Urgency of Normal, the Great Barrington Declaration, and the antivax movement

I’ve written a number of times about the Great Barrington Declaration (GBD), a statement produced a couple of months before COVID-19 vaccines started being distributed under an emergency use authorization (EUA) that advocated a “natural herd immunity” approach to the pandemic. The GBD was written by three academics at the behest of the libertarian free market think tank American Institute for Economic Research (AIER): Oxford University theoretical epidemiologist Sunetra Gupta; Stanford University health policy professor Jay Bhattacharya; and Harvard University biostatistician Martin Kulldorff, who, after having met with Jeffrey Tucker, Stacey Rudin, and AIER officials at a weekend conference, enthusiastically spearheaded the effort to promote an “anti-lockdown” message, to whose drafting Jeffery Tucker. (He even bragged about it.) The result was the GBD, which was birthed at a second weekend conference held at AIER headquarters in Great Barrington, Massachusetts, hence the name. More recently, a similar sort of effort, dubbed “Urgency of Normal” by its backers, has arisen and reminds me a lot of the GBD, only for children and schools, as you will see. Both enthusiastically argue against masks, “lockdowns,” virtual school, and, now, even vaccines.

With that background, let’s discuss is a “roundtable” discussion held by Florida Governor Ron DeSantis on Monday that involved the GB and “Urgency of Normal.” The result of the roundtable was headlines declaring how Gov. DeSantis and Dr. Joseph Lapado, Florida’s director of Health and Human Services, was going against the CDC’s recommendation and recommending that healthy children not be vaccinated against COVID-19:

Gov. Ron DeSantis had assembled Florida Surgeon General Dr. Joseph Ladapo and 10 other medical and scientific professionals for a live discussion on the “Failure of Lockdowns and Mandates.” Included were some of the medical community’s most vocal skeptics of pandemic mitigation measures. They spent the bulk of the conversation — which was recorded in a West Palm Beach studio and aired on social media and Rumble by DeSantis’ office — criticizing all the ways the US Centers for Disease Control and Prevention and federal government attempted to slow the spread of the coronavirus and protect people from infection. There was some discussion as to whether vaccines were necessary for kids, with the argument being that the virus does not seem to affect children like adults (though almost 4.5 million children have tested positive just since the beginning of January and some cases have resulted in dangerous complications). 

But it was not until the very end of this 90-minute event that Ladapo abruptly shared his news, telling the viewing audience: “The Florida Department of Health is going to be the first state to officially recommend against the Covid-19 vaccines for healthy children.” He did not elaborate on it or explain how this decision had been reached, when it would be official or what led to this decision. Later Monday, DeSantis clarified that Florida parents would have the choice, but he added: “We are not just going to follow the CDC in the state of Florida. … We’re going to do our own stuff.”

While one can argue that it is not necessarily antivax to argue that children don’t require boosters for COVID-19—after all, Dr. Paul Offit, no antivaxxer himself, has made that argument, and even though many of us don’t agree we don’t call him antivax—but to argue that in general children should not be vaccinated against COVID-19? That’s at least borderline antivax, given that COVID-19 vaccines are safe and effective and the CDC recommends vaccination against COVID for children aged five years and older. At the very least, the doctors who make the sorts of arguments commonly used to say that children shouldn’t be vaccinated against COVID-19 (e.g., that “only” ~1,000 children under 18 have died of COVID-19 during the pandemic and therefore COVID-19 is not “that dangerous” to children) don’t realize that antivaxxers have been making the very same argument about measles and varicella vaccines for decades. As I like to counter, measles used to kill around 500 per year right before the measles vaccine was introduced while varicella killed around 100, and that doesn’t count the many more cases of neurological injury from both diseases. As I like to point out to all these physicians arguing that COVID-19 “isn’t very dangerous” to children, if you make that argument for COVID-19, then why don’t you oppose school vaccine mandates for MMR and varicella? If you make the same argument about COVID-19 vaccines, like it or not, believe it or not, you are parroting more general antivax talking points.

I also counter that children shouldn’t die, if we can do anything to prevent it. That used to be the norm before vaccines, lots of children not making it to adulthood, thanks to childhood diseases. Such is no longer the case to the degree that even small numbers of children dying of such diseases is now rightly considered intolerable, at least if you don’t subscribe to the GBD or “Urgency of Normal.” In fact, the same rationale used to argue against COVID-19 vaccination could be used to recommend shutting down a whole lot of other pediatric care, because children don’t die of anything at anywhere near as high a rate as adults:

But back to Gov. DeSantis’ “roundtable” with the GBD, “Urgency of Normal,” and other COVID-19 minimizers and antivaxxers. It was a very striking event because of whom it brought together. Here’s the video:

The video is still on Facebook as well.

