A Letter To Robert F. Kennedy Jr. And Friends: On COVID-19 Vaccine Efficacy, Safety, and the Potential Danger Of Indiscriminate Vaccination In The Already Infected
Dear Mr. Kennedy,
Let me start by thanking you for rising relentlessly in defense of minority subsets of people in harm’s way from our society’s necessarily utilitarian practices. You are true to the Kennedy form — as I see it.
Be it in your defense of the environment, of the potentially wrongfully accused (including your own father’s alleged murderer), or of those in iatrogenic harm’s way in our contemporary American healthcare system — you are acting in a fundamentally American way. And I believe that nearly half of America sees this and understands it viscerally.
It is, indeed, American to rise in dissent and to demand proper discourse — your opponents, including some you love, have tragically forgotten this fact.
I write you, here specifically, as an Immunologist and physician from Philadelphia, PA — to inform you and your friends of the realities we must all accept with clarity, as our world grapples with the COVID-19 pandemic. If, we are to stand a chance at recovering and healing.
In articulating my argument below, I ask that you indulge me and read with care. And I truly hope that your friends and supporters will also give me the benefit of the doubt and the honor of considering and trusting my words — I know both the healing power of American medicine, and the unjustifiable and unforgivable destruction, and minority harm, that mindlessly utilitarian medical practices are capable of. This, I say in the name of my wife, Dr. Amy Josephine Reed.
Mr. Kennedy, the SARS-CoV-2 virus is real. It is a pandemic virus, which means that a large majority of the globe’s population is susceptible to it. And, unlike its more benign cousins, this coronavirus makes up to 20% of those it infects, seriously ill — it kills up to 1% of the infected.
This minority subset of the world’s population amounts to 1.6 billion people susceptible to being made seriously ill, and up to 80 million killed by natural SARS-CoV-2 infection, globally.
The casualties from this pandemic in America have already been staggering — the over 500,000 Americans dead as a result of COVID-19 disease is not a fabricated number. And though many of these people were the elderly and frail, who already had short life expectancies, still, their avoidable deaths were tragic and awful. Of course, the elderly and frail are not the only ones catastrophically affected or dead — many of the deceased are young and otherwise healthy members of our society and the world.
From a scientific perspective, SARS-CoV-2 is not a mechanistically complex virus, like HIV or some other viruses we know. It’s simplicity, from an immunological perspective, means that in the vast majority of us, our immune systems can effectively mount a response that ultimately rids the body of actively replicating virus.
This protective immune response consists of an antigen-specific response by B-cells and T-cells leading to the generation of IgG antibodies and primed T-cells. These immunological processes not only ultimately clear the infection, they also protect the immunized person from future infection by the virus.
As you know, if enough people develop such immunity to the virus, the world can achieve herd immunity and the pandemic disaster can end. So it is critical to achieve such “herd immunity”.
As an immunologist, I know the efficacy of vaccines in generating the type of protective immune responses that can clear SARS-CoV-2 from the body — and rendering the person immune. To deny this would be to deny the science of immunology, mature for well over 200 years now.
I would be remiss not highlighting the fact that our vaccine technologies in the year 2021 are nothing short of miraculous from an efficacy perspective, at the population and individual levels. The mRNA vaccines, in particular, are some of the most powerful vaccines (and the cleanest) ever made — and they have been nearly 30 years in the making. This is not a haphazardly developed product or a brand new technology.
The fact that these vaccines were built by the United States in under one year to defend us from a pandemic virus, is truly akin to putting a man on the moon — or on Mars — in record time and under duress. We must all be proud of the scientists and American institutions that were able to create these effective products in record time.
I do believe that the COVID-19 vaccines stand a chance of inducing herd immunity and benefiting the majority of those treated. That is, deployed efficiently enough, these vaccines could protect the lives of the 1.6 billion people in harm’s way from the pandemic, across the US and the world — susceptible persons, who could be any one of us or our loved ones.
“Majority benefit”, as you know, defines utilitarian efficacy in clinical medicine — and elsewhere in our democratic market economy.
But, what about the minorities who do not benefit from our market utilitarianism and its products — and what of those minorities who are harmed by our practices — despite the efficacy that benefits the majority?
