Needle Points: Sympathy For The Hesitant

Hesitancy is not an unknown term in the world of psychology. Along with phobia and procrastination it conjures being held back or blocked by an emotional response. A strong belief. A world view. Whatever the reason, those who are hesitant need to be explore the reasons to construct a healthy response .

In turn, Norman Doidge, a psychiatrist and psychoanalyst, has explored the reasons why people are hesitant to take the COVID vaccine. While COVID put physical immunology in the forefront, Doidge was tracking our other immune system, the behavioral immune system (BIS).

BIS was triggered on both sides of the COVID debate: the pro vaccine’s side was switched on by the danger of the virus; the other side was switched on by the fear of a viral surrogate or chemical that could possibly be poisonous. Doidge observed that both sides panicked and distrusted the other side.

In Needle Points, a well-researched 39-page essay published October 27, 2021, Doidge explores the vaccine hesitant “those who are concerned and anxious about COVID but also anxious about these new vaccines.”

Call it the jab; call it following the science. According to Doidge, the vaccines are the main component of the COVID master narrative. Needle Points is a wide net of information. I’m breaking down the salient most interesting points to give you the flavor. If you have the time, read it or listen to Doidge read it on an episode of Jordan Peterson’s podcast.

Long, Winding Road to Vaccines

Doidge explains his fascination with the kernel insight involved in vaccinations. Kernel insights offer deep insights into behavior. Before modern medicine, exposing a person to a weakened form of a pathogen or toxin came in stages through observation. In 1534 Paracelsus noted that “what makes a man ill also cures him” when treating people during the plague. The heal-harm paradox is “a deep archetype in the human psyche,” according to Doidge. It’s the idea that something dangerous can also be healthy. By exposing a person to an attenuated version of a microbe, vaccines protect them from a future “potentially lethal encounter.”

Humans have always existed with microbes; vaccines use our “educable immune system” to work with nature not against it. Its counterpoint, as mentioned, is the BIS which works in humans, though not alway harmoniously. The immune system works to protect us once infected. The BiS works to protect us from getting infected.

Our ancestors knew that exposure to a new tribe meant exposure to their pathogens which held the possibility of wiping them out. Thus we developed stranger danger.

Vaccination comes from the Latin term vaccinia, the term for cowpox virus [vacca means cow]. In 1700’s England, milk maids with cowpox were immune to the deadly smallpox virus. A cattle breeder named Benjamin Jesty first exposed himself to cowpox and then the wife and kids. They remained immune from smallpox for 15 years. Physician Edward Jenner learned of this and went further and began exposing patients. Though ridiculed, he got results.

It’s not surprising to learn that the road to vaccine development and acceptance was rocky. With the successes came disasters: bad batches of polio vaccine infected 40,000 children, killing 10 (Cutter incident); 450 vaccinated people developed a neurological disorder from the 1976 swine flu vaccination campaign.

There’s the Tuskegee experiment where the U.S. Public Health Service fooled black men into thinking they were getting treatment for syphilis. Instead they received a placebo while researchers watched them die, noting the natural course of the disease. For science. For four decades (1932-1972).

During the same time the U.S. public health system bought into the international eugenics theories, sterilizing 70,000 people with learning problems, the blind and poor, and forcibly removed the uteruses of black and indigenous women. To further science these government-sponsored programs used “population-based thinking, dehumanizing people into numbers to be toyed with” without informed consent.

In the ‘70s parents began filing law suits arguing that their children were damaged by vaccines. Pharma began raising the cost of doses to offset litigation costs. Some stopped producing vaccines. The U.S. government stepped in forming the National Childhood Vaccine Injury Act. This Act indemnified companies from lawsuits; complainants could argue injury in “vaccine court.” The government would pay damages from a tax-payer fund. However, indemnified companies had no incentive to improve safety, shifting liability from makers onto taxpayers, a group that included those who were harmed.

