One of the happy delusions that many in the science-based community (including, at least somewhat, myself) and mainstream press have held over the years that has been punctured by the arrival of COVID-19 is that one main reason that antivaccine beliefs persist is that we’ve forgotten the toll that the diseases against which we vaccinate. If, for instance, measles returned with a vengeance, or haemophilus influenza type B, or polio, antivaxxers would see the error of their ways, and resistance to vaccination would diminish. How many times have you heard this argument? How many times have I suggested this? It’s a comforting thought. However, truth be told, it is also one that makes us, as science advocates, feel a bit smug and confident. That’s not to say that there isn’t a grain of truth in this idea, particularly for the vaccine-hesitant, but for hard-core antivaxxers, it has been a comforting myth. But why is it a myth? It seems so obvious, so rational, to think that the return of deadly diseases would knock some sense into antivaxxers’ heads. So why have antivaxxers aligned themselves with COVID-19 deniers and conspiracy theorists in the most emphatic way possible, with a number of COVID-19 lockdown protests being organized by antivaxxers? Let me provide some perspective as someone who’s been following the antivaccine movement for nearly two decades and writing about it regularly for over 15 years. I will admit that these are my observations, and that there isn’t a lot of research, but perhaps I can provide some ideas for actual research and action regarding public health.
Before I go on, I feel obligated to point out that the evidence that this idea that, if only antivaxxers could see the pain, suffering, and death caused by infectious diseases, antivaxxers would come to their senses, was revealed fairly clearly to be a myth long before COVID-19 hit the US earlier this year. As I described a little over a year ago, you have to do is to look at the reaction of antivaxxers to the numerous measles outbreaks that have occurred over the last decade in areas of low uptake of the measles-mumps-rubella (MMR) vaccine. (As an aside, in this age of the COVID-19 pandemic, it’s hard for me not to be almost nostalgic for times when measles outbreaks were one of my main concerns. That’s not to downplay the severity of measles. Anyone who’s read my work, either here on this blog or over at my not-so-super-secret other blog should know that I do not downplay the severity of measles.) I could mention how antivaxxers reacted to the measles outbreaks among Somali immigrants in Minnesota, a reaction that involved denial of their culpability for fear mongering about MMR as a cause of autism and of the severity of measles. Basically, they doubled down on their antivaccine propaganda. Measles in Samoa? The same thing. Antivaccine “thought leader” Robert F. Kennedy, Jr. wrote a pseudoscience- and misinformation-filled letter to the Samoan Prime Minister, while antivaccine activists doubled down promoting fear mongering about MMR. Meanwhile, across the US, in response to the measles outbreak in Brooklyn, antivaxxers denied responsibility, even though they had promoted fear mongering about MMR. Basically, if you’re surprised that antivaxxers have allied themselves with COVID-19 deniers, you haven’t been paying attention. The unholy alliance between antivaxxers and COVID-19 conspiracy theorists is a natural fit.
I’ve alluded to the affinity between antivaxxers and COVID-19 conspiracy theorists before, but at the time I focused on how both of their ideologies are rooted in conspiracy theories, such as the notion that 5G somehow predisposes to (or even causes) COVID-19, that glyphosate predisposes people to COVID-19, that COVID-19 was created in a laboratory and is a “plandemic” designed to provide a pretext for authoritarian control, or that the flu vaccine predisposes people to COVID-19. Basically, COVID-19 has been a magnet for medical conspiracy theories, which is why antivaxxers have launched a pre-emptive disinformation campaign on a COVID-19 vaccine that does not yet exist.
Hostility towards public health
So, what is the other commonality between antivaxxers and COVID-19 deniers and conspiracy theorists? Think about it, and I suspect you’ll come up with the same answer I did: An unrelenting hostility towards public health. This hostility towards public health interventions manifests itself with a refusal to take responsibility to do anything that decreases the risk of COVID-19 transmission. Think about it. For example, how many times have we seen antivaxxers denying the very concept of herd immunity, at least due to vaccines? (They like to claim that “natural herd immunity,” gained through a large percentage of the population getting a disease, is far superior, even though such immunity cannot be achieved without mass suffering from a large percentage of the population getting an infectious disease and might not even be a thing.) Here’s another way of putting it: How many times have you heard antivaxxers making the argument that, if vaccines work, you shouldn’t be worried about their unvaccinated children? How often have you heard them reject any responsibility whatsoever for any children other than their own, dismissing the concerns of parents of children with cancer or other conditions that leave them immunosuppressed and unable to take certain vaccines? Some of you might even recall antivaxxers dismissing vaccines as important and then saying they’d just quarantine in the event of an outbreak. Contrast that to what antivaxxers are doing now, protesting against lockdowns, refusing to wear masks, refusing to abide by social distancing, and, in essence, claiming that COVID-19 is no big deal.
