In 2003, rumors spread across Nigeria that the program to eradicate polio was injecting children with chemicals meant to sterilize them as adults. Particularly if they were Muslim. Other rumors suggested that the vaccine was spreading HIV. These rumors grew to the point where the program to vaccinate against polio was suspended in several Nigerian states. Despite reassurances from the federal government, state officials, and the World Health Organization (WHO), resistance to the vaccination program only grew, and eventually vaccination was halted. As a direct result, there was a polio outbreak that spread to more than 20 countries, including several outside Africa. Ten African nations that had been polio-free for years saw new outbreaks. 80% of all cases of polio that occurred over the following decade could be traced back to this single source. Bringing the outbreak under control ended up costing over half a billion dollars and left thousands suffering.
There were a number of reasons that the rumors grew and the vaccination program was halted. Some of it came from the same anti-vax sources that flourish in the United States. Those sources play to local fears that parents have for their children. In the United States, that’s autism. In Africa, it’s AIDS. But the bigger issue is that there was no trust in the healthcare institutions that were encouraging the vaccination campaign. There was no trust in state officials, no trust in federal departments, no trust in the WHO.
What happened in Nigeria—and what then happened in 23 other countries—was the result of what happens when trust in institutions breaks down. Which is why the degradation of the WHO and the undercutting of the Food and Drug Administration (FDA) by sources on the American right is so damaging. And why the Centers for Disease Control and Prevention (CDC) buckling to political pressures in altering testing practices has a cost that exceeds the current pandemic.
There were good reasons for people in Nigeria to lose faith in all the institutions involved. Part of the problem in Nigeria came from 1997 trials of an antibiotic called Trovafloxacin that were being conducted by the company Pfizer. The effort was aimed at an outbreak of meningitis, which Pfizer saw as an opportunity to test its new drug alongside an older antibiotic. The trial was limited to just 200 children, but of that number, 11 died and several were left with brain damage or blindness. To be clear, it does not appear that either antibiotic was the direct cause of the death or other bad outcomes. Meningitis appears to have caused those bad outcomes. Trovafloxacin simply failed to be any more effective than the older antibiotic.
However, to parents involved, what was clear was that a western company sanctioned by WHO swooped in, involved their families in a test, and left them with children who were dead or damaged. The families of those children, Pfizer, and both federal and international organizations were all involved in a running set of lawsuits when the polio campaign came to the area.
The same kind of distrust was reflected in 2019 in the United States. Over the course of that year, the CDC confirmed 1,282 cases of measles across 31 states. This was a shocking number—far higher than any time since measles was declared “effectively eliminated” in the United States in 2000. Not only was this the greatest number of U.S. cases in three decades—more than 73% of all cases could be traced to a single outbreak among unvaccinated children in New York.
Those New York outbreaks occurred almost exclusively among a tightly connected group of Orthodox Jewish communities. The children involved not only attended religious schools where the rate of vaccination was low, but their families used religious exemptions to avoid vaccines normally required of all children. There were a series of reasons for doing this. First, in some communities rumors spread that the use of vaccines was against Jewish law. It’s not. But a bigger issue was a general distrust of what were seen as secular authorities intruding into the tight-knit religious communities—old fears that had very fresh results. Parents in the communities went on to make connections with other anti-vax groups, including seeking advice from the author of the long-discredited study that first falsely claimed to link vaccines to autism: Andrew Wakefield.
All of this distrust erupted during a public meeting in which a pediatrician accused authorities of giving Jewish communities “bad vaccine,” Wakefield appeared via Skype to deliver warnings about how vaccines were meant to set the stage for even more horrible diseases, and an ultra-Orthodox rabbi accused New York Mayor Bill de Blasio of deliberately given Jewish children measles as part a plot to promote a Latino takeover of their communities. Conspiracy theories, by their nature, don’t have to make sense. They just have to stir emotions.
Obviously, these all too recent events are sharply in focus as the United States limps through the remainder of 2020 with the hope of a vaccine sometime in the coming months. Not only are the same anti-vax forces still in place that were present in the measles outbreaks, these forces have been strengthened by claims around connections between health officials and the “deep state.”
