The following is a conversation with Jay Bhattacharya, professor of medicine, health policy, and economics at Stanford University. Please allow me to say a few words about lockdowns and the blinding destructive effects of arrogance on leadership, especially in the space of policy and politics. Jay Bhattacharya is the co-author of the now famous Great Barrington Declaration, a one-page document that in October 2020 made a case against the effectiveness of lockdowns. Most of this podcast conversation is about the ideas related to this document. And so, let me say a few things here about what troubles me. Those who advocate for lockdowns as a policy often ignore the quiet suffering of millions that it results in, which includes economic pain, loss of jobs that give meaning and pride in the face of uncertainty, the increase in suicide and suicidal ideation, and in general the fear and anger that arises from the powerlessness forced onto the populace by the self-proclaimed elites and experts. Many folks whose job is unaffected by the lockdowns talk down to the masses about which path forward is right and which is wrong. What troubles me most is this very lack of empathy among the policymakers for the common man and in general for people unlike themselves. The landscape of suffering is vast and must be fully considered in calculating the response to the pandemic with humility and with rigorous open-minded scientific debate. Jay and I talk about the email from Francis Collins to Anthony Fauci that called Jay and his two co-authors fringe epidemiologists and also called for a devastating published takedown of their ideas. These words from Francis broke my heart. I understand them. I can even steel man them. But nevertheless, on balance, they show to me a failure of leadership. Leadership in a pandemic is hard. Which is why great leaders are remembered by history. They are rare. They stand out and they give me hope. Also, this whole mess inspires me on my small individual level to do the right thing in the face of conformity despite the long odds. I talked to Francis Collins. I talked to Albert Bourla, Pfizer CEO. I also talked and will continue to talk with people like Jay and other dissenting voices that challenge the mainstream narratives and those in the seats of power. I hope to highlight both the strengths and weaknesses in their ideas with respect and empathy, but also with guts and skill. The skill part I hope to improve on over time. And I do believe that conversation and an open mind is the way out of this. And finally, as I've said in the past, I value love and integrity far far above money, fame, and power. Those latter three are all ephemeral. They slip through the fingers of anyone who tries to hold on and leave behind an empty shell of a human being. I prefer to die a man who lived by principles that nobody could shake and a man who added a bit of love to the world. And now a quick few second mention of each sponsor. Check them out in the description. It's the best way to support this podcast. First is Athletic Greens, the all-in-one nutrition drink I drink twice a day. Second is Inside Tracker, a service I use to track my biological data. Third is Coinbase, a platform I use to buy cryptocurrency. Fourth is ROA, my favorite sunglasses and prescription glasses. And fifth is Indeed, a hiring website. So the choice is health, money, style, or teamwork. 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To our best understanding today, how deadly is COVID? Do we have a good measure for this very question?
So the best evidence for the deadliness of COVID comes from a whole series of seroprevalence studies. Seroprevalence studies are these studies of antibody prevalence in the population at large. I was part of the very first set of seroprevalence studies: one in Santa Clara County, one in LA County, and one with Major League Baseball around the US. If I may just pause you for a second, if people don't know what serology and seroprevalence is, it does sound like zero prevalence. It's not. Sero and serology is antibodies. So it's a survey that counts the number of people that have antibodies specific to COVID, which perhaps shows an indication that they likely have had COVID, and therefore this is a way to study how many people in the population have been exposed to have had COVID.
Exactly. Yeah. Exactly. So the idea is that we don't know exactly the number of people with COVID just by counting the people that present themselves with symptoms of COVID. COVID has a very wide range of symptoms possible, ranging from no symptoms at all to this deadly viral pneumonia that's killed so many people. And the problem is, if you just count the number of cases, the people who have very few symptoms often don't show up for testing. They're outside the purview of public health. And so it's really hard to know the answer to your question without understanding how many people are infected because you can probably tell the number of deaths. That's even though there's some controversy over that, but the numerator is possible, but the denominator is much harder. How much controversy is there about the deaths? We're going to go on a million tangents. Is that okay? We're going to, I have a million questions. So, one, I love data so much, but I've almost tuned out paying attention to COVID data because I feel like I'm walking on shaky ground. I don't know who to trust. Maybe you can comment on different sources of data, different kinds of data, the death one. That seems like a really important one. Can we trust the reported deaths associated with COVID, or is it just a giant messy thing that's mixed up? And then there's these kind of stories about hospitals being incentivized to report a death as a COVID death.
So there's some truth in some of that. Let me just talk about the incentive. So in the United States, we passed this CARES Act that was aimed at making sure hospital assistance didn't go bankrupt in the early days of the pandemic. A couple things they did: one was they provided incentives to treat COVID patients, tens of thousands of dollars extra per COVID patient. And the other thing they did is they gave a 20% bump to Medicare payments for elderly patients treated with COVID. The idea is that it's more expensive to treat them in the early days. So that did provide an incentive to sort of have a lot of COVID patients in the hospital because your financial success of the hospital or at least not the lack of financial ruin depended on having many COVID patients. The other thing on the death certificates is the reporting of deaths is a separate issue. I don't know that there's a financial incentive there, but there is this sort of complicated thing: when you fill out a death certificate for a patient with a lot of conditions, like let's say a patient has diabetes, that diabetes could lead to heart failure. You have a heart attack, heart failure, your lungs fill up, then you get COVID and you die. So what do you write on the death certificate? Was it COVID that killed you? Was it the lungs filling up? Was it the heart failure? Was it the diabetes? It's really difficult to disentangle, and I think a lot of times what happened is they have erred on the side of signing it as COVID. Now, what's the evidence of this? There's been a couple of audits of death certificates in places like Santa Clara County where I live and Alameda County, California, where they carefully went through the death certificates and said, okay, is this reasonable to say this was actually COVID or was COVID incidental? And they found that about 20-25% of the deaths were more likely incidental than directly due to COVID. I personally don't get too excited about this. I mean, it's a philosophical question, right? Like ultimately, what kills you? Which is an odd thing to say if you're not in medicine, but really it's almost always multifactorial. It's not always just the bus hits you. The bus hits you, you get a brain bleed. Was the brain bleed that killed you? Would it have burst anyway? I mean, the bus hits you, killed you, right? The way you die is a philosophical question, but it's also a sociological and psychological question.