Notice the bit about “COVID theater.” You might remember Gov. DeSantis berating high school students at a press event for wearing masks, derisively calling mask wearing “ridiculous,” saying, “Honestly, it’s not doing anything, and we gotta stop with this COVID theater. So if you want to wear it, fine, but this is ridiculous.” It’s a talking point, but of course I can’t help but think: Project much? After all, this roundtable was primo “COVID theater.”

COVID-19 denial a-go-go!

One thing that struck me immediately about Gov. DeSantis’ bit of COVID theater was the list of participants. First, every single author of the GBD participated—all three of them, Jay Bhattacharya, Martin Kulldorff, and Sunetra Gupta, all participating via Zoom. (Every. Single. One.) In person, of course, we find Dr. Ladapo, who is a member of the COVID-19 quack group America’s Frontline Doctors and was recruited by DeSantis to head up Florida’s entire public health infrastructure as surgeon general and director of Florida HHS. You might recall that America’s Frontline Doctors first reared its ugly COVID-19 disinformation head in the summer of 2020, when they held a press conference to promote hydroxychloroquine as a miracle cure for COVID-19, despite the increasing evidence at the time that it didn’t work. Indeed, Dr. Ladapo even appeared in that infamous video, along with Dr. Stella “Demon Seed” Immanuel, a physician who claimed that endometriosis and other gynecological complaints were due to dreams of sex with demons and witches. So naturally, Dr. Ladapo was down with that group, which later went antivax and sued over “deaths from COVID-19 vaccines.”

But who else took part? I note that the second person to introduce themselves was none other than Dr. Robert “inventor of mRNA vaccines” Malone. (That Gov. DeSantis gave Dr. Malone the second speaking slot after his own Secretary of HHS tells you all you should know about this roundtable.) Amusingly, he claims himself to be an expert in bioethics as well.

This is someone who did some early work in the late 1980s as a graduate student using lipid nanoparticles to get mRNA into cells in cell culture and have it make protein and now claims himself to have been the “inventor of mRNA vaccines,” even though he was not. More recently, he’s falsely claiming to have been “erased by Wikipedia” over his claims about COVID-19 vaccines. (He wasn’t, although his wife was apparently busted trying to edit his Wikipedia page to proclaim him the “inventor of mRNA vaccines.” More recently still, he’s gone full antivax conspiracy theorist, claiming on Joe Rogan’s podcast that vaccine advocates are a victim of “mass formation psychosis.” Word to all three authors of the GBD: If you want to be taken seriously, you really shouldn’t appear at the same roundtable with a bonkers conspiracy theorist like Dr. Malone. In particular, you shouldn’t want to speak right after someone like Dr. Malone, as Dr. Høeg did, although she did echo the “brave maverick doctor” rhetoric of others on the panel by mentioning how, as a private practice physician, she is “free” to speak out about COVID-19 even if she bucks the consensus, and how she supports “academic freedom,” which apparently, if you listen to this panel, means the “freedom” to spew disinformation and nonsense about COVID-19 without being harshly criticized.

Which brings me to “Urgency of Normal.”

“Urgency of Normal,” or: Let the kids all catch COVID!

Interestingly Tracy Beth Høeg was also at the roundtable—and there in person as well. You might remember her as the private practice sports medicine doctor who, despite having studied epidemiology, had no relevant expertise in infectious disease or other aspects of epidemics or pandemics. None of that stopped her from coauthoring a paper that was the result of an incompetent dumpster dive into the Vaccine Adverse Events Reporting (VAERS) database with Josh Stevenson, a prominent member of Rational Ground, a COVID-19 denying (and antivax) group. It was a thoroughly awful study in which Høeg (unwittingly, I’ll assume) used the old antivax tactic of weaponizing VAERS reports to demonize a vaccine. Unsurprisingly, used by antivaxxers to argue against vaccinating children against COVID-19.

More recently, Dr. Høeg has spearheaded an effort that launched in late January called “Urgency of Normal,” along with a number of other of the “usual suspects” of COVID-19 minimizing doctors. The basic idea behind “Urgency of Normal” was that schools should, in essence, stop all COVID-19 mitigations, particularly mask mandates and social distancing, because—there’s that antivax argument again!—children are at such low risk of dying from COVID-19 that we should just let the virus rip and, of course, because masks and the mitigations supposedly do so much more harm than the virus to children:

Meanwhile, children’s already-low risk from COVID has become even lower. Vaccines are available to children aged five and up, the Omicron variant is causing milder disease, and vaccines continue to be extremely protective against severe disease in the Omicron era.

