The New IOC Transgender Participation Rules Are Unfair To Biological Women

 The International Olympic Committee released its new framework for transgender and intersex athletes Tuesday. Hard as it is to believe, it is even worse than the old 2015 rules, which required testosterone level verification — despite the utter lack of science behind this. (The problem is the ineradicable changes wrought by male puberty: even after a year of hormone therapy, M2F transsexual athletes retained the vast majority of their strength advantage.)

The document itself is a pastiche of delusion, starting with its first section. Titled "Inclusion", all else follows from that idea, namely, that anyone who claims to be female should also get to compete with them in athletic events. The rest is filled with rationalizations for how this is to happen and why. Quoting Fair Play for Women's response (emboldening all mine):

UK sports governing bodies now have two different sets of guidance to consider, and on this point they agree. The new Sports Councils Equality Group guidance also concluded that testosterone suppression was pointless. But unlike the IOC, they kept sight of the implications: there is no fair way to include people who’ve been through male puberty in female competitive sport. Women will always be disadvantaged. That’s why a separate category for the female sex exists in most sports in the first place.

The IOC claims it has taken notice of the UK Sports Councils Equality Group’s output. It’s hard to see how. The IOC’s new guidance has abandoned the science and says there should be “no presumption of advantage”.

“No athlete should be excluded from competition on the exclusive ground of an unverified, alleged or perceived unfair competitive advantage due to their sex variations, physical appearance and/or transgender status.”

What does this mean? It means that being transgender is no longer to be counted as having any relevance at all for sporting eligibility. No one is arguing that we don’t need separate female and male (or open) classes. Without them, females would barely get a look-in. Yet the IOC is saying being born male is not a factor.

“Transgender status” is what permits a male to compete as a female when there’s a massive advantage, ranging from 10% at the low end, in running and rowing, to 35% in weightlifting. This advantage is unaffected by gender identity. It would be laughable, were it not so disappointing, that the IOC has thrown out the fig-leaf of testosterone suppression and ended up with self-identification.

 The gasoline that will keep this car moving is the fact that there is necessarily a limited supply of M2F transsexuals wanting to participate in women's sports. That does not make this any more fair to biological women.

COVID Hospitalization Stats Ain't What They Used To Be — And That's Good

It's been a while since I posted anything here, but this was so important, it was vital to get it out, on the grounds that it's important to change your opinion when the data changes. For a very long time, I've said that the "with COVID/of COVID" hospitalization and death dispute was mainly a distraction, one designed to minimize the disease burden from people who didn't want to believe the pandemic was worth all the bother others invested in it. It's now fair to say that COVID-19 hospitalization data isn't as meaningful as it used to be. Researchers tried to find out how many people were really in the hospital for severe COVID, but because it is a "must-report" disease, hospitalization counts include people in the hospital for other conditions who incidentally test positive for COVID-19. The way to understand this, then, is to get a handle on just how sick people with COVID are:

Instead of meticulously looking at why a few hundred patients were admitted to a pair of hospitals, they analyzed the electronic records for nearly 50,000 COVID hospital admissions at the more than 100 VA hospitals across the country. Then they checked to see whether each patient required supplemental oxygen or had a blood oxygen level below 94 percent. (The latter criterion is based on the National Institutes of Health definition of “severe COVID.”) If either of these conditions was met, the authors classified that patient as having moderate to severe disease; otherwise, the case was considered mild or asymptomatic.

The study found that from March 2020 through early January 2021—before vaccination was widespread, and before the Delta variant had arrived—the proportion of patients with mild or asymptomatic disease was 36 percent. From mid-January through the end of June 2021, however, that number rose to 48 percent. In other words, the study suggests that roughly half of all the hospitalized patients showing up on COVID-data dashboards in 2021 may have been admitted for another reason entirely, or had only a mild presentation of disease.

This increase was even bigger for vaccinated hospital patients, of whom 57 percent had mild or asymptomatic disease. But unvaccinated patients have also been showing up with less severe symptoms, on average, than earlier in the pandemic: The study found that 45 percent of their cases were mild or asymptomatic since January 21. According to Shira Doron, an infectious-disease physician and hospital epidemiologist at Tufts Medical Center, in Boston, and one of the study’s co-authors, the latter finding may be explained by the fact that unvaccinated patients in the vaccine era tend to be a younger cohort who are less vulnerable to COVID and may be more likely to have been infected in the past.

