The unpopular solution – vaccine hopes, fears and denials

Within the last week we’ve experienced a sprint of good news – with press releases showing vaccine efficacy above 90% toppling over one another as BioNTech/Pfizer and Moderna race their vaccines towards the finish line.

The efficacy found in those trials is spectacularly higher than the set approval target of 50% from the United States Food and Drug Administration and much higher than effectiveness of vaccines against seasonal flu, which need to be “remade” each year, due to the influenza virus’ high mutation rate.

Under normal circumstances  - meaning “old normal” - vaccine development takes more than 10 years even in a best case scenario. The companies that are now submitting their data to regulators did it in less than a year.

There may be differences in safety, temperature stability and associations to Dolly Parton (the latter being a decisive factor for my own humble favoritism). But contrary to the usual drug to market contest, where the first drug over the finish line gains a (sometime massive) advantage, this vaccine race knows only winners. The demands for COVID-19 vaccine are so high that there is space for many contestants to take the crown.

How does the public react to that hopeful piece of news?

For people like me, the news of a potentially effective and safe vaccine mean a relief that equals a huge suffocating weight (huge, like for example the sum of all pandemic weight gain in my city of 4 million people) falling off my chest. An effective vaccine seems to be the ONLY realistic hope of ending the pandemic soon and without even more dramatic casualties and economic damage, than we’re already experiencing.

There is a second group of people, the indifferent bunch, who don’t seem too enthusiastic about the vaccine news, thinking – SO WHAT? They’d seen the development of an effective vaccine as a given and feel nothing but a mild disappointment that the looming vaccine doesn’t end the pandemic in an instant and that it may still take at least a year or more for the existence of vaccines to translate into a return to normal – in this case “old normal” or a better version of “new normal” .

Then there is a third group of people: those who don’t want to be vaccinated. Some of those people have concerns that vaccination might do more harm to one’s health than it would do good. Others see vaccination as the work of the devil, as a big ploy of evil elites, who try enslaving the ignorant population, as a money-making scheme by the pharma industry, who hide vaccines’ dangerous side-effects, from autism to mind control via microchips (I guess I don’t have to spell out that neither autism nor microchip-mind control are side effects of vaccines, o wait, now I’m spelling it out anyways), and that as a final coup, those vaccines will be delivered by genetically modified mosquitoes (which, I must admit might actually work in the future) .

The antivaccination movement hasn’t been born amid the pandemic but as other anti-science movements, is gaining momentum as the pandemic tide washes over us, leaving people confused and desperate for alternative explanations – explanations which deviate from the general tenor of “This sucks but it might be over eventually if we all grit our teeth and push through”.

 

Underlying vaccination hesitancy is a deep-set human refusal to acknowledge bad things might befall us, or our children. It’s too abstract to imagine the threat from diseases, which have been virtually eradicated by vaccination, or in the case of COVID-19, too abstract to connect the pictures on the television of overrun hospitals and of exponential growth curves to our own lives. We feel young, and healthy and above all invincible – even if we never truly are.

And then there is the believe in alternative truths – COVID19 is a hoax and scientists are idiots in league with dark powers... The ability to hold those different theories in one’s mind is a complex feat worthy of Orwell’s doublethink (though it might even be triplethink here): 1) believing in the impotence of science, 2)  granting scientists with the ability to bring about the scientific miracles worthy of a dystopian sci-fi thriller (microchip-mosquito-mind-control) 3) believing that the protection from those high-tech threats lies in methods worthy of a medieval witch craze, like wrapping your head in metallic foil or wearing protective gemstone charms.

While those ideas appear as enjoyably absurd as a Monty Pythons sketch, the spillover of the crazy ideas into mainstream thinking endangers the population and the economy. Polls say that only ~50-65% of people want to be vaccinated against COVID19 in the US, UK, Germany.

SO WHAT? say the indifferent (because that’s what they always say) ...

If those people don’t want to get vaccinated, more vaccine left for the smart ones who’ll get their shot at the shot earlier. BUT (and that one’s a clear all caps) BUT we need enough people vaccinated to achieve herd immunity and hopefully make the virus disappear. And the people who refuse vaccination, and who will likely also refuse other security measures like wearing masks and keeping social distance, will still fall ill with COVID-19, will still need treatment in hospitals and take up space in ICUs. It’s not an option to deny them treatment for their own stupidity. Punishing stupidity is not a tempting idea as all of us are prone to endanger our health with some kind of stupid behavior, from unhealthy lifestyle choices, from fatty food to dangerous sports.

No, punishing stupidity is not and shouldn’t be an option, and yet, we have to live with the reality that the stupidity of some has the power to punish the rest of society with their antivaccination stance.

How to celebrate science in anti-science times

Today is world science day, yesterday the news on a potentially efficacious vaccine against COVID-19 were declared a victory for science.

But the reality that scientists face is much less rosy than those news might suggest. Large parts of the population seem to be suffering from science-fatigue, from the unwillingness to try to comprehend scientific facts.