Pharmaceutical Intervention

To understand the polarized reactions to vaccines, Doidge needs to illuminate three things: the kernel idea behind one of humanity’s greatest health interventions, the execution of the vaccine which refers to how it is produced, tested for safety and efficacy, and regulated; and communication from producers and health officials. Only those who reject the first thread of the argument can be called “anti-vaxxers.” Those who doubt the execution and communication are the hesitant.

The execution and communication of vaccines fall into hands of the pharmaceutical companies. In a September 2019 Gallup poll, Big Pharma was the least trusted of 25 industrial sectors. It had the highest negatives and the lowest positives. This study occurred just months before the COVID-19 pandemic began.

At No. 24 was the federal government, and the health care industry was No. 23. Of the 25 sectors, 21 have positive views. PR joins the bottom three. The sectors, seen as net negatives, are the biggest players in the roll out of the COVID vaccines. These conclusions didn’t happen overnight but developed over decades of lawsuits and headlines.

To borrow virus terms, the cozy relationship between pharmaceuticals and scientists involved in the approval process was becoming endemic by the 1990s. Public scientists were allowed to receive royalties under the 1980 Bayh-Dole Act, where, like the vaccine injury act, the government once again intervened to solve a problem. It was a two-pronged problem: government research lacked reimbursement and top public scientists were heading to more lucrative private sector. This act allowed government scientists to collect up to $150,000 in royalties on treatments they helped develop.

Abuse occurred. Rampantly. Books like The Truth About the Drug Companies: How They Deceive Us and What to Do About It in 2004 and Bad Pharma: How Drug Companies Mislead Doctors and Harm Paitents in 2012 document conflicts of interests, using marketing as education in medical schools, conventions, and organizations; covering up known side effects, and illegal activities.

Pfizer was fined $2.3 billion for Baxtra; in 2012 GlaxoSmithKline was fined $3 billion for civil and criminal fraud, failure to report safety data among the counts; Abbot was fined $1.4 billion in 2012; Eli Lilly was fined$1.4 billion in 2009; AstraZeneca was fined $520 million in 2010; Merck was fined $1 billion in 2011.

Whenever Americans hear about these abuses, skepticism and doubt begin their creep. TV watchers see lawyers encouraging people damaged by a pharmaceutical product to join their class action suits. Every drug commercial is beset with tedious lists of side effects which can sometimes be death.

Here are some examples. In 1995, the FDA approved OxyContin for short-term pain use like terminal patients based on studies. Approving it to “around-the-clock daily usage” in 2001 was not based on studies. Sixteen of the 20 reports on the clinical trials of Vioxx were ghost written by Merck employees. It was on the market in 1999 and pulled in 2004 for causing heart attacks and stroke. Merck paid out $4.9 billion in lawsuits.

The revolving door between regulators at the FDA and pharma companies and the use of ghost-written studies cause dire mistakes and fuel mistrust. Congress is not breaking down doors to investigate. Is this because Big Pharma and health industry officials are the highest paying lobby in the U.S.?

In Bad Pharma, the author shows that studies are rigged to achieve a certain result. That’s not always needed. This practice is common: “delay the reporting of medication side effects” till the patent runs out. The bad publicity is a tool to sell new patented replacement medications.

Delayed side effects are the chief concern among the vaccine hesitant. The “burden of proof to demonstrate that it is safe and effective must fall on those who offer it.” Questions should be welcome. Anxiety must not be shamed.

The Master Narrative

As the initial buy-in of measures to protect Americans from the novel coronavirus began to be questioned, the master narrative began to emerge, according to Doidge. The 15 days to flatten the curve was extended indefinitely. Initial claims about masks changed from not necessary to absolutely necessary. Standing above these squabbles was the old standby. The master narrative said there is one main tool to vanquish the plague: the vaccines.

The master narrative suggested that there was only one way to return to prior civil liberties, school for millions of kids, and social activities: create a vaccine. And step on the gas, making them quicker than the usual fast vaccine process which is 7-10 years.

