Ch 3.5 | 😰The pandemic

There is a lot to unpack when it comes to COVID-19. In my humble opinion, the pandemic represents one of the greatest failures of the duopoly that we've seen in my lifetime. From the moment we learned of the coronavirus, it became a political issue. The actions and inactions of our leadership at both the state and federal levels ultimately contributed to the death of more than 1 million Americans, the highest toll of any single nation as of March 10, 2023. It's appalling and those deaths are a direct result of the duopoly’s inaction undermining Americans' trust in the government.

Let me start with a personal disclosure. I am not an "anti-vaxxer." That said, I have never taken a flu shot in my life. I am not a proponent of what Peter Attia, the author of “Outlive: The Science and Art of Longevity,” calls "Medicine 2.0." I avoid pharmaceutical drugs and do my best to avoid medical doctors. I am an athletic person who never had any major health issues. That said, COVID (I can't say for certain if it was the vaccine or the virus) has impacted my health. I believe it's the vaccine because to my knowledge (unless I was asymptomatic), I didn't get COVID until August 2022. I had a pre-existing condition that I was blithely unaware would have a correlation to COVID. I have a heart condition known as mitral valve prolapse (MVP) that has been mild for my entire life. Since 2021, I have been living with hypertension that requires me to take a blood pressure medicine daily. While that could be attributable to my age (I am 59 as I write this), I do not believe it to be the case. Worse yet, my MVP has worsened since 2020 and now several other valves have been impacted and I may require surgery. It's worth noting that I have a number of friends who experienced a similar impact since COVID. 

So while I do believe that COVID has negatively impacted my health, I do not regret having taken the vaccine — even if it was the vaccine and not the virus that caused my condition. Every decision we make has risks. That's the nature of life. Moreover, the speed at which the vaccine was developed was bound to come with significant additional risks, although it went through the same clinical trial process as other vaccines. Still, the pandemic was a historic event and, given how our leaders failed us, this was the only path that was presented and I willingly followed that path. 

As we discuss the politics of the pandemic, let's start with an article published in February 2021 by Cathy Young for the libertarian think tank the CATO Institute. In "The Problem with COVID Contrarianism," Young states:

COVID minimization and hostility to aggressive mitigation strategies on the right drove many liberals and progressives more decisively into the “COVID hardliner” camp. (That’s how polarization works.) Social distancing, lockdowns, and later masking—initially rejected but quickly embraced by the medical mainstream—became, for many people, not just public health measures, but badges of cultural and political virtue, and membership in the right “tribe.”

No matter which side of the aisle you're on, it's clear to me that the duopoly failed us in this crisis. Rather than aligning, the parties chose to once again divide and entrench to their partisan corners both at the national and the state levels. 

Young continues:

The COVID culture wars, though, continue to be a dumpster fire. A large portion of the conservative “base” is mired in paranoid conspiracy theories that depict the COVID-19 pandemic as an intentionally engineered (or, at best, blown out of proportion) scheme to establish and justify tyranny—a derangement that has led to Trump being booed for praising vaccines at a couple of his rallies.

And a large swath of the “anti‐​woke dissident” community, to which I loosely belong, has embraced various degrees of COVID contrarianism.

This ranges from the truly deranged off‐​the‐​deep end conspiracism espoused by James Lindsay and Maajid Nawaz, to the more modulated, less obviously nuts, but still deeply insidious anti‐​vaxxism of biologists Brett Weinstein and Heather Heying, to the maverick populism of Joe Rogan.

The underlying theme in much of this backlash, I think, is simply being anti‐​establishment or anti‐​mainstream. There isn’t a particular rhyme or reason to it. The contrarians often claim to be “anti‐​elitist,” but they also emphasize, like Rogan, the elite credentials of the maverick scientists they embrace as vaccine or lockdown skeptics, such as infectious disease researcher Robert Malone or the authors of the Great Barrington Declaration. They often rail against “Big Pharma” as the self‐​interested peddler of COVID vaccines; yet they peddle the anti‐​parasitic drug ivermectin, which is manufactured by Merck—not exactly a mom‐​and‐​pop outfit—but is apparently fine because it’s rejected by the “establishment,” at least as a COVID remedy. (Incidentally, while it’s true that Rogan got CNN medical expert Sanjay Gupta to admit that CNN was wrong to mock him for taking “horse dewormer” when he was treating his COVID symptoms with ivermectin—Rogan was taking a version of the drug approved for human consumption—his fans overlook the fact that Gupta categorically stressed it had not been approved for COVID treatment; no, not even in Japan, as Rogan has wrongly claimed.)

It's a great article and worth reading!

According to Johns Hopkins University, the right actions in January, February and March of 2020 would likely have prevented "a substantial number" of deaths.

Those actions should have included a national coordinated strategy across state lines, rapidly scaled-up testing, the ramped-up production and mobilization of resources, and more clear communications of what was known about the virus and how to prevent it.

One study from Columbia University reinforced the point that I made earlier:

[T]he country has witnessed a complete lack of federal leadership.

The infighting between the parties wasn't confined to the federal government either, the lack of coordination and politicization at the state level was, at times, equally damaging! 

