Short Summary: An insider’s look at the COVID-19 pandemic response from a seasoned epidemiologist, unraveling myths and lessons with straightforward science.
About the guest: Martin Kulldorff, PhD is an epidemiologist and biostatistician with decades of experience in infectious disease monitoring and vaccine safety. He was formerly a professor at Harvard Medical School. Originally from Sweden, he co-authored the Great Barrington Declaration, advocating focused protection over lockdowns. He now works as a private consultant, researching disease outbreak monitoring systems outside academia.
Note: Podcast episodes are fully available to paid subscribers on the M&M Substack and to everyone on YouTube. Partial versions are available elsewhere. Full transcript and other information on Substack.
Episode Summary: Dr. Martin Kulldorff discusses the COVID-19 pandemic response, reflecting on the controversial Great Barrington Declaration, which opposed lockdowns in favor of protecting the vulnerable. They explore the virus’s fatality rates, asymptomatic spread, and vaccine efficacy, contrasting textbook epidemiology with real-world decisions. Kulldorff critiques institutional failures, like the CDC’s misleading claims, and shares optimism for future pandemics with better leadership and public awareness while introducing his new open-access journal to reform science communication.
Key Takeaways:
Lockdowns ignored basic public health principles, causing collateral damage like missed cancer screenings, while Sweden’s focused protection approach led to lower excess mortality.
Early data showed COVID’s risk was 1000x higher for older people, yet lockdowns didn’t prioritize them, unlike textbook strategies.
Asymptomatic spread made containment impossible, unlike Ebola, where isolation works due to clear symptoms.
Natural immunity was downplayed despite 2500 years of evidence, leading to wasted vaccines on those already immune.
CDC falsely claimed vaccines stopped transmission, eroding trust when people got sick anyway, fueling vaccine skepticism.
mRNA vaccine boosters lack proper trials, and their long-term effects need rigorous study, not assumptions.
Kulldorff’s new Journal of the Academy of Public Health pushes open peer review to rebuild trust in science.
Related episode:
M&M #100: Infectious Disease, Epidemiology, Pandemics, Health Policy, COVID, Politicization of Science | Jay Bhattacharya
*Not medical advice.
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Episode transcript below.
Chapters:
00:00:00 Intro
00:06:25 The Great Barrington Declaration & Focused Protection
00:11:15 COVID Fatality Rates & Santa Clara Study
00:17:04 Asymptomatic Spread & Containment Challenges
00:24:24 Natural vs. Vaccine-Induced Immunity
00:30:47 Misinformation on Vaccine Efficacy
00:35:56 mRNA Vaccines & Transmission Evidence
00:40:54 Lessons for Future Pandemics & Institutional Change
00:47:02 mRNA Technology & Booster Efficacy Concerns 00:53:23 SARS-CoV-2 Origins & Current Research
00:59:56 Public Trust in Science Post-Pandemic
01:05:08 Open Science and the New Journal Initiative
Full AI-generated transcript below. Beware of typos & mistranslations!
Nick Jikomes 1:33
I really wanted to talk to you again. I talked to you back in early 2022 I believe, which was, you know, very much the before times, we're still in the midst of the COVID pandemic. And, you know, it's been, you know, maybe three years now. And I definitely wanted to talk to you again, specifically because of what we discussed last time, and because, you know, it's been three years we we've all lived through the COVID era. We're in the sort of new phase of the pandemic and how we deal with it. And you know, people have had three more years of experience, personal experience. And you know, lots of new evidence, lots of new things to discuss. But I just wanted to touch base at first. You want to remind people who you are, to get us started and just talk a little bit about about your background as an epidemiologist.
Martin Kulldorff 2:25
Well, I'm an ethnologist and a biostatistician. I worked for a few decades on the infectious diseases, on the early detection and monitoring infectious diseases, as well as on the safety monitoring the safety of vaccines
Nick Jikomes 2:42
and so last time I spoke to you again, it was three years ago, and at that time, for those who don't remember at that time, and maybe even today, still to this day, for some People, you were kind of considered a controversial character. Can you talk a little bit about why that was and why people perceived you to be somewhat controversial at the time?
Martin Kulldorff 3:10
Well, I think that's true. Maybe not so much anymore, but so in if you go back five years in 2020 where the country was closing schools and doing lockdowns, and people weren't going to the hospitals when they were supposed to because they were afraid of COVID, etc. That was not done according to the basic principles of public health or evidence based science. So most of my colleagues that I work with, technologists, they did not agree with those lockdowns that Anthony Fauci and Deborah Birx and others imposed on us.
Nick Jikomes 3:50
So most of your colleagues, most of the people with your background, epidemiologists who study this stuff, didn't agree with the way things were going, even though they weren't. A lot of people weren't saying that publicly, though, right?
Martin Kulldorff 4:02
That's true, and I try to say it publicly during the spring and summer of 2020 and I was able to do so in my native Sweden, I published in the major daily newspapers there, but in the US I was I failed until August, when I finally was able to publish something about school closures in CNN, but not the CNN that you think. CNN Espanol, I know how to write Spanish. If I can publish in English, at least maybe I can publish in Spanish. So dn Espanol published a piece where I was arguing that Sweden did the right thing, not to close the school. So we should open all the schools, CNN, even in English. We're not interested in it. But then in October of 2020 together with Dr J Bucha at Stanford University and Dr Sonata group at Oxford University, and at the time, I was a professor of medicine at Harvard University. The we wrote was a one page thing that's called the Great Barrington declaration, where we argue that we shouldn't lock down society. We should do much more to protect older people, because they are the higher risk of dying from COVID. So we didn't we were not doing enough to protect older people. But then we were closing schools, which is very harmful to children, and we were closing down society which has enormous public health impact, which we now have evidence for in people are not getting their cancer treatment or cancer screening they need. There were increased problems with cardiovascular disease that were not properly treated. People were dying at home instead of going to the hospitals, probably with diabetes care, mental health, of course, very much so. So the list is sort of long of all those other aspects of public health that we ignored, to our detriment, and the only country that sort of opposed this lockdown philosophy was Sweden, and we now know that during the pandemic, Sweden had the lowest excess mortality among major Western countries. So it's clear that Sweden did the right approach to focus protection on older people by letting children go to schools and having younger people live more normal lives. And
Nick Jikomes 6:25
so after talking with you last time, and after having you know the last few years to learn and to think about things, I just want to emphasize for people and correct me if I'm getting any of this wrong, but your position not to do lockdowns, not to close schools and to do to focus on protecting the vulnerable, which in this case means the elderly or people at risk for severe COVID who have certain comorbidities. That is literally textbook epidemiology. This is not, you know, even though you were in the minority of in terms of people publicly saying this, this is literally what's in textbooks. It wasn't some crazy, wacky thing that you were just coming up with.
