• njikomes

Martin Kulldorff: Public Health, Pandemics, Epidemiology, SARS-CoV-2 & COVID Public Policy

Updated: Mar 8

Full episode transcript below. Beware of typos!

Nick Jikomes

Dr. Martin Kulldorff. Thank you for joining me.


Martin Kulldorff 4:50

Thank you. It's a great pleasure.


Nick Jikomes 4:52

So you're an epidemiologist and a statistician and you've worked on infectious disease outbreaks and studying them for For many years now, can you give everyone just a basic sketch of your scientific training and professional background?


Martin Kulldorff 5:07

Yeah, so for about two decades, I worked on the early detection and monitoring of infectious disease outbreaks, I started work while I was working at the National Institute of Health. The idea is that if you're in public health, if there isn't sudden outbreak of some disease, could be salmonella, or it could be something else that you want to know about as soon as possible so that you can take actions as early as possible. So I've developed statistical ecological methods for early detection of outbreaks, and that are used by almost every state health department, the US by many people at CDC and around the world.


Nick Jikomes 5:53

What does that actually involve? So when they're using the software to detect the early phases of an outbreak, what does that typically look like?


Martin Kulldorff 6:00

So you will have, for example, data reports of some disease, it could be a reportable disease, like salmonella, for example, or Legionnaires disease, so on, and the health department will get these reports and they will see where did it occur. And if there suddenly is many cases of Salmonella in the same place that are related to each other, maybe some store is selling some food that's contaminated or something, so then they will do an investigation. But the first step is then to find out that something might be wrong. And that's what the method is that I've developed us. And then the second step is for the public health officials to to investigate what is going on there. And that's something that they have to do them through other other means of interviewing people, and so on. So for example, I think it was in 2015, there was a big outbreak of Legionnaires disease in Bronx, in New York. That was the title through these measure measures. But then they of course, had to figure out what caused it because the method doesn't do that. And it, it turned out that it was caused by by one of the cooling towers that was spreading literacies in the neighborhood. But that's something that has to be investigated after you sort of have the suspicion that something might be wrong.


Nick Jikomes 7:21

Interesting. So we're gonna spend most of our time talking about COVID related stuff, because that's, that's what we're all in the midst of right now. But I'm hoping maybe we can build some background for people. So, you know, when you think about pandemics and epidemics, generally such as you know, any that have have occurred historically, what are some of the tried and true public health measures that most experts would agree are effective at minimizing the negative impacts of the spread of infectious disease? You know, whether or not it was was COVID, or anything historically, what are the basic tools in the toolkit that most people like yourself would say, are, are useful.


Martin Kulldorff 8:00

So there are it depends on the disease. So for example, for something like COVID, which is very contagious, similar to the influenza, the key thing there is to protect those who are at most at risk. For COVID, we know that by age, so anybody can get any, anybody can get effected, everybody do get infected. So in that sense, everybody's at the same risk. But for young people is mostly a very mild disease. For all people, it's often deadly. So when anybody can get infected, there's more than 1000 fold difference in the risk of mortality of dying between the oldest and the youngest, youngest. So that means that the key thing for disease that's very contagious, like COVID, is to protect the older people. And to do it without shutting down society, or harming society in other ways. Because if you do a lockdown that fear for COVID, that has collateral damage and other public health, like cancer, cardiovascular disease and mental health, so you have to protect the old people, while not harming the population in general, through this collateral damage. Now, that's for a very contagious disease. If you have another disease like Ebola, for example. This is more, which is a more deadly disease. But we did have some Ebola in the US some years ago. And there the key is not as contagious. So the key thing is to contain it and suppress it so that it doesn't spread you infect others. And you do that by quarantining people who are sick. And by having all the protective gears for the hospital, people who care for them, and then to do was his contact tracing and testing where you say, Who are they in contact with, you ask that, then you test them to see if they have Ebola, if they did all about to be isolated, as well. So that's something that you can do for something that is less contagious, that you want to suppress. But that's the technique that's impossible for the seeds to influence, or for disease like COVID. It doesn't work because it's so contagious, that so many people that eventually most people are going to get it.


Nick Jikomes 10:50

So So a key variable here is the contagiousness of the disease, how easily it spreads, because that determines whether or not it's even going to be possible to suppress it.


Martin Kulldorff 10:59

Correct. And it's mostly because how contagious it is, it's also depends on how easy it is to detect before it continues to spread. So if it's a very serious disease, like Ebola, you know that if somebody has Ebola, you know, because they get very sick. So you can, you can identify them for a thing like influence our COVID, some people get very sick, but others get only very mild symptoms are no symptoms. So then it's a harder also to see how it spreads. And we knew that from the very early on, because outside of China, the two areas that was hit hard very early, the first two were hit very hard where northern Italy, and Iran. Now we have no clue who brought it in there, we can still trace the people in front of him there. So that means it's anonymous, already many other places around the world at that time. So that means it's impossible to, to suppress and suppress it through contract racing, and then testing.


Nick Jikomes 12:09

I see. So if particular contagion can present with mild symptoms, where you don't even realize someone is sick. It's It's futile to try the contact tracing and suppression route, because you're simply not going to be able to see everyone who's sick, and they're going to spread it anyway.


Unknown Speaker 12:24

Yep, pretty much.


Nick Jikomes 12:26

So I do. So I do want to kind of go back to those early days of the COVID pandemic. So I can remember back to very early in 2020, when some of this was happening. I live here in Seattle, which also was sort of relatively early in terms of when we started seeing it here compared to other spots in the US. That


Martin Kulldorff 12:44

was one of the early hotspots. Yeah, yeah. So


Nick Jikomes 12:47

I, you know, I remember, in the very early days, it was, you know, very unclear, at least to me, and the people in my life, how serious this was how contagious it was. And so we were all literally, in our homes, you know, wondering what was going to happen, but you know, as, as experts like yourself, and others started to learn about SARS, cov, two coming out of China in late 2019. But before it kind of became the full blown pandemic, and and became aware, the public became aware of what was going on. What was what was, what were your initial reactions to the prospect of a global pandemic? Did you think it was likely by the time we got to early 2020? How were you looking at it at that time?


