Towards ‘Yom Kippur’ - An Israeli physician-scientist on the response of society to the Sars-cov-2 pandemic
I am pleased to introduce a guest post from Dr Raya Leibowitz from Israel. This is a far ranging discussion of COVID policy. I remain a supporter of the initial vaccination series recommendation for most adults who did not already have covid in early 2021 and boosting elderly or high risk people in fall 2021, but I am staunchly opposed to mandates as she is. You cannot mandate an intervention that does not provide benefit to third parties. And you shouldn't mandate this shot in America due to spill over effects.
I am skeptical of universal boosting in perpetuity without well done randomized trials. I would have made the same choice she did about boosting, if they didn't threaten me with loss of employment. I think myocarditis was handled poorly in the USA, and I would like to see better methods to assess safety signals, as she does. Our current methods in the US are primitive and insufficient. My views are generally aligned with the Governments of Sweden and Norway. I enjoyed Dr. Leibowitz's essay for its unique perspective about another nation with strict rules and close ties to Pfizer. The goal of Sensible Medicine is to expose the reader to range of ideas, and this essay does just that.
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Vinay Prasad MD MPH
Towards ‘Yom Kippur’ - An Israeli physician-scientist on the response of society to the Sars-cov-2 pandemic
Raya Leibowitz, MD/PhD; Shamir medical center, Be’er Yaakov; Faculty of Medicine, Tel-Aviv University, Tel-Aviv; Israel. email@example.com
I am writing so not to forget the response of governments and societies to the COVID-19 pandemic over the last 2.5 years; responses that were, for me and many others, dystopian. During this time, Israeli society, as I knew it, has dramatically changed for the worse.
It is now October 2022, just before the Jewish day of atonement (‘Yom Kippur’), which is a time of self-reflection on one’s deeds, a time of admissions of one’s mistakes, errors and faults. It's time to take stock of what we have done.
I am an Israeli medical oncologist, a scientist (MD/PhD) and the head of a medium-sized oncology institute in Israel. Needless to say, I am an integral part of the medical system. My kids and I are vaccinated with all routine childhood immunizations.
Israel has been globally renowned for its leading role in the vaccine roll-out; yet many considerations are not widely known. The views presented in this essay are my own, and do not represent my hospital, the university to which I am affiliated, or the Israeli ministry of health, my employer.
In March 2020, when the WHO declared that the infection-fatality rate (IFR) of the covid-19 virus was 3.4%, I first realized there was a huge mistake. Together with a few scientists and medical doctors in Israel, we felt that COVID-19 is a respiratory virus with a sinusoidal appearance and an IFR that was slightly higher than influenza (but NOT by orders of magnitude higher), and that its' violence is exponentially associated with older age. I wrote my first assay in the public press back in March 2020, entitled ‘the virus may disappear, but with it - so will our democracy and economy’.
Unfortunately, my words had no impact. The media in Israel (like many other countries) was filled with horrifying clips of body bags from Italy, of field hospitals in New York, of Chinese people collapsing and dying in the streets in midday. Israeli scientists, many without any appropriate qualifications, predicted dozens of thousands of deaths in our small country, Israeli doctors were terrified. The Ministry of Health in Israel, politicians and the media allowed no room for questioning these prophecies, there was only one narrative.
We – a small group of Israeli doctors and physicians, like similar groups across the world – thought from the start that not only are lockdowns not efficient in combating this virus, but that their harms will eventually significantly outweigh any potential benefit. We suggested differential protection measurements, based on age and risk factors, realizing early on the that this virus could not be eliminated. We were ridiculed or ignored.
In November 2020 we appeared in a documentary movie entitled ‘and what if most of the world is wrong’, in which we stated our views on lockdowns. We were publicly shamed for being ‘grandma killers’. We were dubbed ‘covid deniers’, with a clear reference to ‘holocaust deniers’ (which, in Israel, is naturally a terrible connotation).