A big player in this push was Bill Gates. The Gates Foundation are major contributors to Gavi, the Vaccine Alliance, having a permanent seat on its board. Gates is also the biggest private contributor to the World Health Organization (WHO).

Gates insisted that developing the COVID vaccine required trade offs: less safety in testing, and because of the risks and need for indemnification “governments will have to be involved.” In August 2020 the PREP Act was amended for the first time to allow pharmaceutical companies to be indemnified before the vaccine was even made or fully assessed.

Pharma press releases, not verified science, gave the public its first impressions of its products. AstraZeneca, Pfizer, and Moderna claimed their data is proprietary and withheld their study protocols from outside scientists and the public. It is standard operating procedure that government regulators go along with this.

“Conducting experiments that everyone can objectively see and verify” and transparency are the foundation of the scientific method, according to Doidge. He concludes that there have never been studies of this size and importance done so quickly for a vaccine given to hundreds of millions of people around the world. Patients in the COVID Phase III clinical trials were only followed for two months after the second dose to assess its safety and efficacy.

Effective or Efficacious?

Though new mRNA technology allowed vaccines to be produced quickly, the two-month testing period caused concern. Thalidomide was developed originally as a sedative but showed to help with nausea. In theory and practice it helped with pregnant women. But it caused birth defects and took longer than nine months and a lot of cases to link it to the drug. And even longer for the drug company to stop opposing these facts.

Empirical science is always “science after the fact.” Unforeseen consequences aren’t always detected in the population at large for years. Pharma’s messaging about the vaccines were that it was a novel technology. When side effects showed up the message morphed that mRNA was a longstanding technology. Hesitant people notice flip-flops.

If public trust is desired, Doidge knows what we shouldn’t do: “act as though there is no chance that any legitimate concern could ever possibly emerge, or that we know more than we do after only two months of study.”

Efficacious describes how effective a treatment is in clinical trials. It differs from effectiveness, which describes its success in the real world. They became synonymous. But at what endpoint or conclusion were the vaccines efficacious? Stopping transmission, preventing severe illness and hospitalization, or death? And for how long?

Moderna and Pfizer’s trials claimed to look any clinically symptomatic infection of “essentially any severity” as their endpoints. In the Pfizer trial, not a single person in the trial or placebo group died of COVID. In Moderna’s report to the FDA, death was considered a secondary endpoint. No deaths showed in the trial and one appeared in placebo group.

Juxtapose the hundreds of thousands of deaths in real life with Moderna and Pfizer’s trials that produced one death in a group of over 70,000 people. Moderna admitted “you would need a trial that is either 5 or 10 times larger or you’d need a trial that is 5-10 times longer” to collect all the endpoints.

Despite questions and distrust in “the systems that delivered the vaccines,” the master narrative rolled on. Doctors, leaders, media pundits, even the U.S. president made these claims: “If you’re vaccinated, you’re protected. If you’re unvaccinated, you’re not.”

Boldly the government chose to message that vaccinating pregnant women would not lead to adverse affects on development after birth even though the data wasn’t there.

Distrust Breeds Distrust

Doidge says it is “difficult to assuage those who distrust the systems” that delivered the vaccines. When the public and a few scientists requested to see the raw data of the studies, they were denied. Perhaps confidence would have been “astonishing” and knowledge “enriched” if the raw data could have been scrutinized by the world’s scientists who, digging in, could see for whom the vaccine was most effective and who was a most risk of side effects. By following them longer than two months they could determine which groups to most protect.

“A lesson in human nature: When public health officials distrust the public, the public will come to distrust them,” says Doidge.

Mainstream media downplayed problems in the vaccines like Johnson & Johnson’s blood clot discovery and insinuated that skeptics were housed in the Christian Right. But 34% of frontline health workers did not plan to get vaccinated, according to a January 2021 Gallup poll. An additional 18% were hesitant. Not all of these frontline workers were uneducated religious Republicans.

The most hesitant group in May 2021 were PhDs [Carnegie-Mellon, U of Pittsburgh study]. Dr. Anthony Fauci, head of the National Institute of Health (NIH), told Congress that approximately 60% of NIH employees were vaccinated. The FDA boasted about the same number for their employees.