Del Bigtree: “We need to catch that cold!”
A week and a half ago, a prominent antivaxxer, Del Bigtree, whom you will likely remember as the genius behind the antivaccine propaganda film disguised as a documentary, VAXXED, demonstrated this hostility towards reasonable public health interventions in a segment from his online video show, The Highwire With Del Bigtree posted on June 19.
Here’s the video as posted to Facebook:
And here’s a version of the video as posted by The Real Truther, with a fascinating counterpoint at the end:
And on YouTube:
It occurred to me as I watched this video that there’s one other characteristic that antivaxxers share with COVID-19 deniers: Victim blaming and an utter lack of concern for those with chronic health problems. (In the case of antivaxxers, there is one exception. They do care about children whose chronic health problems they think they can blame on vaccines, but from my perspective they only care about them insofar as they can use them to blame vaccines for autism, autoimmune diseases, sudden infant death syndrome, diabetes, and the myriad chronic health conditions that have led antivaxxers like Robert F. Kennedy, Jr. to falsely claim that today’s generation is the “sickest generation“, all due to vaccines.) Look at the title of Bigtree’s video, WE NEED TO CATCH THAT COLD!
Bigtree starts out by claiming that COVID-19 has a “death rate” of 0.26%. (One notes that he doesn’t cite a source.) Even if that is true, he seems oblivious to the law of large numbers and unconcerned that, if one million people catch the disease, that means 2,600 dead and that if 100 million people catch the disease (as could happen) that means 260,000 dead. He then goes on to claim that it might only be one-fifth that, again, without citing the evidence. He then goes into a despicable diatribe, which, in case Bigtree memory-holes his rant, I am transcribing extensively because it is a near-perfect distillation of antivaccine “thinking” and the “screw the old and infirm” attitude that many COVID-19 deniers express:
What is the group that is really at risk? Let’s be honest about this and say something that might get me some trouble here, but let’s be honest. That group is very well known. It’s people over the age of 65—not just because you’re over the age of 65, but you’re sick with other diseases. You have heart disease. You have COPD. You have diabetes. You have issues, many of those issues coming from the fact that you didn’t treat your body very well while you were on this planet. And I want to talk about this for one minute as we close this down. That 0.26% are the most sick among us, and I have nothing against you. Go ahead and bubble wrap your house. Lock yourself in your basement. Go and do what’s necessary.
But here’s the problem. When you were my age, you were most likely eating food and fast food and Doritos and drinking Coca-Cola, which you’ll never find in my home. You were eating that all the time. You probably were drinking a lot of alcoholic beverages and really liked to party and enjoyed your cigarettes and said to yourself, “You know what? It’s more about the quality of my life right now. I don’t care if I live to be 100 years old. I want to enjoy my life right now. I like the finer things in life. I like good rich food. I like smoking a cigarette once in a while. I like to drink my drinks.” And you know what? Good on you! That’s the United States of America. No problem, that, some of my best friends think like that. It’s great, and they’re fun to hang out with. That’s perfectly OK.
But here’s what’s not OK. When you reach that point in your life where now your arteries are starting to clog up, your body is shutting down, and the alcohol is eating up your liver, and you have diabetes, or you have multiple COPD, you have asthma, you can’t breathe, all the cigarette smoking has finally caught up with you, you have heart disease because of the way you decided to live your life in the moment, here’s what you are now. You are pharmaceutical-dependent. You did that to yourself, not me. You decided that the moment mattered, and now you find yourself pharmaceutical-dependent, which is really what that 0.26% is, and that’s OK too. Thank God there’s drugs out there! There’s drugs that allow you to eat the Philly cheesesteak even though your body knows it hates it, but, go ahead, take the Prilosec. What difference does it make? Drug yourself! Drug yourself! Get through the day! Don’t exercise! Maybe just attach an electrode and see if a little electricity to the stomach will give you the abs you want.