Martin Kulldorff 13:27

So that's good. So I was. So first of all, when, when it hit Italy and Iran, it was clear, I was obvious that this was going to be a worldwide pandemic, and that he will eventually hit every all parts of the world. So that was clear to me, very early on. Second, I was worried for maybe 1020 minutes, I was very worried. And because I knew he was going to spread to the world, so he would eventually hit everybody I know care about and every country. But I then looked at the data from Wuhan. And the mortality data. And I could see there that the people who had died because very early on in Wuhan were mostly older people. There was a huge I think there were very, very few young was one person who was somewhat young, but was basically older people. And at that time, nobody was taking taking precautions because nobody really knew what was going on at that time. So presumably all A's crew were approximately equally exposed. I would expect that middle aged people were probably exposed more because they're more active in the in the in society and maybe older pupils slightly less. And very young children maybe also less, because maybe they are more home but fairly equal distribution of being exposed to the virus. At the same time, it was only the older people who were dying. So at that time, it was already very clear that there was a huge risk gradient in age. And I did some calculations myself then, and found that it was more than 1000 fold difference in the mortality risk, based on those four numbers only. And that's turned out to be correct calculations. Those estimates are, have been validated from other places of the world. So that meant that I have three children, as every parent, I am more concerned about my children and by myself. So it was clear that this was not dangerous to them. They were not gonna die from this disease. And then I wasn't really that scared anymore. I'm in my 50s. So I, I was sort of medium risk, but I figured I was not at any more risk of dying from COVID than I was from being diagnosed and dying from cancer in the next so many years. So, to me, it was not so scary for that, so that I wasn't scared anymore. Now, we didn't have that. So at that time, I was able to calculate the relative risk by age. At that time, we didn't know what was the absolute risk. We didn't know if it was very, very low if it was somewhat high. On the other hand, the strategy for dealing with the pandemic depends more on the relative risk than an absolute risk, because we weren't going to be able to suppress it. So what was the key then, was to use the relative risk knowledge, we had to protect the oldest people who, who needed protection, and that strategy would be valid no matter what the absolute risk is.


Nick Jikomes 17:19

And there for people, can you just explain the difference between relative and absolute risk.


Martin Kulldorff 17:25

So for example, if if a young person has a risk of one in a million, and an older person has the risk of dying one in 1000, the relative risk is a million divided by 1000. So the relative risk is 1000. Settle relative risk. If, if the risk of dying for an older person is for younger person, one is 10,000. For all the person is one in 10. That's a much much higher risk is 100 fold higher risk. On the other hand, the relative risk is the same, because 10,000 divided by 10 is also 1000. So the relative risk between the ages is the same, but the absolute risk is much bigger in the second scenario.


Nick Jikomes 18:15

I see. So like an old person can be 100 or 1000 times as likely to die from something. But you could have another you could have another virus another contagion where the same thing is true. And yet that one is like 100, or 1000 times as deadly, just in general. Alright, so yes, yeah. So one of the things so so we'll probably come back to this in a number of ways that there's this relative risk thing that has to do with the disease being much more severe the older you get. And, you know, again, if I think back to early 2020, earlier, mid 2020, in Seattle, the big thing that was happening here was all of these outbreaks in the nursing homes. And from my perspective, early on, it sort of seemed like a wow, somehow it's specifically in the nursing home. But what I now know in retrospect, is that was actually probably spreading throughout society. It's just that it was more severe in the elderly. But one of the other things I remember that I would, yeah, I would love to get your comment on is people are getting old people in nursing homes are getting sick, you're being taken to the hospital, and then they're being taken back to the nursing home. And that, you know, I know in retrospect, was not a good idea. But at the time, was that a wise decision? Or is that something that we we only learned later on was unwise, and what does that start to tell you about? How are we were dealing with this early on?


Martin Kulldorff 19:33

It was not a wise decision at the time, it should have been obvious to anybody, but there was a very bad decision. We knew that the older people were at highest risk and of course, in nursing homes were not only old, but they're also more frail. So we knew that they were at the highest risk. So to send sick patients to Nursing Homes is basically the same as killing people. Not deliberately but the practice, people die because of that many people die because of that.


Nick Jikomes 20:12

I mean, what was the reasoning? What was the reasoning there that like we wanted to keep them out of the hospital to not contaminate more people in the hospital? What was the thinking that was had there?


Martin Kulldorff 20:24

I think the state of rationale was to open up beds in the hospitals. So once they had sort of were on the path of recovery, they wanted to open up beds for other COVID patients that are expected to come in. And fine, it's fine to have them leave the hospitals, but then you have to put them in a special facility where they don't infect other people, you don't send them to all nursing homes. It's all the thing that went wrong during this pandemic. Yeah, that's one of the big ones for sure.


Nick Jikomes 21:03

I see. And, and, you know, you just said of all the things that went wrong. So you know, everyone at this point has an opinion on on different things, whether or not they're an expert, or not. But I want to obviously get your expert opinion on some of this stuff. You are famous and infamous, I suppose for writing this document called the Great Barrington declaration. So that was written in 2020. You co authored it with some other scientists, can you explain for people who don't know what that is, what it is and why you wrote it


Martin Kulldorff 21:37

was written together with two other infectious disease technologist. One is Dr. snippet Gupta, Oxford University who I view as the preeminent infectious disease diagnosis in the world. And that is Dr. J. Barcia. At Stanford University. So the integrate Barrington exploration, we put forward a call to deal with a pandemic using focus protection, where we are going to do a much better job protecting older, higher risk people. While at the same time, we were very concerned about all the collateral public health damage. So we were urging children or younger people to live near normal lives, to minimize the collateral damage. And for example, to keep the schools open for children, it's important for children to go to school and to have a good education both for what they learned, but also for their social development, and so on. And nothing of this was any novel or new at the time, this is the same thing that was part of the pandemic plans that had been prepared by many countries long before the pandemic plan before COVID. So there was nothing new and novel. And as we were sort of just re re re iterating basic principles of public health that had been thrown out the window. And the three of us as well as many other infectious disease, technologists around the world, were very frustrated. Because we were trying to speak up and say that this strategy against COVID was not a smart strategy. And in the beginning, we were silenced. So it was very difficult to make our voices heard, not just the three of us, but others as well. So the thought was that, and there were different excuses, there was four silencing people, one of us were the only one person and this goes against the established thinking and narratives or this person is not an ethnologist, etc. So we thought that if the three of us get together, we write this declaration, we all infectious disease technologists, so they can sort of dismiss us from that. And there's three of us rather than zero, or only one person, so 331, and we all from reasonable respectable universities. So our hope was that by writing that it will be impossible to ignore that, ignore this. And to make it clear to everybody that what was claimed to be, they claim that there was scientific consensus for these lockdowns and these other restrictive measures, and for not properly protecting the older ones thinking about lock downs for protect, sort of shutting down society and protect and lock now we're protected all the way which is to not wasn't the case. So to show to sort of make it clear that the established narrative and strategy for the pandemic that was sort of forward by Anthony Fauci She in the US as well as other people in other countries, there was actually no scientific consensus for that. And we succeeded, I think, because it was we didn't make it clear that we weren't, we weren't able to change the strategy except in a few places. But we made it clear that there was no scientific consensus for the strategy that the US and other governments employed. And we had over 10,000, other public health scientists signed on to the declaration as well as hundreds of 1000s of people, members of the public.


Nick Jikomes 25:39

So what was, you know, what's the most generous characterization you could give to the strategy, the people that were in favor of the strategy that was implemented in the United States? And who were against the strategy that you were advocating for? So so if you were, you know, you know, what would be Anthony Fauci his perspective on this, what was his justification for, for that approach, if you had to characterize it in the fairest way possible?


Martin Kulldorff 26:07

So I think they viewed it similar to how I described Ebola. That they, their aim was to suppress it, to get rid of it. Even though that was impossible, and we now know that it was impossible, because never ever before in the history has been such harsh public health measures, and people did a great job, obeying those those restrictions and mandates that came from the government. So you can't blame the population, the citizens were doing it, because they certainly did their part. So, but it was a futile thing from the beginning. To do this for for COVID. And so the most terrible thing to say is that he truly believed that it was possible to suppress this virus, but he wasn't. I see. So he did everything he could to suppress it.