Because it seems like every single person who's passed away over the past couple years, the first question that comes to mind is, was it COVID? Not just because you're trying to be political, but just in your mind?
No, I think there's a psychological reason for this. We spent the better part of at least a half century in the United States not worried too much about infectious diseases, and the notion was we essentially conquered them. It was something that happens in far away places to other people, and that was true for much of the developed world. Life expectancy was going up for decades, and for the first time in living memory we have a disease that can kill us. I think we're effectively evolved to fear that. The panic centers of our brain, the lizard part of our brain takes over, and our central focus has been avoiding this one risk. So it's not surprising that when people are filling out death certificates or thinking about what led to the death, this most salient thing that's in the front of everyone's brain would jump to the top. And we can't ignore this very deep psychological thing when we consider what people say on the internet, what people say to each other, what people write in scientific papers. It feels like when COVID was brought into this world, everything changed in the way people feel about each other, just the way they communicate with each other. I think the level of emotion involved, I think it in many people brought out the worst in them for sometimes short periods and sometimes it was always therapeutic, like you were waiting to get out the darkest parts of you just to say if you're angry at something in this world I'm going to say it now. And I think that's probably talking to some deep primal thing that we have for formalities of all different kinds, and then when that fear is aroused in all the deepest emotions it's like a Freudian psychotherapy session but across the world.
It's something that psychologists are going to have a field day with for a generation trying to understand. I think what you say is right, but piled on top of that is also this impetus to empathy, to empathize, compassion toward others essentially militarized. Right. So, I'm protecting you by some actions. And those actions, if I don't do them, if you don't do them, well, that must mean you hate me. It's created this social tension that I've never seen before. And we started looking at each other as if we were just simply sources of germs rather than people to get to know, people to enjoy, people to learn from. It colored almost every human interaction for every human on the planet.
Yeah. The basic common humanity. It's like you can wear a mask, you can stand far away, but the love you have for each other when you look into each other's eyes that was dissipating. And by region too. I've experienced having traveled quite a bit throughout this time. It was really sad. Even people that are really close together, just the way they stood, the way they looked at each other. And it made me feel for a moment that the fabric that connects all of us is more fragile than I thought. I mean, if you walk down the street during COVID, you're sure you had this experience: if you're not wearing a mask or even if you are, people will jump off the sidewalk as you walk past them, as if you're poison, even though the data are that COVID spreads indifferently outdoors if at all really outdoors. But it's not simply a biological or infectious disease phenomenon, epidemiological. It is a change in the way humans treated each other. I hope temporary. I do want to say on the flip side of that, I was mostly in Boston, Massachusetts when the pandemic broke out. I think that's where I was. And then I came here to Austin, Texas to visit my now good friend Joe Rogan. And he was the first person without pause, this wasn't a political statement, just walk toward me and give me a big hug and say, 'It's great to see you.' And I can't tell you how great it felt because I in that moment realized the absence of that connection back in Boston over just a couple of months. And it's tragic to think about that distancing, that dissolution of common humanity at scale, what kind of impact it has on society just across the board, political division, and just in the quiet of your own mind, in the privacy of your own home, the depression, the sadness, the loneliness that leads to suicide, and forget suicide, just low-key suffering.
Yeah. No, I think that's the suffering that isolation. We're not meant to live alone. We're not meant to live apart from one another. That's of course the ideology of lockdown is to make people live apart, alone, isolated so that we don't spread diseases to each other. But we're not actually designed as a species to live that way. And that what you're describing I think if everyone's honest with themselves have felt especially in places where lockdowns have been sort of very militantly enforced has felt deep into their core. Well, if I could just return to the question of deaths, you said that the data isn't perfect because we need these kind of seroprevalence surveys to understand how many cases there were to determine the rate of deaths, and we need to have a strong footing in the number of deaths. But if we assume that the number of deaths is approximately correct, what's your sense? What kind of statements can we say about the deadliness of COVID across different demographics? Maybe not in a political way or in the current way, but when history looks back at this moment of time 50 years from now, 100 years from now, the way we look at the pandemic 100 years ago, what will they say about the deadliness of COVID?
