On risk, vaccines, and Francine Pelletier

After the passage of Bill C-18 in Canada, Meta took what appears to be a two-pronged approach to past content on Facebook. Any post with a single link to news media simply had that link deactivated, with all content otherwise left intact. But any post with multiple links seems to have been destroyed, or at least made inaccessible via the site’s Activity Log.

What follows are three letters I wrote and published on Facebook in January and February 2022, all presumably removed in this way. I thought them important enough to write at the time, and important enough to rescue from the memory hole today. They have been lightly edited.

On risk and complicity (January 2nd, 2022)

Customarily one sends only good vibes at this time of year, but I’ve got none for you. The daily looming onset of curfew makes me feel like a prisoner in my own home, and all I can think about is your complicity.

Now it doesn’t cost very much to criticize power when talk is cheap, but governments lie and everyone expects them to. Often they believe their own lies. But a people also tends to get the government it deserves, and reckoning with one’s own perhaps unconscious facilitation of the crushing use of state power is uncomfortable. Such introspection is nevertheless encouraged in other domains. If you’re doing it for systemic racism, which I commend, you might think about doing it here.

What would an honest government have told us at the outset? That our healthcare system is woefully unprepared; that this virus will be dangerous for some, with cascading consequences for the rest of us; and that we have to work together to contain the damage while getting on with life as best we can. A responsible government would have paired these admissions with an immediate commitment to build a better system, one more resilient to shocks.

Instead our government used our distress to its advantage and did little to stave off hysteria. The reason should be obvious to anyone who has spent any time thinking about propaganda. It behooves officials to scare people into doing what they want them to do, especially when the alternative is admitting monumental failure—a failure accruing not simply to their tenure in government but to the entire field of government, which is to say: the stewardship of a state that spends half its tax revenue on health care.

The first example of this spin? “Covid is dangerous for everyone.”

Is it?

*

As of January 1st, the INSPQ records 357 covid deaths [1] for those aged less than 60 years. That’s out of nearly 487,000 confirmed cases, a number everyone agrees is an underestimate. There have been no deaths of children aged 0-9, and two deaths between the ages of 10 and 19. Taking the raw figures as they are, that’s an infection fatality rate (IFR) of less than one in a thousand (0.074%) for three-quarters of Quebec’s population [2].

You might object that vaccination has brought covid’s IFR down. I agree. So let’s look at the first two waves, up to March 20th 2021—roughly a year into the pandemic. Before then hardly anybody under the age of 60 had been vaccinated [3].

What do we find? A total of 242 deaths for 228,000 cases, with the same proviso as above—only stated even more emphatically, as we barely had any testing capacity during the first pandemic wave. Again, taking the numbers at face value, we calculate an IFR of 0.106% (or just above one in a thousand) for people under the age of 60. Note that everyone’s included here: athletes in perfect health as well as people with multiple comorbidities. When we look at the breakdown, we see a striking majority (180) of these deaths in the 50-59 age group.

This isn’t rosy. Covid is a bona fide novel source of mortality for everyone, and especially for the middle-aged.

But it’s by no means catastrophic. On what grounds do I make this claim?

In 2020, 246 people under the age of 65 died in car accidents in Quebec [4]. (The SAAQ’s report breaks up its age groups differently than the INSPQ does.)

The standard retort to this observation is a non sequitur: if we hadn’t done anything to mitigate covid transmission, more people under the age of 60 would have died. This is very likely true but very much beside the point. The point is not that nothing should have been done, but that the risk from covid for many people was roughly commensurate with other risks they habitually face without so much as a thought. One might counter that only hindsight can be so crystalline, but covid’s extreme age gradient has been obvious since the earliest data trickled in. Panicking over one’s personal covid risk is irrational for people under the age of 60, and especially so for those under the age of 50, if we define rational as ‘giving equal consideration to equiprobable outcomes’. And this was already true before vaccination.

The second most-common retort has to do with long covid: that dying is not the only bad outcome of this virus. That’s true. But the first problem here is that long covid is not really new, nor is it all that surprising. Post-viral syndromes are well-documented phenomena [5]. At any rate, this is the kind of phenomenon for which only noisy data will exist in the early days of a new pathogen’s circulation, and it’s unwise to put too much stock in something so preliminary. Absent any compelling evidence to the contrary, we shouldn’t assume SARS-CoV-2 is a completely unprecedented pathogen whose capacity to harm borders on the supernatural, either.

The second problem is that dying is not the only bad outcome of a car accident, either. Ditto for other quotidian risks we face. In 2020, there were 1,000 serious injuries and 19,937 light injuries resulting from car accidents in people under the age of 65 in Quebec [6]. For comparison, by March 20th, 2021, before substantial vaccination had taken place in the under-60s, this age group saw 1,137 intensive care stays and 6,666 hospitalizations.