There are different explanations for how the world works.

Even as a scientist, no let me rephrase this, especially as a scientist, I accept this.

There is a lot of grey between the black and white, there is a question behind every answer.

As scientists we learn something new each single day. We don’t need to defend a dogma if its proven wrong, we accept a better explanation if one comes our way and we proudly proclaim that there is much more we don’t know than we do know about the world.

But science suffers from a perception problem. People believe that science offers hard facts and that science can fix things - preferably quickly and without effort. Laboratories should produce shiny new technologies, cure diseases, and find wonder drugs that allow us to eat as much as we want without gaining weight.

With the Corona Pandemic and the climate crisis we are facing problems that can’t be fixed quickly, problems that are as complex as possible solutions, problems that won’t go away because we chose to ignore them, try as we might.

If we want to halt the spread of disease, if we want to slow the downwards slope towards an inhabitable planet, it won’t be easy, it will require sacrifice. That’s what scientists tell us.

But people don’t want to hear bad news, don’t want to change their lifestyle in even a miniscule way, agitatedly defend their right to just go on like we always did, while the forests are burning, the arctic ice is melting and the pandemic deaths are piling up.

We will all die eventually. That much is true. But should this kind of fatalism drive us towards a selfish

Après moi, le deluge attitude that endangers our fellow humans to die from a deadly virus, that will leave a wrecked earth for the children?

Shouldn’t the threats we’re facing make us open for the voice of reason?

Unfortunately, not.

Climate scientists, epidemiologists and doctors are under attack from populist leaders and media and from an increasingly agitated public, out to (in some cases literally) kill those messengers of bad news.

From Galileo to Darwin, scientists had to suffer the rage of those who saw the status quo threatened.

But scientists who warn about the spread of the pandemic didn’t make up the Corona virus, just as Darwin didn’t invent evolution and Galileo didn’t exchange the sun and the earth, as if hanging a new painting at the center of the universe – the facts were always there, the scientists were just pointing them out.

Now again, scientists and doctors who are warning about the problem, who try to explain its complexity, whose predictions are being proven right over and over suffer the backlash of the anti-science climate, are attacked in the crudest ways and even receive death threats.

The anti-science climate hasn’t started with the pandemic, indeed discussions about a war on science have been waged for years, culminating in disbelief in climate change and in anti-vaccination movements.

But the pandemic intensifies the problem because it brings the debate to the forefront. It makes it harder for scientists to maneuver the new terrain of this unprecedented situation, with a lack of canonical knowledge, while under constant siege by (social) media to produce a solution quickly!

What should scientists do then? Stop preaching scientific facts? Move science back into the ivory tower and keep scientific communication to academic journals and conferences, where no alternative facts outside the scientific realm interfere with the blissful vibes of bar graphs and p-values? Doesn’t appear to be a good idea. While scientists are no politicians and shouldn’t speak out on all topics, they should speaks out on the topics, on which they have the most knowledge and they should advise the public on consequences of actions – and non-actions, even if the consequences are dire.

Living inside the Andromeda strain? How life in times of the pandemic compares to the fictionalized apocalypse

Fictional works about apocalyptic diseases have been popular for decades, from Michael Crichton’s Andromeda Strain, to The Walking Dead, from Emily St. John Mandel’s Station Eleven to the Danish series The Rain (and many, many more…)

We’ve enjoyed watching people run for their lives, whilst grabbling with deep questions of humanity, have enjoyed super smart scientists in high-tech labs figuring out the riddling questions of their respective pandemics.

Now the actual pandemic falls short towards those works of fiction on several levels.

Thing is, the pandemic is boring in comparison to the fictionalized apocalypse. There are no zombies chasing us (like in The Walking Dead), we aren’t part of a top-secret government program (like in The Andromeda Strain) and we haven’t developed a gremlin-like fear of getting wet (Like the characters in The  Rain, where the virus is contained in the … yeah you might have guessed it …).

For those of us who’ve been lucky enough to have been spared the direct impact on our lives and livelihoods – we just sit in our homes, we bake bread, take pictures of the bread we bake, post the pictures of the bread on social media, look at the pictures of the bread that other people bake …

What’s the difference between the Corona Pandemic and those works of fiction?

The Speed

The viruses which cause the fictionalized pandemics, spread fast and kill fast.

While the Corona Virus moves in sneaky ways (aka aerosols & super spreaders) turning it into a fast-moving, global problem (unlike its cousins SARS and MERS), while it’s a more proficient killer than the flu (even if some people might try to tell us otherwise), it falls short behind those fictionalized super viruses that kill with a single glance in the eye (o wait, that’s the basilisk on Harry Potter) - but you get the drift.

The great plan behind it all

For many if not all pandemic stories there is some great conspiracy of government or terrorist groups or secret societies (which might even turn out to the same thing), which use the virus to achieve some evil goal.