The top reason for concern: “future unknown effects.” In studies in the West regarding reluctance to get vaccinated, safety and fear of side effects were top reasons. Only a small minority of these consider themselves anti-vaxxers.

They do have a strong mistrust of people and organizations like the CDC and FDA. Mistrust of what Doidge calls the vaccine troika — Big Pharma, government and public health, and the health care industry — and an insistence that vaccination is a personal choice are the common themes of the hesitant. Using group identifiers like race, religion and political affiliation confuses the issue and causes more distrust.

Meanwhile the story emerging upped the mistrust: the agencies authorized to lead us out of the pandemic had links to the Wuhan lab which has a history of safety violations and involvement in dangerous experiments.

The suspicions about the origins of the virus weren’t new. Could it be the result of gain-of-function research that President Obama banned in 2014?

Dr. Fauci stated that the scientists who “were in a position to judge the COVID situation” said its origins were natural. He added that anyone one making other assumptions were conspiracy theorists and their claims were debunked.

It was disturbing to find out that though Fauci’s NIH didn’t directly fund GofF research, he did so through a third party called EcoHealth. He wrote in 2012 that GofF research had the potential for catastrophic events like “a virus with serious pandemic potential” but that gem of “resulting knowledge” was worth the risk.

The soup of distrust thickened when several FDA scientists resigned in June 2021. Three resigned over the way an Alzheimer drug called Aduhelm was approved. Following these departures, the FDA’s top two vaccine officials left because they felt “outside pressure by the Biden administration to approve boosters before the FDA completed its own approval process.”`

The Pfizer booster study presented to the FDA for approval was very small: 306 people aged 18-55 who were followed for only a month. There was not a randomized control group and only antibodies were measured. The FDA panel voted 16-2 to reject it for all ages; on a second vote it was approved only for people over 65. Yet, President Biden began supporting boosters for all in mid-August following the advice of Fauci and NIH.

Big Tech didn’t throw a warm blanket of trust over the COVID debate. In May the lab leak theory was no longer censored by Facebook. Google’s charity arm funded GofF researcher EcoHealth, the same one the NIH supported. Amazon has been looking into developing a pharmacy division while banning books critical of the vaccine-only solution.

Physicians who questioned the ever-shifting narrative about COVID were in danger of having their licenses revoked by three U.S. medical boards, family medicine, internal medicine, and pediatrics.

“Censorship nourishes the weed it purports to exterminate,” according to Doidge. He cites Amnesty International’s report condemning the suppression of criticism and debate. It causes “mistrust in authorities,” a space for conspiracy theories, and suppression of legitimate debate.

Public health officials who demand people change their behaviors must also allow for scientific criticism and debate. When scientific debates are stifled they significantly harm science and medicine. Science is the process of “critical inquiry” and the interpretation of data “requires ongoing debate.”

Nobel scientist Richard Feynman wrote “Learn from science that you must doubt the experts….When someone says science teaches such and such, he is using the word incorrectly. Science doesn’t teach it; experience teaches it…And you have as much right as anyone else, upon hearing about the experiments (but we must listen to all the evidence) to judge whether a reasonable conclusion has been arrived at.”

Doidge says it’s important to understand that there the conditions were ideal for creating skepticism over vaccines: government agencies indemnifying pharma companies; public health officials misleading Congress; regulators resigning from FDA over approvals; revolving door between FDA scientists and Big Pharma; the inability for more than a year to discuss a possible lab leak story; admission by social media platforms that they control what information can be seen; and institutional censorship.

Cracks in the Narrative

As the effectiveness of the COVID vaccines began to wane in subsequent waves and variants, cracks in the master narrative began to show.

Doidge compares Israel, a highly vaccinated country considered a model of public health, with Sweden, with its voluntary public health system that didn’t institute lockdowns. By September 12, 2021, Israel’s COVID hospitalization rate was four times higher than Sweden’ s and seven-day average of 2.89 deaths per million compared to Sweden’s .15 per million.