So that's mainly a good thing: it means nearly half people in the hospital aren't generally in the ICU for COVID, but that they're for some other reason. It would be interesting (but obviously much more complicated) to get similar numbers for deaths.

Administrivia: Sidebar Update

 Cleaned up some dead links and changed links on the sidebar.

India's Vaccine Nationalism Disrupts COVAX And More

 The horrific scenes coming in from India have vaulted that nation to the top of the single-day COVID-19 death tally, not a statistic you want to lead the world in, and this is just the official totals. (For various reasons, the actual number may be substantially higher.) Unsurprisingly, then, the country that has done more to mass produce vaccines than almost anyone else has announced an export ban through October as doses are being diverted to combat disease in India. The ban will affect, at least, Johnson & Johnson (made by Biological E), AstraZeneca's Covishield (Serum Institute and Dr. Reddy's), Novavax (Serum Institute), and Sputnik V (Dr. Reddy's). While we don't know which countries are affected here, the Reuters report makes it sound like it will be mainly south Asian nations and anybody hoping to get vaccines via COVAX, the WHO's distribution network (140 million doses were diverted from the latter). There's some hope from the US:

U.S. President Joe Biden said on Monday his country would export at least 20 million doses of the Pfizer (PFE.N)/BioNTech , Moderna (MRNA.O) and Johnson & Johnson (JNJ.N) shots, on top of 60 million AstraZeneca doses he had already planned to give to other countries.

But those are drops in the bucket compared to demand. Vaccine nationalism was always going to be a problem, and anyone claiming otherwise hasn't been paying attention.

The Importance Of Good Vaccines

 Cases, and somewhat more ominously, deaths are ramping up in Bahrain, one of the most vaccinated countries on earth:

The country relied heavily on the Sinopharm inactivated vaccine, which apparently puts it at greater risk for future reinfection. Along with nearby United Arab Emirates, Bahrain is offering people who did not get a good antibody response a third dose of the vaccine, which is highly suggestive. A recent Chilean study cited by the British Medical Journal claims Sinopharm's jab was only 3% effective after the first dose, with higher figures after the second. Given the sketchy data surrounding Sinopharm's vaccine, it's not a surprise we're seeing irregularities like this.

The Southern States' Vaccine Reluctance

 Call it vaccine hesitance, call it reluctance, call it whatever you want, but it's painfully obvious that the southern states are lagging the rest of the country (and especially the northeast and west) when it comes to getting vaccinated for COVID-19. Because the CDC only reports vaccines actually administered, and not whether they're first doses, I assembled my own map of first doses by state:

The southern states particularly are doing poorly, in the main:

Outside of Virginia, no southern state is even at 50% of the population yet, and many are below 40%. This means there will likely be another wave of infections, albeit deaths will be limited because of greater vaccine uptake among older groups, even there. The CDC reports that more than 80% of Americans 65 and up have been vaccinated, though without individual state reporting on age demographics, there could be large regional holes.

"I Continued To Cry For A Whole Month": Normalized Boy-Hate

 A couple months old story involving the usual (and in this case, literal) navel-gazing by Emily Ratajkowski, and not really on target for my "mothers shaming sons" tag ("feminists raising the enemy" it is), it really exposes the zeitgeist as to certain kinds of women airing their genuine loathing for men in public. The piece contains a story of a supposed friend whose gender reveal did not go so well for her mental health:

My friend who is the mother to a three-year-old boy tells me that she didn’t think she cared about gender until her doctor broke the news that she was having a son. She burst into tears in her office. “And then I continued to cry for a whole month,” she says matter-of-factly. After a difficult birth experience, she developed postpartum depression and decided that she resented her husband more than she’d ever imagined possible. She told me she particularly hated—and she made an actual, physical list that she kept in her journal, editing it daily—how peacefully he slept. “There is nothing worse than the undisturbed sleep of a white man in a patriarchal world.” She shakes her head. “It was hard to come to terms with the fact that I was bringing yet another white man into the world. But now I adore him and can’t imagine it any other way.” She also eventually learned to love her husband again. The sound of his perfect sleep next to her at night is now tolerable.