I think the deadliness of COVID depends on not just the virus itself but who it infects. So probably the most important thing about the deadliness of COVID is this steep age gradient in the mortality rate. According to the seroprevalence studies that have been done now, hundreds of them, mostly from before vaccination because vaccination also reduces the mortality risk of COVID, the seroprevalence studies suggest that the risk of death if you're say over the age of 70 is very high, you know, 5%. If you get COVID, if you're under the age of 70 it's lower, 0.05%, but there's not a single sharp cutoff. It's more like a rule of thumb I use: if you're 50, the infection fatality rate from COVID is 0.2% according to the seroprevalence data. That means 99.8% survival if you're 50, and for every 7 years of age above that, double it. Every 7 years of age below that, halve it. So a 57-year-old would have a 0.4% mortality, a 64-year-old would have 0.8%, and so on. And if you have a severe chronic disease like diabetes or if you're morbidly obese, it's like adding seven years to your life. This is for unvaccinated folks, before delta also.
Are there a lot of people that would be listening to this with PhDs at the end of their name that would disagree with the 99.8%? Would you say?
So I think there's some disagreement over this, and the disagreement is about the quality of the seroprevalence studies that were conducted. As I said earlier, I was the senior investigator in three different seroprevalence studies very early in the epidemic. I view them as very high quality studies. In Santa Clara County, we used a test kit that we obtained from someone who works in Major League Baseball actually. He had ordered these test kits very early in March 2020 that measures very accurately antibody levels in the bloodstream. The test kits were eventually approved by the FDA under emergency use authorization shortly after we did this, and it had a very low false positive rate. False positive means if you don't have COVID antibodies in your bloodstream, the kit shows up positive anyway. That turns out to happen about 0.5% of the time. Based on studies looking at blood from 2018, you try it against this kit, and you know 0.5% of the time in 2018 there shouldn't be antibodies to COVID, so if it turns positive it's a false positive. And a false negative rate about 10-12% something like that. The false positive rate is the important thing there. You have a population in March-April 2020 with a very low fraction of patients having been exposed to COVID, so even a small false positive rate could end up biasing your study quite a bit. But there's a formula to adjust for that. We did that adjustment, and those studies found in a community population, leaving aside people in nursing homes who have a higher death rate from COVID, the death rate was 0.2% in Santa Clara County and in LA County.
Yeah. So like that's actually a real important question too. The Santa Clara study we did a Facebook sampling scheme, which is not the ideal thing but it was very difficult to get a random sample during lockdown. We put out an ad on Facebook soliciting people to volunteer for the study, randomly selected set of people. We were hoping to get a random selection of people from Santa Clara County, but it tended to the people who volunteered were from the richer parts of the county. I had Stanford professors writing begging to be in the study because they wanted to know their antibody levels. So we did some adjustment for that. In LA County, we hired a firm that had a pre-existing representative sample of LA County. But it didn't include nursing homes, people in jail, the homeless populations. So it's representative of a community-dwelling population. And there we found that both in LA County and Santa Clara County in April 2020, something like 40 to 50 times more infections than cases in both places. For every case that had been reported to the public health authorities, we found 40 or 50 other infections with antibodies in their blood suggesting they had COVID and recovered. So people were not reporting, or at least in those days, underreporting.
Yeah. I mean, there was testing problems. There weren't so many tests available. People didn't know. We asked a set of questions about the symptoms they'd faced, and most of them said they faced no symptoms, or 30-40% said they faced no symptoms. Even these days, how many people report that they get COVID? Okay. So those numbers, that 0.2%, has that approximately held up over time?
So Professor John Ioannidis, a colleague of mine at Stanford, who's a world expert in meta-analysis, probably the most cited scientist on earth, I think at least living, he did a meta-analysis of now a hundred or more of these seroprevalence studies, and what he found was that 0.2% is roughly the worldwide number. In fact, I think he cites a lower number, 0.15%, as the median infection fatality rate worldwide. So we did these studies and it generated an enormous amount of blowback by people who thought that the infection fatality rate is much higher. There's some controversy over the quality of some of the other studies that are done. And so there are some people who look at this same literature and say, 'Well, the lower quality studies tend to have lower IFRs. The higher quality studies...'
Oh, infection fatality rate, right? I apologize. I do this in lectures too. I call it... And I'm going to rudely interrupt you and ask for the basics sometimes, if it's okay.
No, of course. So these higher quality studies, they say, tend to produce higher IFRs. But the problem is if you want a global infection fatality rate, you need to get seroprevalence studies from everywhere, even places that don't necessarily have the infrastructure set up to produce very high quality studies. And in poor places in the world, like places in Africa, the infection fatality rate is incredibly low. And in some richer places like New York City, the infection fatality rate is much higher. There's a range of IFRs, not a single number. This sometimes surprises people because they think, well, it's a virus, it should have the same properties no matter where it goes. But the virus kills or infects in interaction with the host, and the properties of both the host and the virus combined to produce the outcome.
So that's one way you would explain the difference between Africa and New York City in terms of the fatality rate is the average age?
Yeah. And in the early days of the epidemic in New York City, the older populations living in nursing homes were differentially infected based on policies that were adopted, right? To send COVID infected patients back to nursing homes to keep hospitals empty.
What do you mean by differentially infected?
The policy that you adopt determines who is most exposed.
Yeah. Then you have a very different risk profile than if you have societies where generations are more separate from one another. Okay, so let me just finish real fast about this. So in New York, you have a population that was infected in the early days that was very likely going to die, had a much higher likelihood of dying if infected. And so New York City had a higher IFR especially in the early days than Africa has had.
And the other thing is treatment, right. So the treatments that we adopted in the early days of the epidemic I think actually may have exacerbated the risk of death, like using ventilators, the over-reliance on ventilators is what I'm primarily thinking of, but I can think of other things. But we've learned over time how better to manage patients with the disease. So all those things combined, that's where the controversy over this number is.
