Science & Technology

TL:DR…He does.

NB: This is a crosspost from Inverse Square, the newsletter I’m trying to get going because (I’m somewhat reliably informed) it’s what authors have to do these days to connect with audiences.  (Did I mention that I have a polemical history of vaccine resistance coming out this May? I did? Oh well…) There’s nothing behind a paywall, so if you’d like an email notification whenever something new hits over there, you might want to subscribe.

Also, Adam S. sent me the NYT article mentioned below yesterday. I’d read it when it came out, meant to blog about it then, and promptly forgot. Thanks to Adam for the reminder.

All that said…let’s have at it.

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This will be a short one, given how much else is going on this weekend, but I didn’t want the month to end without shining a light on a fascinating metastudy that might have gotten while most of us were still recovering from New Year’s Eve.

Late in November of last year a group of Italian researchers (and one Canada-based scientist!) published their review of twenty one studies involving over 100 million people to see what effect of vaccination against a variety of pathogens may have on dementia risk. They asked, in effect, do vaccines reduce the risk that as we age each of us faces of developing Alzheimers and/or other dementias.

Their answer?

Damn straight they do.

The headliner is the shingles vaccine. Taking six studies with total sample of almost a million people, the team found that the shot yields a 47% drop in Alzheimer’s risk, and a significant association with a reduction in the risk of suffering any form of dementia. The tetanus, diptheria, pertussis (DTAP) is no slouch either. It offers a 42% cut in Alzheimer’s peril and, paralleling the shingles vaccine results, also provides some protection against all dementias. The list goes on, with varying but still welcome help coming from everything from the polio shot to the annual flu jab—check out the link above for much more detail.

This work did get some notice. On January 3, Paula Span published a piece in The New York Times that discussed this work amidst a solid review of the range of benefits older people gain from vaccination. But despite the ongoing, seemingly weekly-renewed assault on vaccination led by Robert F. Kennedy Jr. and enabled by so many in the Republican caucus these days, the implications of this work has not made much of an impact (yet) on the civic conversation, or in ongoing media coverage of vaccine policy and politics.

That’s a loss, because there’s implications beyond the (very welcome to this sixty seven year old writer) news about what vaccines can do for old folks’ cognitive health. As Span covers in her story, vaccines produce a catalogue of good outcomes that mitigate the miseries of aging, what are called “off target benefits” — stuff like better cardiovascular health. Exactly how such gifts, including the help with cognitive decline, come about is not known; the work that has established that these effects are measurable rests on observational studies, which cannot (usually) identify causation.

But there are hints. Vaccines keep you from getting sick, or reduce the severity of an infection that does break through. That in turn eliminates or calms your immune system’s response to a pathogen—which means you endure less or no inflammation. It’s that inflammatory reaction to infection that, Span reports, many researchers believe leads to knock-on bad outcomes that can linger long after the primary illness has resolved.

TL:DR—it sucks to be sick, and if you can prevent or mitigate a bout of illness, you not only don’t have to spend a week or two (or more!) feeling miserable, you get better odds of keeping all your marbles long enough to dance at your grandkids’ weddings. (Heck, maybe even your great-grandkids’ nuptials. Dream big!)

So, yes, the first and most tragically unnecessary harms of the Trump administration’s attack on the single greatest life-saving invention humans have ever created will be the wholly preventable suffering and deaths of the young who won’t be vaccinated against common childhood diseases. But health is a lifelong game, and not getting sick when you don’t have to is one of the single most important ways to lead a comfortable and long life.

That’s what is at stake in the vaccine wars we now must fight. So let’s hang this message around RFK Jr.’s and the whole coterie of MAHA scammers’ necks: they are objectively pro-Alzheimers.

Last thought: I don’t want this to be a depressing post. It shouldn’t be! We are reminded, again, of how powerful a tool in vaccines we have to enhance human flourishing. I truly believe that when you tell grandpa and grandma that vaccines can help them enjoy their families and friends throughout their old age, they’ll like that outcome. This is a fight we can win, one conversation at a time.