Nick Jikomes 27:10

So so like, I remember, I think everyone remembers the, you know, the two weeks to smash the curve meme. And, you know, that was shared widely all over the place. So you're saying you're saying the strategy was really, like you were describing for a bola that if you go into lockdowns, and you get everyone to behaviorally, change what they're doing, you can actually isolate all of those who are sick, and prevent this thing from spreading and suppress it. And that works for something like Ebola, which is not nearly as contagious and as easier to see when someone is sick. That strategy is implemented for COVID. Well, you're saying is because it's so contagious? And because of the mild or invisible symptoms that that some people many people present with, that there was just no way this was gonna work even in principle, even and that was known to at least or that was the view of you and and a not insignificant number of experts even back then.


Martin Kulldorff 28:03

Yeah, so I think any I mean, if you know your initial decision, because it's sort of obvious that it wasn't going to work. Now, the problem is that I've met Fauci is not an ecologist or public health scientist, he is an immunologist, a lab scientist. So he understands immunology and viruses from sort of the, the detail perspective of somebody in the laboratory. But to understand whether you can suppress something, you have to understand how the virus spreads, and the probabilistic nature of how viruses sort of move in a society. So what you can do and what was done is by doing some of these measures, some of them are measures, I think were completely ineffective. But some of them like, for example, social distancing, that will temporarily sort of push the Parliament of the future. Now, at the very beginning of the pandemic, we didn't know exactly how serious it was. And there was a concern about overcrowding the hospitals now think that was a very valid concern. So too, and this concept of flattening the curve, I think it's actually a valid concept. Because, okay, people are going to get sick, but you don't want everybody to get sick at the same time, because then you can't give them proper health care. So the idea of flattening the curve is basically to is not to remove move it but to to flatten the peak to spread it out. So instead of everybody getting sick the same, two or three weeks, you spread it out over two or three months. So that's a very valid thing to do. And it could have been done with better Ways closing schools didn't help with that. But making sure that all people didn't go to restaurants that did sort of help with that aspects. So I think that was completely valid to do that. But that mean that that's something that should be done for for a month or two at most. But this sort of continued for several years for two years. And then it's no longer about flattening the curve, it's about suppression, which was impossible.


Nick Jikomes 30:31

I see, I see, you're saying that it's possible to, it's possible to slow the spread of something that's contagious so that your hospitals and healthcare infrastructure doesn't get overwhelmed. But it is not possible to completely suppress it. And that's, that's the difference between these sort of temporary, that sort of temporary, flatten the curve measures versus the perpetual lockdown


Martin Kulldorff 30:52

crises, you can postpone at some at some, you can postpone some new faces into the future.


Nick Jikomes 30:57

Yeah, I suppose we've sort of seen multiple cycles of that at this point, right, because we've seen multiple waves of different variants come and go. And it's, at least to me, it's not obvious that the particular measures that anyone was adopting was, you know, preventing that from happening.


Martin Kulldorff 31:15

Yeah, and those waves actually offer a different reason as well. And that's because it's, we now know that COVID is seasonal. We didn't know that back in March of 2020. But we now know that so there is more COVID. So in the northern hemisphere, like Northern the US, for example, Northern Europe, there are more cases in express more easily during the winter months. So therefore, we have a wave in the winter, and in the summer, there is less. So what basically happens is that in Italy, you have something called the reproductive number, if, if a random person gets sick, how many other persons does does that person in fact, if the average number is less than one, then the professional peter out, if it's more than one, we are spread and spread. Until then there are enough people who all would have been sick, and then you get to have immunity, so then they can't get it, and then they will lower it. But these thresholds is different in the winter or the summer. So what happens is, if it's less than one, that means you have what's called herd immunity, enough people have immunity, that the infection can no longer spread successfully, and in effect, more and more people. And that threshold for her immunity various over time was for seasonal disease was lower in the summer, and it's higher in the winter. So that means in the summer, it is it's less contagious, and therefore, fewer, fewer get it and there will be sort of just be a little bit. And then in the winter, I guess more contagious again. And then you have another wave. Now, in suddenly us the seas. Now this will be different because they have smaller winter weight, but they also have a summer weight. And we don't necessarily know exactly why that is. And we don't know exactly why what's causing the seasonality could be temperature could be humidity, could be the fact whether people are indoors, more outdoors more, or could be a variety of these factors. And additionally, we don't really know what is causing the system, but we know that there is novelty. And we can see also in the southern southern hemisphere. They have their peaks in June, July, August, which is their winter season.


Nick Jikomes 33:48

And so with respect to the the idea of herd immunity, the The basic idea is of a sufficiently high percentage of the population, gets an infection and then recovers. You the herd of people, the full population of people builds up immunity and that decreases the ability of the virus to continue spreading. So so in this document, the Great Barrington declaration, you talked about focus protection, focusing on the most at risk people, which are older people, especially. And you talk about the idea of herd immunity. And I know that some people characterize this, this strategy as being very, very inhumane. And there are people saying, well, you're just want you just want to passively accept that this virus is here and let it spread through the population. And that's inevitably going to lead to more people getting severe disease and dying. And it was being character. I mean, I think the World Health Organization had said that reaching herd immunity was an unethical and unprecedented strategy. So what's your response to those characterizations?


Martin Kulldorff 34:52

So first of all, herd immunity is a scientific fact just like gravity. And that's how pandemic ends. When enough people are immune, then pandemic will enter the endemic land epidemic will end. But and then new people are born. And then they are susceptible because they don't have immunity, and then they will be infected. And then when enough was also affected, it will go down again until there's enough newborns to sort of have another, another wave of it. So before we have a measles vaccine, for example, measles came in waves, because you had a wave. And then enough was immune, we had heard immunity, but then new people are born. So maybe two years later, another wave, because now you have all these young children who are not new anymore. So that's infectious diseases work. So to talk about a herd immunity strategy is nonsense. Because every strategy is a COVID, really to have it will lead to her immunity, the lockdown strategy will also lead to herd immunity, because that's the way infectious disease work, you have seen that was, well, that's what's occurring now. We are sort of moving to the end of this pandemic. And that's because more and more people have had COVID. And therefore, more and more people are immune. And therefore the time we will end, it doesn't mean that people will not get it a second time, potentially. But once you've had it, if you get it the second time effective, then your risk of dying is much less. So that's what's occurring with our previous four Corona viruses that are wildly circulating for for a long time, for probably more than 100 years. And they they don't cause any serious diseases for most people, because most people are exposed when they are young, when this is not a serious thing, and then they have protection for later on. And then maybe when they are 93 years old, they will get it the last time and then they are so weakened immune system is so weak, so maybe they will then get pneumonia, and therefore they will die from it. So so that can happen for the very old and frail. But that's sort of the dynamic stage where people might get infected, but it's not serious because we all gonna have the immunity.


Nick Jikomes 37:28

I see. So so the idea of herd immunity, it's not like there's a herd immune immunity strategy, or there's a different strategy, eventually there will be herd immunity no matter what it's just a matter of how exactly we get there and how long it takes.