In discussing the politics of the pandemic, I want to be transparent that I have a bias! Trump's handling of the COVID-19 pandemic was one of the most egregious betrayals of the public trust of my lifetime. And, while Biden by comparison demonstrated coherent and sober leadership regarding the pandemic, his decision to implement the unproven and untested vaccines developed under Trump's Operation Warp Speed, without consideration for other approaches, shows that both party's leaders failed us when we needed them the most.

We should have been better prepared! 

If you haven't seen it, back in 2015, Bill Gates said we needed to put all our good ideas into practice, from scenario planning to vaccine research to health worker training. As he said, "There's no need to panic ... but we need to get going." Unfortunately, we didn't! Nobody did!

I'm not suggesting that we could have avoided the pandemic. I'm only saying we should have been better prepared. Sadly, our culture of division proved to be our greatest weakness when what we needed was unity and intelligent leadership. What we got was a shitshow of epic proportions that undermined our trust in our government.

It's also worth noting that Trump's early actions as president absolutely hampered the United States' readiness for the COVID-19 pandemic. Back in 2018, Trump disbanded the White House National Security Council's Global Health Security and Biodefense unit, a team specifically dedicated to preparing for global health threats. That decision left the government with a smaller staff and less expertise in pandemic preparedness at a crucial time. 

For what it's worth, there is disagreement over how to describe those changes. The departure of some members due to “streamlining” efforts under John Bolton is documented and established. There is no question that the pandemic response team as a unit was largely disbanded. That said, according to Reuters reporting, while the Trump administration disbanded the team, some of its members were reassigned to roles that included pandemic response. For what it's worth, on March 14, 2020, John Bolton described the changes made to the team as streamlining. He tweeted:

Claims that streamlining NSC structures impaired our nation's bio defense are false. Global health remained a top NSC priority, and its expert team was critical to effectively handling the 2018-19 Africa Ebola crisis. The angry Left just can't stop attacking, even in a crisis.

What's worse, years later we are still no better prepared. 

The irresponsible politics of the pandemic

Early in the pandemic, Trump repeatedly downplayed the threat of COVID-19, calling it a "hoax" and comparing it to the seasonal flu. This came despite Intelligence reports warning of a potential pandemic. This disregard for early warnings delayed the U.S. government's response to the virus's spread. His rhetoric and lies minimized the perceived seriousness of the virus and potentially discouraged proper preventative measures like mask-wearing and social distancing. In fact, in a recorded interview with Bob Woodward for his book about Trump titled "Rage," the president said:

To be honest with you, I wanted to always play it down, I still like playing it down, because I don’t want to create a panic.

Politifact tracked Trump’s responses as the pandemic unfolded. Between January and mid-March of 2020, Trump consistently minimized the threat posed by the virus. He would talk about the handful of cases in the country and compare them with the more than 25,000 deaths caused by seasonal flu. He said the country had gotten "lucky." On Jan. 24, Trump tweeted his thanks to China for working to contain the virus: "It will all work out well.” On Jan. 30, he announced restrictions on travel from China. That night, he told supporters at a campaign rally in Iowa:

We think we have it very well under control. We have very little problem in this country at this moment — five. ... We think it’s going to have a very good ending for it.

On Feb. 2, he told Fox News host Sean Hannity.

We pretty much shut it down coming in from China.

On Feb. 14, in a meeting with members of the Border Patrol Council, he remained reassuring. 

We have a very small number of people in the country, right now, with it. It’s like around 12. Many of them are getting better. Some are fully recovered already. So we’re in very good shape.

On Feb. 24, Trump asked Congress for $1.25 billion in emergency aid. The same day, he tweeted that the virus "is very much under control" and the stock market was "starting to look very good to me!"

As late as March 9, Trump blamed the media and the Democrats for trying to "inflame" the situation "far beyond what the facts would warrant." He cited the U.S. surgeon general as saying, "The risk is low to the average American."

On March 17, after the World Health Organization officially designated the virus as a pandemic, Trump declared a state of emergency. Trump said in a news conference that for the next 14 days, "we’re asking everyone to work at home, if possible, postpone unnecessary travel, and limit social gatherings to no more than 10 people." At the news conference, Trump said there was no shift in tone from the White House:

"I've always known this is a real, this is a pandemic. I've felt it was a pandemic long before it was called a pandemic."

Trump's public statements and actions regarding the pandemic were often inconsistent and mixed, sending confusing messages to the public. This inconsistency weakened public trust in government guidance and hindered compliance with recommended public health measures.

Trump often downplayed the virus and contradicted public health experts and promoted unproven treatments like hydroxychloroquine. This created confusion and distrust towards established scientific recommendations,contributing to the spread of misinformation and hindering effective pandemic response. His public statements regarding lockdowns and other restrictions were often inconsistent and unclear, further fueling political divisions and undermining public trust in government guidance. Trump's rhetoric and actions reflected  conservative viewpoints skeptical of mask mandates and lockdowns. This fueled the drawing of partisan lines, associating pandemic control measures with specific political ideologies and hindering unified national response efforts. He frequently criticized Democratic leaders and states implementing stricter measures, contributing to the politicization of public health policies and further dividing the public along political lines. The politicization of the pandemic hindered effective national response efforts by creating confusion, distrust and non-compliance with public health recommendations. It exacerbated existing political divisions and fueled misinformation campaigns, contributing to the pandemic's severity and hindering control efforts.