I mean New York City also is a central hub for those who tweet and those who write powerful stories and narratives in article form. And I remember there was quite dramatic stories about doctors in the hospitals and these kinds of things. I mean there's very serious, very dramatic, very tragic deaths going on always in hospitals. Those stories, a lot of loved ones losing each other on a deathbed. That's always tragic and you could always write a hell of a good story about that, and you should about the loss of loved ones. But they were doing it pretty well, I would say, over this kind of dramatic deaths. And so in response to that, it's very unpleasant to hear even to consider the possibility that the death rate is not as high as you might feel.
Yeah, I was surprised by the reaction both by regular people and also the scientific community in response to those studies, those early studies in April of 2020. To me, they were studies. They're the kinds of work I've worked on all my life, but kind of the kind that you write a paper and you get responses from your fellow scientists and you change the paper to improve it, you learn something from it. But to push back, it's just a study. But there's some studies that if wrong might have a wide-ranging detrimental effect on society. So that's the way they would perceive the studies. If you say the death rate is lower and you end up as you often do in science realizing that nope, there was a flaw in the way the study was conducted or it's not representative, and then you realize the death rate is much higher, that might be very damaging in people's view. So that's probably where the scientific community just steelman the kind of response is that they felt like there's some findings where you better be damn sure before you report them.
Yeah. I mean we were pretty sure we were right and it turns out we were right. So when we released the Santa Clara study via this open science process and this server called medRxiv, it's designed for releasing studies that have not yet been peer-reviewed in order to garner comment from the scientists before peer review. The LA County study, we went through the traditional peer-review process and got it published in the Journal of American Medical Association sometime in July 2020. The Santa Clara study released in April of 2020 in this working paper archive. The reason was that we felt we had an obligation. We had a result that we thought was quite important and we wanted to tell the scientific community about it and also tell the world about it, and we wanted to get feedback. I think a lot of the problem is that when people think about published science they think of it as automatically true, and if it goes through peer review it's automatically true. If it hasn't gone through peer review it's not automatically true. And especially in medicine we're not used to having this access to pre-peer-reviewed work. In economics, actually, that's quite normal. It takes years to get something published, so there's a very active debate about papers before they're peer-reviewed in this working paper way. Much less normal or much newer in medicine. And so I think part of the perception about what that process happens in open science when you release a study got people confused. And you're right, it was a very important result because we had just locked the world down in middle of March with I think catastrophic results, and if that study was right, if our study was right, that meant we'd made a mistake. And not because the death rate was low, that's actually not the key thing. The key thing is that we had adopted these policies, these test and trace policies, these lockdown policies aimed at suppressing the virus level to close to zero. That was essentially the idea. If we can just get the virus to go away, we won't have to ever worry about it again. The main problem with our result as far as that strategy was concerned wasn't the death rate. It was the 40 to 50 times more infections than cases. It was the 2.5% or 3% or 4% prevalence rate that we identified of antibodies in the population. If that number is right, it's too late. The virus is not going to go to zero. And no matter how much we test and trace and isolate, we're not going to get the viral level down to zero.
So, we're going to have to let the virus go through the entire population in some way.
No, well, that we can talk about that in a bit. That's the Great Barrington Declaration. You don't have to let the virus go through the population. You can shield preferentially. The policy we chose was to shield preferentially the laptop class, the set of people who could work from home without losing their job. And we did a very good job at protecting them.
Well, let me take a small tangent. We're going to jump around in time, which I think will be the best way to tell the story. So that was the beginning.
Yeah. Okay. Actually, can I go back one more thing for that? Because that's really important and I should have started with this. What led me to do those studies was a paper that I had remembered seeing from the H1N1 flu epidemic in 2009. This is something I've been much less active in writing about. I had written a paper or two about that in 2009. There was actually this same debate over the mortality rate except it unfolded over the course of two or three years. The early studies of the mortality rate in H1N1 counted the number of cases in the denominator and the number of deaths in the numerator. Cases meaning people identified as having H1N1 showing up to the doctor, tested to have it. And the early estimates of the H1N1 mortality were like 4%, 3%, really high. Over the course of a couple of more years, a whole bunch of seroprevalence studies of H1N1 flu came out and it turned out that there were 100 or more times people infected per case. And so the mortality rate was actually something like 0.02% for H1N1, not the 3%, a 100-fold difference. So this made me think, okay, it took us a couple of years to discover the truth behind the actual infections for H1N1, and what's the truth here and can we get there faster? And it spreads in a similar way as the H1N1 flu did. It spreads via air, aerosolization, person-to-person breathing contact, and maybe some by fomites but that seems less likely now. In any case, it seemed really important to me to speed up the process of having those seroprevalence studies so that we can better understand who was at risk and what the right strategy ought to be. This might be a good place to kind of compare influenza, the flu, and COVID in the context of the discussion we just had, which is how deadly is COVID. You mentioned COVID has a very particular steepness where the x-axis is age. So in that context, could you maybe compare influenza and COVID? Because a lot of people outside of the folks who suggest that the lizards who run the world have completely fabricated COVID, outside of those folks, kind of the natural process by which you dismiss the threat of COVID is say well it's just like the flu. The flu is a very serious thing actually. So in that comparison, where does COVID stand?
