Bill Ackman is shocked that people think he’s antivax

I must confess that, before I first encountered him lending tactical air support on Twitter to Robert F. Kennedy, Jr. and Joe Rogan’s performative “challenge” to Dr. Peter Hotez to “debate” vaccines, I hadn’t heard of Bill Ackman, billionaire hedge fund manager and Twitter blue check. As you might recall, after Dr. Hotez had Tweeted out a link to an article by Anna Merlan critical of Spotify for letting Joe Rogan continue to host credulous puff interviews with antivaxxers like Robert F. Kennedy, Jr. that allow them to spew the worst antivax misinformation to a large audience, Rogan and RFK Jr. “challenged” Dr. Hotez to appear on Rogan’s podcast to “debate” him, complete with a promise to donate $100,000 to Dr. Hotez’s favorite charity. This “challenge” soon resulted in a social media (and, truth be told, legacy media) pile-on full of hate aimed at Dr. Hotez.

Ackman couldn’t resist adding his own pittance (compared to his overall net worth) to Joe Rogan’s pittance, in order to start putting the screws to Dr. Hotez to “debate”:

As I said at the time, these were deeply unserious offers designed to entice Dr. Hotez into a “bread and circuses”-type “debate,” while shaming him if he did what any reputable scientist should do when faced with a “challenge” like this to debate: refuse. It wasn’t long before Ackman was Tweeting things like:

I have no idea if Mr. Ackman had demonstrated any antivax proclivities before I encountered his foray onto Twitter to amplify Joe Rogan and RFK Jr.’s “challenge.” As I said, I’d never heard of him before. I do know that it wasn’t long after that that Mr. Ackman also started re-Tweeting antivax propaganda:

Bill Maher, of course, has been antivax at least since 2005—at least as long as RFK Jr.!—and I recently discussed the deceptiveness of Aaron Siri’s “no true placebo” (only saline) gambit. (I will be posting a revised and expanded version of that post on Monday.) Let’s just start out by saying that, if you don’t want to be perceived as antivax, then uncritically—nay, approvingly—re-Tweeting antivax propaganda, all while retreating behind a favorite tactic of antivaxxers, namely asking, “Why won’t they debate?” is not a good strategy for you to achieve this end.

Nor is saying that Steve Kirsch has good ideas about vaccines:

Mr. Ackman seems to think that Mr. Kirsch’s recent offer to “collaborate” with scientists on “both sides” of the vaccine-autism “debate” is anything more than delusion in search of an unethical set of clinical trials that don’t need to be done, as I described in depth just the other day.

Then, this week, I saw this:

Regular readers will recognize immediately that in the two long-form Tweets above Mr. Ackman regurgitates a number of “classic” (i.e., prepandemic and older) antivax tropes, and I’m happy to point them out. Let’s begin.

First, our poor, poor, pitiful billionaire Mr. Ackman whines about being so very, very misunderstood as a, well, let me just quote him:

I tweeted that

@RobertKennedyJr raised some important questions about vaccine safety and now I am being labeled a Qanon conspiracist by some and a member of the alt-right by others.

Yes, if you uncritically parrot RFK Jr.’s “questions” about “vaccine safety,” it is not unreasonable to wonder if you are an antivaxxer. Given how much RFK Jr. has been embraced by the alt-right and Qanon, it’s not unreasonable at least to wonder if Mr. Ackman has an affinity for these movements. Seriously, methinks he doth protest too much. Moreover, he can’t be that oblivious to how much the antivaccine movement has associated itself with the far right and Qanon conspiracist movements and that RFK Jr. himself has long been playing footsie with fascists, can he? He might be, but it’s probably disingenuousness. Still, it’s clear that Mr. Ackman views himself as “not ‘antivax'” as he parrots very old antivax talking points.

After using a very hypercapitalist view of vaccine development befitting a billionaire hedge fund manager that portrays a hypothetical situation—cough! cough! COVID-19 vaccines!—in which pharmaceutical companies develop and wins approval for a drug/vaccine in less than a year and…well, given that you can’t just click on his Tweet unless you have a Twitter account to see what he said, I’ll just quote extensively:

Even when a successful drug is brought to market, the drug company remains liable for any potential damages from those who are harmed by the drug.

The above reasons are why getting profitable drugs approved is challenging and risky.

Imagine, however, if:

(1) you could create a drug in a much shorter period of time, a year or two, rather than 10-15 years, and the total cost to get it approved and marketed to patients was a fraction of the cost of a typical drug.