Martin Kulldorff 7:04
No, that's the basic principles of public health, part of that. And actually, if you go and read some of the pandemic preparedness plans that various countries have prepared before the pandemic, that was basically what people were recommending. You can't just close down society, because it has such enormous negative concept, collateral damage on public health.
Nick Jikomes 7:28
So when I think, when I think back to the early pandemic, the first year or two, one of the things so obviously, when this at the very, very beginning, everything was mysterious. You know, this new virus was, was spreading. Nobody knew exactly what it was, or how it worked, or how deadly it was. And, you know, I want to remind people who may have forgotten, in those early days, there was a lot of uncertainty. And one of the things where there was a lot of uncertainty and controversy that I remember was, how deadly is this virus? How deadly is COVID? Exactly? And people started talking about something called the fatality ratio, basically, how, what are your odds of dying if you catch this thing? And early on, I remember that people thought it could be potentially quite deadly. I think the World Health Organization was saying the IFR was, you know, 345, percent, maybe even higher. And then at some point, a man who I think you're familiar with, John ioannides, very well known in the research world, he had a paper come out, and he predicted the IFR was actually much, much lower. And that caused a lot of controversy at the time. Do you remember that episode? And can you talk a little bit about how deadly the virus is, and what we know about that right now today? Yeah, so
Martin Kulldorff 8:47
that's called infection fatality rate, which means, if you're infected, what's the probability of dying? And it's true that in the early pandemic, there were uncertainty about that. But what was not uncertainty about was the relative risk comparing different people. So, yeah, so back in in February, March, or 2020 I did some calculations just by hand, look based on the Wuhan data, and we could see them that who died, and there was mostly older people. So by these calculations, then I found that the risk of dying for anybody can get infected, but the risk of dying from COVID was more than 1000, 1000 times higher among older people versus younger people. So from very, very beginning, we knew that one, there was a huge difference in risk by age, so that was the most important risk factor, and two children and young people were safe from this disease. They would not be dying from it. So we knew that very early on, but we but you're right, we didn't know whether the infection fatality rate was 0.1% if it was half a percent, 1% Percent, 3% or 5% and various numbers was floating around. And you're right that Johnny Unitas as well as Dr J Bucha and Stanford, did what's called a zero prevalence study. They knew how many people had died, but they didn't know how many people were infected, so they did a survey where they take a blood test to look at the zero prevalence, to see Have you been affected or not, to find out what the risk was of dying, and for some very strange reason that became extremely controversial. I think the controversy should not have been that they did this study is to call the Santa Clara study, because they did it in Santa Clara County, which is just south of San Francisco. The controversy should have been why CDC didn't do this at the national scale, because it study in Santa Clara was done like in a shoestring budget, budget, yeah, with volunteers and all kind of things. But that was the job of CDC to quickly do that surveys in different parts of the country, and do it like week by week and month by month, to see how many people were infected they completely failed into
Nick Jikomes 11:15
their tasks. Yeah. So, I mean, you would have expected the CDC to do a big study like that, because there was uncertainty, and this was, you know, you know, this major pandemic we were going through, you would think, you know, just commonsensically, that they'd want to get very robust, very, very robust data from from a large scale study. And that didn't happen. And then, as I recall, you know, when, when some of these estimates, like from the Santa Clara study, were coming out, they were saying that the infection fatality rate was lower than many of the other estimates that had already been coming out. And for some reason, this was causing controversy. People didn't some people didn't like the idea that the number they were coming up with was much lower. In other words, that the pandemic was going to be less deadly for most people than other estimates were implying. And one of the reasons I think some of these estimates differed is that they were making different assumptions, or having different estimates around the number of people actually infected. And as I recall, the reason for this, or a reason for this, is that some of these studies were not taken into account that there were many asymptomatic people who were infected, but we didn't really sort of realize it, because they didn't have symptoms. Can you talk a little bit more about how prevalent asymptomatic spread of this virus actually is? No, you're 100%
Martin Kulldorff 12:33
correct. So people were mixing up infection fatality rate versus case fatality rate. So if you have a case, means that you are diagnosed, you have some symptoms that may be serious enough to go see the doctor. And then how many of those cases were actually led to death. But infection fatality in writing also includes all those who were infected, many of which might be asymptomatic, or maybe they have they may have some symptoms, but they never go see the doctor, so that never became an official case of the disease. So obviously the case fatality rate is always larger than the infection fatality rate, and they were sort of confusing these two numbers and treating the case fatality rate as the risk of dying from this disease if you were infected, which was not the case. So, so that's what's that's why there was a confusion. We know that they are asymptomatic infections and that they're more among, yeah, among young people and children, but I don't think, I haven't seen a reliable number exactly how much that is, and of course, we now also know that you get immunity once you have it, but you can still have it a second time, although it's not as dangerous. But so somebody can be asymptomatic the first time, but then have symptoms the second time, and so on. So, yeah,
Nick Jikomes 14:04
and based on our last discussion, you know, one of the things I think you emphasized well, is the fact that you get that A this virus is quite contagious, but also that it can spread it from asymptomatic people, right? I might have the virus, I don't have symptoms, and then, you know, you catch it from me, but neither of us realizes that I'm even sick because I don't have symptoms. It's it's actually that reason why your position, and the position that you find in a lot of epidemiology textbooks is you, you would want to implement a focus protection strategy for the vulnerable, for a virus that spreads like that, rather than something like a lockdown, because something that contagious, that can spread asymptomatically, is simply not going to be contained,
Martin Kulldorff 14:47