Yeah, the flu is a very serious thing. It kills 50-60,000 people a year something like that depending on the particular strain that goes around in the United States. The primary difference to me, there's lots of differences but one of the most salient differences is the age gradient in mortality risk for the flu. The flu is more deadly to children than COVID is. There's no controversy about that. Children, thank God, have much less severe reactions to COVID infection than to flu infections. I think you mentioned in another conversation there's a U shape to the flu curve, meaning there's actually quite a large number of kids that die from flu. Yeah, the 1918 flu, the H1N1 flu, the Spanish flu killed millions of younger people. That is not the case with COVID. More than 70-80% of the deaths are people over the age of 60.
We've been talking about the fear the whole time. My interaction with folks, I want to have a family, I want to have kids but I don't have that real firsthand experience, but my interaction with folks is at the core of fear that folks had for their children. That somehow you know, I don't want to get infected because of the kids, because God forbid something happens to the kids. And I think that obviously makes a lot of sense. The kids come first no matter what. That's number one priority. But for this particular virus, that reasoning was not grounded in data it seems like. Or that emotion and feeling was not grounded.
It wasn't. But at the same time, this is way more deadly than the flu just overall and especially to older people.
Right. So the numbers when the story is all said and done, COVID would take many more lives.
Yeah. So I mean 0.2% sounds like a small number but it's not a small number worldwide. What do you think that number will be? In the United States, the way the deaths are currently reported like 800,000 something like that. Do you think we'll cross a million?
Yeah. Do you think it's something that might continue with different variants?
Well, I think the end state of COVID is it's here forever. I think there is good evidence of immunity after infection such that you're protected both against reinfection and also against severe disease upon reinfection. So the second time you get it, it's not true for everyone but for many people, the second time will be milder, much milder than the first time. There are studies that follow people who are infected for a year, and the reinfection rate is something like between 3% and 1%. A pretty fantastic study out of Italy and one in Sweden found similar things. The reinfections tend to produce much milder disease, much less likely to end up in the hospital, much less likely to die. So the end state of COVID is it's circulating in the population forever and you get it multiple times.
Yeah. And then there's studies and discussions like the best protection would be to get it and then also to get vaccinated. A lot of people push back against that for the obvious reasons from both sides because somehow the discourse has become less scientific and more political.
Well, I think the first time you meet it is going to be the most deadly for you, and so the first time you meet it, it's just wise to be vaccinated. The vaccine reduces severe disease. We'll talk about the vaccine because I want to make sure I address it carefully and properly and in full context.
Um but yes, sort of to add to the context, a lot of the fascinating discussions we're having is in the early days of COVID and now for people who are unvaccinated. That's where the interesting story is, the policy story, the sociological story and so on. But let me go to something really fascinating just because of the people involved, the human beings involved, and because of how deeply I care about science and also kindness, respect, and love and human things. Francis Collins wrote a letter in October 2020 to Anthony Fauci. I have the letter, it's not a letter, email. 'Hi Tony and Cliff, gbdeclaration.org. This proposal, this is the Great Barrington Declaration that you're a co-author on, this proposal from the three fringe epidemiologists who met with the secretary seemed to be getting a lot of attention and even a co-signature from Nobel Prize winner Mike Levitt at Stanford. There needs to be a quick and devastating published takedown of its premises. I don't see anything like that online yet. Is it underway?' Francis Collins, director of the NIH, somebody I talked to on this podcast recently. A million questions I want to ask. But first, how did that make you feel when you first saw this email come to light? Which when did it come to light?
This week actually, I think, or last week.
Okay. So, this is because of freedom of information.
Which by the way, sort of, I do want to add positive stuff on the side of Francis here. Boy, when I see stuff like that, I wonder if all my emails leaked, how much embarrassing stuff. I think I'm a good person, but I haven't read my old emails. Maybe I'm pretty sure sometimes late I could be an asshole.
Well, I mean, look, he's a Christian and I'm a Christian. I'm supposed to forgive, right? I think he was looking at this Great Barrington Declaration as a political problem to be solved as opposed to a serious alternative approach to the epidemic.
So maybe we'll talk about in more detail, but just for in case people are not familiar, Great Barrington Declaration was a document that you co-authored that basically argues against this idea of lockdown as a solution to COVID and you proposed another solution that we'll talk about. But the point is it's not that dramatic of a document. It is just a document that criticizes one policy solution that was the policy solution that had been put forward by Dr. Collins and by Tony Fauci and a few other scientists and epidemiologists in charge of the advice given to governments worldwide, and it was a challenge to that policy that said that look, there is an alternate path, that the path we've chosen, this path of lockdown with an aim to suppress the virus to zero effectively though that was unstated, cannot work and is causing catastrophic harm to large numbers of poor and vulnerable people worldwide. We put this out on October 4th, 2020, and it went viral. I've never been involved with anything like this where I just put the document on the web and tens of thousands of doctors signed on, hundreds of thousands of regular people signed on. It really struck a chord of people because I think even by October of 2020, people had this sense that there was something really wrong with the COVID policy that we've been following, and they were looking for reasonable people to give an alternative. I mean, we're not arguing that COVID isn't a serious thing. It is a very serious thing.