Martin Kulldorff 37:41

Exactly, that's exactly what it is. And what herd immunity means is that if a certain percent of the population, how are immune, it varies by diseases and so on. And it depends on exactly who is immune, but to say it is 80%. That means that those 20 Plus extenders, then the virus can no longer circulate efficiently. So that means that those 20%, who haven't been sick yet, they're actually protected by the herd by those who already are Indian. So but but one thing that has actually happened is that we all had new variants that are more contagious than the earlier ones. So the OMA covariant is more conditional Delta variant, and the Delta variant was more contagious than the previous variants. And that means that when we get a virus even more contagious, that means that the threshold for herd immunity goes up. So we don't know what the numbers was, but maybe it was 6070, or something for the earlier ones and alpha Omicron is actually close to 100% 95% or so more. So it basically means that by doing this lockdowns, by sort of holding back that spreads among those younger people who are not at risk. By doing that, we sort of forced the virus to mutate into more, more variant more more contagious variants, because that was the only one way for them to sort of see the various virus to succeed. And there was enough susceptible people to sort of for the new variants to spread. So that means that with these new variants, the 100 threshold is larger. And that means that more people will be sick before we reached our immunity, which means that the proportion of people that we can protect through the data protected by by the herd and their immunity is actually smaller IC. So it's, it's actually counterproductive to do this because we got this more contagious variance. I see some more that made it more difficult to protect those older, very vulnerable people.


Nick Jikomes 39:55

So just to reiterate that what you're saying is, if you've got a virus and Got a certain level of contagiousness, it could mean that, to reach herd immunity, maybe 60% of the population has to be exposed to the virus and get infected or get vaccinated against that. And once you get to that 60% of the population with immunity, you sort of you're protecting everyone, including the other 40%, who have not been infected, yet. But if another more contagious virus comes along, maybe that number goes up to 80%. And now you've got to have 80% of the population that's exposed or vaccinated to protect the 20%. So now, there's an even smaller number of people that are in that that smaller group and effectively what's happened as as these lockdowns have progressed, and as these more contagious variants have come, that number is kept going up, the percentage of the people that need to be exposed are immune. And so it's it's actually, I mean, you're saying it's actually counterproductive that that happened.


Martin Kulldorff 40:54

Yeah. And I mean, when the vaccines came, we were hoping that the vaccine would help with immunity, and help with herd immunity. But unfortunately, that was not the case. So the vaccines were very good at protecting severe disease and death. So therefore, I mean, it's very important for especially older people to get the vaccine, if they haven't had a COVID already, because then they're immune. But if they haven't, that COVID All the people, it's very, very important for them to be vaccinated around the world, no matter where they live. But we know that the vaccine doesn't really protect you from getting infected, too. It doesn't really reduce transmission, it might do it for a short period of time. But vaccine, the efficacy of the vaccine against being effective wanes very quickly within a few months. So that means that we need the vaccine is not really helping ending the pandemic and ending the the spread of the disease, we have to rely on national immunity. And that's what people who are vaccinated, they're still getting infected. But then once they get infected, they have good immunity for the future. I see. So the vaccines are very great and important for reducing the severity and mortality from COVID. But unfortunately, it didn't, it wasn't very helpful in terms of building the immunity in population.


Nick Jikomes 42:25

So it's been very clear that these new vaccines do decrease substantially the mortality risk and the severity of the COVID you get if you get infected, but you're saying that they have not been as good as we hoped at reducing transmission, is that typical for a vaccine? Or does it really depend on the vaccine in terms of how effective it is at reducing transmission and infection?


Martin Kulldorff 42:45

It depends on the vaccine. So for example, the measles vaccine is very good at reducing transmission. So the measles vaccine protects both against Sadat of the disease, but basic. Most people who have measles vaccine, the vast majority will not get sick and will not transmitted to others.


Nick Jikomes 43:08

I see. And, you know, on the subject of vaccine induced immunity versus natural immunity, this has also been something that's very controversial. In at least in the public sphere, I think, you know, my perception has been that, you know, discussing the potential effectiveness of natural immunity has been controversial to a lot of people, because I think a lot of people think that if natural immunity is effective, or we tell people that it is effective at preventing future infection, this might incentivize more and more people not to get the vaccine. And there's some concern there. And so I want to start talking about the the immune response induced by the mRNA vaccines as compared to a natural infection. And I think maybe a good place to start is, I know that you've written about, you've written about the subject, and in 2021, in the fall, there are two studies about natural immunity that came out one was from an Israeli group, and one was from the CDC. So can you talk to us about those two studies and what they started to tell us and why that's interesting.


Martin Kulldorff 44:14

Yeah, so the study from Israel was one of the first one. So first of all, the fact that you have better immunity from having recovered from the disease that is better than the immunity from the vaccine is shouldn't be controversial. Because that was you expect. The vaccines are meant to sort of simulate the immune response from the disease without you getting sick. But typically, it's not as effective as doing that as being sick. It's sort of better still better to get the vaccine because you don't get sick, you don't risk dying. But once you've had the disease versus once you've had the vaccine, you will expect the person who have the disease to have better immunity. And of course, we've known about natural immunity for for two and a half 1000 years since 1430 BC during the Athenian plague, whether knew that it wants to recover from the plague, you are not at risk of, of the disease anymore, and they use those to sort of care for for the sick. So what is really study do the so called so it's nothing surprising in this what the study was did this for for silica COVID. And it looked at at those who are vaccinated versus those who have recovered from COVID. And they found that those who were vaccinated had 27 times higher risk for being getting a symptomatic disease of COVID versus those who were recovered. So that's very clear evidence that natural immunity is stronger than vaccine immunity. There was also a difference for hospitalizations. But in both groups, number of deaths was zero. So both the vaccinated and those were recovered, were well protected against death. But now, we asked me many other studies since then, who has sort of reproduced the Israeli study showing that natural immunity if the core recovery is better than vaccine immunity. Now there was the CDC study that you mentioned, which was very, very strange, because what they did, they looked at people who came into the hospital, and whether there had COVID, or whether they had some other respiratory disease, and then to see whether they were vaccinated or not. But that's a flawed, ethnological design that they used. They weren't really comparing the vaccinated versus unvaccinated with a bedrock disease. They were basically comparing those who were hospitalized for COVID versus those who were hospitalized for other respiratory diseases. What was their vaccination status status? So there was sort of comparing not the viral compare the two right groups, and I wrote, it's hard to describe, verbally, especially since it was a few months since I wrote this, but I wrote sort of a better comparison of the strengths versus weak weaknesses, are these two studies that are published on browser Institute? So? Yeah,


Nick Jikomes 47:49

I guess the point is, so these two studies come out in the fall of 2021, one from an Israeli group, one from the CDC, they come to different conclusions about the effectiveness of natural immunity. But the CDC study is a God of different design, which which struck you at the time as a very strange design, the Israeli study was well controlled in a number of ways. And since then, a number of studies have replicated the result of the Israeli study, which is the expected result the entire time, which is that of course, natural immunity is going to be more effective in certain ways, just because you're, you know, you're being exposed to the full pathogen.