I get that some women have serious postpartum mental issues (and pregnancy can make you loopy as well). But this is extreme.

The States That Will Need Vaccine Bounties

 I recently came across a story about West Virginia offering young people a $100 savings bond as a bounty for getting the COVID-19 vaccines. It seems to me this will be necessary in a number of states, particularly in the south, intermountain west, and to some degree, even in the midwest. Here's a chloropleth map I just built of first vaccinations per 100 population:

(The CDC has a similar map, but it only tracks population-adjusted vaccines administered, which tells us little about the overall number of individuals vaccinated.) The states in trouble are Idaho, Wyoming, Missouri, Arkansas, Louisiana, Mississippi, Tennessee, Alabama, Georgia, South Carolina, and Indiana. I expect to see these states follow suit presently.

More On The J&J Vaccine "Pause" Causing Vaccine Hesistance

 A terrific and more detailed look at the aftermath of the "pause" causing people to walk away from vaccination by Dan Elton, looking at not just the total vaccination numbers, but the daily un-averaged figures, vaccination by age bracket, and the difference between the UK's approach (warn but keep vaccinating) and the US/EU approach ("pause" or outright ban). The post I wish I'd written (my less-detailed one here).

The Russians Are Coming! Peter Hotez's Zany, Evidence-Free Anti-Anti-Vax Rant In Nature

 Peter Hotez, Dean of Baylor College of Medicine's School of Tropical Medicine, has a theory about why there's so much antivax sentiment in the world. It's nice, he says, to offer solid, scientific evidence for vaccine efficacy and safety, but there are too many bad guys out there spewing disinformation.

I have a long-standing disagreement with many of my US public-health colleagues. I admire their commitment to disease prevention, but when I ask for a more direct way to counter anti-vaccine aggression, I’m told, “that’s not our approach; confrontation gives them a platform and oxygen.” In my opinion, this attitude reflects a time when we had dial-up modems. Today, the anti-vaccine empire has hundreds of websites and perhaps 58 million followers on social media. The bad guys are winning, in part because health agencies either underestimate or deny the reach of anti-science forces, and are ill-equipped to counter it.

So who are these shadowy forces?

Investigations by the US State Department and the UK Foreign Office have described how Russian intelligence organizations seek to discredit Western COVID-19 vaccines. One campaign implies that it could turn people into monkeys. This builds on a longer, well-documented history of Russia-sponsored disinformation, presumably to destabilize the United States and other democratic countries. The administration of US President Joe Biden has warned Russian media groups to halt their anti-vaccine aggression, and announced sanctions tied to disinformation and other behaviour, but we need much more.

But wait — has anyone ever claimed they didn't want Moderna because it would make them into a monkey? Who knows! Who cares? He's on a roll. The solution, he's certain, looks like "The United Nations and the highest levels of governments must take direct, even confrontational, approaches with Russia, and move to dismantle anti-vaccine groups in the United States." That is, the federal government should censor antivax groups in the US.

This of course is unconstitutional. Moreover, that it is unlikely to work even if it were implemented does not occur to him, as it does not to all would-be censors; they imagine themselves the beneficiaries and directors of such activity. The lessons learned from the CDC's early flip-flopping on mask-wearing shows no one has a monopoly on Truth. The likely result of such censorship would be more people, not less, asking, "What do they have to hide?"

If anyone were interested in finding out why people didn't want any of the safe, effective vaccines against COVID-19, the place to start is by asking them. The Kaiser Family Foundation has done a series of U.S. polls that are both informative but incomplete, telling us that some people won't get the vaccines, but not why. We need more of this. My (mostly unsubstantiated) belief is that the Johnson & Johnson vaccine pause has proven destructive to overall vaccination efforts. The April 13 pause directly correlates to a daily decline in the number of vaccinations as shown by the graph below (underlying data from Our World In Data):

In Kansas and Arkansas, vaccine distribution has stalled due to lack of demand. I anticipate more stories in the coming days of similar problems, particularly in the south and midwest. This is a serious issue that deserves serious thought and effort. Dr. Hotez provides neither.