Come on! Grow up! You made choices! And now that you’re pharmaceutically dependent, here’s what you don’t get to do. You don’t get to say I have to take a drug to protect you. That’s what this is. You don’t get to say I have to wear a mask and suck in my own CO2 to protect you. You don’t get to say I have to lock myself in a basement and destroy my career and take away my own ability to feed children because you are pharmaceutical dependent. You lived your life. You made your choice. And thank God we live in the United States of America so you don’t have to worry about grocery police standing outside a grocery store saying, “Really? You really need four liters of Coca-Cola? You really need four bags of Doritos or Chitos or Fritos or whatever the heck it is, little cupcakes with synthetic icing on them? You really need all that?” Because we could go there. We could go there. If we’re really going to get into each other’s schiznit, that’s what we could do.
Or could we live and let live? Eat all the Twinkies you want! Drink all the bourbon you want, and smoke as many cigarettes as you want, and when you find yourself pharmaceutical-dependent I will go ahead and say thank God the drug companies are there for you, but you do not get to make me pharmaceutical-dependent. You do not get to put me in the way of Heidi Larson, who wants to eradicate natural health and natural immunity and make us all pharmaceutical dependent.
Heidi Larson, for those of you who don’t know who she is, is the director of the Vaccine Confidence Project, a group dedicated to combatting vaccine hesitancy. When last we saw her elsewhere, she had put her foot in her mouth most spectacularly by ignorantly discounting how much education about immunology and vaccines a typical physician in training receives, which leads me to just what the heck Bigtree means by “pharmaceutical dependent”. After all, you might think that no one is telling him he has to take a medication to protect others. All he’s being asked to do is to wear a facemask when in public around other people, to abide by social distancing guidelines, and to wash his hands and/or use hand sanitizer frequently. These are hardly onerous requests; yet they’ve produced an extreme backlash. Think about it though. What Bigtree is doing when he says, “You do not get to make me pharmaceutical-dependent” is that he is signaling to his followers that he is preemptively refusing a coronavirus vaccine before one has even been approved by the FDA. Of course, he’s also refusing to wear a mask and social distance—I’ll give him the benefit of the doubt that he’s not refusing to wash his damned hands—but primarily he’s saying he refuses to be vaccinated against coronavirus once there is a vaccine. Larson’s job at the WHO is to develop strategies to increase public confidence in vaccines and combat vaccine hesitancy and antivaccine views. That’s why Bigtree mentioned her.
At this point, let me emphasize how extremely judgmental Bigtree is in this video, his disclaimers of “Good on ya!” and “It’s OK!” to those with chronic diseases notwithstanding. He’s contemptuously blaming people with chronic diseases for being chronically ill. There is, of course, a small kernel of truth buried in his rant in that, yes, lifestyle matters when it comes to chronic disease. Smoking does hugely predispose you to lung and cardiovascular diseases, for example. Overeating does predispose to obesity, although it is way more complicated than Bigtree’s version of it, which, boiled down to its essence, demonizes those with obesity as fat slobs who lived their youth and middle age overindulging without a care in the world for what their “choices” are doing to their body. Those who’ve struggled with weight problems know that you can’t just flip a switch and bring your weight under control, just as those who’ve become addicted to, for example, alcohol or tobacco, can’t just flip a switch and stop drinking and smoking, even though they know their addictions are having adverse effects on their health. Then there are poor people who live in food deserts, where access to fresh, healthy food is very limited and fatty, calorie-dense processed or fast food is almost all there is (or at the very least so much less expensive than healthier choices that the poor have little choice but to choose it given their limited resources).