In August, Donald Trump repeated claims that the FDA contains “deep state” operatives working to delay the release of a vaccine and to block testing of therapeutic approaches to COVID-19. As a result, FDA Commissioner Dr. Stephen Hahn was forced to take on the role of defending the agency against the man who is supposed to be his boss, and deny that there was any sort of plot at the FDA to prevent COVID-19 treatments or vaccines from reaching the public.
Trump’s public confrontation with an agency that he is supposed to administer comes with a strong suspicion that he intends to deliver a “miracle cure” for COVID-19 just in time to sway the fall election. That suspicion has been fostered by Trump’s repeated attempts to convince the public that the drug hydroxychloroquine is effective against SARS-CoV-2 virus despite numerous tests around the world showing that it simply does not work to either cure or prevent infection. Suspicions were further inflamed when Vladimir Putin announced that Russia was going to be the first country to make a vaccine available to the public, approving the deployment of a vaccine without the completion of even phase 2 trials over a howl of concern from health and vaccine experts.
The message on the various nights of the Republican National Convention (RNC) may have been somewhat different, but one theme has played on every night: the idea that Donald Trump has handled COVID-19 “great.” Ignore the 6 million cases. Ignore the 185,000 dead. Ignore the fact that both of those numbers are worse than any other nation on Earth. By some undefined standard, Trump has saved lives, lots of lives, millions of lives. And now that the COVID-19 pandemic is over, everyone can get back to school, and work, and give Trump the opportunity to talk about job growth and “wins.”
So of course there’s suspicion that Trump will try to rush out some sort of last-minute miracle to show his absolute victory over the disease that has ravaged the nation’s health and economy. Add in Joe Biden forthrightly saying that addressing the disease is going to take work because there will be “no miracle,” and it seems almost impossible that Trump won’t try to deliver exactly that. A miracle. Conveniently packaged and ready to go, somewhere around … Halloween.
The release of any COVID-19 vaccine before the end of the year is going to be problematic because it will be met with resistance from both sides. There will be the traditional anti-vax forces, now intimately linked to the “QAnon” supporters of Trump, whose suspicions include not just all things deep state but the idea that an unlikely alliance of Secretary of State Mike Pompeo, infectious disease expert Dr. Anthony Fauci, and Microsoft founder Bill Gates is out to inject them with a “chip” that will allow them to be tracked in everything they do. It’s a thinly veiled version of the “Number of the Beast” claims from evangelical End Times speculations, but that hasn’t stopped banners displaying exactly this claim from appearing at Trump rallies.
On the other side, progressives, and a large amount of the public no matter what their political orientation, will be suspicious of any COVID-19 vaccine appearing so quickly under Trump’s auspices. And rightly so. There are a number of vaccines that may have first results of phase 3 trials sometime in September, but those are very limited, initial outcomes. It would be the height of foolishness and an extraordinary risk to rush into production based on those results. A properly tested and produced vaccine can be expected no sooner than the end of the year.
No matter when it appears, many people are going to look at that vaccine with a good deal of skepticism. There is even an unsettling possibility that a large percentage of the population will never be accepting of a COVID-19 vaccine. The results of that could be devastating. It could mean that even if the population achieves the vaunted level of “herd immunity” where the disease isn’t circulating in large numbers, a reservoir of COVID-19 could remain present many communities, ready to reappear and sweep through the nation, bringing the calamities of 2020 back again. And again.
Two actions in particular have set the stage for this. Neither is directly connected to the production or testing of vaccines, but both speak directly to that single absolute necessity required for any vaccination program to be effective: Trust in institutions.
The first of those events came on Aug. 23 when the FDA approved an Emergency Use Authorization (EUA) for convalescent plasma. This approval came despite the express disagreement of the leading healthcare experts, and in spite of the fact that the only major study on the use of plasma conspicuously lacked the data to support issuing an EUA. However, this action came just days after Trump had squeezed Hahn with accusations of being “deep state“ and claims that the FDA was delaying possible COVID-19 treatments. Hahn authorized the use over the unanimous agreement of experts that the EUA should be placed on hold, and it’s very hard to believe that Trump’s attacks on the FDA as a roadblock to cures was not connected to this extraordinary action.