Which is why we had a policy that aimed at addressing it. We were saying that the policy we're following is not the right one. So how does a democratic government deal with that challenge? You asked me how I felt. I was actually frankly just suspected there had been some email exchanges like that, not necessarily from Francis Collins, around this time. I felt the full brunt of a propaganda campaign almost immediately after we published it, where newspapers mischaracterized it in the same way over and over again, and sought to characterize me as a marginal fringe figure, along with Martin Kulldorff and the tens of thousands of other people who signed it. I felt the brunt of that all year long. So to see this in black and white with the metaphorical handwriting of Francis Collins was actually frankly a disappointment because I've looked up to him for years.
Yeah, I've looked up to him as well. I look for the best in people and I still look up to him. What troubles me is several things. The reason I said about the emails I send late at night is I can understand this email. It's fear, it's panic, not being sure. The fringe three fringe epidemiologists, plus Mike Levitt who won a Nobel Prize. I mean, but using fringe maybe in my private thoughts I have said things like that about others, a little too unkind, like you don't really mean it. Now add to that he recently doubled down on the fringe. This is really troubling to me. I can excuse this email, but the arrogance there, Francis honestly broke my heart a little bit. This was an opportunity to say I was wrong to use those words in that email, I was wrong to not be open to ideas. I still believe that this is not a solution.
The devastating published takedown, as you say, somebody who's sitting on billions of dollars that they're giving to scientists, some of whom are often not their best human beings because they're fighting with each other over money. Not being cognizant of the fact that you're challenging the integrity, you're corrupting the integrity of scientists by allocating them money. You're now playing with that by saying devastating takedown. Where do you think the published takedown will come from? It will come from those scientists to whom you're giving money. What kind of example would they give to the academic community that thrives on freedom like this? I believe Francis Collins is a great man. One of the things I was troubled by is the negative response to him from people that don't understand the positive impact that NIH has had on society. But this is exactly the problem. He's not just a scientist, he's not just a bureaucrat who distributes money. He's also a scientific leader that in difficult times is supposed to inspire us with trust, with love, with the freedom of thought. Those fringe epidemiologists, those are the heroes of science. When you look at the long arc of history, we love those people.
We love ideas even when they get proven wrong. That's what always attracted me to science, like the lone voice saying, 'Oh, no, the moon of Jupiter does move.'
The funny thing is, Galileo was saying something truly revolutionary. We were saying that what we proposed in the Great Barrington Declaration was actually just the old pandemic plan. It wasn't anything fundamentally novel. In fact, there were plans like this that lockdown scientists had written in late February, early March of 2020. So we were not saying anything radical. We were just calling for a debate over the existing lockdown policy. This is a big disappointment because by doing this, you were absolutely right, Lex. He sent a signal to so many other scientists to just stay silent even if you had reservations.
Yeah. Devastating takedown that people, you know, how many people wrote to me privately from Stanford, MIT, how amazing the conversation with Francis Collins was. There's a kind of admiration. A lot of people get into science because they want to help the world. They get excited by the ideas and they work hard to help in whatever the discipline is. And then there are sources of funding which help you do help at a larger scale. So you admire those people that are distributing the money because they're often good people, great scientists. So it's amazing. Sometimes people from outside think academia is broken. No, it's a beautiful thing. And that's why it's so deeply heartbreaking where this person is. I don't think this is malevolence. I think it's incompetence in communication.
I think there's also arrogance at the bottom of it too.
But all of us have arrogance.
Yeah. There's a particular kind of arrogance. Right. So here it's the same kind of arrogance that you see when Tony Fauci gets on TV and says that if you criticize me, you're not simply criticizing a man, you're criticizing science itself. That is at the heart of this email. The certainty that the policies they were recommending, Collins and Fauci, were right. Not just right, but so far right that any challenge whatsoever to it is dangerous. I think that is really the heart of that email. It's this idea that my position is unchallengeable. To be as charitable as I can be, I believe they thought that there was only one true policy possible in response to COVID, and every other policy was immoral. If you come from that position, then you write an email like that. You go on TV and say effectively the same thing. That is what happens when you have this sort of unchallengeable arrogance that the policy you're following is correct. When we wrote the Great Barrington Declaration, what I was hoping for was a discussion about how to protect the vulnerable. That was the key idea to me: better protection of the older population who were at really serious risk if infected with COVID. We had been doing a very poor job in many places in protecting the vulnerable. What I wanted was a discussion by local public health about better methods, better policies to protect the vulnerable. Instead, we were met with a series of essentially propagandist lies. For instance, I kept hearing from reporters, 'Why do you want to let the virus rip?' The words 'let it rip' do not appear in the Great Barrington Declaration. The goal isn't to let the virus rip. The goal is to protect the vulnerable and let society go, open schools, and do other things that function as best it can in the midst of a terrible pandemic. But not let the virus rip where the most vulnerable aren't protected. The goal was to protect the vulnerable. So why 'let it rip'? Because it was a propaganda term to hit the fear centers of people's brains. 'Oh, these people are immoral. They just want to let the virus go through society and hurt everybody.' That was the idea. It was a way to preclude a discussion and debate about the existing policy.
So I've been on an app called Clubhouse recently to practice Russian for some big Russian conversations coming up. It's a great way to talk to regular people in Russian. But I also joined a vaccine room while preparing for a Pfizer CEO conversation. It was a pro-science room, scientists calling each other pro-science. The whole thing was like theater to me. Looking at the resumes, there were pretty solid researchers and doctors, and they were mocking everybody who was at all skeptical. The arrogance was overwhelming. I had to shut off because I couldn't handle that human beings can be like this to each other. I went back to double check, and then I asked to come on stage to make a couple comments. I said I'm worried that the kind of arrogance with which things are being discussed here will further divide us, not unite us. Before I even finished, I was thrown off stage. I mentioned I'm Lex Fridman from MIT, and those people seem to sometimes care about followers. They said, 'Enough of that nonsense.' Somebody who obviously interviewed Francis Collins and the Pfizer CEO.