Again, this is not a rosy picture. Before vaccination, for people under the age of 60, covid looked at least as risky as driving a car. Since then, the overwhelming majority of eligible people in Quebec have been vaccinated, which means their odds of getting severely ill (read: needing hospital) upon infection have diminished by about a factor of twenty [7].

*

Now you might be thinking, “Thanks, Glenn Greenwald, but this is still deadly for the elderly and the immunosuppressed.” You’d be right. To a lesser extent this is still true after mass vaccination because of covid’s extreme age discrimination.

But my argument is not that there was never a crisis, never any cause for concern. That’s not the nature of my beef with you.

You were complicit to the extent that you allowed the obvious to go unnoticed and unsaid. At the height of the emotional blackmail heaped on us by officials and the media, I felt the crushing pressure to keep quiet, to not say any of this for fear of being called heartless, anti-science, a eugenicist, etc. By virtue of our silence, fantastically distorted risk perceptions have multiplied and fed our collective hysteria. This hysteria in turn enabled wild, untested, dubious policy to enjoy free rein without so much as a pip from the average person, let alone the opposition parties sitting in the National Assembly. (Although, to its credit, Québec Solidaire didn’t wait three months to call bullshit on the curfew this time.)

Our intelligentsia, fearful of being called bad names and getting ostracized or fired, ceded any moral authority they might plausibly have claimed by keeping quiet, too.

Yet we all know the value of precedent. Actions have their own momentum. Err once, and it’s so much easier to err again. In time we might even come to call it virtuous.

**

[1] https://www.inspq.qc.ca/covid-19/donnees/age-sexe

[2] https://en.wikipedia.org/wiki/Demographics_of_Quebec#Age_structure

[3] https://www.inspq.qc.ca/covid-19/donnees/vaccination

[4] https://saaq.gouv.qc.ca/fileadmin/documents/publications/bilan-routier-2020.pdf

[5] https://www.medicalnewstoday.com/articles/326619#summary

[6] https://saaq.gouv.qc.ca/fileadmin/documents/publications/bilan-routier-2020-annexes.pdf

[7] https://www.lapresse.ca/covid-19/2021-12-19/variant-omicron/attachez-vos-tuques.php

–

On boosters and the vaccine passport (January 12th, 2022)

This letter was sent to the Montreal Gazette before being published on Facebook.

I’m a Double-Vaccinated, Thirty-Three-Year-Old Man. Here’s Why I Refuse to Get a Booster Shot

At the start of the SARS-CoV-2 pandemic, the idea of a vaccine reducing the odds of a severe bout of covid by more than 90% seemed like wishful thinking.

Yet here we are, less than two years later, in precisely that situation—with over 90% of our adult population vaccinated, to boot.

I got my first dose of Pfizer last May and my second in August. The protection this primary series offers against severe disease is durable, which was expected on immunological grounds. The systemic immunity conferred by vaccination tends not only to last longer than the humoral kind, which fends off infection, but also to resist mutations in the pathogenic culprit’s genome. Consequently, a vaccinated body is somewhat effective at resisting infection for a while, but quite effective at defeating infection for considerably longer.

On the other hand, people with senescent immune systems, whether due to advanced age or a medical condition, don’t always respond to an inoculum robustly. Boosting these individuals against a disease that has taken an immense toll on them makes sense. My parents, who are healthy but getting older, both received their booster shots last week.

But the usefulness of a booster is less clear-cut in my case—and even less so for my twelve-year-old nephew.

For starters, vaccination does not durably reduce one’s odds of being infected with or transmitting SARS-CoV-2. This, again, was expected on immunological grounds. The antibodies that destroy invading virions circulate in large numbers for some time after the body’s exposure before eventually waning. Boosting a healthy person is likely to buffer these defenders for a spell, but its enduring protection against severe disease—or whether it offers any at all—is an open question. The Omicron variant weakens the case for boosters even further, since it is excellent at evading the immune system and causing infection.

(Acknowledging this also necessarily calls into question Quebec’s vaccine passport—which, depending on whom you ask, is meant to reduce transmission, to protect the vaccinated, or to protect the unvaccinated from themselves. None of these objectives seem to have a very solid grounding in fact.)

Furthermore, there is a small but non-zero risk of heart inflammation in young men following a dose of mRNA vaccine, and it is more pronounced with Moderna than with Pfizer.

But my absolute risk from covid is also quite small: there have been nine deaths in my age group since July, when vaccination had just gained a strong foothold. So is my nephew’s: there have been two deaths in his age group since the beginning of the pandemic. Like me, he’s doubly vaccinated. Both risks—from a booster dose or from covid—are so small that it’s hard to determine which one is weightier. There seems to be no compelling reason for either one of us to get boosted.