correct? So it started in in Wuhan, in China, but then the two areas outside of China that sort of had a big outbreak first were Northern Italy and Iran. Yeah. Yeah, and we didn't know who brought it in there, so it was sort of spreading under the surface without be able to check it. And that meant that it was very obvious to me and to other infectious disease technologies that it was impossible to contain this disease. It will spread sooner or later to all parts of the world, which is exactly what happened. And that's not strange, because influenza is the same. It sort of spreads throughout the world, and it's impossible to sort of contain. And that's different from something like Ebola, for example. So we had some cases of Ebola in the US, and that's a very serious disease, and people have symptoms when they get infected. So there is a situation where you want to isolate those people who have Ebola so they don't spread it to others, and then you do what's called contact tracing. You see who do they meet with. You have want to check if they were infected, and then if they are infected, you want to isolate them too. So contact tracing and isolation of individuals is important for disease like Ebola, because,
Nick Jikomes 16:08
because it's clearly symptomatic and it's very deadly, yeah,
Martin Kulldorff 16:13
but to do contact tracing and isolation for COVID is hopeless because
Nick Jikomes 16:19
you have so many people without symptoms, yeah, symptoms,
Martin Kulldorff 16:22
or very mild symptoms. So So yes, like influenza, we cannot sort of suppress it. There was a movement like, call it zero COVID, who wanted to eliminate COVID, but that's impossible. So that just create a lot of collateral damage, without any any prospect of success. Yeah,
Nick Jikomes 16:43
so, because it's not feasible to contain and get down to zero for something that contagious, that can spread asymptomatically, and because it's inevitable that there will be downside to doing something like lockdowns, basically there's there's only downside. There's no upside, because your attempt to contain that contagion is going to be
Martin Kulldorff 17:04
futile, yeah? So what you can do is you can push it a little bit into the future, but that's also a principle of public health. You just don't want to push the problem forward, yeah? So it's not like a if we have a hurricane, for example, well, the hurricane comes. You hunker down during a few days, and then the hurricane is over, and then you can come up and resume normal life. But infectious disease doesn't operate that. If you hunker down for a while, it might maybe you can sort of hold it off for a while, but as soon as you sort of come up again, then it was spread.
Nick Jikomes 17:41
Yeah, the hurricane is going to come, no matter what. Cannot prevent it. Yeah. Another thing I want to ask you about in terms of like, textbook epidemiology and immune biology is, like, historically, so, so obviously, what happened with this pandemic is the virus started spreading, and then we introduced these new COVID vaccine like technologies, these new mRNA shots during the pandemic, while we're still in the midst of a pandemic. Historically, is that the way that that things have been done when we come up with vaccines, where, historically, what happens when you have a new vaccine, do you want to or is it advisable to do that during a pandemic? Or do you normally wait until after the pandemic has stopped spreading on its own?
Martin Kulldorff 18:30
No, if you can get a vaccine during the pandemic, that's good. Okay, so I think there were every reason to try as hard as possible to develop vaccines. Now, there are problems with how that how that happened, but the principle of just trying to get a vaccine that I think is good and you want to do it as quickly as possible,
Nick Jikomes 18:56
some people have argued that when you roll out a vaccine like that in the midst of a pandemic that's spreading very widely, it creates evolutionary pressure for novel variants of the virus to evolve that can escape the vaccine induced immunity. Do you have? Do you have thoughts on that and whether or not that can happen?
Martin Kulldorff 19:18
I think that could potentially happen, but I don't think it's an argument against trying to develop a vaccine.
Nick Jikomes 19:27
And so obviously the vaccine the lockdowns
Martin Kulldorff 19:29
also can change those things, because that can sort of force mutations to new mutations, and sort of promote new mutations of the new variants of the vaccine or the of the of the virus. So lockdowns can also have that impact on the virus.
Nick Jikomes 19:51
The other thing I want to talk about is natural versus vaccine induced immunity. And obviously we can talk about COVID stuff, but. I want to ask you about this in more general terms. Can you talk just a little bit about the difference between natural and vaccine induced immunity? What are those two things? And in general, do most vaccines produce an immune response that's very comparable to what you would get from actual exposure to a pathogen, or is the immune response typically different between those two?
Martin Kulldorff 20:22
Yeah? So we have known about infection, acquired immunity, or natural immunity, for about two and a half 1000 years, since 430 BC, during the Athenian play is described. So that's about the same amount of time as we have known that the earth is not flat, but like a sphere around so this is all knowledge that we have immunity to disease once we have recovered. Now the vaccine is sort of trying to mimic the that natural immunity without having to have the disease, so without risk for dying. So it's sort of mimic is triggering your own immune system to react and create that immunity. Yeah, and
Nick Jikomes 21:14
I suppose, I mean, it makes a lot of sense, to the extent you can mimic that response, you'll get immunity, which is good, and you're also you don't have the downside risk that a disease can have, which is that it could really, really permanently damage you or even kill you,
Martin Kulldorff 21:31
correct? And a good vaccine will give you almost as good immunity as infection acquired immunity. Some are some are close. Others are far from close. But you will never expect infection acquired immunity, or vaccine acquired immunity to be superior to infection acquired immunity. That will be astonishing if that happened. Yeah, and that that
Nick Jikomes 22:00
makes Yeah. Sorry that that should make intuitive sense, right? Because, you know the way that vaccines work. Once you dig into the details, they're rarely going to expose you to all of the antigens and components of the natural bug, and therefore the immune response would never be expected to to exceed the the what you would get from from a natural infection, is that the idea, yeah,
Martin Kulldorff 22:24
so. And among the vaccines that we have, some of them are good and some of them are less, has less efficacy. But during the during the pandemic, it was very strange to have the CDC director, or colleagues of mine at Harvard who were questioning infection, acquired immunity, who were basically questioning two and a half 1000 years of scientific knowledge to claim that and claims that vaccine provide a superior immunity. So this whole idea that those who have that had recovered in that's very strange. If you have a vaccine, let's say you are the biggest vaccine supporter in the world. Then you don't want to vaccinate the people already have a acquired immunity, because you want to use those vaccines for people who actually need it. So we were basically wasting vaccines, but by mandating vaccines to people without who had already had COVID, we were wasting vaccines. Some people
Nick Jikomes 23:44
didn't need it. It's just an inefficient use of resources. Yeah. Well, there were people
Martin Kulldorff 23:48
like including my 87 year old neighbor, who hadn't been vaccinated. Many other older Americans, as well as older people around the world, India, Nigeria, Mexico, Brazil and so on, who had not had it because they were short or short supply of vaccines. So we were not distributing the vaccines, using them in an ethical manner. And I would argue that if you already had the COVID, it was unethical to force them to be vaccinated, because it meant the last vaccines for those who really needed it. Yeah.