A good conspiracy theory is helpful in explaining this unfair world. And let’s face it, the pandemic is the height of unfairness. Maybe that’s what brings the already Pre-COVID, hot to the boiling conspiracy belief of people to explode right now. Because wouldn’t it be nicer if there was some reason, like for example that the virus is made up by the deep state or that it spreads via 5G, and it’s possible to protect yourself by putting tinfoil around your head? For some people it seems better to believe in scenarios so ludicrous no sane fiction writer would dare to dream them up, than just accepting the evolutionary coincidence of a mutation event, of a jump from the unknown animal to the unknown patient zero to cause all the trouble we’re facing.

The world after

And then there’s the lack of perspective. In the typical pandemic story, disaster strikes, and the world is never the same after. And you don’t have to worry about keeping your job or about finding a supermarket that still stocks toilet paper, because you’re running from zombies, or evil rain, or your fellow humans who’ve turned hostile by lack of resources. The characters in pandemic stories don’t experience Pandemic Fatigue – when would they find the time. In the alternative scenario of the pandemic setting we find the disaster averted, after the super smart scientist saves the day and the world can return to normal.

What we experience is a slow-moving disaster that many people can’t even grasp. We know that fall and winter will be hard. We know to expect the next wave. But we just want it to be over with. And the super smart scientists that are working their asses off, to create vaccines and drugs, are smart enough to tell us we need to wait a little longer until disaster is averted.

Suggestions for the pandemically fatigued?

If you can - stay at home.

Bake some more bread.

Read an apocalyptic novel (recommendations welcome).

Go for a run and imagine hostile zombies/ rain/ people are after you to increase your running speed…

Can Corona headlines help decision making under uncertainty?

In times of crisis, decision making - which isn’t easy at the best of times – is made even harder.

Decision making during Corona times is ‘Decision making under uncertainty’.

Of course, we always face uncertainty when we ponder where to live (city or countryside, in our native country or abroad), with whom we want to share our lives (partners, children, pets, friends, family) and what we want to do for a living (earn money, save the planet, have fun or a mixture thereof).

For a naturally indecisive person like me this uncertainty might extend to the questions of what to wear (black or white sneakers), what to buy for dinner (salad or pasta) and which book to read next (mind-enhancing masterpiece or guilty pleasure romantic mystery) - questions that can easily keep my mind running amok for hours and prevent me from doing anything useful.

But since the pandemic the uncertainty has grown to unknown levels - and it doesn’t only concern the next years or decades, it concerns the next months, weeks or even days.

Will I still have a job?

Will I be able to travel?

And WHEN (for fuck's sake) can we go back to NORMAL, go back to making our choices on our own terms, instead of the virus’?

When can we go back to hugging our friends, to kissing our grandmother’s cheek, to sharing a drink with someone in a bar, to enjoying the blissful closeness of the crowd in a concert or at a sports event, without the constant risk of triggering an avalanche of new infections and endangering the risk groups?

If we want NORMAL, the virus has to disappear. To make it disappear we need one or more of the following:

·       A powerful vaccine, in enough supply to vaccinate large parts of the population

·       A treatment, which prevents serious disease courses of COVID19 and/ or longCOVID

·       Herd immunity

·       A miracle

We watch the headlines like hawks trying to glimpse pieces of information that will tell us when to expect any of those things to materialize.

There are headlines that show the progression of vaccine trials, of miracle cures with a sample size of n=1 or more… There are the shock moments of vaccine and drug trials being put on hold for safety concerns. There are scary headlines that show that immunity seems to be waning fast, of reinfections with severe course.  

Reading those headlines in the morning (because yes, I do admit to checking the news on my phone first thing in morning even though I should probably rather meditate or something) jerks around our emotions, can make or break our day.

Do those headlines help our decision making though? Do they tell us how long we have to wait until NORMAL returns?

As an emotional human being, I tend to like the thrill of a good headline. As a scientist, I admit that it might be worth the tedious work of reading some of the associated articles whole - though like many modern humans I seem to have developed a severe attention span issue (by the way, reader, great you’ve hanging in there, we’re almost done here).

Reading beyond the headlines dampens both fear and excitement. It seems likely that one or more of the numerous vaccine candidates will work and even if it doesn’t offer full protection might prevent serious disease courses. The same might be true for some of the approved or currently tested treatment approaches. The loss of immunity might not be as depressing as it appears on first glance, though herd immunity (at least for me!) still seems like a ludicrously dangerous approach, with too many lives at stake.

But none of these approaches currently seems to be the miracle, which will end the pandemic once and for all and none of them has a (believable) near-term time stamp on it, telling us when NORMAL will be back.

What does this mean for our decision making?

Postpone decisions until the Pandemic is over?

I would suggest a different approach.

Embrace the uncertainty.

Make important decisions now.

We might not know how the post-pandemic NORMAL will look like and when it will arrive but then, the future has always seemed more certain than it turned out to be…