And then there was Trump's decision in April 2020 to halt U.S. funding for the WHO while a review of the organization's handling of the COVID-19 pandemic was conducted. He cited concerns about the WHO's transparency, alleged bias towards China, and handling of the early stages of the outbreak. This decision sparked legal challenges and criticism from various international actors, public health experts and even some members of his own administration.

Trump’s announcement set off a torrent of criticism from Democrats and international health experts who accused the president of trying to deflect blame from his own mishandling of the situation while weakening the principal international organization leading the response to the pandemic. Bill Gates, whose foundation is the second-largest donor to the WHO after the U.S. government, said the decision was “as dangerous as it sounds.” This decision sparked a set of legal challenges as to who has the authority to cut off that spending — the White House or Congress. The legal challenges went unresolved during Trump’s term due to various lawsuits. In January 2021, Biden reversed Trump's decision and resumed funding. However, the legal questions surrounding the president's authority to withhold such funding remain unsettled.

As one would have expected, the public's support for Trump generally decreased over time (as often happens), particularly after the initial surge in cases in spring 2020. And his response became a major issue in the 2020 presidential election, contributing to his defeat. 

While Trump's handling of the pandemic exposed his weakness as a leader, I don't give a free pass to the Democrats either. It's not like they didn't take full advantage of the situation for their political gain.

In remarks from the Senate floor on Feb. 24, Minority Leader Chuck Schumer claimed the Trump administration made “drastic cuts to the global health division at CDC,” before saying, “In 2018, CDC was forced to reduce the number of countries it operated in from 49 to 10.” This claim was reported widely by the media. But, according to FactCheck.org, that was untrue:

Those hypothetical cuts were avoided, however, because Congress later provided more funding for the CDC’s global health programs, the CDC told us in a statement.

Oh, and then there's this doozy in the lead up to the 2020 election: Joe Biden stated in a CNN town hall on Sept.17, 2020:

If the president had done his job, had done his job from the beginning, all the people would still be alive. All the people. I'm not making this up. Just look at the data.

Even with all the criticism that I have laid at Trump's feet, this is patently false — nothing was going to prevent any loss of life.

As an aside, since we're discussing a lack of leadership in the early days of the pandemic, I'd be remiss if I didn't point out that several senators, including Richard Burr, Kelly Loeffler, Jim Inhofe and Dianne Feinstein profited off the pandemic by making suspicious trades after gaining access to non-public information. These transactions included selling stocks in industries likely to be negatively impacted by the pandemic, raising concerns about insider trading and allegations they violated the STOCK Act. The Department of Justice opened investigations into some of these cases, but as far as I can tell no charges were filed. 

Either way, allegations of insider trading further erode public trust in government and raised concerns about ethical conduct during a crisis.

Following the so called ‘science’

Had our political leaders chosen to put their partisan issues aside, we might have been able to have an intelligent discussion about the virus and the potential ways to address it. But instead, we were subjected to grave dangers as a result of the duopoly's continued need to use every opportunity to attack the other side. There was no need to politicize the virus, and what unfolded was atrocious.

In the Free Press introduction to an interview with Joe Nocera titled "Why We Still Need to Talk About America's Covid Failures," Bari Weiss:

We now know that so much of what we were told was wrong. (Last week, Anthony Fauci admitted in closed-door congressional testimony that the six-feet apart rule was “likely not based on scientific data.”) And if the guidance wasn’t flat-out wrong, it was certainly debatable. But debate was not only discouraged—it was shut down. Respected dissident scientists were dismissed as fringe scientists. They were deplatformed on social media.

For most of us, all of this seems like a lifetime ago. But the problem is that here we are, four years later; millions of Americans suffered, more than a million died, and it’s not clear we have any better understanding of what exactly went wrong. How was it that our leaders—and our economy—were so brutally underprepared for a global pandemic?

Nocera is the co-author of "The Big Fail: What the Pandemic Revealed about Who America Protects and Who It Leaves Behind." It's worth reading and his interview on the “Honestly Podcast” is worth a listen. According to the Free Press: 

The Big Fail takes a critical look at what the pandemic uncovered about our leaders, our broken trust in government, and the vulnerability of the biggest economy in the world. Nocera also investigates the perverse incentives (and devastating effects) of hospital systems and nursing homes run by private equity firms. All this makes him ask: Does capitalism have its limitations when it comes to healthcare?

Trump made a fool of himself on a regular basis throughout his handling of the pandemic. He repeatedly touted unproven treatments during the daily briefings on COVID-19. For instance, he called hydroxychloroquine a potential "game changer," but health officials strongly cautioned against it. In fact, an Arizona man died in late March 2020 after having ingested chloroquine phosphate, believing it would protect him from becoming infected with the coronavirus. The man's wife told NBC News that she had watched televised briefings during which Trump talked about the potential benefits of chloroquine. Trump suggested the possibility of treating an infected person with an "injection" of disinfectant during one daily briefing. 

Bill Bryan, who led the Department of Homeland Security's science and technology division, gave a presentation on research his team conducted that shows that the virus doesn't live as long in warmer and more humid temperatures. Bryan said, "The virus dies quickest in sunlight," leaving Trump to wonder whether you could bring the light "inside the body." 