The second event came just two days later on Aug. 25, when the CDC altered its guidance on testing protocols, recommending that only those who display COVID-19 symptoms should be given tests. This event came after numerous instances earlier in the year in which Trump had blamed both the World Health Organization—from which the United States has now withdrawn—and the CDC for failures in addressing the coronavirus. And it came after repeated claims from Trump that America had so many cases of COVID-19 only because it was conducting “too many tests.” Restricting testing to those showing overt symptoms isn’t just nonsensical, it is enormously threatening. It removes all possibility of actually describing the extent of infection in any community. It is counter to the experience gained in every nation around the world that has successfully fought back COVID-19. There is absolutely no sense in which this is an acceptable approach—and it’s no wonder that Trump’s in-house team and CDC Director Dr. Robert Redfield pushed this decision through while Dr. Fauci was literally unconscious on an operating table.
At this point, Donald Trump has disassociated the United States from the the World Health Organization, discounted their warnings, and blamed them for his own errors in failing to recognize the importance of the initial COVID-19 outbreak. Trump has forced the FDA to issue emergency use authorizations—more than one—over the advice of experts, and without regard for experimental results. Trump has pressured the CDC to alter public guidelines, including the latest change designed to reduce testing to the extent that testing might as well not be done. Because testing only those expressing COVID-19 symptoms is effectively useless in fighting the spread of the disease.
In the process, Donald Trump has successfully done with these institutions what he has done with the EPA, the NSA, the State Department, and so many others—he has destroyed the public trust. He has taken institutions that are not only apolitical by design, but apolitical by necessity, and turned them into tools of his reelection campaign.
The result is being felt immediately in that testing is being reduced to provide the false sense of “fewer cases” that Trump wants. That aspect alone has a direct cost in money and lives. But the greater damage may be in the long term. Long after 2020 is a bad memory and COVID-19 is hopefully relegated to history books, the cost of diminished trust in the WHO, CDC, and FDA will exact a toll. It will certainly make fighting the next plague facing the United States much more difficult than it needs to be.
The pressure Trump applied to the FDA and CDC might generate some short-term benefit for his reelection chances, and buckling to Trump may provide Hahn and Redfield with momentary relief. Neither will last. But the damage from this moment will be paid out over decades.
Sources
Diplomacy And The Polio Immunization Boycott In Northern Nigeria, Judith R. Kaufmann and Harley Feldbaum, Health Affairs, Vol 28, 2009
Despite Measles Warnings, Anti-Vaccine Rally Draws Hundreds of Ultra-Orthodox Jews, Kimiko de Freytas-Tamura, The New York Times, May 14, 2009
Interviews with Orthodox Jewish moms reveal barriers to measles vaccination, Charles H. Hennekens, Helio, May 31, 2019
FDA commissioner disputes Trump, says no 'deep state' thwarting vaccine, Jeff Mason, Reuters, Aug 24, 2020
Russia’s fast-track coronavirus vaccine draws outrage over safety, Ewen Callaway, Nature, Aug 11, 2020
Recommendations for Investigational COVID-19 Convalescent Plasma, FDA, Aug 23, 2020
Effect of Convalescent Plasma on Mortality among Hospitalized Patients with COVID-19: Initial Three Month Experience, Michael J. Joyner, et. al, pre-print
Previous Daily Kos articles containing additional relevant links
CDC is the latest scapegoat for Trump's epic failure, Daily Kos, Jun 23, 2020
Plasma from recovered COVID-19 patients will not be widely available after 'weak' data from study, Daily Kos, Aug 19, 2020
CDC was pressured 'from the top down' to change coronavirus testing guidance, official says, Nick Valencia, Sara Murray and Kristen Holmes, CNN, Aug 27, 2020
hite House coronavirus task force waited until Fauci was unconscious to do the unconscionable, Daily Kos, Aug 27, 2020