This question, I know you recognize, as the age-old problem plaguing America from its beginning. But, I digress.
Safety in clinical medicine and elsewhere, is defined by the extent of “minority harm”. And underlying this definition of harm is the concept of avoidability. In other words, harm is done when something avoidable is not avoided, or a mitigatable risk is not mitigated adequately. If a complication is avoidable or if its risk is fully mitigated, it is not harm — it is an unfortunate complication. But leave an avoidable complication un-avoided, or a mitigatable hazard unmitigated — and you have given birth to harm.
So when our democratic society agrees, based on consensus and expertise, that a particular utilitarian product or strategy is beneficial to the majority, and thus effective, the equally important question ALWAYS must be: what are the real and prognosticated risks of harm, who is at risk of harm, and is the risk of harm fully mitigated?
As it pertains to the COVID-19 pandemic, if vaccine induced herd immunity against SARS-CoV-2 can effectively save up to 1.6 billion people on the planet, who could be any one of us or our loved ones, from catastrophe — THAT, is grand!
But this amazing efficacy cannot be simply accepted and unleashed into the world without equal and deliberate consideration to the source(s) of “minority harm” and safety concerns. Because no matter how immediate the need and how acute the threat, in America, we cannot allow ourselves to sacrifice the lives of a minority group for the benefit of the majority — not anymore, not again, anyway. For when we do, as we have done before, such mindless action tears at the fabric of our national ethos and threatens its very civil survival.
So, in this COVID-19 vaccine campaign, which I know will be highly effective, I rise with YOU to ask: what about the minority subsets of people harmed or in harm’s way? Shall we assume their lives to be negligible, and call it a day? Should we assume that harm is not actually harm at all, but rather an unavoidable and negligible part of our justified utilitarianism? Should we downplay or sugarcoat real or prognosticated hazards to certain subsets of people? Should we jeer at those concerned about risk, as though their reasonable scientifically based concerns are works of fear-mongering or fiction? I think not.
As an immunologist and physician, I cannot fully align myself with any narrative that rejects the scientific and immunological efficacy of vaccines in inducing herd immunity — this is especially true in the COVID-19 pandemic, caused by a simple coronavirus.
However, I am almost 100% aligned with you on the problem of vaccine safety. The COVID-19 vaccine was tested too rapidly and the clinical trials, which demonstrated its extreme efficacy in creating immunity, did not have sufficient granularity to assess its safety in certain subsets of the population.
Again, as a cellular immunologist, my thinking about the safety of this vaccine does not operate in generalities. Rather, I ask: what specific subset or subsets of people are at risk of harm — and have our clinical trials established safety in such subsets?
As you know, I do not believe that the COVID-19 vaccines have been adequately tested for safety in a VERY SPECIFIC subset of persons — daily growing in numbers. I have prognosticated and warned the FDA, CDC, Pfizer and Moderna, that a potentially severe hazard exists in the indiscriminate deployment of the COVID-19 vaccine in the midst of this outbreak. My safety concern, inadequately addressed by the clinical trials, is whether vaccination of those persons with recent or occult SARS-CoV-2 infection is hazardous.
As you know, up 20% of the world’s population is recently or currently infected with SARS-CoV-2 as of this writing in March 2021 — more are becoming naturally infected daily. It is simply an unprecedented event in the history of vaccine science in the western hemisphere to be deploying a mass scale and indiscriminate vaccine program in the midst of a pandemic outbreak, with so many already naturally infected. It is my opinion that there is a certain danger of immunological harm to a non-negligible minority subset of such persons — likely numbering in the millions globally.
To repeat, it is my immunological prognostication that these individuals with recent or occult SARS-CoV-2 infection, are at high risk of harm when vaccinated indiscriminately. And, especially, in the category of elderly and frail with underlying cardiovascular disease, as well as, in populations with high exposure risk — such as front-line healthcare providers, blacks and Latina.
Because the number of the world’s population with natural infections is daily growing, so is the size of the immunologically susceptible to COVID-19 vaccine harm. Additionally, the most socioeconomically vulnerable fractions of our society are bearing the brunt of the natural infections — and so they will also be more susceptible to the iatrogenic harm I have prognosticated. Because more of them are already infected at the time of proposed vaccination.