The J&J Pause Has Likely Poisoned Acceptance Of All Vaccines

 The FDA and CDC's April 13 pause of the Johnson & Johnson vaccine, which I predicted would cost lives, appears to have done so in the worst way. While we don't have polling data available yet (the KFF poll is probably wrapping up right about now), the last data available indicated Americans were losing their vaccine hesitancy. If this graph of daily vaccinations is any indicator, that hesitancy has come right back up:

 Good job, guys! Explain the risks and don't "pause".

The Big Lie About US COVID Vaccine Exports

 Last month, I expressed disbelief at EU claims the US had installed a vaccine export ban, which mainly was based on Israel's early vaccination program, one I assumed was based in the US, based on the early huzzahs about first doses leaving a plant in Portage, Michigan. But this was flatly contradicted by Charles Michel's claim that "Most of the doses with which Israel embarked on its mass vaccination programme were sent from Belgium."

There I left it, until another Politico EU article came to my attention, this one about AstraZeneca production shortfalls. The relevant grafs (emboldening mine, as usual):

While a Belgian subcontractor making the serum or "drug substance," was fulfilling its contract with AstraZeneca, another plant in the Netherlands wasn't producing enough to be included in the company’s application for approval to European regulators at the end of December, according to EU documents seen by POLITICO and the Belgian magazine Knack.

With so little drug substance coming from the EU, AstraZeneca turned to its U.S. plant in Maryland to make up the difference.

"The most important quantity" of drug substance came from the American plant, owned by Catalent, before being put into vials in Italy in a process known as "fill and finish," the documents said, detailing inspections in January and early February of three AstraZeneca plants in Belgium, Italy and the Netherlands that produced vaccines for the EU.

 So, perhaps they mean arm-ready shots? Either way, there is, as I suspected, a lot less there than meets the eye. The US has not, in fact, stopped exports of vaccines.

mRNA's Cherry On Top: The EU Buys Another 100M Pfizer Vaccines

The EU exercised its option to buy another 100 million doses of Pfizer/BioNTech COVID-19 vaccine, bringing the total to 600 million. Combining that with the 1.8 billion dose order drafted earlier in the month, this means the EU has essentially gone all-in on mRNA. Reviewing my post on the situation back in February, this means the EU has 3.365 billion mRNA vaccine doses either delivered or deliverable. Presumably CureVac's doses are still on order as part of that sum.

The buy makes it appear that the EU has lost faith in Sanofi's protein subunit vaccine, which had trouble with efficacy in the key older group. Sanofi has since shifted gears, and on March 12 announced with partner Translate Bio, that they, too, would have an mRNA vaccine candidate, with phase 1/2 trials commencing soon (?), but these are not expected to conclude until Q3, 2021.

COVID Vaccine Bullets

•  The European Union is negotiating a 1.8 billion-dose order with Pfizer to be delivered in 2022 and 2023 (!!!) and will not renew contracts with AstraZeneca or Johnson & Johnson. The doses will be manufactured in the EU.
• For all that mRNA manufacturing has generally scaled well, we finally have a story of missed shipments from Moderna, who has announced they will cut vaccine deliveries to Canada and the UK due to manufacturing problems.

  While the company didn’t specify how many doses would be cut and where, Canada’s Procurement Minister Anita Anand said Friday that its shipments will contain 650,000 doses this month instead of the expected 1.2 million. 

  Moderna also warned up to 2 million of a planned 12.3 million shots scheduled for delivery in the second quarter would be delayed until the following quarter, according to a report from Reuters. However, a company spokesperson also told the news agency that its deliveries to the European Union and Switzerland remain on track.

• Pfizer's CEO now says there will likely be a need for COVID booster shots, possibly annually.
• CureVac plans on releasing trial data of its mRNA vaccine in the coming weeks.
• Moderna is putting its mRNA influenza and HIV vaccines into phase I trials this year.
  