Doidge says this suggests that “once Sweden’s natural herd immunity was established, combined with its vaccines, it was now more protective than Israel’s largely vaccine-only immunity.”

Still the master narrative was pushed by the CDC, even if it meant delaying its reporting data that Pfizer vaccines were leaky in Israel. In the U.S. by July 15, new cases of COVID were falling among the unvaxxed and increasing among the full-or-partially vaccinated. Those with breakthrough cases could carry viral loads as big as the unvaxxed

In the summer of 2021 the CDC’ Director Rachel Walensky told CNN’s Wolf Blitzer that the vaccines work well against serious illness. “But what they can’t do anymore is prevent transmission,” she said.

Though the master narrative was touting 95% effectiveness in stopping transmissions, the lack of nuance whether vaxxed or unvaxxed were able to transmit COVID gave the vaccine hesitant more reasons to doubt. Meanwhile the master narrative inched over to the message that the vaccines are essential as protection against COVID illness. The CDC subtlety changed its stance: vaccines can produce immunity to a disease became vaccines can produces protection from disease.

In true master narrative mode, the FDA, which had said regulators wouldn’t approve a vaccine less than 50% effective was now saying something less effective was “not just approved but mandated.” In Israel, the U.S. and Qatar studies showed vaccine effectiveness was plummeting.

The drumbeat that this is a epidemic of the unvaccinated fell flat as doubly vaxxed athletes, politicians, entertainers were getting breakthrough cases. Yet, public health officials and “Twitter-certified human nature experts” began doling out threats and rewards based on vaccination status.

The delta variant wasn’t the sole cause of the breakthrough infections; the potency of the vaccines was fading after five months. New York Magazine’s David Wallace-Wells spoiled Fauci’s claim that the vast majority of COVID deaths was among unvaccinated (99.5%). The data that formed that percentage came from January 1 to date and included all the months when the vaccine was sparsely distributed. It was only by April 1, 2021 that 15% were vaccinated and two-thirds of cases and 80% of deaths for the year had already occurred. Wallace-Wells said there weren’t head-to-head comparisons between vaxxed and unvaxxed because “the CDC stopped tracking most breakthrough cases in early May.”

The master narrative and the data about breakthrough cases were off sync. Eric Topol, head at Scripps Research told Wallace-Wells that data coming from public health officials wasn’t coming in real time. Topol’s concern with the people messaging was “they just want to get vaccinations up…and they don’t want to punch any holes in the story about vaccines. But we can handle the truth. And that’s what we should be getting.”

Radio Silence: Natural Immunity

Developing countries were predicted to fare poorly with the pandemic. Yet Ethiopia and Kenya had low death rates and very low vaccination rates (1% in Ethiopia). These countries have younger more rural population and strikingly lower obesity and Type 2 diabetes rates. In the U,S. where 70% of the population is overweight, the CDC data shows that 78% of hospitalized are obese. “By lowering immunity, obesity increases the chance of severe illness, and also decreases vaccine efficacy, as has been shown with the flu vaccine,” Doidge writes.

Also butting against the master narrative is natural immunity. Ethiopia’s fewer lockdowns and better metabolic health combined with natural immunity to create a potent protection for its people.

Eighteen months into the pandemic, Dr. Fauci told CNN’s Sanjay Gupta that he didn’t have a firm answer about natural immunity but it was something to look into. U.S. policy was fervently saying everybody must get the vaccine, even those with natural immunity. Strangely, as Doidge points out, vaccine immunity relies on the body’s ability to produce natural immunity. Vaccines work by triggering our preexisting immune system.

Johns Hopkins epidemiologist Dr. Martin Makary pointed out that about half of the unvaccinated Americans have been exposed to the virus and have natural immunity. He added that there are 16 studies that natural immunity lasts years, and even “when antibodies go down, cells in the marrow are ready to produce them.” An Israeli study of 76,000 people showed that people who recovered from previous COVID infection in January and February 2021 were 27 times less likely to get symptomatic reinfection than those who got vaccine immunity.