Based on a careful review of all of this evidence, we believe it is time to allow children the same return to normalcy that adults have enjoyed. Children’s schools, athletics, and activities should be restored to their 2019 norms. Masks should become optional in US schools (we suggest, by February 15), and we can also return to pre-pandemic norms for quarantines: if you are sick, stay home. 

I find it rather interesting that, although “Urgency of Normal” mentions the vaccines as making “already-low risk” children even “lower” risk, they don’t recommend that children be vaccinated; instead they note only that vaccines are “available to children aged five and up.” This tracks with Høeg’s dumpster dive into VAERS regarding myocarditis that sought to portray COVID-19 vaccines to be at least as dangerous to children as SARS-CoV-2, the virus that causes COVID-19, itself. I also find it…interesting…how many reports I hear of parents citing “Urgency of Normal” to say that quarantines are no longer necessary for children with COVID-19.

“Urgency of Normal” provided a toolkit to parents to use to argue to school boards to drop mask mandates and other COVID-19 mitigation measures. I have relatives who have pointed out to me just how successful this effort has been, with lots of parents whom you wouldn’t otherwise think to be susceptible to such an effort enthusiastically embracing the slogan. Almost immediately, though, it was pointed out how “Urgency of Normal” misused and misrepresented scientific studies. I’ll cite just a couple of examples of Twitter threads ripping apart the misuse of suicide statistics:

And:

Epidemiologist Gregg Gonsalves has also demolished the claims of “Urgency of Normal.” The whole thread is worth reading, but Gonsalves makes one point that explains why there is an affinity between the GBD and “Urgency of Normal” that’s worth looking at:

Others have also piled on, given how obvious the propaganda of “Urgency of Normal” is.

So, when you boil it down, both the GBD and “Urgency of Normal” argue that COVID-19 isn’t dangerous to most people, and therefore we should just stop trying to stop its spread and use “focused protection” to keep massive numbers of the vulnerable from dying. In the case of GBD, the argument goes that “lockdowns” cause far more harm than COVID-19 (which is not dangerous to most people) and that we should therefore let the virus rip to achieve “natural herd immunity” faster and instead “focus” protection on the elderly and those with chronic health conditions that make them more vulnerable to severe disease and death from COVID-19. In the case of “Urgency of Normal,” the argument goes that school mitigations such as mask mandates and virtual school have caused a wave of child suicides and depression doing more harm than the virus and that we should therefore drop all those mitigations and let the virus rip through schools, which will eventually result in—you guessed it!—”natural herd immunity.” And guess what? Just yesterday, Martin Kulldorff himself published a new article in his new gig as scientific director of the Brownstone Institute (a.k.a. the “spiritual child of the GBD) entitled Should I Vaccinate My Child Against Covid?, which argues exactly the same thing, that children are at such low risk from COVID-19 that risk-benefit ratio of vaccinating is unfavorable.

What do the GBD and “Urgency of Normal” have in common?

I’m really not going to go into the propaganda promoted in Gov. DeSantis’ roundtable that much, given that I’ve discussed a lot of it before on numerous occasions, although I will mention a few tidbits. For instance, there was the usual equating COVID-19 mitigations and mandates with “unscientific” assaults on freedom that are based on “fear”:

“Under the leadership of Governor DeSantis, Florida has continued to stay ahead of the federal government by following sound science – not coercion,” said Surgeon General Dr. Joseph Ladapo. “Today, we were able to bring doctors from around the world to discuss COVID-19 and the lack of data to support mandates. Scientific debate takes place in a public forum – it is not hidden in federal bureaucracy. We need to get back to living – not hiding in fear.”

Unsurprisingly, Dr. Bhattacharya equates criticism of the GBD with “censorship” and “silencing” of “brave maverick scientists” like himself, because of course he does:

“The lockdowns were an enormous catastrophic mistake that should never be repeated,” said Dr. Jay Bhattacharya, M.D., Ph.D., Professor of Health Policy, Stanford University Medical School. “When we think about lockdowns, we should recoil with horror because the policies we followed have violated not just medical ethics, but also crushed the ability for scientists to discuss openly with each other facts and evidence. It’s taken a great amount of effort and willingness to face abuse in order for scientists to speak up and many have been silenced. I think [we need] the restoration of the freedom for scientists to discuss with one another openly what the evidence actually says without fear of repression that we’ve seen during the pandemic in order to support the lockdowns. I think that the proper place of science in society needs to be restored so that scientists can advise, but not dictate policy.”