Martin Kulldorff 48:23

Yeah. And actually, CDC came up with a subsequent study, which was well designed, and that showed similar results to the Israeli study.


Nick Jikomes 48:32

I see. And so do you think that this was just a flawed study that came out? Because people were maybe not as careful as they should have been? Or maybe the researchers were not as experienced or something? Or do you think that they wanted to publish this at the time because they thought that particular results was worth having out in the public sphere?


Martin Kulldorff 48:57

I think there's probably two reasons, I think and chances are some of the scientists probably thought that they were doing a good study, even though they didn't realize that it was a flaw study design. And then they sort of presented that, I think, but that's sort of the individual scientists. So the question is, then why was this sort of blown up? Or propagated so much? And I think that's because probably, so the director of CDC, Russia Wolanski. In already in 2020, she came out, questioning national immunity. Together with a few other scientists, they published what they called a memorandum in The Lancet, which is the British Medical, supposedly prestigious British medical journal. So they were at that time they were questioning the existence of, of immunity after recovering from COVID which was very strange because all of the band, we knew that very few were, were infected more than once. And it went sort of against what we would expect, historically from infectious diseases. But for some reason she went out with that thought that questioning immunity after recovering from COVID. To me, it's very strange to have a director of CDC who doesn't believe in national immunity. It's like having a director of NASA who is questioning whether the earth is flat around. Because it's such a basic fundamental aspect of infectious disease technology. So I think maybe some sub something was sort of, maybe she felt that this study was sort of indicating her position from before, and therefore she was pushing it.


Nick Jikomes 50:57

Yeah. And it's, um, I mean, it's also not difficult to imagine how these things can happen sort of organically, it's, you know, you can imagine, you know, if, if your boss, if the director has come out stating like one thing, they don't necessarily need to come to you and tell you to go find that answer. But if you're doing a study, and it seems to be that one result is congruent with what your boss has heard, he said, You'll maybe have less incentive to to dig deeper into it, then than otherwise.


Martin Kulldorff 51:24

Yeah. Now, that's probably how the human psychology works sometimes.


Nick Jikomes 51:29

So I also want to get back to discussing the mRNA vaccines themselves. So not only are these new vaccines in the sense of we've recently created them to help with the COVID pandemic, but it's a new kind of technology, they work in a different way from a normal vaccine. It's something that I've discussed on the podcast before. So I don't think we need to go into too too much detail about like the mechanics of the mRNA vaccines. But you know, What's your general perspective on the overall effectiveness of these vaccines so far with respect to mortality with respect to contagiousness? I know that we've touched on this before, but I just want to reiterate it for people.


Martin Kulldorff 52:06

So let's go back a little bit to the late 2020, when these vaccines were approved Pfizer Madrona. And it was quite interesting in that, when they were approved, they were approved because they did a randomized trial, which is what they're supposed to do. And they were able to show that there were about 95% efficacy against symptomatic disease. So that's what they showed in the study. And that's why they were approved during the emergency use authorization. At the time, there were two things we didn't know, because randomized trials didn't even attempt to answer those questions. We didn't know if it reduce transmission art. And the whole positive word, because the hope is if you can reduce symptomatic disease, you will hopefully also reduce transmission. But that wasn't studied in those trials. The other thing that wasn't studied was it reduced mortality. So when this were approved, we know it reduced symptomatic disease, but we didn't know if they reduce mortality. And the reason we didn't know was that when they recruited patients to this randomized trials, the vast majority were young or middle aged adults, between ages 18 And let's say 50, or 60. So there were very few people in their 70s 80s and 90s in these studies, and if you're in your 20s 30s or 40s or 50s, you're likely to survive whether you're vaccinated or not. So there was very few deaths in either group. So if they had wanted to study mortality as outcome, which is the most important outcome, they should have recruited mostly older people in the 70s 80s and 90s. But they didn't do that. So this, the Pfizer Madonna's that is actually not designed to determine whether it reduced mortality or maybe I should say they were designed not to be able to determine that. So we knew at the time when they were approved through the mercy of operation, we knew that they reduced symptomatic disease within the next few months because obviously, we had to be able to follow the people more than a few months because it was


with the code hadn't been around had been around for less than a year. so you can follow them for more than a few months because this trial started, I think, around August or so. So we knew there was short term efficacy against genetic disease, but we knew nothing else. In terms of from the trials. No, the what it turns out was that the hope that they would reduce transmission to not to be not true, it doesn't reduce transmission, maybe yes, briefly. After that, they will reduce mortality did play out, it did a good job reducing mortality.


Nick Jikomes 55:31

So did you did you personally get vaccinated with one of the mRNA vaccines? And you know, given your age did, how did you think about that in terms of risk benefit?


Martin Kulldorff 55:44

So I think, medical, what one decides for one's own medical treatments, I think should be a personal decision. So I'll refrain from answering that. But I will answer in terms of as a public health scientist. For that, if you had COVID, already, you have very good immunity so that you don't need the vaccine. If you haven't had COVID, if you are older person, then for sure is very important to get the vaccine that will reduce the risk of hospitalization, but even more importantly, the risk of death. So if you're above 60, you definitely should get vaccinated, maybe even in your if your 50s. If you're a child, the risk of you can still get infected, but the risk of mortality or hospitalization is minuscule. So children do not give us vaccine. We can give an example from the first wave in Europe, where Sweden did not close down those universe, the only major western country didn't close down schools, who kept schools open throughout the first week of the pandemic for all children between ages one and 15. Daycare in schools. And there are 1.8 million children in Sweden of this age group. And I psyched to see rotation COVID During this wave, and there was just a few hospitalizations, and teachers for no higher risks than other professions. So we knew very early on that COVID has miniscule risk for children. And I also work on vaccine safety to evaluate the vaccines. And there's always uncertainties about the risks that we don't know that there are some risks like myocarditis, which is inflammation of the heart, and blood clots from some of these vaccines. So there's always some risks are done. And if you are, if you're a 77 years old, the benefit, in terms of reducing mortality is enormous for the vaccines. So even if there's a small risk from some adverse reaction from the vaccine, the benefits outweigh the risks widely. So it's a no brainer to take the vaccine in my view. On the other hand, for a child, even a tiny, tiny risk would outweigh the benefit, because the benefits are, are almost non existent. And we actually saw a recent paper coming out from the New York State Health Department, looking at the benefit of these vaccines for children. And for those who are five to 11 years old. They were very small benefit in terms of symptomatic disease, I think it was a 12% reduction, which is which is ridiculously low for vaccine. And they also looked at hospitalizations, but it was not statistically significant reduction. Of course, there was no death in either group, because the death are very small with it for sure if you have a PhD or not. So I think the data is sort of confirming that for children. These are not important vaccines. Now, where do you put the cut offs in age? I don't know. So I think people have to sort of make a guess themselves when and where that cutoff should be.


Nick Jikomes 59:36

I see. So what is your How are you thinking about new variants? We've talked about some of the variants a little bit. They have tended to become more contagious over time. Do you think you know can you talk a little bit more about the the extent to which these new variants were evolving sort of spontaneously on their own, so to speak versus evolving? It As a direct reaction to some of the selective pressures we were placing on them, because of how we were responding to the pandemic socially.