  Current flu vaccines in the market have efficacy rates in the regoin [sic] of 40-60%: which Moderna believes its mRNA technology can improve on. It also says that its technology has several advantages over egg-based vaccine production: not only in terms of production advances but in accurately targetting vaccines against strains (egg-based production has the potential to cause unintended antigenic change to the vaccine virus).

  They also released phase I trial data for a respiratory syncytial virus (RSV) vaccine, and a cytomegalovirus (CMV) vaccine.
  

The Bogus Story About Vaccine Racism

The woke crowd has unsurprisingly turned to its favorite hobgoblin of "structural racism" (i.e. this piece in Journal of the American Medical Association) as explanatory for differing rates of COVID-19 vaccine uptake. Per recent polling by the Kaiser Family Foundation, Hispanics (61%) and blacks (55%) say they have either already gotten a COVID vaccine or plan to do so as soon as possible. The big problem the "structural racism" argument has is this reticence is more or less mirrored in historical data for influenza vaccines. Blacks (by about 15%) and Hispanics (~13%) lag white vaccination rates considerably for the most vulnerable age group (69.9% for ≥ 65 years). Otherwise there is a lag, sometimes quite noticeable, other times not so much, but the idea that COVID vaccine reticence is somehow driven by systemic racism fails to heed the historic story.

The Trouble With Labels And Facebook's Censorship

 The New York Post has a story about BLM co-founder Patrisse Khan-Cullors buying four million-dollar-plus homes in the New York area, scoping out property in the Bahamas, and last month buying a $1.4M home in Malibu. This is in addition to homes in the Atlanta and Los Angeles areas.

 BLM, of course, is a label, which means anyone can use it. There really is no unified formal organization, which has led to grifters capitalizing on the brand's goodwill. BLM Global Network Foundation, Khan-Cullors' particular instance, is one among many:

Founded by Khan-Cullors and another activist, Kailee Scales, the nonprofit Oakland, Calif.-based BLM Global Network Foundation was incorporated in 2017 and claims to have chapters throughout the US, the UK and Canada, and a mission “to eradicate White supremacy and build power to intervene in violence inflicted on Black communities.” The group does not have a federal tax exemption and donations are filtered through ActBlue Charities and Thousand Currents, two nonprofits that manage the cash.

This, of course, sounds awfully familiar; the whole point of ActBlue is to hide the operations of political scam artists. What makes this worse is Facebook censoring attempts to share the story, something mainly reported by News Corp. outlets. (Twitter has not, so far, attempted to step on this.) What good can come from this? The fact that the BLM name is being openly used by grifters is bad enough; that Big Tech covers for them is appalling.

The Insane, Reckless "Pause" Of The Johnson & Johnson Vaccine Will Cost Lives

 The FDA and CDC have called for a "pause" of deliveries of the Johnson & Johnson (Janssen) COVID-19 vaccine. This is absolutely insane based on relative risk alone: one woman died among the six women affected (all 18-49 years old), versus over seven million vaccinated. Meantime, the CDC's own best-guess infection fatality ratio shows twenty deaths per million infected among the 0-17 years age group. So the FDA and CDC are stopping vaccinations that could save the lives of twenty times the number of people even in the best case scenario. The most likely case, the 18-49 age bracket, sees an IFR of 500, which means you are looking at two orders of magnitude more risk of death than without vaccination. The FDA has a history of safetyism overriding sense, and this will kill people, especially as it means fewer vaccines will be available.

 In a sense, the pause may not matter, because the vaccines wouldn't be available even if these thrombotic events hadn't happened. Johnson & Johnson took over production at contract manufacturer Emergent BioSolutions following production errors there that mixed up their vaccine with AstraZeneca's, and this caused the destruction of up to "15 million doses". Accordingly, the CDC announced it expects J&J to cut supply by 80%, putting the overall annual goals of 100 million doses in the US and one billion worldwide in jeopardy.

Lastly, for anyone who wants to get into the weeds on this subject, Derek Lowe has a good explainer on the subject. This seems to be a problem shared with the AstraZeneca ChAdOx1 vaccine as well, and while I recommend the whole post, I wanted to highlight this one section in particular:

Is this blood clotting happening with the mRNA vaccines, too?