(2) the new drug is prescribed for everyone, regardless of their health, and therefore the market for the drug is every newborn or potentially everyone on the planet.

(3) the drug is prescribed for everyone regardless of their age or consent and they need to take it in order to attend school or keep their job, and the gov’t pays for it.

(4) the patients who are prescribed the drug are of an age where they are incapable of assessing the risk versus the reward for taking the drug.

(5) the drug needs to be taken every year regardless of the health of the individual who takes it.

(6) the drug companies who manufacture these new drugs are exempt from liability for these drugs even if they cause serious harm or death.

and

(7) drug companies are: (a) permitted to advertise on TV and on other media and are one of the largest sources of revenues for the news media who are responsible for educating the public about risks to public health and safety, and (b) the drug companies are also major lobbyists to the government and funders of the FDA.

If (1) – (7) were true:

and you were a drug company, you would seek to obtain approval for as many of the above drugs as possible, as the above drugs would have the lowest R&D costs, the fastest time to market, the lowest marketing costs, the largest addressable market, and no liability.

You would be crazy not to develop as many of the above drugs as possible and do everything possible to convince the government to make them standard of care, and motivate the public to take them.

Although (1)-(5) are not unreasonable questions/criticisms of pharmaceutical company, one quickly notices that (6) is an oft-repeated antivax distortion beloved by RFK Jr. that the National Childhood Vaccine Injury Act of 1986 somehow provided “blanket legal immunity to all vaccine companies.” This is a common antivax version of events, which leaves out what the bill really did. In the wake of claims that the DPT vaccine had caused neurologic injury to children, there were so many lawsuits against vaccine manufacturers that pharmaceutical companies were strongly considering leaving the US market due to increasing difficulties obtaining liability insurance, with only one manufacturer still making pertussis vaccine in 1985. The solution agreed upon by Congress and President Ronald Reagan and codified in the NCVIA of 1986 was to set up a special “no fault” compensation program for those injured by vaccines, the National Vaccine Injury Compensation Program.

The law set up a special court with special expertise, commonly called the Vaccine Court, funded by a small excise tax on each vial of vaccine sold. Complainants denied compensation through the Vaccine Court still have access to federal courts. All the law does is to require complainants to use the Vaccine Court first. I also like to point out that, not only does the Vaccine Court bend over backwards to be fair to complainants by allowing them to posit “theories of injury” that don’t pass the Daubert test for expert testimony, but it is a civil court, in which the preponderance of evidence—sometimes referred to as “50% and a feather”—wins. But that’s not all! The Vaccine Court pays the complainants’ attorney fees and reasonable expenses, too, win or lose! That’s part of the reason that antivax attorneys hate the Vaccine Court. While they do get a guaranteed paycheck, it will never be more than their hourly charges plus reasonable expenses. It will never be the giant payout that they hope for from a huge judgment. They tend to the high risk/high reward tactic of contingency cases rather than the low risk/low (but reliable) reward tactic of taking Vaccine Court cases for a guaranteed hourly rate.

Mr. Ackman continues in the same vein:

If you were a citizen, however, you would want the above drugs to receive the highest scrutiny for safety and efficacy, and you would want longitudinal studies to understand the long-term effects and the potential cumulative effects of these drugs, in particular, on children.

Now, if the number of doses of these drugs taken by children increased from 3 to 72 in the last 30 or so years, and over the same period there was a massive unexplained increase in the percentage of kids that suffered from debilitating diseases like autism and other less debilitating, but concerning issues, like allergies and eczema, you would look deeper until you understood what was causing the massive increase in these issues.

Congratulations, Mr. Ackman! You’ve rediscovered an antivax trope that Jenny McCarthy used to use routinely 15 years ago! Very impressive.

I trust that readers will immediately recognize an old antivax trope too commonly employed by antivaxxers that we who have been combatting antivaccine disinformation for a long time have a name fore it: “too many too soon.” “Too many too soon” falsely claims that, thanks to the expansion of the childhood vaccination schedule since the 1990s, children are now receiving “too many” vaccines at too young an age (“too soon”) and then insinuating (or outright claiming) that this increase in the number of vaccines that children receive is fueling an increase in autism, allergies, eczema, sudden infant death syndrome (SIDS), and many other problems falsely attributed to vaccines by antivaxxers. This trope ignores, as Dr. Mark Crislip once put it, the infection schedule versus the vaccination schedule. There is no evidence to support this idea; indeed, there is evidence very strongly refuting this idea, and it’s old evidence too.