Image: Rembrandt van Rijn, Portrait of an Old Man (Possibly a Rabbi), 1655

Does RFK Jr. Hate Old People?Post + Comments (47)

Back again with another cross-post with Inverse Square. This one was prompted by a comment in the morning thread that led me to The Hill’s (sic!) report on what RFK Jr.’s new head of the CDC’s vaccine advisory panel had to say about the polio vaccine. Nothing good, as you might imagine.

There’s some history in it, drawn from the new book, but mostly it’s a scream of rage at the endlessly renewed malignant folly (and grift) that impels the professional anti-vax crowd. Some of this stuff is getting understandably drowned out in the ever-renewed tsunami of bullshit and evil delivered by Trump and the GOP, but the idea that having so recently won (hard-won) a reprise from infectious disease, the worst among us are throwing all that away.

Feh.

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Let me begin by saying how well and truly my gob has just been smacked.

By whom, you may ask?

By the bipedal public health catastrophe who answers to the name of “Kirk Milhoan.”

Dr. Milhoan is a pediatric cardiologist—which is to say he’s mastered (I assume) a genuinely difficult craft. Impressive as that might be, it isn’t a qualification for his current post as head of the Centers For Disease Control’s Advisory Panel on Immunization Practices—the top vaccine panel at America’s pre-eminent public health agency. That is: knowing how to fix tiny hearts is impressive as hell. But it’s not relevant to the matter at hand. Milhoan isn’t a virologist, a vaccine researcher, an epidemiologist, a public health specialist, and so on.

No matter. Milhoan is confident in his judgments despite lacking the essential base of knowledge needed to form rigorous ones. In a podcast interview last month that was reported out today Milhoan said that he questions the value of the polio vaccine: “Our sanitation is different, our risk of disease is different” which, he argued, meant that “we need to not be afraid to consider…whether this is worthwhile of taking a risk for a vaccine or not.”

Scorching yet more earth, Milhoan went on to declare that mandatory school vaccination is “authoritarian” and said that it was his priority not to advance public health, but to advance “individual autonomy to the first order.” That is: Milhoan sees the liberty of the individual as such an inviolable first principle that it does not matter if the exercise of that freedom harms others. You shall not tread on vaccinate me, even if it means kids in my neighborhood will get sick, or worse.

Tracing the history of this radically atomized vision of individual autonomy occupies a big chunk of my upcoming book A Pox on Fools.* It turns out that there’s nothing new about the insistence on absolute autonomy. Soon after the British Parliament first required smallpox vaccination for all children, some of England’s most prominent thinkers objected to this overweening state overreach. As I write in A Pox…, Herbert Spencer, perhaps the type specimen of a public intellectual (and the man who coined the still-unfortunate phrase, “survival of the fittest”) argued that “it was folly, and more than that, a fundamental misuse of the power of government to seek to protect ‘each individual against himself—against his own stupidity, his own idleness, his own improvidence, rashness or other defect.’”

Some years after Spencer wrote, an anti-vax MP made the same point with much more impressive vitriol: There was, Peter Alfred Taylor thundered, “no law on the statute book…of so tyrannous and crushing a nature as that which compels vaccination.

Mintour was much less articulate (and entertaining) in his denunciation of any state attempt to require its citizens to protect themselves and others, but the echoes are clear. What’s different now, of course, is that biomedical research has revealed much more about all of vaccine science than Spencer and his contemporaries knew. We now grasp how they work, what epidemiology has to say about the prevention of the transmission of disease, and the explicit costs, the losses, that come when the overall vaccination coverage against common infectious diseases—like polio—falls below the level needed to reach herd immunity (the fraction of a population that, if vaccinated, will leave a pathogen no path to find an unprotected target).