No. That seems quite clear – to the best of my knowledge, there have been no reports like this at all with either the Moderna or the Pfizer/BioNTech vaccine. That’s good news, and it tells us a lot. For one thing, this blood clotting problem is not a general feature of trying to vaccinate people against the coronavirus. It also means that it apparently has nothing to do with inducing the coronavirus Spike protein in people, since that’s what both the adenovirus vectors and the mRNA vaccines are doing, in the end.

The version of that protein brought on by the AZ/Oxford vaccine is slightly different from the others (it doesn’t have a key set of protein-stabilizing mutations), and when the clotting problems showed up in Europe some people were wondering if that had anything to do with it. But the appearance of such side effects with the J&J vaccine would seem to rule that out. Instead, what those two have in common is that they’re both adenovirus vector vaccines [emboldening mine — RLM]. Oxford used a chimpanzee adenovirus, and J&J picked a less-common human one. Which means that if this is a side effect shared by adenovirus vectors, it’s shared at a pretty basic level, isn’t it? I’m not enough of an adenovirus jock to tell you in detail about the similarities between the proteins in the ChAdOx vector versus Ad26, and at any rate it’s probably more about the antibody response to these things (and why, in a small number of people, that goes awry with the PF4 protein).

It's becoming increasingly obvious that the vectored virus vaccines are a technological dead end: harder to manufacture at scale, more likely to generate weird side effects, and less effective than mRNA vaccines. But any of them are still better than getting COVID.

Update 2021-04-15: Alex Tabarrok has a useful thread detailing post-vaccination thrombotic events in the UK. The mRNA vaccines maybe have dodged a bullet on this?

Pfizer, All UK spontaneous reports received between 9/12/20 and 28/02/21

Deep vein thrombosis 8
Pulmonary embolism 15
Thrombocytopenia 13

AZ, All UK spontaneous reports received between 4/01/21and 28/02/21

Deep vein thrombosis 14
Pulmonary embolism 13
Thrombocytopenia 12

— Alex Tabarrok (@ATabarrok) March 15, 2021

What Does Pandemic's End Look Like?

 The pandemic will go on a lot longer than people are probably comfortable with, to the extent that the disease is likely to become endemic. And it's likely to drag on a while: Moderna has committed to making 1.4 billion doses of its COVID-19 vaccine in 2022, which suggests a couple of things:

• Moderna thinks other vaccine platforms won't actually be able to scale. This is somewhat laid out by the continuing manufacturing problems Astrazeneca has had in Belgium, Mexico, and a Dutch plant that hasn't been certified for production yet. Johnson & Johnson has similarly had manufacturing problems delaying shipments and putting commitments at risk. Likewise, the Russians are also facing similar problems scaling their Sputnik V vaccine. One might be excused for thinking this is a trend among vectored virus vaccines.
  
• And/or, a variant booster will become necessary. Moderna has already committed to work on a vaccine for the the B.1.1.7 and B.1.351 variants.

For its part, Pfizer says they do not foresee strong demand for their COVID-19 vaccine in 2022, although they are similarly lining up for possible variant boosters, this mainly on the strength of many entrants to the market. Assuming Moderna is right and Pfizer is wrong, this could mean a COVID shot becomes an annual affair, like influenza. The good news, to a certain extent, appears that the virus is convergently evolving, i.e. the same mutations are showing up in different places. That is, we have a pretty good idea where the beast is headed. We also now know that the impact of the variants on T-cell reactivity is "negligible". Antibodies are nice, but they're not the whole immune system. In all, this makes it look like we're getting very close to this pandemic coming to an end.

Update 2021-03-30: Some interesting polling data:

• First, a Washington Post poll showing "one in three" health care workers are not confident the vaccines have been adequately tested for safety and effectiveness.

  While about 2 in 10 health-care workers said they had scheduled a shot or were planning to, 3 in 10 health-care workers said they were unsure about getting vaccinated or not planning to do so. As many as 1 in 6 health workers said that if employers required them to get vaccinated, they would leave their job.

• Next, the Wall Street Journal summarizes a U.S. Census Bureau poll showing that for the first time since polling began in December, "will not take" is now below 20% ("about 17% of adults said they would either definitely or probably not get vaccinated, down from 22% in January"). Good news.
  