Towards the end of 2020, the global narrative had become unanimous – only a vaccine can save the world from extinction. This narrative scared me from its onset. As a medical oncologist, I am only too aware of the huge influence that the pharmaceutical industry has on our practice, many using bias and spin to promote new drugs or technologies with only marginal benefits. I therefore read the Pfizer vaccine paper, published in the NEJM in December 2020, meticulously, and thus immediately realized that the pivotal trial was never designed – nor did it demonstrate – that the vaccine prevented infection or transmission of the virus. I contacted Pfizer in Israel, that indeed confirmed that there was no prospective data to suggest that it does.
In a few weeks, the vaccine campaign in Israel expanded from the high risk population of older people to the entire over 18 population. Key opinion leaders, from within and outside the medical profession, celebrities, politicians and media figures engaged in convincing the public to ‘run and get vaccinated’. Any hesitance was met with shaming and vicious attacks over social media, professional forums and associations.
I don’t exactly remember when we first realized that Israel was ‘the experimental country’ of the Pfizer vaccine. Almost all of the contracts and agreements between Pfizer and the Israeli government were kept confidential and not exposed to the public. On the other hand, as a practicing physician, I knew from ‘day one’ that there wasn’t a good and reliable way to report adverse events in Israel during the vaccine roll-out throughout 2021. This was troubling but was not discussed in any forum, nor was it bought to the knowledge of the public.
The beginning of 2021 brought about a sense of euphoria in Israel – the common notion was that soon all we be vaccinated and the pandemic will be over. I, on the other hand, became increasingly worried.
Then, starting March 2021, large retrospective trials (both Israeli and from other countries) were published in the best medical journals, demonstrating that the vaccine is associated with reduced hospitalization and covid-related deaths. The data from these analyses were also used to make the assertion that the vaccine prevents viral infection and transmission, despite these trials being inherently and inevitably biased, as the subjects in these types of analyses were not randomly assigned to the intervention, and the follow-up time was short. It was also unknown if the vaccine would protect against escape variants. These limitations were acknowledged by the authors of the trials within the academic publications, but this was not relayed in the lay press (even not by the authors themselves), and so the public, the politicians and the press were led to believe that there is a significant altruistic value in taking the vaccine. This brought about the notion that those who decided – for whatever reason – not to take the vaccine, are egoistic, or crazy, or both.
In parallel with the vaccine roll-out, people – normative people, from all from all walks of life– started to report all types of adverse events. These people were not listened to, their complaints were often not documented or investigated, and they were commonly perceived as ‘hysterical’ or even as having a ‘mental’ issue. Troubling anecdotes and signals continue to resonate (or, shall I say – continue to be whispered), yet it is still considered almost a taboo to be asking whether vaccinating at any age for any amount of boosters was, indeed, a medically correct policy. Any query of this sort immediately tags one as a conspirator.
Towards spring 2021, an Israeli group reported upon an emerging, previously unknown, adverse event of myocarditis in young men. Indeed, the FDA recognized the need to further investigate this signal, yet vaccine roll-out and ‘boostering’ within the younger age group continued uninterrupted. The policy of repeated booster shots in young healthy adults has only recently (i.e. in late 2022) been re-evaluated and challenged, and only in a few countries by now (Israel not being one of them).
Around March 2021, the ‘green pass’ was first introduced as a public policy intervention– namely, that the ability to move freely, work and study will be dependent on one’s COVID vaccination status. What was astonishing - and ever so disappointing to me – was that this idea was accepted almost unanimously, without any debate, without any question as to its medical justification or ethical validity. It was accepted across the board by scientists and doctors who were not well-acquainted with the details of the clinical trials or with the complexities of retrospective clinical research. It was accepted after merely a short time following vaccine administration and without any long-term follow-up of either vaccine side-effects nor effectiveness. Scientists, doctors, engineers, philosophers, artists, journalists, historians, judges and politicians hardly challenged its justification or validity. The university in which I am faculty, for instance, accepted the premise of the ‘green pass’ without any questioning; without performing even one seminar or colloquium to discuss it.