This sort of attitude is very typical of antivaxxers and is born of how much antivaxxers believe in alternative medicine and “natural” treatments. It’s also, I’ve noticed, very typical of COVID-19 deniers, many of whose attitude seems to be, “Screw the old and chronically ill, I need to golf and get a haircut!” Indeed, this attitude started to take root fairly early in the pandemic, when a number of politicians of a certain political bent (you know which one) argued in essence that we need to sacrifice grandpa and grandma in order to save the economy. Fortunately, this is not an attitude shared by most Americans, although it is de facto policy in too many parts of the country.
I once coined a term, the central dogma of alternative medicine, to describe the belief that we have near-total control over our health through lifestyle, such as diet, activity, exercise, and a Secret-like belief that wishing makes it so. Antivaxxers and COVID-19 deniers share that mystical, magical belief system in which they are healthy entirely because of their choices, and they (and their children) are not at risk of horrible outcomes due to infectious disease because of their choices. It never occurs to them that age is a major risk factor for death from COVID-19 and that people can’t do anything about how old they were when the pandemic hit. Similarly, it never seems to trouble antivaxxers like Bigtree or COVID-19 deniers, the vast majority of whom are white and at least middle class if not affluent, that COVID-19 has exacted a much worse toll on African-Americans and other people of color, who are far more likely to suffer severe disease and die. (Yes, I’m going there.)
Bigtree goes way farther than that, though. He goes deep into the realm of very dangerous advice. After laying down an obvious lie in which he states that he does “care about his pharmaceutical-dependent friends”, and says that the only thing he can do for them (other than hoping for a “vaccine unicorn”) is to catch “what is just a common cold”. Of course, COVID-19 is far worse than “just a common cold”. The common cold doesn’t kill 120,000 Americans in less than four months and nearly a half a million worldwide in six months. It just doesn’t. Influenza hasn’t done anything like that in over 100 years!
Bigtree goes on to claim that for over 97% of us COVID-19 is so mild that you won’t get a fever or even know that you have it, claiming “it’s a common cold for 99.74% of us”. This is a gross exaggeration. The rate of asymptomatic COVID-19 has been notoriously tricky to estimate, given that often there’s no longitudinal testing to see if those who are asymptomatic when tested go on to develop symptoms. In reality, the percentage of cases of COVID-19 that remain asymptomatic is probably 30-50%, and these people with asymptomatic infection can still transmit the disease. Also, there is a growing body of evidence showing that masks do decrease the rate of transmission of COVID-19 to other people, as I discussed a couple of weeks ago. Since then, there’s even more evidence suggesting that masks work to prevent the spread of COVID-19
None of this stops Bigtree from saying:
So here’s what we do. Let’s go outside. Let’s take off our masks. We’re not on drugs, and we don’t need to be on drugs. Let’s catch this cold! Whether or not it’s just the 20% of us and maybe we’re not even in that category, let’s give it a college try to catch this cold, so that we can protect the pharmaceutical-dependent amongst us!
At this point it’s hard not to retort: You first, Mr. Bigtree. I’m sure one of your fans out there has COVID-19 right now and would be willing to hang out with their hero in a small, enclosed room for hours and cough in your face as much as it takes for you to acquire SARS-CoV-2, the coronavirus that causes COVID-19. What are you waiting for? Do it for the “pharmaceutical-dependent”! Lead by example! Record yourself on video doing it!
I’m being sarcastic, of course. I would never wish COVID-19 on anyone, not even someone as odious and harmful to public health as Bigtree. I note that Bigtree just turned 50, so he’s entering the age range of elevated risk. Whether Bigtree believes it or not, if he were actually foolish enough to take my sarcastic advice, I’d actually feel terrible if he turned out to be one of the minority who develop disease severe enough to require hospitalization, even worse if he were among the smaller minority who end up needing mechanical ventilation, and worse still if he were one of the probably fewer than 1% who die of COVID-19.
Perhaps the best retort, though, is what The Real Truther did in editing Bigtree’s video. During the last minute and a half or so of The Real Truther’s version, there are shown a series of photographs of people who were young (or, at most, middle aged) and otherwise healthy who died of COVID-19, the youngest of whom was 22. He also added a soundtrack of somber piano music. Brilliant. And in case that’s enough, SFGate published a story recounting the damage done to young people who have survived severe COVID-19, including kidney failure requiring dialysis, shortness of breath that persists for many weeks, the need for chronic oxygen, multiple relapses, and other complications.