But even in the 19th century the essential issue was clear: when a person who has chosen not to get vaccinate falls ill they both do harm to themselves and serve as a vector, someone who can pass the disease on to the next victim—who would then suffer in their turn, and perhaps die. No autonomy for them. There is no liberty in the grave.

That fact prompted what maybe the single most powerful response to 19th century advocates of untrammeled individual agency. In 1857 Sir John Simon, the Chief Medical Officer to the Privy Council (pretty much Britain’s top medical official) wrote that far from infringing a citizen’s inalienable freedom, “the so-called ‘liberty’—thenceforth to be abridged—was the of exposing unconscious infants to become the prey of a fatal and mutilative disease. It was this liberty of omissional infanticide which the law took courage to check.” (Emphasis in the original.)

Omissional infanticide.

I gasped when I first read that phrase. But it’s spot on, now as much as it ever was in Victorian England. That’s what happens when someone makes a decision not to inoculate children against wholly preventable but sometimes fatal disease. Like polio. Like measles. Like…we all know the list.

It’s true that vaccines are not without risk; nothing humans do is entirely free of peril. But as vaccinologist Paul Offit has written, vaccines are by far the safest intervention modern medicine performs. And it is possible to remember (even if Milhoan chooses not to) what the alternative actually is. For just one example, in the summer of 1952, three years before the first polio vaccine became available, the US recorded about 57,000 cases of polio; 21,000 suffered some level of paralysis. 3,145 Americans, lots of them kids, died.

That’s the real risk here—not the vaccines, but the danger that a lapse in vaccine coverage will give infectious diseases that have almost entirely disappeared in the US (and much of the world) the opening they need to roar back into our daily life. History again: just three years after British anti-vax advocates managed to make smallpox vaccines optional, the disease flared again in London and other cities. Those most at risk of death in the outbreak? Young children just “liberated” from the demand that their parents protect them against that “fatal and mutilative disease.”

History may not repeat itself, but as a cliche I’ve used before reminds us, it knows the chords. January 2026 marks a full year of a continuous outbreak of measles in the United States. The US managed to eliminate measles in 2000, meaning there was no ongoing transmission of the disease. A quarter of a century later, that’s about to be officially no longer true.

We can do better. If we don’t, we’ll go back to burying people who will have died of diseases that never had to happen.

(PS: there’s yet more awful to be mined from Milhoan’s interview, a direct line into one of the fundamental delusions that sustains anti-vax convictions, but this screed is already long enough. I may well revisit the good [Narrator: not good at all] Dr. in  another post)

This thread is now as open as Kennedy’s mind is not.

*Not to be too relentlessly self-promoting, but…

…preorders are incredibly helpful in propelling books to their audiences. They tell booksellers there’s interest in a title, and so much flows from that realization. This is doubly true if you order from a local bookstore you value, but any early eagerness at any venue is such a gift.

Image: WPA commissioned poster, The President’s birthday ball “So we may dance again”between 1936 and 1939

Today’s Vaccine AtrocityPost + Comments (73)

NOTE: This is another mini-essay that I just posted over at the new Inverse Square. I’m guessing the jackaltariat is already familiar with just about everything here, but y’all might find it interesting and if you don’t then someone else will post something better here soon enough. But my hope is it evokes some interesting thoughts, memories, hopes, and perhaps rage, and if so, you know what to do…;-)

Again, there’s no paid tier on this foray into Substack, so if you’d like to get an email when stuff like this appears (not that often, but I hope more often than I’ve managed to do here lately), head over there and hit “subscribe.”

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We’ll get to the question above—what would Jesus do if confronted with a syringe?—but by a bit of a twisty way ‘round. We’ll start with some fascinating science news that might seem at a bit of remove from speculation about the thoughts and deeds of a carpenter from Galilee. Don’t worry. We’ll get back here in moment.

Yesterday, Diane Kwon published a report in Nature that wrestled with an obvious but often overlooked mystery: why do some people sicken and die from an infection with bugs that are harmless to most of us?