Nick Jikomes 24:24
So, so not only is there an opportunity cost, there you are giving vaccines to people who already have natural immunity, which is going to be as good or better than the vaccine induced immunity. And you know that doesn't mean acknowledging the reality of natural immunity. Doesn't mean we're necessarily saying nobody should get the vaccine. It means we should, we should allocate vaccines that exist, if they exist, to those who haven't already gotten natural immunity.
Martin Kulldorff 24:49
Yeah, and that's how we used to do things. For example, I'm a huge fan of the measles vaccine. I think it's a very important vaccine. Is the good vaccine, but I have not. See if the methus vaccine ever and the reason is, I had measles as a child before the vaccine was available, so there's no reason for me to be vaccinated. And that was established medical knowledge for a long time, but then during the pandemic, we suddenly forgot about evidence based medicine, or some people did at CDC and FDA and Anthony Fauci and so on. Why? Why
Nick Jikomes 25:27
do you think that was? I mean, the people at the CDC and these other institutions, these, these are right. They're supposed to be the people who know all this stuff, who've read the textbooks, who know what the science says. Why do you were people just in a panic? Did they have ulterior motives? Why do you think that they forgot things that that were already well established?
Martin Kulldorff 25:50
They clearly knew this thing? Because this is basic science. I know there was a meeting with Anthony Fauci and Rochelle walensky, the CDC director at the time, and others, had with four academic scientists, including Paul Offit, who is the vaccine scientist, and Peter hortas and a couple of others, where they discuss whether they whether infection acquired immunity should count and that which therefore shouldn't vaccinate them. And I think the argument there was different opinions in that group, but I think the argument was that the public is too stupid to understand these things, so it's better to tell everybody to get vaccinated. I think that's actually counterproductive, because people are actually smart, and when they saw that they were managing vaccine to people who clearly didn't need it, that has generated an enormous hesitation and skepticism towards other vaccines that are recommended if the PDC and NIH can't get this one right about the COVID vaccine, which is very simple, forcing people to take the vaccine when it's not needed, well, how can you trust them about other vaccines? So it's a very natural thing to ask. So they sort of complain about what they call the anti vaxxers, but they never what they were never able to put a dent into the confidence in the vaccine. There was one or 2% maybe the population who was hesitant about vaccines, but the vaccine fanatics of or the of these people, I think they have created an enormous skepticism towards vaccines now.
Nick Jikomes 27:46
So by not by not talking to the public in real terms, by not saying, Hey, this is what we actually know. This is the way we should do things. By treating people as adults, instead of treating people as adults and just being open and honest, they took this approach where, you know, maybe the public isn't smart enough to really understand this stuff, therefore we'll just tell everyone to get vaccinated no matter what, even if they don't need to because they already have natural immunity. That messaging approach may have inadvertently generated more skepticism and more distrust than just being open and honest would have, I
Martin Kulldorff 28:21
definitely think so. So they are the they are the those vaccine fanatics. Those are the cause, I think, of, of the vaccine hesitancy that we see now. And I don't, I don't blame the people who start questioning what CDC have said about other vaccines, because they clearly lied about the COVID vaccine. So of course, people should be skeptical about other things that CDC says, Yeah, but that doesn't mean that CDC is always wrong, because, for example, when CDC says you shouldn't smoke, well, that's very wise advice. You shouldn't smoke because that can cause cancer. So it's not that everything CDC says is wrong. They say many things that are true, but when they get it wrong, you know, put a thing like that, then people are gonna question, what? What other all the other things they say, yeah,
Nick Jikomes 29:08
yeah. And, you know, one of the things you know, as you know, as all of this was happening, and I was learning stuff and talking to people like you, talking to other people, reading papers, and then just my own experience. You know, like so many people, my thoughts evolved over time. And, you know, one of the things that I think started to get people thinking in new ways and questioning what we've been told and what's going on and what's true and what's not true is, you know, I actually got, you know, at the time in 2021 I decided to get the first two COVID shots, I got the two dose Pfizer shots. I had not been sick, as far as I knew already, and that was just the decision I made at the time, for better or for worse. And but then just, you know, when my my view started to when I started to have questions and really and really start thinking into. Different way was just a few months after I got the shots, I got COVID. I got what was probably the Omicron variant at the time. And I thought, wow, this is, this is very strange. I got pretty sick after the second Pfizer shot, and then several months later I got, I got a SARS COVID Two infection anyway. And I think that happened to a lot of people at around that time. And that was really, I think, probably a shift in people's minds where it's like, okay, I was just told, I mean, I remember very clearly, people on the news, the CEO of Pfizer, people at health institutions, saying, this vaccine is highly effective at stopping infection. You definitely won't get infected if you get it. And then I got it anyway. And so I thought, Huh, why? Why did that happen?
Martin Kulldorff 30:47
No, you're right. The CDC director Rochelle valensky, was saying very clearly that if you take the vaccine, you cannot get COVID, and that was not true. And they also said that if you take the vaccine you can spread COVID, and that's not true either. So those were an untruthful statement that CDC told the public.
Nick Jikomes 31:07
But at that time, did they know that wasn't true and they said it anyway, or did they think it might be true based on the evidence at at the time?