That last line made me cringe. Since when have scientists ever dictated policy, even during a pandemic? But let’s move on to Dr. Tracy “Urgency of Normal” Høeg:

“We’ve really had an inversion of the precautionary principle,” said Dr. Tracy Beth Høeg, M.D., Ph.D., Board Certified Interventional Sports and Spine Medicine Specialist, Northern California Orthopedic Associates. “I think that’s a great theme because it relates to school closures, lockdowns and masks. We know that masks interfere with communication, and children do not like wearing them. The children with hearing impairments and other impairments have difficulty wearing masks. And, we’re forcing them to do this just because we have this idea that they’re going to be doing something good. We have actually no high-quality evidence showing that they are.”

Of course, this is utter nonsense. There is a lot of evidence, albeit mostly epidemiological and observational, that masks do work to slow the spread of COVID-19. I also can’t help but point out that Dr. Høeg, of all people, should not be one to be chastising anyone for not using rigorous evidence, given how Urgency of Normal has cherry picked and misrepresented evidence and she herself has published utter dreck about myocarditis and VAERS. Then there is the double standard. She demands gold-standard randomized clinical trial evidence for masks, but will accept all sorts of low quality and dubious evidence, as long as it reinforces her preexisting belief that masks harm children.

Then came the outright opposition to vaccinating children from Kulldorff:

“If you have had immunity, you don’t need vaccines, and that by itself sort of reduces any argument for having a vaccine mandate or vaccine passports,” said Dr. Martin Kulldorff, Ph.D., Scientific Director, Brownstone Institute; Fellow, Hillsdale College’s Academy for Science & Freedom. “But for children who haven’t had COVID, the question was, we don’t know to what extent it helps, up against death and serious disease. Right now in the U.S., the Omicron wave is going down. Right now I think the benefits of vaccinating children are very small. We know that there’s a risk of myocarditis for young boys and young men, but also for girls. There might be other adverse reactions that we don’t know about yet. So for children, the benefits we know are at best, very small and we don’t know what the risk benefit ratio is. I think under those circumstances, it’s unethical to mandate vaccinations for children.”

Kulldorff is, of course, ascribing magical mystical properties to “natural immunity” (more properly called postinfection or infection-induced immunity) to COVID-19 that ignores the observation that “natural immunity” is not any more robust against new variants than vaccine-induced immunity. Also note Dr. Kulldorff’s new gigs. He’s no longer Harvard faculty; instead he’s a fellow at the new right wing program at Hillsdale College, which is unfortunately in my state. That’s quite the comedown!

More importantly, when you sound exactly like Dr. Malone, you really should question where your life has taken you:

“There is no justification for mandating vaccines for children, full stop,” said Dr. Robert Malone, M.D. “We’re of the strong opinion that if there is risk, there must be choice. As far as we’re concerned, there is no medical emergency now, and there is therefore no justification for the declaration of medical emergency and the suspension of rights that has occurred with that reupping of the medical emergency by the executive branch. Another thing that the state of Florida has led on that we are very grateful for is enabling physicians [and providing] the latitude to provide early treatment to patients. We have really tried to advocate for the ability of physicians to just practice medicine.”

“If there is risk, there must be choice” is not a new talking point. It’s a talking point that antivaxxers have used as long as I can remember, although often it’s phrased, “Where there is risk there should be choice” or something similar. For example, this is from before the pandemic:

There have even been T-shirts:

As I’ve described many times before, this messaging is common in the antivaccine movement. The idea is to conflate what I like to call “misinformed refusal” of vaccines with an uncontroversial medical topic like informed consent by insisting that all the exaggerated and made-up “risks” of vaccination that are not supported by science (and are usually even refuted by science) be included in informed consent discussions for vaccines.

We’ve now seen just how alike the GBD (a propaganda document advocating a do-nothing approach to the pandemic) is to “Urgency of Normal” (a propaganda “toolkit” designed to be used to stop doing anything in schools about the pandemic). But why? Why are they so alike? And why do right wing politicians who want to “reopen” everything love the GBD and “Urgency of Normal” so much?