Immune and not immune should be included in the debate instead of just vaccinated and unvaccinated. The European Union’s Digital Covid Certificate allows travel for those “recovered from COVID-19.” Doidge wonders that, if science gives absolute direction, are European or American officials not following the science?

Doidge concludes that vaccinism, the “all-or-nothing approach” that makes vaccines the only tool to fight COVID and makes no exceptions, is the ideological mirror of anti-vaxxism. “Vaccination is a tool, a means to an end: immunity. But the American government has made the means, vaccination, the new end.”

Needle Point: Conclusions

Remember the behavioral immune system (BIS)? It has had many months to brew in society with the master narrative. Operating on the hard-hitting promise that only the vaccinated person would not pose a threat to public health, many want old measures to continue and don’t want to factor in the costs of all these measure. This thinking is consistent with government messaging.

Meanwhile for the hesitant, Doidge claims the lockdowns broke their trust. While one-third of small businesses were closed by April 2021, big box stores allowed people to gather and thrived. The wealth of the 10 richest men in the world is estimated to have risen by $540 billion in the first 10 months of the pandemic, while some politicians were caught breaking their own regulations.

Doidge isn’t afraid to explore the deep questions plaguing the unvaxxed and civil libertarians. There is the core sense in democracies that if anything is yours, it’s your body. Fear of forced medical treatment “runs very deep in the modern psyche.” The argument that vaccination is needed for the greater good that governs much of public health begs the question of how we’re measuring the good and is it the same for all people? How are you helping the group when you’re weakening the individual by overriding his or her rights? Do you know many evils in history have been done under the same banner of greater good? Until it answers or seriously engages these questions, Doidge says “utilitarianism is but a shallow form of arithmetic, one passing itself off as moral philosophy.”

The two main reasons behind the master narrative have holes. The percentage needed to get herd immunity isn’t one that scientist agree on. Dr. Fauci, who originally touted 60-70%, quietly shifted the percentage upwards, while President Biden said 98% was needed in the U.S. Denmark accepted 74% and Norway lifted restrictions at 67%.

Secondly, the state says it has the obligation to protect those who cannot protect themselves. With the rollout of vaccines and boosters, protection is widely available to everyone. There is scientific consensus that COVID cannot be eradicated because it exists in a dozen animal species. It’s accepted that this virus will become endemic and that “global herd immunity is unreachable.”

These justifications for mandated vaccinations present challenges that “requires flexible thinking, new kinds of planning, and above all acknowledgement, lest its denial becomes yet another example of bungled trust.”

Mandates don’t build trust, and public trust has to be a two-way street. Sweden’s participatory system and messaging has led to the highest vaccine rates and confidence in the world. “Public health has to be based on public trust.” How do you build trust with these dual tactics: the government has indemnified Big Pharma’s incentive to improve safety and the mandates have removed public health officials’ motivation to listen, understand, and have consistent communication.

Since our drug and vaccine regulatory systems do have problems, “demonizing people for having doubts” is counterproductive. Only 12% of the registered clinical research trials have made their protocols available as of May 2021 according to the WHO Collaborating Centre for Governance, Accountability, and Transparency. Researchers want transparency from the FDA and Big Pharma. They want to see the internal deliberations about policy decisions and rationale about the endpoints chosen in testing vaccine efficacy.

Pro-vaccine advocates shouldn’t accept this lack of transparency either. They should want “to rescue their extraordinary technology from the flawed and broken system of poor regulation, insufficiently transparent testing, and manipulative messaging,” according to Doidge.

As he ends this essay, Doidge explains his rationale for the personal decision to get the vaccination. Yet his final thought is Tocqueville’s insistence that “the tyranny of the majority over the minority” remains a danger in democracies. There needs to be protection of tendency in society to impose civil penalties on those who dissent. Doidge agrees that it’s difficult but essential when a plague “besets a democracy” especially one that wants to survive it in good condition.