Martin Kulldorff 31:17
So in early 2021 we did not know whether, whether the COVID would to what extent the COVID prevent getting the disease. We actually knew very little from the randomized trials, which is the gold standard of scientific or medical research. We knew that it reduced symptomatic infection by 95% during the first few months after vaccination, but there were the studies, the randomized studies were not designed to determine whether it reduced mortality or not, or whether it reduced hospitalization from COVID or not. So we didn't even know that, and they should have been designed to evaluate mortality. Because, to be quite honest, I don't really care if you have COVID for a few days and have to be in bed. I care about what I care about is you staying alive so symptomatic COVID disease is not the interesting outcome to study in these randomized trials. The interesting outcome is mortality. But they recruited mostly young people for these randomized trials, and most young people survive, whether they are vaccinated or not. Yeah, it's it's older people who will die from COVID. So if they wanted to look at mortality, if this vaccine prevented mortality, they should have recruited mostly older people. But they did not. They recruited mostly young people. So, so
Nick Jikomes 32:57
the type of, you know, important lesson there is that the result you get in the study depends very heavily on how the study is designed, and sometimes the headline result can can sort of fool us in a certain way if we're not careful about knowing the methodology.
Martin Kulldorff 33:11
Yeah, of course, if it reduces symptomatic infection within those first few months from getting the vaccine, you would assume that it also reduces mortality, but you don't know for sure. And they also stopped the trial too early. They stopped it after a few months. They should have continued the trials to see if what was the long term, both long term efficacy as well as the long term adis reactions of the vaccine. So I don't think that the randomized, they were randomized, which is good. That's very good. But they were not properly designed to actually answer the important questions, and in terms of transmission affecting others, we don't know if the vaccine, the vaccine could actually help prevent transmission, but they could also increase transmission actually, so that's impossible to know ahead of time. For example, suppose you have a vaccine that just reduces the symptoms, yeah. Well, then instead of staying at home in bed, you're going to be out and about at work or at the pub or of playing volleyball or whatever you do, and you might actually spread it more because you don't have as many symptoms. So if the if the vaccine reduces symptoms, it could be, theoretically, that it spreads more because you're out and about more, rather than being at home and sick and not infecting others. So this idea that it will reduce transmission, and those claims were based on nothing, there was, and it could go and it could go in either direction for so, so
Nick Jikomes 34:56
there was no evidence supporting that claim. It could have been true. But no one actually acquired the evidence that showed that
Martin Kulldorff 35:03
correct. And you can actually, you can actually study that, because they could have looked at the so some people randomized to the placebo and some to the vaccine. They could have looked at the spouses of them, what extent were they affected, or they can look at neighbors or or work colleagues or others to to check transmission. But so it's it's possible to do that as part of the randomized trial, but they decided not to study that question.
Nick Jikomes 35:40
What do we so what's your understanding like today, based on all the evidence that we've acquired so far about how effective the mRNA vaccines from Pfizer and moderna are at stopping transmission, do they have any effectiveness, or is it just weak effectiveness? What do we actually know today?
Martin Kulldorff 35:56
I don't know if they increase or decrease transmission, and I think it's very hard to study in observational studies. What I do think is that I think there's evidence that the vaccines reduced mortality among older people through observational studies. We don't have the solid evidence from randomized trials, I think for younger people, we don't really know to what extent if it reduced mortality or not.
Nick Jikomes 36:32
When we think about pandemics, generally, when we think about the spread of respiratory viruses, other pathogens, one of the things, and I don't know too much here, so hopefully you can help me fill in the blanks. But I know people have been talking about, okay, now that, now that COVID is endemic, basically, or SARS, COVID two is, you know, it's it's circulating. It's with us. You know, we're seeing different waves of it every year. New variants are evolving. I think there's been some discussion out there about how that has affected the spread and the evolution of other viruses and other pathogens. Has, has SARS? Has the SARS virus affected things like influenza or respiratory viruses that cause the common cold. Have those things changed now that this virus is sort of in the mix?
Martin Kulldorff 37:20
Well, one virus can affect the spread of other viruses, but, and you're right, it's endemic now, and we should remember that there actually are four other coronaviruses that we have lived with for for at least 100 years, that caused the common cold, and my expectation is that COVID, the new one, would now obviously has caused a common cold. And among older people it might who are very frail and they have a reduced immune system, it might actually continue to kill some older people, just like influenza does, or other common infection does, but we're now in an endemic state, and it's just one out of several other viruses that are circulating and that we will live with as long as we are alive.
Nick Jikomes 38:19
And you know, in terms so, so again, like you and others, Jay banacharya, you wrote the Great Barrington declaration. You publicly took the stance which was publicly unpopular, but, but as you stated, you know, was all based on textbook, textbook science. And you, you, you got skewered publicly by by some high profile paper for doing that you were infamously referred to as fringe epidemiologists. I think, why do you think that that kind of negative response that you received? Why was that? Why was that even said? Why were you targeted in that way?
Martin Kulldorff 38:59
It was unpopular among the scientific establishment. It was the NIH Director, Francis Colin, who called us French technologist and who asked for a devastating takedown. We were unpopular among many of the politicians, also among many leading journalists. So we were criticized in the UK Parliament, and we were criticized by the director of who so on at the same time, I think among the general public, it was very popular. We have, we received almost or a million people who co signed the declaration. So there were many people who were living the collateral damage on a daily basis, who see the who saw through the nonsense that was advocated by CDC, Anthony Fauci and others. So in that sense, I think it was also very popular among the general public. Now, why did they slander us? I think the reason is they didn't have any. A scientific argument to counter us. And if they don't have scientific arguments, they have to make things up and accuse us of silly things.
Nick Jikomes 40:12
Are you? Are you optimistic at all that the leadership at some of those institutions is now changing? And you know, if so, or just in more general terms, you know, what do you think we should learn from, from the aftermath of all of this stuff, and how do you think these institutions should operate moving forward, in terms of how they allow, or don't allow, multiple opinions from credentialed people like yourself to be publicly stated, how they craft their messaging to the public. Do you think, are you optimistic about about positive change moving forward, or are you worried that that we haven't learned our lessons here?