Martin Kulldorff 1:00:09

So, they will always be mutations in a virus, and most of them will not make any changes, because they might only influence the fact that few people. So it's when the rest mutation that makes the virus more contagious, that's where that's when that will sort of take over from the old variants. So that that's sort of what that was bound to happen. So that's why the Delta variance was more contagious. And that's why sort of competed out other ones to previous variance, and then the former current was even more contagious. So that's what's competed out the delta. So you would expect when you have new variants, so the mutation might be more or less contagious, but it's the mutations that are more contagious, that will actually sort of evolve and then sort of compete with other ones. So that's what you would expect to see. New variants can be either more or less dangerous, more or less fatal, so that I think could go in either direction. But more, but mutations, new new virus spread will be typically more contagious. Now, variants will sort of occur. Variants will occur randomly in different parts of the world. And what happens is that if a lot of people get infected early on, then those variants that occur won't really have much time to spread. Because already a lot of people are immune. i We know that this immunity cross these variants, so if you had one variant, you're still immunity immune against other ones. On the other hand, if you drag it on more longer, we should deal with lockdowns and social distancing. That means that those variances when they occur, they have more time to spread around the world. So that's exactly what happened. This sort of when the Delta variant came, there was still a lot of people who were susceptible who weren't immune, and therefore it could spread from the Omicron came later on, there was still a lot of people who were immune, susceptible, not immune susceptible and sort of spread. After Omicron, I think that most people are going to want to charisma cause most people to be immune, having had to have natural immunity. So I don't, I don't, I don't necessarily foresee that there will be another even more contagious variant that this will be able to spread.


Nick Jikomes 1:03:14

I see. So you think it's it's plausible that we are truly sort of at the end of the pandemic?


Martin Kulldorff 1:03:21

Yeah, because as more and more people have natural immunity, whether they're vaccinated or not, but they have had COVID, either, before they were vaccinated, or after they were vaccinated, then they will have natural immunity, and then we will enter the endemic stage, which means that the virus is not going to go away, we're going to live with this for hundreds of years, it can always be with us. But what's going to happen is that when you get infected, a second time is not going to be serious, unless you're very, very old and frail. But he will maybe filler, you may be might be asymptomatic, but you might see to have a normal cold, just like with existing coronaviruses. I was lucky was good. What sort of lucky with this that is not a serious disease for children. So children who are born susceptible, they don't have immunity, when they're born, they will get it in the first few years of life. And at that point, this disease is not dangerous. And I think that has to do with that they have a sort of a very adaptable immune system. So that can protect them at this early stage. And then once they've had it as a child that will then protect them from serious disease later on. So when they are 60 years old, they will have good protection against this virus, unlike those who are 60 years old now who hadn't been exposed to this throughout their lives.


Nick Jikomes 1:04:57

So it sounds like if I sort of taken everything that you've said It sounds like what you're saying is, if we hadn't if we had if we had listened to you and some of your colleagues, and implemented that kind of strat the targeted approach strategy that allowed us to reach herd immunity faster, rather than the strategy that the US and other other places often implemented, that we would have ended up in the exact same place, we just would have gotten there sooner.


Martin Kulldorff 1:05:23

Correct. And with less collateral damage on other aspects of public health, with less collateral damage, and education, and so on. At the same time, one of our big concerns when we wrote a grant writer declaration was that people thought that doing this general lockdown across the population will protect the old and vulnerable, the high risk people. And that was clear, but that wasn't the case. So one of our goals with a grand final declaration was to urge governments to do a better job protecting those high risk, older people who were not properly protected.


Nick Jikomes 1:06:07

And what are some of the major areas of collateral damage in the public health sphere that that you think are worth pointing out?


Martin Kulldorff 1:06:16

So I know that cardiovascular disease outcomes has gone down. People were afraid of going to the hospital either, but maybe because they were afraid of catching COVID, or because the hospitals were closed, they could only do a virtual visit maybe, or maybe because they knew if they went there, they wouldn't be able to be with their husband or wife or daughter or son or they will be all alone, because visitors from alone and therefore I know people who didn't go to the doctor, or the hospital because of that. They didn't want to be isolated, all alone. So cardiovascular disease outcomes has been worse. Another one is cancer. Now, that's different, because it doesn't mean that more people are going to die in cancer in 2021, or 22. Because this is more of a long term thing. But cancer screening is important. So for example, somebody who didn't get the screening for cervical cancer might not die three or four years from now, instead of living another 1520 years. So that's something we can have to live with and die with for a long time, these consequences. Another one is of course, I mean, diabetes care, care. We knew that childhood vaccination rates plummeted during in 2020. So that's concerning that children are not getting the vaccines that are critically need against for example, measles, and so on. We have mental health, which has deteriorated. We have more opiate overdoses and so on. I have a colleague who was working with she's a psychiatrist working with autism and families with children with autism. They deteriorated during this time because they didn't have they didn't get the proper treatment that they needed during during this lockdown, so during this pandemic, so some of these collateral polygraph diagnoses short term and others is long term, if we go to the developing world is even more tragic because they locked down they closed markets and so on. And many families there they live day to day, they they sell some projects on the streets on the markets and that's their income to feed the children for that day. And that was down so in India, you had people working for 10 days to get back to their home villages because they couldn't survive in New Delhi or in Bombay anymore. You have people in children in Africa who died from starvation or malnutrition, because of this and malnutrition has long term consequences for for health if you have if you don't get enough food when your child. So these are people who are already living on the on the edge and the lockdowns were devastating in the developing world. So I anybody who cares about people in other parts of the world in the developing world. It's impossible for them to sort of to support these, these lockdowns that occur during the pandemic.


Nick Jikomes 1:09:45

So, you know, obviously in the US there was one, we kind of took one path for the most part. And there were of course, differences between the different states. lockdowns were imposed, as you said in many places, but not everywhere. One of the one of the countries that I remember hearing about a lot in the news for some time was Sweden. And there was a lot of contrasting of what was going on in Sweden compared to here and other places, you yourself are from Sweden. And I would love for you to kind of compare and contrast the way that the US and Sweden handled their public health strategy. You know, now that we've had sort of two years to look back on it, are there any clear, you know, clear differences there in terms of you know, one strategy being more or less effective than the other.