Early on Doidge realizes the importance of messaging in how people come to grips with a viral pandemic. He recognizes brain circuitry in reactions and begins a psychological dive into the phenomena.

The all-or-nothing thinking that caused crystallization within debates on public policy and reactions to COVID were apparent from the start. Though Doidge was vaccinated for personal reasons he found a sympathetic response to those who were as anxious about the virus as the vaccines.

My Conclusion:Beyond BIS

Everyone has witnessed overwrought responses to COVID, whether people are shamed for wearing a mask or not wearing a mask. Others in the psychological field saw responses in play. In Belgium Dr. Matias Desmet, a clinical psychologist with a masters in statistics, saw early on that the statistical models over estimated the dangers of COVID and the warnings that lockdown measures would do more overall harm than the virus were not being heeded. He guessed that powerful things were going on at a psychological level.

Risk and reward analysis are necessary if you’re acting in good faith. It’s not that the other way could bear out to be wrong; it’s that it wasn’t even attempted. Desmet wanted to try to understand what caused the frenzy of people “so narrowly focused on the coronavirus.”

He rolls out his theory called mass formation psychosis. BIS occurs in individuals. MFP occurs in societies that met a certain threshold. He spells out why the four things were functioning when COVID struck: a lack of social bond and isolation; feeling life is meaningless or senseless; free floating anxiety or discontent; and free floating frustration or aggression.

When mass formation psychosis occurs, the narrative introduces an object of anxiety and a strategy to deal with it. By participating with it, people feel connected and a new social bond is formed.

It’s interesting to read psychological takes on the pandemic. The response to it has caused reactions most haven’t experienced in their lives regardless of your stance. It’s a worthwhile to look into it.

While concluding this in April of 2022, the FDA is authorizing the 4th dose or 2nd booster by bypassing the vote of its external experts. It will convene after to discuss the authorization. According to Dr. Marty Makary, “it’s like a judge issuing a verdict and then having lawyers make their arguments.”

Makary, a Johns Hopkins professor, says there is zero clinical data that the 4th dose reduces hospitalization risk. There isn’t even evidence that the third dose reduces hospitalization risk in young people.

He recalls the political interference over boosters that caused the departure of two FDA panelist in the fall. “There is no greater slap in the face of science than bypassing the customary FDA external expert voting process over an authorization with insufficient supporting clinical data,” said Makary.

He continues his chastisement: “Biden and his new FDA commissioner (under pressure from Pharma) should insist on a vote by FDA’s external experts before authorizing 4th doses. Public health confidence has been significantly eroded. …Science > politics.”

Doidge published Needle Points five months ago. Makary’s current concerns over the erosion of confidence in the FDA and Big Pharma fit Doidge’s template for hesitancy.

I consider myself hesitant; I also got the vaccine. I didn’t fear COVID because I’m healthy metabolically and physically. The severe illness and death rate for my age is very low. I rarely defer to experts unless they have skin in the game. My usual deferral is skepticism and I despised the messaging and politicization, but when I look back my response was an emotional one.

I hated the lockdowns. I felt cut off and isolated even though I went in to work. I didn’t like wearing masks. I don’t breath well in them and feel claustrophobic. Vaccines, we were told, would usher in a return to normalcy. I don’t get flu shot but am not against vaccinations. If my vaccination could help lead to herd immunity which I believe in, then maybe I could be part of a solution. Without much risk of vaccination side effects, I got my two shots in May 2021. I could forsake the masks like I’ve never forsaken anything.

Not so fast. I got COVID on Labor Day weekend 2021. It was very mild. Was that because of the vaccination or my health? Or a little of both? In truth, I regret getting the vaccine even though I’ve suffered no effects to date. My reasons weren’t flawed but the promises were. The little trust I had was broken leaving me more hesitant in the future..

Norman Doidge does deeper dives into the psychology of the pandemic in his column Journal of a Plague at Tablet magazine.