Imagine my surprise, then, when I discovered our health minister’s plans to make the vaccine passport conditional on a booster shot—and to use up the province’s stock of Moderna wherever Pfizer doses might be running out.

At a time when the European Medicines Agency is invoking the eventual endemicity of SARS-CoV-2 to advise against a strategy of repetitive boosting, and experts and media outlets are piping up about the questionable benefits of boosting healthy young people, Legault and Dubé’s increasingly heavy-handed proposals seem out of touch.

Taking our officials at their word, I will soon no longer be able to go to the SAQ, among other places. I’ll be tagged as “inadequately vaccinated” for refusing a third dose on scientific grounds, even though I’d happily revisit the booster question next fall—after evaluating any new evidence, of course.

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Concernant Francine Pelletier (début février 2022)

Cette lettre a été envoyée à Pivot après sa publication sur Facebook.

Un consensus semble se dessiner selon lequel Francine Pelletier a gravement erré dans sa chronique intitulée « La pandémie revue et corrigée », parue le 26 janvier dernier dans Le Devoir [1]. Or, ce n’était pas mon impression en la lisant, et après analyse je ne crois toujours pas qu’elle se soit autant trompée que la classe médiatique québécoise le prétend. Qui plus est, j’ose croire que si cette dernière se souciait de rigueur journalistique, elle serait pour le moins également consternée par la mise au point publiée dans Le Devoir que par la chronique que celle-ci prétend corriger.

Notons qu’un des évènements déclencheurs de cette affaire semble être la publication d’une vidéo par le docteur Nadeau-Vallée (Walmart_Justin_Trudeau) sur un ou des réseaux sociaux quelconques. Cette personne est de toute évidence une source fiable de critiques scientifiques pour certains. Analysons, élément par élément, ce que l’on reproche à Pelletier dans la première version de sa chronique litigieuse [2].

(1) Dans sa vidéo, Nadeau-Vallée s’indigne du fait que Pelletier ait comparé la fluvoxamine au Paxlovid. Son reproche n’est pourtant pas inspiré d’une erreur factuelle : il n’aime pas la perspective exprimée et trouve la comparaison tendancieuse. Je tends à être d’accord avec lui en l’espèce, mais il faut distinguer ce qui relève des faits de ce qui relève de l’interprétation. Pelletier tentait d’attirer l’attention sur le fait qu’un de ces deux médicaments ait eu jusqu’ici très peu de couvertures médiatiques malgré son profil prometteur, son coût minime et sa disponibilité. Elle a ensuite fait des inférences discutables, mais c’est son devoir en tant que chroniqueuse de stimuler la réflexion, ce qui suppose un certain scepticisme face aux narratifs dominants.

Dans sa mise au point, la rédactrice en chef du Devoir émet un doute légitime quant à l’efficacité de la fluvoxamine comme traitement pour la covid. Il importe pourtant de noter que La Presse venait tout juste de publier un article comparant la fluvoxamine au Paxlovid [3]. L’auteur dudit article n’hésite pas, quant à lui, à citer un expert qui qualifie de « prometteurs » les essais cliniques concernant ce médicament réaffecté. Notons que La Presse n’a pas senti par la suite le besoin de faire une mise au point. Ajoutons qu’il s’agit dans ce cas-ci d’un article et non d’une chronique, et donc d’un type de publication où l’on tolère relativement peu de spéculation.

(2) Pelletier s’est véritablement trompée au sujet des essais cliniques de Pfizer. Elle a écrit que la compagnie « demandait un délai de 75 ans (!) avant de déposer toutes les données utilisées pour produire son vaccin » et que la géante pharmaceutique « n’a jamais rendu publics ses essais cliniques ». Dans les faits, c’est la Food & Drug Administration (FDA) des États-Unis qui refusait de publier de façon expéditive l’ensemble des documents et données brutes des essais cliniques de Pfizer, qui lui ont été soumis pour qu’elle puisse approuver (ou non) son vaccin contre le SRAS-CoV-2. Pour ce faire, la FDA demandait une échéance s’apparentant au chiffre avancé par Pelletier. Une cour fédérale aux États-Unis lui a alors ordonné d’accélérer considérablement le rythme de publication de ces données, ce qui sera essentiel pour une vérification indépendante des résultats.

Il est à mon avis une dangereuse exagération de dire qu’il s’agit ici d’une erreur grave. Pelletier s’est trompée dans les détails – en fait, elle rapporte incorrectement l’article qu’elle cite – ce qui ne constitue pas un manquement sur le plan de son jugement, car l’essentiel de sa critique est valide. Il est risible de prétendre, comme quelques-uns le font par négligence, que la publication de résultats équivaille au partage de données brutes et complètes. La science se base sur l’analyse de telles données et non sur des résumés inscrutables de celles-ci.