Martin Kulldorff 1:10:31

So first of all, even though I'm Sweden, it's not just Sweden, I would say the Scandinavia as a whole have a different approach. Skimmia, Sweden, Denmark, Finland and Norway. If you look at sort of the severity, indexes on the lockdowns, those four countries all have the least severe lockdowns among Western Europe, European countries. And they also have among the lowest COVID mortality and very low excess mortality. So I think that that was a much more sound approach that was given even countries did based on basically basic principles of public health. It didn't mean that they did everything perfect. For example, in Sweden, in the first wave, there were a lot of deaths at the nursing home, they didn't protect the nursing home residents that are well, he was better in some other parts of Sweden, where they have a different where they have more smaller nursing homes, but the nursing homes in Stockholm was was a catastrophe. So that was a bad thing. But Sweden kept schools open for ages one to 15, as I mentioned, and why they were briefly closed in Denmark and Norway and Finland, they sort of quickly open them again. So that's very different from the US where, where school schools work close to many places for more than a year in some places for almost two years, which is, of course, very detrimental to children. And other differences, facial masks, there will never be mass mandates for children's in, in Sweden. While they were the US mean, the evidence from masks working is is very, very marginal. There's only been two clinical randomised trials on masks and in adults was was from Denmark, which show that didn't show in evidence that it worked. Another one was from Bangladesh, which was a community randomized trial, where they randomized villages. And they found that mass reduce transmission between zero and 18%. Somewhere so very marginal. So basically massive either no or variable efficacy in terms of reducing transmission.


Nick Jikomes 1:13:11

Why do you think so the sort of cluster of Scandinavian countries that took a somewhat different approach? Was that a coincidence? Or what what reason? Was it that was driving this difference in in the policies that they were implementing compared to other countries? Are they getting different information from different sources?


Martin Kulldorff 1:13:31

No, I think that they had access to the same information. I do think that the Scandinavian countries tend to sometimes we share languages, similar languages. So I think, various, that they maybe look a little bit at each other. So I think we are some of that. I think that Sweden had a very sound state acknowledges and understand now, as well, as an advisor, a former state emerges was the vice a young Jessica, who kept their heads cool during the beginning of the pandemic, and realize that this is kind of a long haul thing, and they didn't basically didn't panic. I think that's one reason I think also the populations in Scandinavia tend to be less authoritarian compared to other European countries.


Nick Jikomes 1:14:28

Interesting. You also mentioned a term a moment ago, excess deaths. What does that refer to? And why is that an important thing to track?


Martin Kulldorff 1:14:37

So excess death is how many people died, let's say in 2020, compared to how many you would expect in a normal year. So what do you usually do you compare? So for example, for COVID were to sit in the number of excess deaths in 2020 and 21. And then we can compare so we can compare the total number of deaths With what was the number of deaths in the previous five years, from 2015, to 19, for example. And there is one advantage of doing that compared to looking at COVID does, and that's that what is a COVID? F is not necessarily a simple clear thing to define. Many countries define it as somebody who died who had a particle COVID test during the prior month, for example. But you can have a prime, you can have a positive COVID test, and then give me a symptomatic and you die in a car accident. Well, that's not you decode it. So, so then, for actually, of those who are classified as COVID death, how many actually die from COVID versus with COVID. You can do those studies. But CDC has, hasn't really wanted to do those studies. And there has been some studies in other countries. Where I think there was one study in Sweden, where of the COVID has 20, I think 50% was reduced to COVID. I think about 30%. It was a contributing factor and 20%, it was completely unrelated. I forgot the exact numbers, but they were those three groups. So don't quote me on those exact percentages. But but with when you look at overall depth, you can't really fool around with a statistic because other somebody dies, they don't die, sort of very clear. So so that's one reason why it's interesting to look at access to stuff. The reason is that, well, if you do COVID measures that will affect death of COVID. But it also affects cardiovascular death, or, or diabetes death, for example. And what matters in public health is not just one disease. It matters health overall. So what really matters is what is the mortality from everything combined, both on COVID any collateral damage from the COVID strategy. So that's reflected in, in, in excess mentality, and there was one study, this came out, I think, in 2021. In the US, they found that if you look at the x, they looked at excess mortality in older people. And that was fairly similar to the COVID mortality. So it meant that most of the excess mortality in older people, but due to COVID. But then they looked at people in the 20s 30s and 40s. And they found that there was quite a bit of excess mortality, but that excess mortality was much larger than the COVID mortality. Now, was this due to underreporting a COVID? Well, probably not. Because then you will also have under reporting among older people. So you will see that effect, they also wish we didn't. So what's what's so my interpretation is that of the excess mortality in younger middle aged adults, a small part of it was due to COVID. But the majority of it was due to the collateral damage to the cardiovascular disease, opioid overdoses, etc.


Nick Jikomes 1:18:33

So you've you've been quoted as saying, I think referring to the US that both science and public health are broken. What What exactly do you mean by that?


Martin Kulldorff 1:18:50

For public health, we threw out the basic principles of public health for this pandemic. The results were not good. And I think that's being more and more obvious to more and more people. So it's natural that people no longer have the same trust in Public Health Authority. Agencies that they used to have. As for understandable, so for example, for for CDC and the government to insist that people who have already have immunity because they've had COVID. That doesn't count, they still have to be vaccinated, that goes against basic public health. And it's even worse because you have nurses and doctors who worked in the COVID wards during the height of this pandemic, TennCare COVID patients, many of them got infected. They were homesick for a while and recovered now they and then they went back to work. And then suddenly those hospital administrators who had been working from home out of risk Now vaccinated decided that these nurses and physicians who have superior immunity, they were going to be fired by the hospital for not being vaccinated, that's goes against science goes against public health, they should have the opposite. They should take special hired nurses and physicians with natural immunity and put them to work on the geriatric worse, were the most vulnerable high risk patients for COVID work because even if they're, even if the vaccine doesn't give 100% protection, so even if this all the patients were vaccinated, they can still contract COVID and die from it. So they should use the nurses and physicians with natural immunity on those words, because those are the least likely to infect those vulnerable patients, but this fire them. How can you trust hospitals? How can you trust CDC, who make this decision that goes completely contrary to both scientific evidence and basic principles of public health? So that's one aspect. Other thing is I think we're sciences that we saw a situation where there were in terms of her thinking or bubble thinking, a certain narrative became the established narrative that you will not allow to question. And so scientists were slandered or attacked for speaking up against the established narrative. And a lot of scientists therefore kept quiet because they were afraid of speaking up. And one example where I was is that the director of NIH, said that those of us who wrote the grant writer declaration, we were finished ethnologist had to be taken down. That's what he wrote to Anthony Fauci, who, who concurred. And then he director and Anthony fat, sits on the biggest pile of medical research funding in the world. Sort of Anthony Fauci is the director of the National Institute of Allergy and Infectious Diseases, which is part of NIH. So Anthony Fauci system, the biggest pile of infectious disease research money, so that they are propagating a particular strategy, which turned out to be catastrophic. But they said in all the research money means that scientists do not dare to speak up against them, because they will be attacked and slander, just like we were who wrote the grip rehabilitation. And you can't have science function like that. Science only functions by having an open discussion. So for example, the author's who wrote his CDC paper, which I think was very bad, but they shouldn't be silenced and prevented from doing it. They need to be able to present what they think is good research, and then I can and others can criticize it and say, No, these are the reasons why that's not a good study. But they should never ever be silenced. And they should never be slandered or attacked, for presenting what they think is a good science, because


science works with, with putting things out there and then discussing it. And if you can do that science cannot progress. You can't have science that has to sort of follow a particular narrative. Because the death of science that means that if you go down that road, that means the end the final years of enlightenment in terms of the science. So we have to have a situation where we don't have we have an atmosphere where everybody feels that they can present things and then we discuss it and sort it out. Both both I and Dr. Bhattacharya Gupta, we have always been willing to discuss our view of the epidemic with those leading people like Anthony Fauci or others who supported him to have a frank discussion about it. But there were very few people who even dare to do that. Some did, and I respect them. Some did do it with us and had a different views and I think that was very instructive for people to listen to. So I respect those who are willing to debate it even though they had different views than us. But in terms of Anthony Fauci, he has not been willing to debate anybody and the only one who he has forced to is Rand Paul? Because he has to do the Senate hearings. And he's one of the few members of Congress who, who, who is a physician. So he knows not something about medicine. But other than that, Anthony Fauci has not been willing to have any discussions, open discussions about his his his misguided strategy.