"So supposing we hit the body with a tremendous — whether it's ultraviolet or just a very powerful light — and I think you said that hasn't been checked because of the testing," Trump said, speaking to Bryan during the briefing. "And then I said, supposing you brought the light inside the body, which you can do either through the skin or some other way, and I think you said you're going to test that, too."

Any reasonable person should conclude that statements like those from the sitting president of the United States not only undermine his credibility to lead, but are objectively dangerous. 

My research shows the vast majority of the scientific community supports vaccination and measures that increase vaccination rates, including mandates in certain contexts. Of course, like everything, there are sources that express reservations and/or criticisms, not only regarding vaccine mandates but the vaccines themselves. I'm not a scientist, and I am not qualified to discuss the science of vaccines, but I can assess the credibility of our politicians who love nothing more than to attract followers by stoking fear.

From a political perspective, one of the most outspoken critics of vaccines is Robert F. Kennedy Jr. He has used vaccine conspiracy theories to propel his political career, and Americans who believe his conspiracy theories further undermined our ability to discern fact from fiction.

According to FactCheck.org:

Kennedy, who is also an environmental activist and lawyer, has been opposed to vaccines since at least 2005, when he published an error-laden story in Rolling Stone and Salon that pushed the false notion that certain vaccine ingredients cause autism. The publications later retracted or withdrew the story. 

In 2017, Kennedy said that he was going to be heading up a panel on vaccine safety for Trump. Scientific American, in "How Robert F. Kennedy, Jr., Distorted Vaccine Science," responded to the news.

For more than a decade, Kennedy has promoted anti-vaccine propaganda completely unconnected to reality. If Kennedy’s panel leads to even a small decline in vaccine rates across the country, it will result in the waste of untold amounts of money and, in all likelihood, the preventable deaths of infants too young to be vaccinated.

Fast forward to 2023, Time Magazine published an article titled "Robert F Kennedy Jr. Is Dead Wrong About Vaccines" in which the author reported:

Kennedy also made the false claim that COVID vaccines are the deadliest vaccines ever made. Let’s take a look at this claim.

Deaths from vaccines are exceptionally rare for two main reasons. The first is that precautions are taken in who gets vaccinated—for example, the MMR vaccine is a live vaccine, so it is not given to people who are severely immunocompromised. The second is the stringent safety standards that must be met for any vaccine to ever reach the public.

Kennedy’s false claim is based on reports of deaths after receipt of COVID-19 vaccines in the Vaccine Adverse Event Reporting System (VAERS). His claim does not hold up to scrutiny, and shows his misunderstanding of VAERS. Anyone can report any event to VAERS. A report of an event is not proof that the vaccine was the cause. Indeed, VAERS’s own disclaimer states: “VAERS reports may contain information that is incomplete, inaccurate, coincidental, or unverifiable.” Deaths reported in VAERS have included car crashes and even the death of a girl who fell into a well—these events were clearly not caused by a vaccine. The main purpose of VAERS is as an early warning system: If there’s a dramatic rise in a particular event, this signal can be investigated with more robust surveillance systems, like the Vaccine Safety Datalink (VSD), which has access to medical records and can make detailed comparisons between vaccinated and unvaccinated individuals. Evidence from these more robust systems has shown that COVID-19 vaccines are remarkably safe and that deaths from the vaccines are extremely rare, which has also been confirmed by studies outside the U.S.

In Kennedy’s conspiracy-laden fantasy world, a shadowy cabal conspires to hide the risks of vaccination. In the real world, U.S. public health agencies take vaccine safety extremely seriously and approach it with great transparency. After millions of the Janssen COVID-19 vaccine were given, just 6 cases of an unusual pattern of blood clots were enough to trigger a pause on vaccine—eventually a preferential recommendation for mRNA vaccines was issued because of the seriousness of this very rare condition, one that does not occurfrom mRNA vaccines. A safety signal for the bivalent Pfizer COVID-19 vaccine for strokes in older adults was immediately communicated when it was identified even though subsequent data suggests that this finding is a statistical artefact.

A large part of his conspiracy theories hinges on the National Childhood Vaccine Injury Act of 1986, which establishes the National Vaccine Injury Compensation Program as an alternative remedy to judicial action for specified vaccine-related injuries. He points to parts of the legislation that state, “No vaccine manufacturer shall be liable in a civil action for damages arising from a vaccine-related injury or death” resulting from unavoidable side effects or due to the manufacturer's failure to provide direct warnings. 

He also often references "Bruesewitz v. Wyeth," a Supreme Court case from 2011. In discussing the case, RFK has consistently evangelizes the notion that: "If (vaccines) are truly safe, then how is it that the Supreme Court declared them unavoidably unsafe?" But according to USA Today, "No, the Supreme Court didn't declare vaccines 'unavoidably unsafe.'"

In 2011, the Supreme Court released its decision in a case called Bruesewitz v. Wyeth, ruling a federal law does not allow vaccine manufacturers to be held liable by people seeking compensation for injuries caused by vaccine side effects. …

Nowhere in the opinion, though, does the court broadly declare all vaccines to be "unavoidably unsafe," as the post claims. Michelle Mello, a law professor at Stanford University, told USA TODAY the court's opinion in the case "did not decide whether vaccines are unavoidably unsafe or not. Rather, it interpreted some language in the statute that set up the Vaccine Injury Compensation Program in order to determine whether the (parents) were permitted to sue for their daughter's injury."