Martin Kulldorff 40:54
So there will be another pandemic at some point. I don't know. It will be five years from now, 10 years or 50 years from now, but there will be another pandemic, because they are recurring events in through world history, and I'm optimistic that it will go better, because I don't think the public will accept what was done during COVID So I'm optimistic that the public will prevent the same mistakes to happen next time as for the institutions. So my colleague and co author of the Claire parental literature in Dr J Bucha at Stanford, he has been nominated to be the next NIH Director. I think that's fantastic. He's very much in favor of evidence based medicine. He's very much in favor of open discussions of ideas, and I think that's critical. So I'm very optimistic that we will see changes at NIH, also FDA, where I'm optimistic about because Dr Martin McCarey at Johns Hopkins has been nominated there, and he's also he was also a brave speaking out against the insanity during the pandemic, and he very much believes in evidence based medicine. So I'm also very optimistic about the FDA getting its ship on the right direction. So, but there will be a struggle. Because I think while the politicians and the media has sort of shifted and they realize what went wrong, I think the old god of the scientific establishment, they are probably never going to acknowledge that they made a huge mistake. And there's a saying in science that science progress One funeral at the time. So I think they were never recognized the huge damage that they did during the pandemic. I should also say that open scientific discussions are critically important. That's the only way to have science move forward and reach the truth, which is what science strive after. And I had a very different experience. I'm a native of Sweden, so I also participated in the discussion in Sweden, but there I was actually in favor of the of the official policy, because which was focused protection instead of lockdowns. But there was a group called the group of the 22 academics, only one infectious disease technologies, but there was some ecologist and some mathematician and so on. They argue that Sweden should do the rest the rest of the world on lockdown. And I had debates with them in the major daily newspapers there. So I strongly disagree with what they said, but I'm actually very thankful that they did speak up and that they published it, because I think that was very important to have that discussion so the people is really needed to know, why are we doing it differently than the rest of the world? So it was important for them to be able to have that, see that debate, and read both sides and then come to the conclusion, and the vast majority of the population in Sweden supported the focus protection that Anders take now and you and others implemented in Sweden, but that, but I'm very thankful that those who opposed it, that they actually spoke up, because I think that discussion, the debate was very important to have. So I think that NIH director Francis Colin did a huge mistake when he asked for a devastating takedown, instead of inviting us to have open discussion and debate about these things, because as the NIH Director, I think that was his job, actually, to ensure that there is open scientific discussion in the scientific community.
Nick Jikomes 44:46
When we think about the next pandemic, there will be a next pandemic at some time. We don't know when it's going to be we don't know what it's going to look like, but we do know the different paths it could take, in the sense. But you know, it could be something like COVID that is highly contagious, that can spread asymptomatically, but that doesn't kill most people, unless you're very vulnerable. It could be something like Ebola, in contrast, where the symptoms are very clear, it's a much more deadly diseased. And it sounds like, if I'm hearing you correctly, that your stance would be that whatever the next pandemic is we we should go by what, what the established science you know already, what we already knew going into the last pandemic, which is that the strategy is going to be different if it's one of these highly contagious respiratory viruses that spreads asymptomatically and has a low fatality rate, compared to if it's something more like a bull Ebola.
Martin Kulldorff 45:41
That's very true. So that's correct, and we can compare it to the 1918 flu pandemic, for example, that was affecting more younger people, while older people seem to have some protection, probably because they were exposed to some similar virus maybe 50 years ago, when they were young. So of course, if you have a pandemic like that, which affect most more younger people rather than older people, then you then the countermeasures has to be different. It should still be focused protection, but protecting those who are at highest risk.
Nick Jikomes 46:20
And you know, as we've learned more, as we've just learned more across the board, do you think so? So one of the things I want to talk about is the COVID vaccines, as most of us hopefully know at this point, they're different than most other vaccines that have been developed historically. They rely on mRNA technology. This is a brand new this is the first time we've ever used something like this. What are your thoughts on, you know, how much, how cautious should we be about redeploying that technology? How much should we be focused on looking at things like any side effects or any long term effects that come from not only getting vaccinated but but getting, say, multiple boosters, year in and year out.
Martin Kulldorff 47:02
So to the vaccines, the Pfizer moderna were mRNA vaccines. The other vaccines, AstraZeneca and J and J were not mRNA vaccines. So, so we had actually both. They were more traditional vaccines. We had both types, so in terms of the boosters, I think there hasn't been a proper randomized trials to look at the efficacy of the boosters. So I think if you want to continue to give the boosters, then we should ask the pharmaceutical companies. Faisal would have to actually run a proper randomized trials, and to do it in older people to see what, what the efficacy is for mortality. So that's my view on boosters, in terms of the technology, if there is the next virus, I'm all for trying new technologies, and if they do try another mRNA vaccine, that's fine, but it has to be properly evaluated through a well conducted, a well designed randomized trial. That was not the case for Pfizer moderna. So that's my view, try everything you see in my work, but then be very strict in evaluating it for both efficacy and safety.
Nick Jikomes 48:28
I mean, are these the type of trials you're describing that we should do? Is this stuff being done right now or or is it not being done and you're just saying we should hopefully do it in the future?
Martin Kulldorff 48:39
No, there's no COVID, randomized COVID trials going on now, and there were no proper randomized trials for the boosters. I think either we should stop giving the mRNA vaccines for COVID, or we should run a randomized trial to see what the efficacy is. I mean,
Nick Jikomes 49:00
I mean, I mean, that seems very strange to me, like, why wouldn't these trials already be in the works, especially if the boosters are recommended so widely. I mean, they're still even being recommended for children and pregnant women and stuff. Is it surprising or strange to you that that these types of studies are not already underway?
Martin Kulldorff 49:16
It's very strange, as a scientist, surprising. Well, if you ask me, five years ago, yeah, we've been super surprised. But now I guess I'm not surprised by all these things anymore. There's been too many mishandling of these things that I'm no longer surprised that that's going on. Unfortunately, I wish I was surprised.