Urgency of Normal and GBD: Propaganda, not science

I’ve written before a number of times about how the GBD is a campaign that has always been far more about ideology than science. Indeed, as a document, it started out as what we call “magnified minority” of the sort long used by science denying cranks of all varieties, including creationists, HIV/AIDS denialists, and antivaxxers. The idea is to write a statement denying some aspect of science and to get a bunch of what appear to be “experts” to sign it. Nearly always, the vast majority of the “experts” who sign such documents are not really experts at all, but they appear to be to the general public. Moreover the GBD originated in ideology from the
“new merchants of doubt,” not science, with AIER having recruited Martin Kulldorff, who then became a willing useful idiot who recruited Sunetra Gupta and Jay Bhattacharya to meet at AIER headquarters, where the GBD was written and given a huge publicity push by AIER. Of course, the GBD’s “focused protection” was never really a viable strategy—a great argument why can be found here—but rather cover for opposing collective action to slow the spread of COVID-19 using a seemingly scientific rationale that “natural herd immunity” would be reached faster that way. (How’d that work out, with Delta and Omicron?)

There also appears to be a fair amount of overlap between “Urgency of Normal” and the GBD:

Other members of the group include Dr. Scott Balsitis, a virologist who develops antivirals and monoclonal antibodies for Gilead Sciences, which makes the Covid antiviral remdesivir (Balsitis did not return interview requests by press time), and Dr. Vinay Prasad, a hematologist and oncologist who joined the group shortly after it was formed. Prasad also writes for the Brownstone Institute for Social and Economic Research, a group advocating a more libertarian approach to the pandemic. (After this article was published, Prasad clarified on Twitter that the pieces on Brownstone’s website are republished from his Substack newsletter.)* Brownstone’s donor breakdown is unclear, but its founder consults for the American Institute for Economic Research, which receives funding from the Charles Koch Foundation and a Koch-funded public relations firm Emergent Order. AIER aided the Great Barrington Declaration—an early (and widely denounced) campaign to drop Covid precautions under the theory that “focused protection”—i.e., precautions only for the vulnerable—would be sufficient. Brownstone describes itself as”the spiritual child of the Great Barrington Declaration.” (One Koch-backed group has also been linked to school unmasking efforts.)**

The attitude is also quite callous:

That McBride brought this up is interesting, because the prospect of children losing more loved ones to Covid-19 is also why some experts argue schools should maintain precautions during times of high transmission: While studies suggest masks don’t affect mental health, they say, the trauma of picking up Covid at school and passing it to a grandparent who gets sick or dies can be significant.

The anti-mask crowd doesn’t find this argument convincing. “I see hundreds and hundreds of kids in a clinic space over the course of a week,” one physician in favor of removing precautions like masks and quarantines after exposure, who asked not to be identified because of professional repercussions, told me. “I have not had one child say, ‘What is causing me to be upset is because I had a grandmother die.’”

I’ve called the GBD “eugenicist” because its “focused protection” is a sham given that what it proposed is not much different than mitigation measures that were already in place and could not actually result in “focused protection.” Basically, the GBD proposal of “focused protection” never made sense and devalued the lives of the elderly and those with chronic health conditions with a “let them die” policy poorly disguised as an effort to protect them. I’m rapidly getting the same vibe about “Urgency of Normal.” Although there hasn’t been such an explicit link to “Urgency of Normal,” it has been documented for a while now how dark money interests have been doing their best to fuel antimask activism among parents.

Interestingly, “Urgency of Normal” admits:

The Urgency of Normal acknowledges that its recommendations are “particularly focused toward highly vaccinated communities.” But what neither this group nor other voices urging normalcy typically emphasize is that there are huge equity problems when it comes to which communities have been vaccinated.

Funny, but that sounds a lot like the GBD, which caters to privileged, better off people who tend to be less susceptible to harm from COVID-19 and better able to engage in something resembling “focused protection” and ignores all the disadvantaged communities who have suffered the most from the pandemic. That’s why a group to counter “Urgency of Normal” was formed, called Urgency of Equity:

It’s easy to see why Gov. Ron DeSantis loves both GBD and “Urgency of Normal.” Both groups promote a narrative that massively downplays the actual documented harms due to COVID-19. Both groups advocate “focused protection,” just in different contexts. Both groups oppose mask mandates and any sort of COVID-19 vaccine mandates for children, even going as far to parrot common antivax talking points that predate the pandemic. Both groups basically oppose any sort of collective action against the pandemic in favor of getting “back to normal,” using cherry picked studies, misinformation, and disinformation that massively exaggerate (or even lie about) the harms of mitigations used to decrease the spread of and harms due to COVID-19. Neither seems to care about being associated with outright antivax cranks, like Dr. Malone, or quacks like Dr. Ladapo. Both are engineered efforts; i.e., astroturf, rather than true “grassroots” efforts.

Basically, “Urgency of Normal” and the GBD are two sides of the same coin that are nearly identical or, as I like to say quoting an old commercial, two crappy tastes that taste crappy together.