The Pandemic Isn't Over, But It's Getting Closer

 Coyoteblog (somewhat prematurely, I think) declares the pandemic over, at least in Arizona, this based on Arizona Department of Health hospitalization data. The obvious rejoinder to this is that we have previously seen downturns in hospitalization, but this time we have vaccinations. Arizona recently surpassed 40% of its population with one or more jabs, which the ADH boils down to 26.8% of its population vaccinated. 

Costco may have quietly come to their own conclusions on this matter:

A sign that the end (of the pandemic) must surely be nigh. pic.twitter.com/YUf3LZdUUm

— Joanna Robinson 🇺🇸✌️🏳️‍🌈 (@jowrotethis) March 14, 2021

There's reason for hope. Hopefully next month we start seeing the large vaccine increases promised back in February. Of course, this won't help if we continue to see vaccine hesitancy in younger groups — or in ethnic groups otherwise disinclined to get vaccinated. This is already being chalked up to, in part, Russian disinformation (some of which is probably due to Sputnik V vaccine marketing). But none of this makes sense against the background of historical influenza vaccination uptake.

 In the Kaiser Family Foundation's most recent poll, 51% of whites, 52% of Hispanics, but only 42% of blacks either had already been vaccinated or planned to get vaccinated as soon as possible. Yet, if you look back a ways — to this 2013 NIH study on influenza vaccination — you would see that whites lead inoculations in all age categories, with blacks trailing around 10% and Hispanics a similar percentage. As only 32.2% of whites 18-64 got inoculated in the 2010-11 season, that means about a 20-point shift in confidence and/or necessity. That's pretty impressive when you consider all the shade thrown at the vaccines as "rushed" or whatever other imagined flaws they might have.

The Coming Need To Sell The COVID-19 Vaccines

Dr. Scott Gottlieb recently tweeted something of great import about the COVID-19 vaccines:

"Everyone is going to be able to schedule appointments at some point in early April," says @ScottGottliebMD. "As you move down the age continuum you are going to see demand isn't as deep as it was for the older individuals--we are going to need to do more to stimulate demand." pic.twitter.com/NsY0kMpnp6

— Squawk Box (@SquawkCNBC) March 15, 2021

As we move from scarcity to plenty, we also move to more-averse age groups. A large cohort of people either refuse to get the vaccine at all (about 15% in recent polls) or will only if forced (7-9%):

This is not encouraging, especially considering there is a very large group that will not be able to get a vaccine for many months: children. As of February, Moderna is only testing their vaccines on children from 12-17, with the trial concluding "around midyear 2021", followed by a second trial of children aged 6 months to 11 years. Given children 17 years and younger amount to 22% of the US population, if you combine that with the roughly (and optimistically) 20% who refuse to take the vaccine under any circumstances, you're left with only 60% who will take the vaccine — far below the 70% needed for herd immunity (at a bare minimum). We had better hope a lot of those people get immunity somehow.

This sales job is not helped by the CDC's message that, even after vaccination, we will still have to mask and keep away from other people (emboldening mine).

"Currently, we do not have enough data to be able to say with confidence that the vaccines can prevent transmission," National Institute of Allergy and Infectious Diseases Director Anthony Fauci said last month. "So even if vaccinated, you may still be able to spread the virus to vulnerable people," he continued, and therefore you should continue to wear a mask and socially distance. Don't go back to normal, he advised, even after you've gotten the shot that is supposed to put things back to normal. In fact, we may still be in masks in 2022, Fauci added a few weeks later. Guidance from the Centers for Disease Control (CDC), expected to be released this week, strikes similar notes.

This is not how we should be talking about vaccines and the return to normalcy. However good the intent—and the intent is almost certainly to discourage reckless behavior that could undermine the vaccines' impact on disease transmission—the effect is discouraging and detrimental. Insofar as it might dissuade some people from getting vaccinated, advice like Fauci's might even be dangerous.

Getting vaccinated is a step — the biggest step — toward normalcy. It's too bad the CDC doesn't appear to see it that way.