Kwon lead her story with the tale of a boy who was brought to a London hospital already desperately ill. Nothing the doctors there could do checked his disease, and he ultimately died of an infection by Mycobacterium fortuitum, a bacterium found in water and soil that for the most part cohabits with humankind perfectly peacefully. So what made it deadly to that particular child?

It took several years but researchers were able to nail down the culprit: a mutation affecting a specific step in his immune system’s response to a microbial invader.

One by one, such genetic alterations can be quite rare—but it turns out that there are a lot of ways that changes in our genes can cause what have been named “inborn errors of immunity.” That means that the number of people suffering some deficit in their ability to fight off infection reaches into the millions.

These discoveries reaffirm one of the most critical 20th century developments in the germ theory of disease. The initial “central dogma” of the new theory was that one pathogen produces one disease (which is true) and that disease is a more or less consistent phenomenon.

That part’s not so solid. It’s easy to see that different people do not have the same experiences of various maladies, which ultimately suggested to researchers that the disease process couldn’t be a simple cause and effect transaction. Instead, it could be better understood as an dance between a pathogen and its target, the human host.

Yesterday’s report in Nature is an update on what researchers know so far about what shapes that interaction, why some people are unaffected by germs that pose a deadly threat to others. Crucially such differences don’t just affect a handful of people. It turns out that there are a lot of genetic variations that increase the danger from known pathogens, including (usefully for the purpose of this essay) Neisseria meningitidis, the bacterium that causes meningococcal disease.

N. meningitidis makes this something more than a tale of potentially useful basic research. It takes us back to the question at the head of this piece: what Jesus might do in a world where some people are going to be especially vulnerable to one particular germ or another?

A choice of one action or another emerges because there’s a vaccine that can block an N. meningitidis infection, safeguarding its users from meningococcal disease. Hence the question: would Jesus get the shot? Or Hillel, for that matter, or the spiritual leader of your choice?

I’m no theologian; far from it. I would not presume to place my words in ancient sages’ mouths. But I am willing to bet that it’s extremely unlikely that they would have affirmed what Robert F. Kennedy Jr. and the Trump administration just did: remove the inoculation against N. meningitidis from the schedule of recommended childhood immunizations (along with several other previously recommended vaccines). Meningococcal disease is a vicious affliction — it kills 10 percent or more of hospitalized patients — and it is a truly dire threat to those whose immune systems cannot respond vigorously to that infection.

Every vaccine received can thus save a life. The Jewish tradition holds that to save a life is to save a universe; other systems of belief have similar framings. As for Jesus himself, he said, “Truly I tell you, whatever you did not do for one of the least of these, you did not do for me” (Matthew 25:45)—which in this context can reasonably be read as whatever shot you did not get to protect others puts me in harm’s way as well.

I confess: I’m beating a drum I’ve struck before and will hit again: vaccination is first and foremost something one does for oneself (and one’s kids.) Getting the measles when you don’t have to is miserable even if it doesn’t kill you (and it can). COVID vaccines aren’t perfect, but they reduce the risk of both severe disease and death. The smallpox vaccine saved its recipients from one of the most terrifying infectious scourges ever to strike humanity, and so on.

But as great as such protection is for a single individual, vaccines are gifts we give each other. They bind up the web of society with love. Every shot I accept means that a pathogen has a harder road to travel to find another host; strangers I will never meet get some mote of extra protection because I bared my arm to the needle. Every jab you receive does the same for me. That kindness redoubles for those more in danger than the common run of humanity, people whose luck-of-the-draw variations in their immune system can put them at lethal risk if, say, N. meningitidis finds its way to them.

I want to live in a community, a nation, a world that celebrates such kindness.

This thread is as open as a Walmart on 12/26.

Image: Albrecht Dürer, Christ washing the disciples feet, c. 1508

What Would Jesus Do…Contemplating a Vaccine?Post + Comments (21)