Of course, I write this letter hoping and praying that my prognostication turns out to be immaterial and untrue — as my critics are wishfully assuming and attempting to convince me, with no convincing evidence of their own. I do accept the critique that I have no evidence that my prognostication is material, other than a few powerful index cases and anecdotes so far. The case of Dr. J. Barton Williams of Memphis, TN being one prominent example in the American press. But because I am hedging in the direction of safety in the face of an already massively deployed vaccine program, I believe that my position in defense of those potentially susceptible citizens of the world, already infected, is more ethically sound than my jeering critics’, with their MDs, PhDs and JDs — who wish to ignore or downplay this immunological prognostication.
The fact that FDA, CDC, Pfizer and Moderna have not yet acted on my very specific and scientifically reasonable prognosticated warnings about indiscriminate vaccination of the infected, especially in susceptible or exposed populations, should seriously alarm every citizen of the United States. Because, any one of us or our loved ones, could be a member of that minority subset in iatrogenic harm’s way from the COVID-19 vaccine — in the same way that we could be in harm’s way from the natural infection itself.
Safety is efficacy’s equal, not its illegitimate sibling — in medicine and in our society at large.
In my estimation, as a public health strategy, indiscriminate vaccination of the already infected is a clear and present iatrogenic danger to the American public — and it is an unprecedented scale policy, which I am nearly certain is doing unjust and totally avoidable harm to many Americans, in the minority, daily. Persons like Dr. J. Barton Williams of Memphis, TN.
I’ve been shocked by how some very well decorated academics and respectable citizens seem radically incapable of seeing the need for equally weighing, both, efficacy and safety. I understand this problem in our healthcare system quite viscerally, as it is the deadly ethical error that killed my beautiful wife, prematurely or unnecessarily in 2017.
The “pro-vaccine” camp is dumb and punch drunk enamored by the utilitarian efficacy of our new vaccine technology. Theirs is an intellectually lazy but marketable position in a democratic market economy, where empathy and insight are in short supply — but ethically unhinged money, ego and power interests rule the day.
The “anti-vaccine” camp, on the other hand, resides in fear for safety — seething with anger over, now, generations of unjustified iatrogenic harm in America (the kind that killed my own wife), but unable to accept that we can work to identify the susceptible and mitigate against harm done by the COVID-19 vaccine, which is certain to be a highly effective and necessary utilitarian product we need to end this pandemic with maximal damage control.
Of course, when our corporate and governing establishment dominantly take the side of utilitarian efficacy and mindlessly ignores safety — no wonder a vast number citizens in our democracy fear for their lives and do not want a vaccine that could save their lives and communities. In America, the minorities harmed, are simply too many now — and they do not trust the so called experts and regulators.
Mr. Kennedy, fundamental trust among citizens is at the core of a stable democratic market economy and constitutional republic — this, I know you recognize deeply as a member of the Kennedy family. The error your opponents are making is that they seem incapable of understanding how much public trust they have eroded by their arrogance and mindlessness in adhering to utilitarian efficacy alone as their moral compass. They are fools for not seeing that ignoring minority harm — and calling the harmed “ignorant” or “stupid” is coming to roost. Nearly 50% of America does not trust this expert governing class anymore!
I digress, but on 1/6/2021, the United States congress almost fell to this mistrust — and, of course, I believe the jury is still out on whether America’s mistrust and division will actually break us. I pray not.
But I also believe that most Americans are decent and capable of understanding and healing. We can channel our hopes and fears into productive discourse and action, consistent with the American ethos. We can accept that our utilitarian market economy puts men on the moon, rovers on Mars, and builds vaccines against pandemic viruses in months. We can accept that the safety and security of minority subsets of people can be defended well and on equal footing with efficacy and majority benefit — by carefully looking for real and prognosticated risks of harm, by avoiding these or mitigating them.
Mr. Kennedy, I do respect your position as a public advocate— standing firmly on the side of safety as a lone voice in an establishment you are engrained in by virtue of history and genetics. But let us take care not to throw out the baby with the bathwater.
I write to you in friendship and in defense of US and global public health — and I write in the name of Georgina of Yardley, always.
Hooman Noorchashm MD, PhD