The phrase "unavoidably unsafe" does appear several times in the opinion and in the dissent. However, it's used in reference to similar language in the National Childhood Vaccine Injury Act, which says vaccine manufacturers can't be held liable for vaccine-related injuries if they were caused by "side effects that were unavoidable even though the vaccine was properly prepared and was accompanied by proper directions and warnings."

Dan Farber, a law professor at the University of California, Berkeley, said while the opinion does quote the phrase "unavoidably unsafe," it does so "only to say that it wasn't relevant."

Conspiracy theories aside, it has been argued that mandates in low-vaccination regions might create further distrust and backfire, or that focusing solely on mandates could divert resources from other crucial public health efforts. While some might critique the evidence or ethics for  universal mandates, they likely wouldn't deny the overall benefits and effectiveness of vaccines. 

I tend to agree with those who argue for the virtues of "natural immunity." 

For example, the American Journal of Public Health published a report titled, "The Unnaturalistic Fallacy: COVID-19 Vaccine Mandates Should Not Discriminate Against Natural Immunity," in which it argued against policies that failed to recognize "natural immunity" acquired through infection as equivalent to "vaccine-induced" immunity. The authors assert that the evidence for the superiority of one over the other is unclear, and mandating vaccination for those with natural immunity raises ethical concerns. It's an interesting read but my concern with the author’s premise is that by definition "natural immunity" required that we should have allowed the pandemic to spread and infect millions of people. That way, according to their rather Darwinian logic, those who survived would have natural immunity. I do agree with the authors when they state that vaccines "can only be justified if they are necessary for achieving a proportionate public health benefit." 

All that said, it seems clear to me that the science remains unresolved. Consider this Dec. 6, 2023, letter from Florida Surgeon General Joseph Ladapo to Food and Drug Administration Commissioner Robert Califf and Centers for Disease Control and Prevention Director Mandy Cohen. It concerned questions pertaining to the safety assessments and the discovery of billions of DNA fragments per dose of the Pfizer and Moderna COVID-19 mRNA vaccines. 

Like many things, only through the passage of time will the truth reveal itself. But what is irrefutable is that our politicians on both sides of the aisle undermined our ability to trust in our government when we needed it the most.

Only time will tell whether the risks taken by Operation Warp Speed were warranted. Either way, the extenuating circumstances in the case of the COVID pandemic was several-fold and required taking calculated risks. My big question is, were the risks actually ever "calculated"?

Trump's early inaction and public denials undermined our ability to act. The novelty of the virus, the lack of sufficient knowledge to produce treatments and the fact that early strains were the most deadly variants caused our hospital systems to be overwhelmed. Let's never lose sight of that fact! 

Vaccines, mask mandates and lockdowns aimed to reduce hospitalizations to put less strain on health care systems. Vaccines ultimately mitigated the severity of illness so that even those who contracted the virus faced less severity of symptoms and complications, leading to shorter hospital stays and a lower risk of requiring critical care. But nothing is without risk.

Vaccine mandates and personal liberty

I have always had libertarian-leaning views on the role the federal government should play in our lives, which led me to vote along more Conservative Party lines for most of my adult life. But, as I've also highlighted, the GOP has evolved. Republicans are very inconsistent in their approach to governing when it comes to traditional "conservative" values and individual liberties, especially when it involves social issues and the culture wars — where they are more than comfortable interfering with individual liberties.

But liberty is a two-way street. When it comes to vaccine mandates and the role of government in a pandemic, according to the ACLU:

far from compromising civil liberties, vaccine mandates actually further civil liberties. They protect the most vulnerable among us, including people with disabilities and fragile immune systems, children too young to be vaccinated and communities of color hit hard by the disease. …

by inoculating people from the disease’s worst effects, the vaccines offer the promise of restoring to all of us our most basic liberties, eventually allowing us to return safely to life as we knew it, in schools and at houses of worship and political meetings, not to mention at restaurants, bars, and gatherings with family and friends.

Here is an excerpt from a 2006 Harvard abstract, "Mandatory Vaccination: Why We Still Got to Get Folks to Take Their Shots":

Vaccination is widely considered one of the greatest medical achievements of modern civilization. Childhood diseases that were commonplace less than a generation ago are now increasingly rare because of vaccines. In order to be effective at eliminating communicable diseases, vaccines must be administered to sufficient levels of persons in the community. Because of this, public health officials have mandated vaccination for certain diseases as a condition to school attendance. The overwhelming effectiveness of vaccination programs may lead individuals to ignore the benefits of vaccination and focus more on the risk of side effects. Moreover, some have criticized the coercive nature of these programs. These objections may lead to an unacceptably high number of exemptions, which can compromise vaccination programs and leave the population susceptible to outbreaks.

That is an interesting point worth considering. If it's true that if we don't vaccinate everyone, vaccines are not as effective and our liberty is compromised. But you can view that in two ways. First, and most importantly, with respect to transmission: If the COVID vaccine prevented transmission (spoiler alert: it didn't, and wasn’t intended to do that) then this point is truly compelling! Second, with respect to the vaccine’s ability to reduce hospitalization: We know the vaccine did effectively reduce the severity of the virus so this was in the public good because it helped alleviate the strain on our hospital system. Too many Americans died of non-COVID-related illnesses because our hospital system was overwhelmed.