Nick Jikomes 49:38
Yeah, yeah. Have you seen there's a new pre print out right now from some researchers at Yale that it's it was able to look at people who have been vaccinated with prior infection, vaccinated without prior infection, as well as not vaccinated with and without prior infection. And you know, they were looking at some of the immune system differences in those cohorts of people. Have you seen that new study? No,
Martin Kulldorff 50:00
I haven't, I haven't read that. I think it was an observational study. No, they
Nick Jikomes 50:05
were so they were able to, yes, they had some people from some trial that was done in the last couple years, and they were able to look at blood samples, so they were able to confirm, from, you know, testing for certain things in the blood whether or not someone had a previous infection, even if they were asymptomatic, they could they could see if, you know, they had antibodies. And so that was really nice, because now they could truly cohort people into, you know, with and without vaccine, plus with and without prior infection. And one of the the headline results here is that people who had received one or more doses of one of the COVID vaccines who had no previous infection. Some of them report what they call post vaccination syndrome. And they basically show that they've got, you know, elevated levels of CD eight, positive T cells, which are, you know, secreting, potent inflammatory molecules. They've also got some immune deficiency. They've actually got lower levels of CD four TDT helper cells, and they saw that even in people with no previous infection. And so that implies that these are being driven by the vaccine, at least in a subset of people. And it's a really interesting study that's just come out. I just wanted to know if you had seen it yet.
Martin Kulldorff 51:19
No, I should read that. But it shows also that these are things that we should have known about in 2021 by maintaining the randomized studies and measure these things in the randomized studies. So it's great that they do these studies, but they should have been done in 2021
Nick Jikomes 51:37
Yeah. I mean, it's remarkable. It's remarkable that, you know, it's now half a decade later, and we're just starting to see results that you would have expected to be done in those first couple of years. Yeah,
Martin Kulldorff 51:50
and I think it was the failure of the scientific community in the US, which a lot of the blame goes on NIH there, as well as in the UK, and we saw that many of the early work on interesting, important things from the pandemic sort of came from countries with small countries with as good science, but they are not under the umbrella of Anthony Fauci at NIH, Because Anthony Fauci sits on the biggest pile of infectious disease, richest man in the world. So people are afraid to sort of go against him. So some of the most interesting, most important work came from small countries like Iceland or Denmark, Sweden and Norway, Israel, Qatar, which have good scientists, but they are not dependent on NIH funding. They have more freedom to actually do the studies that were important to do.
Nick Jikomes 52:49
Have you followed very closely the controversy and the debate around the origins of the SARS, COVID, two virus?
Martin Kulldorff 52:58
I have followed it very closely, but it's not my area of expertise, so I have stayed out of commenting on it.
Nick Jikomes 53:05
I see, do you think it's a relevant question to ask, like, do you think it matters from an epidemiological standpoint in terms of pandemic preparedness in the future? Is it relevant for us to to understand as a society, whether this was, say, a zoonotic spillover event versus a lab leak.
Martin Kulldorff 53:23
It's very important for us to know which it was, but not in order to determine what strategy used for the pandemic was completely irrelevant in terms of whether we should do focus protections or lockdowns or any other strategies. So for that is irrelevant, but it's obviously important for us to know, and it's important for research policy, because should we really do this gain of function research or not? That is an important question, and even whatever the answer is to lab versus natural uh, dissemination of the virus. And the lab could actually be two things. It could be a lab, just by accident that they they collected a virus from the Batcave, so then it escaped, or without any gain of functional reason. Or it could be that it was manipulated and then it escaped. But we need to know, it's important for us to know those things, and we need to make sure that we don't take any risks from the lab work to create the pandemic.
Nick Jikomes 54:35
And so you spent, you know, many years as a researcher. I think much of your career was spent at Harvard. You're no longer there. What are you doing today? What are you up to right now?
Martin Kulldorff 54:47
Well, so I had problems with the leadership at Harvard and at Brigham women hospitals, and they were the one who decided that they didn't want me to work there anymore. But I've never had. Problems with the colleagues that I work with and do research with. So I'm still doing research with many of the same people I used to I asked do it now as sort of a private consultant, but I'm doing it outside of the university.
Nick Jikomes 55:17
Yeah. So, so you're you're basically doing the same stuff, but you're no longer inside the university system, correct? Yeah, what can you talk at all about some of the research questions that you're looking into right now?
Martin Kulldorff 55:31
I work still on monitoring infectious disease outbreaks, and it's not just COVID, because suppose you have an outbreak of salmonella, for example, frequently, and then the health departments, they want to know about as soon as possible, so they can go to the restaurant or the to the supermarket where the salmonella is spreading through the chicken or the cheese or the whatever the fish. But so I'm, I'm helping to build those systems to sort of closely monitor disease outbreaks and monitoring them, whether it's whether it's COVID or influenza or salmonella or Legionnaires disease or many of Other potential pathogens.
Nick Jikomes 56:19
Have your like views or your priorities on the epidemiology side, on the pandemic preparedness side, have they changed at all as a result of what's happened over the last few years? It kind of sounds to me like you're saying, you know our strategies for how to deal with these outbreaks. You know, we already knew how to do this, and we should, we should stick to what was already established science, you know, even five years ago, depending on how contagious and how deadly the disease is, something like COVID versus something like Ebola, that should dictate how we handle an outbreak. It sounds like your views. You know, in terms of how we do that stuff, have basically been consistent and and probably you'd say, you know, we should have been, we should have been following the same principles all along.
Martin Kulldorff 57:06
Yes, so we knew 10 years ago, I deal with this, then five years ago, we suddenly didn't know how to deal with it. But if we go back to what was planned 10 years ago, I think we'll be fine.
Nick Jikomes 57:18
And like, how do we achieve that? Is that something that will be achieved, hopefully as a side effect of changing the leadership at these institutions.
Martin Kulldorff 57:28
Changing the leadership is good, but we can never guard ourselves against bad leadership that can always happen in the future. So I think the only way to make sure that this this doesn't happen again, is if the public is sort of well aware of and understands what went wrong. Make sure that we write the history correctly about the pandemic. Yeah, that it is sort of well known, and I think it is now, the the more and more members of the public realizes what a mess was. The mistake it was sort of, if I meet somebody who doesn't know that I'm an ethnologist, I will ask them, so what do you think about the pandemic? And the vast majority will spontaneously say, oh, that didn't make any sense. And that that makes me hopeful for the future.
Nick Jikomes 58:26
And you know, there will be another pandemic at some point of some kind. Is there any way to predict these things? We can't predict their timing, but are there particular viruses or particular pathogens that are more likely to turn into a major pandemic, or is this something that's fundamentally unpredictable?
Martin Kulldorff 58:47
I think it's fundamentally unpredictable. But if some genius can come up with a way to predict, it sure, great, but I think it's very hard.
