Paul Offit on the Causes and Legacy of COVID Misinformation

— "It's OK to say that you didn't get it right the first time. Science is a process of evolution."

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    Jeremy Faust is editor-in-chief of app, an emergency medicine physician at Brigham and Women's Hospital in Boston, and a public health researcher. He is author of the Substack column Inside Medicine.

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    Emily Hutto is an Associate Video Producer & Editor for app. She is based in Manhattan.

In part 2 of this exclusive video interview, app editor-in-chief Jeremy Faust, MD, and Paul Offit, MD, director of the Vaccine Education Center at Children's Hospital of Philadelphia, discuss the nuances of COVID misinformation and how to better communicate science to the general public.

Watch part 1 here, where Faust and Offit talk about the science behind vaccines, COVID's future, and the anti-vaccine movement.

The following is a transcript of their remarks:

Faust: Let's talk about some other forces involved in that loss of trust, which is the misinformation that is out there. The strange public conversation in which suddenly people who've never thought about biology are talking about furin cleavage sites and gain-of-function research.

How do you explain the fact that I got text messages during the pandemic from pretty bright people on Wall Street who I know, I went to college with or have known who are saying, "Oh, doesn't the furin cleavage cleavage site issue become a smoking gun for the lab leak theory?" Why do really smart people, actually, in some cases, go for low-hanging-fruit conspiracy theories?

Offit: Right. So what you're referring to is there's a book by Alina Chan and Matt Ridley called Viral, which makes that point -- that this must have been a lab leak. This must have been lab-created because the furin cleavage site, the cleavage of which allows the virus to enter the cell, doesn't exist in nature and therefore it has to have been man-made.

First of all, it does exist in nature. So, that was wrong.

I'm not sure I know exactly the answer to your question, but I'm going to make this offer. There is a Wikipedia site called "," and the point of that site is they go through a number of Nobel Prize winners who have these just outlandish beliefs, either false beliefs or biases or conspiracy theories. And the point that they're trying to make -- and there's a fairly large psychological literature on this now -- is that people who are really smart and are really accomplished are actually more susceptible to false beliefs for a variety of reasons.

Maybe that's it. For whatever reason, you're so accomplished in one field that you feel you can master any other.

Faust: I also think it's possible that a lot of these Nobel laureates are people who had the experience of being right when everyone else was wrong. That's why they got a Nobel. So that experience saying, "I can see through the smoke and mirrors to see the truth," I think it's an addictive feeling, I would imagine. I think that probably explains some of it.

That said, we also have minds of people who, again, ostensibly are prepared to do science -- people who graduated with PhD's or who are MDs, some of them are in the United States Senate, some of them are surgeon generals of states. When you think about some of the misinformation that comes out of the mouths of these individuals, other than pulling out any hair you may have lying around, how do you process what their day feels like?

Like, you're a senator and you get up in the morning and you say, "I'm going to go put Tony Fauci on the stand and tell him obviously this is a lab leak and anyone who says otherwise is wrong." What is motivating that, in your view, people to do that?

Because I don't actually believe that people get up in the morning and say, "How can I hurt people today? Oh, I know, I'll tell them that vaccines cause autism." I think that they're driven by something else. How do you think about those individuals?

Offit: Well, I think among politicians, whether it's senators like Ron Johnson or congressmen like Marjorie Taylor Greene or Matt Gaetz, I think they're in the let's-just-throw-away-the-federal-government mode right now and we'll do everything we can to do that, so everything becomes political.

So if you can sort of nail Tony Fauci down for the fact that the Obama administration gave money to the Wuhan Institute of Virology to study coronaviruses because it's in that area, a large metropolitan area in central China where there's a lot of commerce that this kind of animal-to-human spillover event would occur, it's just very easy to offer that conspiracy theory. Conspiracy theories are seductive, they're very easy to understand, they're just wrong, so everything becomes political.

It's really sad to watch, because it's really important to understand how these animal-to-human spillover events occur so that the next one won't occur. We do everything we can to just confuse people. It is hard to watch.

The hardest part for me is when you see well-recognized scientists or clinicians like Peter McCullough, for example, or Robert Malone or Marty Makary who get up in front of Congress or whatever and say, "the DNA fragments in mRNA vaccines insert themselves into your DNA and cause cancer" or "we all know it's a lab leak; it's a no-brainer" or in the case of Peter McCullough that the spike protein is toxic. They're telling people what they want to hear, and unfortunately they're doing it with the platform or with the imprimatur being an MD or a PhD or both. It's hard to watch.

Faust: I just wonder what it is that they think they're doing, but I guess that's just hard to imagine. I also think there's a cognitive dissonance between, "Oh, this was created in a Chinese lab and the Chinese government must be held accountable. But by the way, it's just a cold."

Offit: Right? Well first of all, I think the Chinese government should be held accountable to some extent. I mean, there was in that western section of the Hunan wholesale seafood market several dozen animals that were sold illegally, and they were all housed in unsanitary, close conditions. I mean, it was ripe for an animal-to-human spillover event to occur, much as it did with SARS-CoV-1 in 2002.

That in combination with the fact that the Chinese government was loath initially to let an international team of scientists come in and evaluate what was going on there just fueled conspiracy theories. They weren't a good player here.