You're bringing on French epidemiologists also.
Yeah, exactly. But this broke my heart. The arrogance echoes what you see in this email. I really would love to figure out how we can find a path forward. I think a lot of the problems we've seen in the discussion over COVID, especially in the scientific community, come from two competing ways to look at science. One way, which I find attractive, is an invitation to a structured discussion tempered by evidence, data, reasoning, and logic. It's a dialectical process where if I believe A and you believe B, we talk about it, come up with an experiment, and if B turns out to be right, I buy you dinner and we go on from there. That's what science is at its best. On the other hand, there's another way people have used science as truth in and of itself. If it's science, it's true automatically. But science never says what to do. It says here's what's true, and then we apply our human values. Underneath it, at the individual and institutional level, arrogance is really destructive. The productive thing is humility, always not being sure that you're right. Stuart Russell talks about this for AI research: build in a module that always doubts its actions. That 'maybe I'm wrong' is essential for progress. The question I have for you is, this email captures the core of the problem. Do you put responsibility on individuals or institutions?
No, this is an institutional failure. I've had two decades of NIH funding and sat on NIH review panels. The purpose of the NIH is to support the work of scientists and help direct them to work on important public health issues. It is not a policy organ. It doesn't say what public health policy should be. For that you have the CDC. What happened during the pandemic is that people in the NIH were called upon to contribute to public health policymaking, and that created the conflict of interest you see in that email. The head of the NIH in effect said to all scientists, you must agree with me in the policy I've recommended or else you're fringe. That is a deep conflict of interest. He had a dual role as head of the NIH, supporter of scientific funding, and then inappropriately called to set pandemic policy. That should never have happened. There should be a bright line between those two roles.
Let me ask you about Francis Collins. I had a chance to talk to him on a podcast. A lot of people wrote to me negative things about him, but I still believe he's a great man and a great scientist. One thing when I talked to him off mic about the vaccine, the excitement he had when recollecting when they first got an inkling that it was possible to get a vaccine. He was really excited because he gets to help a lot of people. There could be institutional self-delusion and arrogance that lead to this kind of email, but ultimately the reason he would call you a fringe epidemiologist and call for a devastating published takedown is because he really believes it could be very dangerous.
Yeah. And it's a lot of burden to carry on his shoulders because in his role where he defines some of the public policy, depending on how he thinks about the world, millions of people could die because of one decision. That's a lot of burden to walk with.
Yeah. No, I think that's right. I don't think he has bad intentions. He was put in a position where this kind of conflict of interest was going to create this reaction. The kind of humility you're calling for is almost impossible when you have that dual role. I agree with everything you just said except the last part. Humility is always difficult, but I think there's a huge incentive for humility in that position. Great leaders that have humility are popular as hell. If you like being popular, having impact, legacy, the incentive for humility is pretty high.
Well, there's a lot that he has to be proud of in his career. The human genome project wouldn't have happened without him. He is a great man and a great scientist. So it is tragic to me that his career has ended in this particular way. Can I ask you a question about my podcast conversation with him by way of advice or criticism? A lot of people wrote to me kind words of support and respectful constructive criticism. How would you suggest to have conversations with folks like that? I was debating whether to talk to Anthony Fauci. He wanted to talk. What kind of conversation do you have to inspire humility and trust in science?
I think your style really works well, Lex. You're not an attack dog trying to force somebody to admit they were wrong. I find that form of journalism and podcasting off-putting. Is it actually effective? I don't think so. I think about interviewing Hitler or Stalin. How do you have conversations to understand who they are, not to yell at them, but to inspire a large number of people to be the best version of themselves and avoid the mistakes of the past? I believe everyone involved in this debate has good intentions. They come from their points of view with their weaknesses. If you can paint a picture through sympathetic questioning of those strengths and weaknesses, you've done a service. The key is understanding where they're coming from, their thinking, the constraints they faced, and how they managed them. The hope is to discover a flaw in a person's thinking together, not just the positive thing.
Yeah. That's how science is. I like it when a student shows me I'm thinking incorrectly. I'm grateful because now I have an opportunity to change my mind and think more correctly. This is probably a good time to say what I think I got wrong during the pandemic. For instance, you said Francis Collins had a moment when he learned it was possible to get a vaccine. He must have learned that quite early. I didn't learn that early. In March of 2020, based on my experience with vaccine development, I thought it would take a decade or more to get a vaccine. That was wrong. I was so happy when I started to see the preliminary numbers in the Pfizer trial that strongly suggested it was going to work. Very few times in my life have I been so happy to be wrong.
And it changes things. I've heard you mention that a lockdown is still a bad idea unless the vaccine comes out tomorrow. There's still suffering and economic pain even on a scale of weeks versus months.