Despite being vaccinated and eligible to receive a ‘green pass’ (I decided, as a 47-year old woman with risk factors, to take the first 2 vaccine shots in April 2021), I decided not to collaborate with it, as I was convinced it is ethically and medically wrong. I also felt that my medical record and personal health choices were solely my own, not feeling compelled to report such personal information to 20-year-olds at entrances to restaurants or theaters. I decided not to receive a booster after considering my risk.
Life then became very hard for me. I was banned from all types of cultural activities. I could not fly. I was asked by my managers in the hospital not to talk about my views. Moreover, I became estranged to my family, my friends, my medical community, my political camp – all because I did not accept the common narrative; all because I kept asking questions.
In June 2021, and not surprisingly to me, a new wave of infection appeared, starting mainly in the vaccinated population. Naively, I was now certain that the huge mistake – namely, that the vaccine halts transmission and can eliminate the virus – will be realized, and hence it will finally be acknowledged that vaccine uptake should only be voluntary, by people who so chose after informed consent. Indeed, I was naïve, as the narrative has quickly changed to ‘turns out we need 3 shots, and not two’, but the logic of the green pass not only prevailed, but that sentiment towards those who decided not to further take up the vaccine, for whatever reason (prior infection, prior side effects, lack of will, loss of trust), became even harsher. The definition of being ‘fully vaccinated’ changed within a week, and people, at any age, were coerced to take a booster shot on which no randomized safety data was available, lest they lose their jobs or their ability to study or move about freely.
The fall of 2021 was, to me, dystopian – doctors were saying things such as ‘we have no compassion for the unvaccinated’, and this seemed acceptable to most. The public sentiment towards unvaccinated was no less than violent. It seemed like a competition was taking place as to who would call the unvaccinated more horrific names. Our prime minister called upon parents to fight among themselves in schools in order to push kids and teenagers to take the vaccine. I felt ashamed to be an Israeli doctor and citizen in such a toxic environment. Society, to me, became inhumane.
Surely I was not entirely alone; From ‘ear to mouth’, we found more than a hundred doctors who felt the same, and formed a group called ‘there is a different way’. We started publishing public manifests, we approached the ministry of health and the government several times; we started appearing – insofar as was possible (which was, alas, very little) – in the public media. We were collectively designated ‘anti-vaxxers’ (albeit all being certified practicing physicians). Despite many attempts, we were refused any type of academic or public debate. We were constantly ridiculed and shamed. Again, we were accused by some of ‘killing people’.
I personally felt uneasy in clinic, felt uncomfortable to walk about in the hospital. I felt unsafe, as if any day I might be persecuted for my opinions, which – right or wrong – were based on my careful reading and interpretation of the scientific literature and on my long discussions with my colleagues. I was truly scared I would be fired for my views. My family did not get me. My friends did not get me. My colleagues thought I lost my mind. I could not enter my university campus.
Many more things occurred since –publication of randomized trials of the vaccine in decreasing age groups, with disappointing or clinically-meaningless endpoints that served as a basis for further vaccine recommendations and roll-out; publication of many more biased or flawed retrospective trials; an explosion of bad or insignificant science; a fourth, and now firth, shot without any safety data to inform decision; and importantly, no clear proof that the vaccine saves lives (i.e., decreases all-cause mortality), with excess all-cause mortality being, in 2022, higher than ever before, including the pre-vax pandemic year of 2020.
Currently – autumn of 2022 - it seems like at least in most countries, and at least to some extent, it is now realized that the Sars-cov-2 virus is here to stay, is predicted to continue to cause morbidity and mortality (almost exclusively in elderly and frail), and must be dealt with without harming society or our future generations. Similarly, albeit as a slower pace, it is becoming accepted that the mRNA vaccine – like any other form of medical intervention –has a therapeutic range and must have an indication and a target population, and that it has – again, like any other intervention – a ‘price’ in terms of side effects (and also – alas – a price).
Notwithstanding the importance of this realization – better late than never, I guess – it is still important to study and analyze what went so terribly wrong in the response of society to the pandemic, so that such processes never ever happen again.
‘Yom kippur’ of 2022 may be a good time to start.