You shouldn't have had to depend on a whistleblower in China to tell you that there was a virus that was circulating and killing people, a man who became a hero ultimately, and posthumously because he died from this virus. But it shouldn't come to that.

Faust: Yeah. But then I also think about people who I think mean well, they were in positions of power.

I'm thinking particularly of an anecdote that you talk about: Stephen Hahn, the FDA commissioner at the time, getting in front of cameras and blatantly misreading the literature on convalescent plasma and doing an apology tour the next day. But actually, if you think about what he said in the days that came after, still his statement doesn't make sense. The relative risk reduction as opposed to an absolute risk reduction was dredged from a subgroup of a subgroup.

And I don't know Stephen Hahn, but I know people who say he's a smart guy. Why do people like the FDA commissioner make mistakes like that?

Offit: That was the saddest part of this whole 4 years for me. I mean, I was asked by Francis Collins to be part of this so-called ACTIVE Group, Accelerating COVID Technological Innovations and Vaccines, in combination with being on the FDA Vaccine Advisory Committee. So I had to some extent a closer look at what was going on with the FDA, and to some extent the CDC because I'd been on the Advisory Committee for Immunization Practice.

I love those people. I love people at the FDA and CDC. I think they really wanted to get things right and they're public servants who are trying to do good. But what happened starting, really, in April of 2020 was you saw a real politicization of those organizations.

I mean, when the Trump administration wanted a magic medicine for this pandemic to go away, they settled on hydroxychloroquine, an anti-malarial drug, and they were able to twist the arm of the FDA to basically authorize it. So the government bought 29 million doses of hydroxychloroquine, and then studies were done showing clearly that hydroxychloroquine didn't work to treat or prevent the disease. So 3 months later, they then withdrew that authorization.

That looked terrible. That was a sad day throughout the human services and the FDA, and people got scared, me included.

I wrote an with Zeke Emanuel in the New York Times fearing an October surprise, fearing that the Trump administration would also twist the arm of the FDA to authorize vaccines before they had been adequately tested for safety or efficacy. And a number of states formed their own vaccine advisory committees because they didn't trust the FDA either. And that was all understandable.

I mean, Dr. Hahn, to his credit, did stand up to the Trump administration and allow us to have a 2 month safety follow-up after the last dose of vaccine, which then pushed that authorization into December, which was a month after the election. Because Donald Trump had pulled Stephen Hahn into his office and in an invective laden tirade had said, "You have got to approve this or authorize this vaccine before the election." And he didn't do it, to his credit. So he didn't stand up on the hydroxychloroquine, but he did stand up, I think, on the vaccine. So that was good to see.

Faust: Let's close with a little bit of a conversation about the public conversation that scientists and researchers and physicians like yourself are having and the idea of how and where we should engage.

You obviously have been outspoken pro-vaccine, but also with some nuance saying, "We don't have to just repeat the talking points of pharmaceutical companies who at some point have a different interest. Sometimes they align with public health, and sometimes there's a little bit less alignment." You've been out there saying, "These vaccines are miracles and they're great, but you have to be thoughtful about them." And you've gotten criticism for that.

But on the other hand, if you go on Joe Rogan's show like Dr. Sanjay Gupta -- who I really like and admire in a lot of ways -- if you do that, you often regret it.

Where should we be having these conversations to reach the people we need to reach?

Offit: That's a great question.

I would say this: growing up in the world of science, working on rotaviruses, when you would present at a national meeting, you drew a conclusion based on your data, and so you would be criticized. You wanted to be criticized. You wanted people to say, "I don't think you can say these two surface proteins are both equally able to invoke neutralizing antibodies because you didn't do this control or that control." That's good, because that makes your science better.

That kind of public debate regarding the science, or in this case the science behind a policy recommendation, does not work well in public policy. It doesn't.

For me, those examples included in August of 2021 when President Biden stood up and said, "As of a month from now, we're going to have a third dose for everybody over 12 years of age in this country." Like, what? Where did that come from? And then we meet a month later as an emergency meeting with the FDA Vaccine Advisory Committee to go through the data, which were unimpressive. Or the bivalent vaccine, it was a step sideways. It wasn't a bad idea. It didn't work out to be any better than the monovalent vaccine we had, and it's OK to say that. I think it's OK to say that you didn't get it right the first time. Science is a process of evolution. You learn as you go. I just think we have to be much better at explaining that to people and explain every other day or every third day, the CDC gets out there, with at the time Rochelle Walensky, and says, "Here's what we know now. Here's what we're planning on doing."

I'll tell you an interesting story. In 2009, we had a swine flu pandemic. At the time, Richard Besser was the head of the CDC, and he was great. He was out there every other day talking about, "Here's what the vaccine can and can't do. Here's where we are in this pandemic." I saw him at a recent meeting and I said that, "You were great." He said, "Thank you. I could never do it today. Two reasons: politics and social media."

So I think that's what you're up against that you weren't up against in the past. It's sort of like you're on the bus or you're off the bus, to quote Ken Kesey. And the minute that you have any sort of counter to the science behind a particular recommendation, you're off the bus and people get angry with you.

Faust: Well, your book is a fascinating review of both the pandemic and the problem of information and misinformation. It's called, . Dr. Paul Offit, thanks for joining us.

Offit: Thank you.