Well, let's talk about the vaccine. What are your thoughts on the safety and efficacy of COVID vaccines at the individual and societal level? For vaccine safety data, it's challenging to convey how this is normally done. Normally you have a long trial with large numbers, follow them over time, and the trial gives some indication of safety. It did, but the way the trial was constructed, once it was shown to be protective, it was no longer ethical to have a placebo arm. So that placebo arm was vaccinated, meaning you couldn't get long-term safety data from the trial. Also, tens of thousands of people is not enough to see rare events when deployed at population scale. So I wasn't surprised when people were skeptical. The trial showed they were pretty safe and quite effective at preventing symptomatic COVID. That was an amazing achievement, organizing a trial of that scale and running it so quickly, with the final result being surprisingly high. But normally the FDA would tell Pfizer to go back and test in subgroups, work on dosing, etc. We didn't have time for that in a pandemic. So the basis for approval was less full than normal. But the results were good, and for the most part that's been borne out in terms of protection against severe disease.
Let's separate this because there are critics of both categories, but for older people, the reduction in fatalities and serious illness seems to be something like 10x. For older people, the vaccine is a godsend. It transforms the problem of focus protection from something quite challenging into something much more manageable. The vaccine in and of itself when deployed in older populations is a form of focus protection.
Yes. We'll talk about focus protection in one segment because it's such a brilliant idea for this pandemic and future pandemics. I thought the sociological and psychological discussion about the letter from Francis Collins was so recent and troubling, so I'm glad we talked about that first. The vaccines work to reduce deaths, especially for the older. Now let me tell you the second thing I got wrong in the pandemic. In January of 2021, I thought the vaccines would stop infection. The antibodies produced looked like neutralizing antibodies that would block you from being infected at all. That turned out to be wrong. Data from Israel showed surges of infection even in a highly vaccinated population. The vaccine does not stop infection. So if you were selling the vaccine, the features you thought it would have—reducing death, reducing chance of getting it, reducing transmission—the latter two are not as definitive.
I think it's a little complicated. The first two or three months after full vaccination, you have 60-70% efficacy against infection. That's pretty good. But by 6-8 months, it drops to 20%, some studies suggest even zero. And you're also infectious for some period if you do get it, though the period is shorter. The infectivity per day is about as high, so the vaccine might reduce some risk of infecting others but not categorically. So it's not safe to be in the presence of just vaccinated people; you can still get infected. There's a million things I want to ask, but is there a sense that because the vaccine really helps on the worst part—killing people—doesn't that mean vaccine hesitancy is misplaced? Obviously a vaccine is a powerful solution to open things up.
Yeah. I wrote a Wall Street Journal op-ed with Sunetra Gupta in December of last year with a very naive title: 'We Can End the Lockdowns in a Month.' The idea was simple: vaccinate all vulnerable people and then open up. The lockdown harms are devastating. The Great Barrington Declaration said protect the vulnerable. With the vaccine, we have a perfect tool to protect the vulnerable. Vaccinate the older population, and there's a 10-fold decrease in mortality risk. That was the strategy. What happened is the vaccine debate got transformed. You're asking about vaccine hesitancy. There are inherent limitations in measuring vaccine safety. We talked about the trial, but after the trial, there's a mechanism I've been involved with for tracking safety. The central challenge is causality. You no longer have a randomized trial. You want to know if the vaccine causes adverse events at scale. You can't just look at vaccinated people; you need a control group. The CDC uses systems like VAERS, where anyone can report adverse events. But if you vaccinate older people first, and older people die sometimes, it's hard to tell if the vaccine caused it. Other systems like VSD and BEST track cohorts with careful matching. That's how myocarditis risk was picked up in young men, and blood clots in middle-aged women with the J&J vaccine. These are rare outcomes, but vaccine-linked. How do you deal with that? You tell people the risks transparently.
Yeah. Don't treat people like children and tell them lies because they won't understand the full complexity of the truth. People are good at understanding data, but better at detecting arrogance. One thing that greatly undermined vaccine demand is the denial that if you recover from COVID, you have extremely good immunity against infection. That denial leads people to distrust the message from the CDC director. Why deny such an obvious fact? The data pops out that recovered people are not getting infected again at high rates. After conversations like this, I often get messages from Joe Rogan and Sam Harris, who I admire as intelligent, thoughtful human beings. They represent a group of people. Each group has smart, well-intentioned people. I don't know who is right, but they're a little tribal. The question is, what do you think about these two groups and the tension over the vaccine that keeps finding different topics to focus on, like whether kids should get vaccinated or vaccine mandates?
I think it's a symptom of the distrust people have in public health. This schism over the vaccine does not happen in places where public health authorities have been more trustworthy. You don't see this vaccine hesitancy in Sweden. In the United States, the vaccine became a touchstone issue because of politics and scientific arrogance. People line up on both sides. Before the election, I gave testimony in the House on measuring vaccine safety. I was invited by Republicans. There were other experts invited by Democrats, each with experience in vaccine safety. I was surprised to hear them doubt whether the FDA would do a reasonable job. These are professionals whose goal is to ensure unsafe vaccines don't get released. They were casting doubt on the ability to track vaccine safety before the election. After the election, the rhetoric switched on a dime. Suddenly Republicans were cast as vaccine hesitant. That kind of political shift, the public notices. If all it takes is an election to change how people talk about vaccine safety, we're not talking science anymore. That creates hesitancy. Also, some politicians viewed hesitancy as a political opportunity to demonize people, which fueled more hesitancy. If you tell me I'm a rube who wants everyone to die, I'll react negatively. If you talk down to me about my legitimate concerns, like whether the vaccine is safe for pregnant women, and you pretend to know for a fact when you don't have the data, that breeds hesitancy. People can detect that. If you just tell people, 'I don't know,' with humility, you'll end up with a better result.