Sadly, Trump mainstreamed and normalized anti-vaccine rhetoric. It's infuriating on many levels but most galling when you consider that all states require some minimum set of vaccinations for school attendance and we've never seen any president politicize them!.As Pew research highlights, "Long before COVID-19, states have been mandating vaccines" Every U.S. citizen has been mandated to take the following vaccines: measles, mumps, and rubella; tetanus, diphtheria, and pertussis (Tdap); polio; hepatitis B; haemophilus influenzae type b (Hib); varicella (chickenpox); meningococcal conjugate (MenACWY); pneumococcal conjugate (PCV); and Human papillomavirus (HPV). Some states require additional vaccines, such as rotavirus, hepatitis A, influenza and/or meningococcal B. So when I hear people assert that they are against the COVID-19 vaccine mandate, I question whether this would have been an issue at all had Trump not politicized the virus from Day One.

To this day, public opinion polls show a mixed picture. Notably, a July 2023 CNBC survey found 49% in favor of, and 46% opposed to vaccine mandates nationwide. You won't be surprised to learn that, thanks to Trump, support for mandates generally aligns with political affiliation, with stronger support among Democrats and weaker support among Republicans.

Specific groups:

• Age: Younger individuals tend to be less supportive of mandates than older adults.

• Education level: Those with higher educational attainment generally show higher support for mandates.

• Urban vs. rural: Support for mandates is generally higher in urban areas than in rural areas.

• Vaccination status: Unsurprisingly, vaccinated individuals are more likely to support mandates than unvaccinated individuals.

While we have no way of knowing for certain how the Trump administration would have handled the vaccine rollout because the FDA didn't grant emergency use authorization for the Pfizer-BioNTech vaccine until Dec. 11, 2020, we do know that Trump stirred u phis base and undermined the scientific community to create millions of skeptics. As a result, I think we can safely assume that his administration would have emphasized individual choice and autonomy regarding vaccination decisions. While Trump said, "I recommend you get vaccinated" and he encouraged people to take the vaccine during Operation Warp Speed's rollout, he often voiced concerns about government overreach and restrictions on individual liberties, which could be interpreted as opposition to mandatory vaccination. Moreover, he criticized other countries and states that implemented vaccine mandates, calling them "tyranny" and "unconstitutional." More hyperbole and politicization that frankly isn't necessarily black and white. Unfortunately, we'll never know.

Vaccine mandates became a huge political liability for Biden. Ironically, despite GOP talking points, we really never had any "vaccine mandate" in this country. So when my friends say they are going to vote for Trump in part because of Biden's vaccine mandate policy, I scratch my head. Let's explore this a bit. If I'm missing something, please let me know in the comments!

On Jan. 13, 2022, the Supreme Court issued two rulings on the constitutionality of vaccine mandates. If you want to learn more about the rationale for the conflicting rulings, here is an interesting article from Stanford Law School that provides some insights, including:

What’s driving the majority’s stance is concern that unelected officials [at OSHA] are making decisions with sweeping implications — decisions that in our democratic system must rest with more accountable officials. In other words, if Congress wants to do something this big, it needs to do it directly or state very clearly that an agency is allowed to do it.

The three dissenters in the case don’t disagree with that principle, but think the majority engaged in some contorted thinking to reach the conclusion that Congress didn’t give OSHA the authority to address COVID. They point out that the statute makes no distinction between hazards that are confined to the workplace and those that also exist outside it. Fires and unsafe drinking water are also hazards workers may encounter off the job, for example, but that doesn’t mean they don’t still fall within OSHA’s purview. And, they note, OSHA’s rule does exempt workplaces where the risk of COVID transmission is low, so it’s not overbroad.

It is true that early in his administration, Biden did impose several federal vaccine mandates, however the one that affected the broadest constituency only lasted four months, from September 2021 until January 2022, and I'm unclear how many people fell under the mandate before it expired since the vaccines were first made available in December 2020. In any event, here's a summary of the only large-scale mandates that I am aware of:

1. Large employers: In September 2021, the Department of Labor's Occupational Safety and Health Administration issued an emergency temporary standard requiring employers with 100 or more employees to mandate COVID-19 vaccination for their workforce. This mandate covered about 84 million workers and allowed for testing as an alternative to vaccination, with masking requirements for unvaccinated employees. This requirement lasted a mere three months because, as referenced above, in January 2022, the Supreme Court blocked it on a technicality that OSHA lacked the authority to enforce it on such a broad scale. The court didn't state that vaccine mandates were unconstitutional, merely that OSHA lacked the authority to issue such a mandate.

2. Health care workers: In November 2021, the Centers for Medicare & Medicaid Services issued a rule requiring health care workers at facilities participating in Medicare and Medicaid to be vaccinated. This mandate covers approximately 17 million workers at over 76,000 facilities. It has also faced legal challenges but, in January 2022, the Supreme Court issued a 5-4 decision lifting injunctions that had blocked the CMS rule in 24 states. In lifting the lower court injunctions, the Supreme Court stated that Congress has authorized the CMS to impose conditions on the receipt of Medicaid and Medicare funds that are "necessary in the interest of the health and safety of individuals who are furnished services." The court held that ensuring providers take steps to avoid transmitting COVID-19 to their patients is consistent with the "fundamental principle" of the medical profession: Do no harm.