The consequences are potentially dire
As I’ve documented for a long time, antivaxxers are hostile to the very idea of public health, other than letting nature take its course and producing “natural herd immunity” at a horrific cost in terms of suffering and death. If you don’t believe me, consider how in recent years they have manifested their hostility towards public health interventions not just in the form of resistance to school vaccine mandates, but in proposing laws and regulations that would make it more difficult for local health authorities to prevent and respond to outbreaks even leaving aside the issue of vaccines. For instance, in my own state, antivaccine-sympathetic legislators proposed a law that would have made it much more difficult to remove vulnerable unvaccinated students from school in the middle of an outbreak and removed a lot of flexibility to respond to outbreaks. More recently, a chickenpox outbreak at a high school in my state revealed that antivaxxers were not being entirely truthful when they claimed they’d comply with reasonable self-quarantine orders, as parents protested the order to keep their children at home. Meanwhile, antivaxxers have joined COVID-19 conspiracy theorists in portraying contact tracing and quarantine as “subjugation.”
That rhetoric is having terrifying consequences, too, as public health workers have come under attack, with harassment and threats, leading an alarming number of them to resign to protect themselves and their families or to be fired for standing up for public health:
Emily Brown was stretched thin.
As the director of the Rio Grande County Public Health Department in rural Colorado, she was working 12- and 14-hour days, struggling to respond to the pandemic with only five full-time employees for more than 11,000 residents. Case counts were rising.
She was already at odds with county commissioners, who were pushing to loosen public health restrictions in late May, against her advice. She had previously clashed with them over data releases and control and had haggled over a variance regarding reopening businesses.
But she reasoned that standing up for public health principles was worth it, even if she risked losing the job that allowed her to live close to her hometown and help her parents with their farm.
Then came the Facebook post: a photo of her and other health officials with comments about their weight and references to “armed citizens” and “bodies swinging from trees.”
It’s not just harassment and political resistance. Being overworked and stretched thin because of how inadequate many states’ public health infrastructure was before the pandemic play a role too. A week and a half ago, Ohio health director Dr. Amy Acton, who had made national news for her science-based approach to COVID-19 and public health, resigned, due to a burnout from overwork and dealing with protesters and resistance, for example:
Acton’s experience was no different. Protesters, some armed, showed up at her home in the Columbus suburbs several times. Her neighbors counter-protested in her front yard and put up “Dr. Amy Acton Fan Club” yard signs. Acton was given security detail, an unusual step for a cabinet member.
It’s hard to blame Dr. Acton for deciding that she couldn’t take it anymore. Nationwide, a number of health directors have either retired, quit, or been fired in the face of harassment, resistance, and the unhappiness of politicians:
This isn’t just happening in California. Ohio’s state health director, Amy Acton, resigned last week after facing legal challenges to her authority and protests in front of her home. Wisconsin state health director Jeanne Ayers was asked to resign in early May, at a time when COVID-19 cases in the state had surpassed 10,000, and top officials would not say why.
“Things have gotten ugly,” said one Northern California health officer who asked not to be named over personal safety concerns. “The health officers are kind of in this position where everything that everyone is angry about is the health officer’s fault.”
The official described death threats received by email and on social media as well as protesters showing up to their home. “It … makes you feel that there is nowhere that’s safe.”
No one argues that there isn’t a difficult tradeoff to be made between public health and economic interests. However, the hostility towards public health interventions goes beyond anger at the economic consequences of lockdowns. Wearing masks and contact tracing, with targeted quarantines, are thought to be our best options to be able to emerge from lockdowns and revive the economy, and yet the unholy alliance of antivaxxers and COVID-19 conspiracy theorists feverishly resist these measures, too.
Truly, it should surprise no one that antivaxxers have joined COVID-19 deniers in their conspiracy theories or that they loudly proclaim opposition and resistance to any COVID-19 vaccine, even though a COVID-19 vaccine is many months, if not years, away. When you boil it down, both groups share a profound resistance to taking the least bit of responsibility for anyone but themselves and a tendency to blame the victim. They fail to understand that personal health can’t be separated from public health. It’s no wonder that the US has had more cases and deaths from COVID-19 than any other country in the world.