Nick Jikomes 59:02
Yeah, so. So basically, your views on how to handle pandemics have remained the same throughout all of this. It's just that you think that the way that we actually handle things in the United States, in particular, in certain other countries, it was misguided for various reasons, but, but none of the fundamental sort of principles of epidemiology have actually changed here. We can still rely on the same body of work in the same way.
Martin Kulldorff 59:27
We can rely on what we knew 10 years ago. We should not rely on what we did five years ago.
Nick Jikomes 59:37
Well, Martin, I want to thank you for your time. I really appreciate you taking the time to do these things. I know that you're very busy. Is there anything that you want to emphasize that we haven't already talked about, or any topics related to the pandemic and its aftermath that we haven't touched on, that you think are important to go into for people?
Martin Kulldorff 59:56
Well, I think one negative consequence of the pandemic is that. The General trust in the scientific community has taken a no style, and the scientific community is dependent on taxpayers, because it's the taxpayers who pay for scientific research. So while I don't I don't expect much from the past scientific leadership, but I think it's important that the rank and file scientists sort of starts to work to regain the trust of the public. Because I do think science is important and scientists can have huge benefits, but I think it requires the the mistakes and were done by leading people in the in the medical field, they caused these problems with the pandemic and the decline in the trust. But I think it's not up to every scientist, whether they are in medicine or in astronomy or geology or chemistry or whatever, to help rebuild the trust that is now has been destroyed. So I would just hope that the rank and file scientists will sort of step up and and support the reforms that are needed to regain the trust by the public and stop following the old leaders who messed up during the pandemic. Well,
Nick Jikomes 1:01:29
I mean, what are some of the ways that rank and file scientists can actually work to regain public trust?
Martin Kulldorff 1:01:38
One thing is through publication process to have open peer review, for example, that peer reviews are published together with articles. And I actually just recently started a new journal called the Journal of Academy of public health, where we publish the peer reviews, and we will also actually pay the reviewers, because the reviewers are doing an important job. But I think that should be open, that discussion about the pros and cons of our studies should be open, and then they will be rejoined by the authors. Now it's all secretive and anonymous, which might be good for the general editors, but it's not good for the public, for science as a whole. So to open up scientific discussions on that and not to be afraid of it. I think it's important. I think it's also important how that we reduce conflicts of interest. I work on vaccine and Drug Safety, and I've always felt that, well, since I work on that, I should not take any money, any funding, at all, from the pharmaceutical industry, because they are the ones I'm sort of the watchdog over. So the conflict of interest for me to take money from them, and I think that we should minimize this conflict of interest and the revolving door between, for example, FDA and the pharmaceutical industry. So those are two things that are, I think we can as as ranking for our scientists. We can try to change so
Nick Jikomes 1:03:07
so promoting open science, the publication of the reviews openly together with the papers that come out at journals, as well as reduce, doing what we can to reduce conflicts of interest, so people aren't simultaneously taking money from the people that they're supposed to be the watchdog for. Yeah, and
Martin Kulldorff 1:03:28
all people in science believe, I think, in academic freedom, but it is under threat, and I think we have to guard academic freedom, including the academic freedom of those people who we have different views from, like the people in Sweden who I had different views from, I think they should have the academic freedom to say what they think, and I'm glad I did. I wish I always encourage people with different views and discuss things with them. Does,
Nick Jikomes 1:04:01
does the current sort of Structure of Scientific publish the public the publication industry, you know, it's, it's a for profit industry. Many of the journals are for profit companies. They are staffed by by very well compensated people in many cases, and they sort of control what does or does not, not only get published, but what even goes out for peer review. If you want to promote a system where you've got more open science, open public open, open access science, so the public can read all of the papers and see all of the data, open publication of the reviews from peers, scientific peers, and even a different financial structure where scientists are actually compensated for their time, which they are presently providing for free to the journals, is one thing that could help facilitate that change, that maybe rank and file scientists at the big name universities maybe stop sending in their papers. So much to you know, nature science, the big sexy journals, and focus more on publishing at open access journals that promote this type of thing. I
Martin Kulldorff 1:05:08
think that would be good if people do that at the same time. I understand young scientists. They know that to get promoted, they need to publish something in Nature or Science, so new journal, medicine and so on. So I understand why they it's very difficult for them to break free from that system, but I think I mean many of these Elsevier and other publishing houses, they have profit margins of 30 to 40% they the the editors and the and and the people who run the journals they are, they get good salaries for reimbursement for it, but you're right, the reviewers get nothing. So I think that as reviewers and peer review is extremely important, but I think we should expect to be paid for that work for scientists, I think, Well, I think scientists should, should be rewarded for the important they work of peer review. Because if you compare like the archives, like you met archive, for example, people, you can publish papers there, put it up there, anybody can read it. So the only added value that the journals provide is the peer review, because it sort of puts the step of approval that this is reviewed by some peers, and seem to be good science, but those peer reviewers who actually contributing that added value, they don't get paid for it. So I think Reviewers should be paid, and maybe they can't get paid for or to compensate for the time it takes to write a good review, but at least they should get a nominal payment. So we pay $500 per review. That might not be enough to cover all the time, but at least it's something out of principle, at least.
Nick Jikomes 1:06:58
And so how long? How long is that mid journal up. That's a brand new thing.
Martin Kulldorff 1:07:02
Yeah, actually started a few weeks ago, earlier this month, and
Nick Jikomes 1:07:05
you focus just on infectious disease research, or is this a broad journal?
Martin Kulldorff 1:07:11
It's public health. So anything in public health, but we won't publish things in astronomy or in the molecule or those things, unless it's somehow health related. All
Nick Jikomes 1:07:21
right. Can you remind us one more time what is the name of that journal, and where can people find
Martin Kulldorff 1:07:26
it? Journal of the Academy of public health, and it can be found by googling that name.
Nick Jikomes 1:07:31
All right. Well. Dr Martin coldorf, thank you very much for your time. Very, very thankful that you take time to talk about this stuff, and I look forward to talking to you again in the future.
Martin Kulldorff 1:07:43
Sounds good. Thank you for very pleasant conversation.
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