(3) Pelletier parle d’une baisse d’efficacité de 95 % « à 39-42 % » pour les vaccins à ARN messager « après seulement 6 mois d’utilisation ». Dans la version corrigée de sa chronique sur le site du Devoir, on y ajoute que cette prétendue baisse d’efficacité est « contre les effets graves de la COVID-19 ». Cependant, dans l’article dont Pelletier tire ces chiffres, publiés dans le Globe and Mail le 22 janvier dernier, l’auteur parle explicitement d’une baisse d’efficacité contre l’infection et cite plusieurs études. (Bien qu’il soit très difficile d’y associer un pourcentage exact, cet effet est maintenant bien documenté.) Il est hypocrite de reprocher à Pelletier un manque de rigueur pour ne pas avoir identifié le type d’efficacité auquel elle faisait référence. Un tel souci, si partagé par la personne qui critiquait – en l’occurrence le Dr. Nadeau-Vallée – aurait exigé une vérification de l’article cité.

De fait, c’est plutôt Le Devoir qui a manqué de rigueur par la suite, puisqu’il a faussé la chronique de Pelletier avec son ajout. De surcroit, il n’était pas nécessaire pour la rédactrice en chef de nuancer quant aux deux types d’efficacité, puisqu’il est généralement su que le fameux 95 % des essais cliniques de Pfizer – ce premier des rares chiffres réjouissants de la pandémie – concernait l’efficacité contre l’infection et non contre les effets graves de la covid.

(4) Pelletier s’est permis de passer pour un fait une spéculation discutable selon laquelle « la nature de ces vaccins — qui ne cible qu’une petite partie du virus, la protéine de spicule — encourage la prolifération de variants en étant plus facile à contourner ».

Est-ce vrai ou faux? Je ne dispose pas de l’expertise requise pour trancher la question, mais ce n’est pas la première fois que je l’entends. En effet, il y a eu beaucoup de spéculation au sein de la communauté scientifique quant à la relation précise entre la vaccination et l’évolution virale. En échantillon : le 28 novembre dernier sur sa page Twitter, l’épidémiologiste François Balloux écrivait, au sujet du variant omicron, qu’il se pouvait que « les avertissements concernant des vaccins qui conduisent à des nouveaux variants […] étaient justes, mais que la vaccination, même à des taux peu élevés, aurait pu contribuer à l’évolution d’un variant plus bénin » [4, ma traduction].

Or, Nadeau-Vallée, et à son tour la rédactrice en chef du Devoir, affirment avec quasi-certitude dans leurs réponses à Pelletier que l’inverse de sa proposition est vrai. Selon la mise au point, « les vaccins [limitent] l’apparition de nouveaux variants en empêchant la réplication du virus chez les individus vaccinés ».

Cela semble contredire une autre publication de Balloux où il affirme qu’« avec l’augmentation du taux de vaccination de la population mondiale, les pressions sélectives sur le virus pourraient devenir encore plus fortes et plus homogènes […] au point où le nombre de variants deviendra probablement difficile à suivre » [5, ma traduction]. Au même sujet, le virologue Jonathan Ball écrivait le 9 février dernier sur Twitter que « les vaccins […] n’empêchent pas l’infection et n’empêchent donc pas l’émergence de variants. L’immunité non stérilisante conférée par l’infection ou la vaccination entraînera l’émergence de variants » [6, ma traduction].

Bref, si l’on se fie à certains experts de renommée – et bien qu’on puisse penser avec justesse que l’affirmation de Pelletier méritait une présentation plus nuancée, peut-être sous forme de question – le docteur Nadeau-Vallée et le Devoir se sont trompés dans leurs corrections.

(5) Finalement, la rédactrice en chef du Devoir dément la prétendue supériorité d’une infection antérieure pour prévenir une réinfection par d’autres variants : elle avance que c’est plutôt la vaccination qui est supérieure à cet égard. Mais contrairement à l’affirmation de Pelletier, qui réfère à une étude particulière – et qui, encore une fois, n’est pas suffisamment prudente pour éviter le verbe « démontrer » – il n’est pas clair à quelles « données publiées à ce jour » la rédactrice en chef fait référence. Je n’ai pas le niveau de connaissances requis pour me prononcer sur qui a tort ou qui a raison ici, mais je me dois de remarquer cette drôle aberration.

*

[1] https://www.ledevoir.com/…/la-pandemie-revue-et-corrigee

[2] http://web.archive.org/…/la-pandemie-revue-et-corrigee

[3] https://www.lapresse.ca/…/l-efficacite-des-traitements…

[4] https://mobile.twitter.com/Bal…/status/1464923140128223246

[5] https://mobile.twitter.com/Bal…/status/1395566532072251393

[6] https://mobile.twitter.com/Jon…/status/1491423361062572032