weeks after the second dose. Effectiveness declined gradually thereafter, with the decline accelerating ≥15 weeks after the second dose, reaching diminished levels of protection by the 20th week. Effectiveness against symptomatic infection was higher than against asymptomatic infection, but still waned in the same fashion. Effectiveness against any severe, critical, or fatal disease increased rapidly to 67.7% (95% CI: 59.1-74.7) by the third week after the first dose, and reached 95.4% (95% CI: 93.4-96.9) in the first five weeks after the second dose, where it persisted at about this level for six months.
CONCLUSIONS: BNT162b2-induced protection against infection appears to wane rapidly after its peak right after the second dose, but it persists at a robust level against hospitalization and death for at least six months following the second dose.
So this study finds that efficacy remains high against severe disease.
But what about the risk of anti-body dependent enhancement (ADE)?
The theoretical possibility of anti-body dependent enhancement, in which vaccines backfire and increase susceptibility to disease, has occasionally been cited by those opposed to vaccination. Alexander summarizes a recent two page letter to the editor of The Journal of Infection as follows:
Reported that “in the case of the Delta variant, neutralizing antibodies have a decreased affinity for the spike protein, whereas facilitating antibodies display a strikingly increased affinity. Thus, ADE may be a concern for people receiving vaccines based on the original Wuhan strain spike sequence (either mRNA or viral vectors).”
Alexander’s summary makes it sound as if there is evidence that ADE is actually happening with current vaccines, in real people. In fact, the letter is based only on theoretical modeling, and we know that ADE is not happening in the real world, because . . . we know that vaccines greatly reduce the risk of serious illness. You can read more about this nonsense here.
Again, the words in quotes are not actually from the paper.
Who is Alexander, anyway?
The Brownstone Institute had every reason to be cautious about publishing this article. This is from Wikipedia:
Alexander was recruited from his part-time, unpaid position at McMaster University to serve as an aide to HHS assistant secretary for public affairs Michael Caputo in March 2020. In that role, Alexander pressured federal scientists and public health agencies to suppress and edit their COVID-19 analyses to make them consistent with Trump’s rhetoric.
Yes, this is bad
Reasonable people can argue about the ethics of vaccine mandates. We can debate exactly how effective vaccines are at preventing infection, serious disease, and transmission. We should acknowledge that vaccines are not perfect and seem to wane in efficacy against infection and – at least for some groups – against serious disease. But to publish an article that appears to be a review of the literature, that uses selective quotation and even fabricates quotes to exaggerate the limitations of vaccines, and that fails to state clearly and unequivocally that vaccines are very effective at reducing serious disease and death is not just advocacy or even propaganda. It’s potentially deadly to people who become vaccine hesitant. And it contributes to polarization by creating an overblown sense of moral outrage over vaccines and mandates and an environment in which it is difficult for non-experts to know who to trust.