3. Military personnel: In August 2021, the Department of Defense mandated COVID-19 vaccination for all active-duty military personnel, with limited exceptions for medical or religious reasons. This mandate has faced some opposition but remains in effect.

For what it's worth, as of May 2024, no state has a blanket vaccine mandate for all adults. However, several states have implemented mandates for specific groups:

• California and Illinois require students in public or private schools to be vaccinated against COVID-19.

• Several states have mandates for specific state employees or public sector workers.

• Some states have enacted vaccine mandates for health care workers and, in some cases, for other high-risk professions like long-term care staff or first responders.

Whether you agree with vaccine mandates or not, it is irrefutable that states have mandated vaccines long before COVID-19. And, as evidenced by the Supreme Court rulings, if properly authorized by Congress vaccine mandates are not unconstitutional. I am convinced that without Trump’s politicization of COVID-19, we would have fared much better than we did!

The lockdowns

Proponents of lockdowns argued that they were crucial in slowing the virus's spread and preventing health care systems from being overwhelmed. This, in turn, would reduce the number of deaths and prevent a potential collapse of health care infrastructure. Lockdowns were seen as a way to protect the elderly, immunocompromised individuals and other groups at higher risk of severe complications from COVID-19. Many advocated for lockdowns as a measure to "flatten the curve" of infections, buying time for health care systems to prepare and increase testing capacity and mitigating potential for spread.

It's clear that lockdowns inflicted severe economic damage, causing job losses, business closures, and financial hardship for individuals and communities. They emphasized the long-term negative consequences on economic growth and stability. Some questioned the effectiveness of lockdowns in controlling the virus's spread, particularly with emerging variants. They argued that alternative measures like masks, social distancing, and contact tracing could be more effective with less economic disruption. Critics raised concerns about the negative social and psychological impacts of lockdowns, including increased anxiety, depression, and social isolation, particularly for vulnerable groups like children and the elderly.

On Nov. 25, 2020, nearly 1 million scientists signed the "Great Barrington Declaration," which expressed "grave concerns about the damaging physical and mental health implications of the prevailing COVID-19 policies." They outlined a "Middle Ground between Lockdowns & "Let it Rip" and stated as follows:

Both COVID-19 itself and the lockdown policy reactions have had enormous adverse consequences for patients in the US and around the world. While the harm from COVID-19 infections are well represented in news stories every day, the harms from lockdowns themselves are less well advertised, but no less important. The patients hurt by missed medical visits and hospitalizations due to lockdowns are as worthy of attention and policy response as are patients afflicted by COVID-19 infection.

In a recent JAMA sponsored COVID-19 debate with infectious disease epidemiologist Prof. Marc Lipsitch, Dr. Jay Bhattacharya argued against lockdowns and its collateral damage on medical care and public health.[1] At the conclusion of the debate, the moderator, JAMA editor Dr. Howard Bauchner asked whether there may exist a middle ground in COVID policy. That is the right question. Is there a middle ground between lockdowns – with school, business and office closures, curfews, and isolation – and a laissez-faire “let it rip” approach?

In the Great Barrington Declaration, co-signed now by many thousand medical scientists and practitioners, we laid out such a middle-ground alternative, with greatly improved focused protection of older people and other high-risk groups.[2] The aim of focused protection is to minimize overall mortality from both COVID-19 and other diseases by balancing the need to protect high-risk individuals from COVID-19 while reducing the harm that lockdowns have had on other aspects of medical care and public health. It recognizes that public health is concerned with the health and well-being of populations in a broader way than just infection control.[3]

This may surprise some readers given the unfortunate caricature of the Declaration, where some media outlets and scientists have falsely characterized it as a “herd immunity strategy” that aims to maximize infections among the young or as a laissez-faire approach to let the virus rip through society. On the contrary, we believe that everyone should take basic precautions to avoid spreading the disease and that no one should intentionally expose themselves to COVID-19 infection. Since zero COVID is impossible, herd immunity is the endpoint of this epidemic regardless of whether we choose lockdowns or focused protection to address it.

The premise of the Declaration lies on two scientific facts. First, while anyone can get infected, there is more than a thousand-fold difference in COVID-19 mortality [4],[5] between the oldest and youngest. Children have lower mortality from COVID-19 [6] than from the annual influenza.[7] For people under the age of 70, the infection survival rate is 99.95%.[8] We now have good evidence on the relative risk posed by the incidence of chronic conditions, so we know that among common conditions, age is the single most important risk factor. For instance, a 65-year-old obese individual has about the same COVID-19 mortality risk conditional upon infection as a 70-year-old non-obese individual.[9]

Second, the harms of the lockdown are manifold and devastating, including plummeting childhood vaccination rates[10], worse cardiovascular disease outcomes[11], less cancer screening[12], and deteriorating mental health[13], to name a few. The social isolation induced by lockdown has led to a sharp rise in opioid and drug-related overdoses[14], similar to the “deaths of despair” that occurred in the wake of the 2008 Great Recession.[15] Social isolation of the elderly has contributed to a sharp rise in dementia-related deaths around the country.[16] For children, the cessation of in-person schooling since the spring has led to “catastrophic” learning losses[17], with severe projected adverse consequences for affected students’ life spans.[18] According to a CDC estimate, one in four young adults seriously considered suicide this past June.[19] Among 25 to 44-year olds, the CDC reports a 26% increase in excess all-cause mortality relative to past years, though fewer than 5% of 2020 deaths have been due to COVID-19.[20], [21]