Nick Jikomes 1:25:26

Do you think, you know, part of the problem here, based on what you just described is, you've got the same individuals in charge of setting or at least promoting the policies, who are also in charge of where the research dollars goes, should there be some kind of separation of church and state there? Ideally,


Martin Kulldorff 1:25:44

it should be. So that's another good point there should be. And actually there is, because NIH responsibility is to do fund the research for responsibility of the policy is CDC. So organizationally, there is a separation, but somehow Anthony Fauci sort of went in and what to do the policy side, which is very weird, because that's not his job. That's the job of the CDC director. To organize that, what is the job of Anthony Fauci is to found the science that's needed to deal with the pandemic. And unfortunately, that failed. Because one thing that should have been done very early on is to organize clinical trial, randomized trials on various treatments. Doesn't matter if you think they are good or not. They should have been studied in randomised trials to actually find out if they work or not. The only one that had a good study, I think, was remdesivir, one of the few at least, which was found not to work very well. So that was good, where there was a hypothesis that it might work, we do a thorough, randomized trial. Turns out, it doesn't work very well. And then we know, that's important. But that should have been done for several dozens of diff, existing medications. And the reason was done for remdesivir is because it's proprietary. So there is a company owns it. So if it worked, they would have done good profits. So they were saying, Okay, let's do the trial, if it worked for my money, it doesn't work, Soviet, but many of these existing drugs, like our election, for example, are not proprietary. So there's no incentive from a pharmaceutical company to do the trial, because they cost a lot of money. And since it's a generic drug, they won't be able to make money on it. So that was a responsibility of the government to do, and specifically of NIH, because that's our agency for doing medical research, and specifically, of the National Institute of Allergy professional diseases, because that's the part of NIH that's to research on infectious diseases. But Anthony Fauci never launched these randomised trials and treatments. And that was his job to do that. That was his role. And he didn't do it. Instead, he he decided to define public health strategy without being a public law, scientists have to step on the toes of CDC. We see to see, and I was the role of CDC to do that.


Nick Jikomes 1:28:32

Interesting, I didn't know some of those intricacies there. So that's that's, that is very interesting. Are you hopeful? Or are you pessimistic about whether or not the health and integrity of these institutions will get better or worse over time?


Martin Kulldorff 1:28:49

I don't think I get that much worst. At least not CDC. So I don't know if I'm optimistic or not, but I don't think we have a choice. We have to do our best. Because we need have to have a trust worthy and well functioning public health agency. We need to have a strong, vibrant medical research community funded by NIH. So we need those two things. But they are big problems because if you look at for example, university presidents and medical school deans, many of them went on the bandwagon of Fauci and Collins. And just one example is that many universities fired people who were with natural superior natural immunity, basically disregarding 1000s of years of scientific knowledge. So I don't know how these university presidents who took those decisions can sort of claim to the to the upholding Scientific knowledge and to be at the spearhead of all science or the scientific development?


Nick Jikomes 1:30:07

Well, I mean, it sounds, there's a distinction people have spontaneously come up with on the internet between science with a lowercase s. And they often will write it science versus science with a capital S and a little trademark symbol next to it on the internet. And that does seem to be sort of what's going on here in some ways where, you know, people are following not what the scientific not body of knowledge says, in some cases, but they're following what people in certain positions are saying, because they're sort of just declared to be the the final arbiters of truth.


Martin Kulldorff 1:30:41

Yeah, you're right. And that's the problem.


Nick Jikomes 1:30:46

What, you know, what do you think? The I think we'll probably just reiterate some of the things that that you've told us about, but what do you hope are some of the major lessons that people even average people, part of the public take away from what has happened in the past couple of years?


Martin Kulldorff 1:31:06

Well, I hope one lesson is that when we get the next pandemic, we will have another pandemic, it might be 10 years from now, it might be 50 years from now, who knows? But there will be another pandemic. And my hope is that we don't repeat these mistakes with having general lockdowns closing down society, closing schools. Now, to exact strategy, we don't know what it will be, because it depends on the disease. In this case, it was too old who was higher risk, we had to take the older people in the pandemic of 1919, a lot of young people died. So if if we get a different disease, the specific actions to protect those at highest risk might be different. But I think the principle I hope we can follow that. We don't close down society as a whole, but we protect those that need the protection the most. And I think when people think about the grip, right of immigration, many people think of it that open schools and those things, which is absolutely critical, and not forcing our society the way we did. But the other half, half is equally like important is so tragic, that we didn't protect the only people that needed to protection, data protection, we didn't really do what all the things we could to protect them. Neither before the vaccine nor after with the vaccine. To me, that's tragic, because a lot of people died, because we didn't protect them as well as we could.


Nick Jikomes 1:32:50

So what is your what is your professional focus right now?


Martin Kulldorff 1:32:58

I think we need to re establish new scientific Institute Institute's research institutes to help with the broken science. So I'm involved in two initiatives of that one is the brownstone Institute, which the goal is to to look at the things we need to do to repair public health, but also to repair society. After to recover from these devastating lockdowns during this pandemic, how to recover economically as well as in sort of socially and with the humanities. I think one important way that we need to do this is to for recoveries the arts, whether it's music, literature, poetry, theater, and so on, painting, sculpture, as well as spiritual and and taking care of each other. Thank you, family members, neighbors, work, work colleagues and so on. Because whether you were for or against a lockdowns, you have gone through a very traumatic time, I think. And in my view, those who are those who have been a lot of people has been scared about this pandemic about the virus, even though they're young and don't need to be very afraid of it. And that's something we should never do in public health to scare people more. Something when we're just not warranted, because the risk was always lower for children. So people have been scared about themselves and their children. And that's the traumatic things that we need compassion to help them overcome. I have a friend who, who hadn't seen in two years because he doesn't want to have any contact with anybody. I talked to him over the phone and I don't completely understand why is he afraid because he just been sitting in the Fed this information from the media. So that's my responsibility is to help to as the friend to sort of help him get out of that here without chastising him or, or blaming him for anything, because it's not he's not gonna do that. So I think we have to show that compassion to every other member of society to recover on the sort of the humanitarian scale and I think that's where the art comes in. The humanities comes in this very, very important things


Nick Jikomes 1:35:54

weren't called after you've shared a lot of useful information with us and I definitely appreciate your time. Is there any any final words you want to leave people with or anything you want to emphasize a reiterate before we sign off?


Martin Kulldorff 1:36:05

Thank you very much for this conversation. was great talking to you. So thank you so much.



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