The harms of lockdown are unequally distributed. Economists have found that only 37% of jobs in the US can be performed wholly on-line, and high-paying jobs are overrepresented among that set.[22] By declaring janitors, store clerks, meat packers, postal workers, and other blue-collar workers as “essential” workers in most states, regardless of whether they qualify as high COVID mortality risk, the lockdowns have failed to shield the vulnerable in these occupations. The economic dislocation from the lockdowns has increased the number of households where young adults who have lost their jobs co-reside with vulnerable older parents[23], which may increase the risk of COVID-related death.[24] In addition, school closures have contributed to shortages of nurses and other medical personnel who stay home to care for their children rather than work.[25] Very clearly, exposing people to the medical and psychological harms from the lockdowns is ethically fraught.[26]

The two main planks of focused protection and the Great Barrington Declaration follow logically from these two facts. For older people, COVID-19 is a deadly disease that should be met with overwhelming resources aimed at protecting them wherever they are, whether in nursing homes, at their own home, in the workplace, or in multi-generational homes. For the non-vulnerable, who face far greater harm from the lockdowns than they do from COVID-19 infection risk, the lockdowns should be lifted and – for those who so decide – normal life resumed.

Lockdown proponents assert without evidence that the only way to protect the older vulnerable population is to limit general community transmission, in effect arguing that focused protection is impossible. We disagree. Standard public health practice regularly seeks creative ways to protect vulnerable people from a host of diseases and conditions that threaten them, and COVID-19 should not be an exception. In many publications[27],[28],[29] and at the Great Barrington Declaration site itself[30], we have delineated many practical policies to this end. These include, e.g., frequent on-site testing and limiting staff rotations in nursing homes, free home delivery of groceries for the home-bound vulnerable, providing disability job accommodations for older vulnerable workers, and temporary accommodations for older people living in multi-generational homes. The prospect of effective and safe COVID-19 vaccines offer an additional avenue for improved focused protection of high-risk individuals, both directly and by vaccinating caregivers. Still, better protection of the elderly cannot and should not wait until a vaccine is widely available.

Inconsistent with the standard pandemic preparedness plans that existed before the COVID-19 epidemic, lockdowns are, and have always been, a radical approach to infection control.[31] Focused protection is the middle ground that will end the pandemic with the least harm to the vulnerable and non-vulnerable alike.

Francis Collins, former director of the National Institutes of Health, openly admitted that public health officials attached “zero value” to the grave damage their COVID-19 policies did to the public. Collins said public health experts did not think about how their policies would affect people “outside” of places like New York City and Washington D.C.

Collins said:

If you’re a public health person, and you’re trying to make a decision, you have this very narrow view of what the right decision is, and that is something that will save a life. … [It] doesn’t matter what else happens, so you attach infinite value to stopping the disease and saving a life. “You attach zero value to whether this actually totally disrupts people’s lives, ruins the economy, and has many kids kept out of school in a way that they never might quite recover from. Collateral damage. This is a public health mindset. And I think a lot of us involved in trying to make those recommendations had that mindset,” he added. “[A]nd that was really unfortunate, it’s another mistake we made.”

Here’s the full video:

It is the failure of our political leaders to understand how to protect us not only from the virus but from the consequences of poorly executed policies that triggered significant economic consequences worldwide.

The economic damage is clear. The pandemic caused a worldwide economic recession, with the International Monetary Fund estimating a global GDP decline of 4.9% in 2020. Major economies like the U.S., U.K. and Europe experienced significant contractions. The pandemic led to widespread job losses across various sectors, particularly in tourism, hospitality and retail. Global unemployment rates soared, with millions losing their livelihoods. Many businesses, particularly small and medium-sized enterprises, struggled to survive the economic downturn, leading to closures and bankruptcies. The pandemic disrupted global supply chains, causing shortages of essential goods and materials, further hampering economic activity. Governments implemented various stimulus packages and financial assistance programs to mitigate the economic fallout, leading to increased national debt levels. The total impact of the pandemic is just being understood. Here's an article from the USC Leonard Schaeffer Center for Health Policy & Economics, which used economic modeling to approximate the revenue lost due to mandatory business closures at the beginning of the pandemic. It concludes:

The economic toll of the COVID-19 pandemic in the U.S. will reach US$14 trillion by the end of 2023, our team of economists, public policy researchers and other experts have estimated.

These losses were offset to a degree by surges in online purchases, a series of large fiscal stimulus and economic relief packages and an unprecedented expansion of the number of Americans working from home – and thus were able to keep doing jobs that might otherwise have been cut.

Please know that I am not unreasonable. I don't hold Trump or Biden solely accountable for the economic toll of the pandemic. The world was unprepared! But we could have done much better than the absolute worst in the world — if our democracy was healthy, if our elected officials had the credibility to earn the trust of the governed and if the duopoly was willing to put patriotism before partisanship.