As the American Academy of Pediatrics puts it:

The amount of antigens that children fight every day (2,000–6,000) is much more than the antigens in any combination of vaccines on the current schedule (150 for the whole schedule).

From this, by the end of his first blue check Tweet, Mr. Ackman concludes:

We need to think about vaccines the same way we think about other drugs, particularly when we are deciding whether or not to inject a one-day-old infant or three-year-old child.

We need to assess what is the benefit to the child in protecting them from a disease versus the potential risk from the side effects from each vaccine.

That mention of a “one-day-old infant” is a clear allusion to the birth dose of hepatitis B vaccine, something antivaxxers have demonized ever since it was first included in the childhood vaccine schedule. I’ll ge too that in a moment. As for the last paragraph, WTF? Does Mr. Ackman think that the CDC’s Advisory Committee on Immunization Practices (ACIP), the main committee that constructs the CDC recommended vaccine schedule, doesn’t think about this as they examine and debate the clinical trial and epidemiological evidence about each vaccine that they consider adding to the schedule? Does Mr Ackman think that he (or RFK Jr., whose talking points he’s regurgitating) is the first person to think of this concept? Does he think that only antivaxxers care about the children?

Won’t someone think of the children?

Seriously, though, this is some insulting bullshit that Mr. Ackman is laying down here, the same insulting bullshit that antivaxxers have long laid down. It assumes that pediatricians, infectious disease doctors, vaccinologists, and scientists don’t think of this issue, but instead just mindlessly add to the schedule, willy-nilly, every new vaccine that comes along, without thinking about risk-benefit ratios and potential adverse events. Basically, what Mr. Ackman is doing here is repackaging one of the most basic “Well, duh!” observations as though it were some sort of brilliant observation that literally everyone involved in constructing the recommended childhood vaccine had never thought of before.

Next up, in his second Tweet, Mr. Ackman invokes another old antivax false comparison:

For certain vaccines, the risk-reward calculation is clear. Polio is a extraordinarily debilitating disease and we have nearly 70 years of safety and efficacy data. As such, every child should be vaccinated for polio.

Alternatively, should it be standard of care for a one-day-old child to get a Hepatitis B vaccine or should we first assess what is the probability of this child being exposed to Hep B in the first few years of her life, and perhaps postpone her injection?

This is a very common trope, one that I can almost—almost!—forgive Mr. Ackman for falling for, for thinking that it might be valid given that a physician who should really know better, Dr. Vinay Prasad, recently echoed. Since I so recently discussed it, I’ll just paraphrase what I recently said about it. Antivaxxers like RFK Jr. love to demand why we are vaccinating newborn babies against a disease that is primarily transmitted sexually or through contact with bodily fluids (e.g., sharing needles). Antivax disgust over the birth dose of hepatitis B vaccine is much more a moral disgust than anything resembling a scientific argument, much as objections to HPV vaccines given to preadolescent girls based on claims that such vaccination will encourage promiscuity are moral, not scientific, arguments. The idea is that my baby or child isn’t at risk because my child doesn’t have premarital sex, share needles, or engage in what I consider morally dubious high risk behavior. The subtext, of course, is that those “dirty vaccines” should be reserved for people who need them because they are dirty too.

As one response mentioned:

To amplify the Tweet above, there are sound scientific and epidemiological rationales for vaccination against hepatitis B shortly after birth, including maternal transmission to the newborn and the observation of hepatitis B transmission in school and daycare settings. Seriously, if Mr. Ackman had done the least bit of research or engaged in the slightest bit of intellectual curiosity instead of parroting old antivax disinformation by RFK Jr., he would have acknowledged the reasons why the CDC recommends a birth dose of hepatitis B vaccine. Not all countries have chosen this strategy, but the US has, and there are very defensible scientific reasons to adopt the hepatitis B birth dose as the first dose in the series.

Mr. Ackman concludes with a typical crank complaint in which he portrays himself as True Champion of Real Science, contrasting himself with the seeming attitude that you “can’t question” science:

It is time we stopped attacking those who question the conventional wisdom about vaccines, and dig deeper to understand and address these issues and concerns.

Attacking the messengers and the critics will not get us closer to the truth. It will only cause those who are concerned to become even more suspicious and fearful.

Science is an unending pursuit of the truth. It is not a dogma to impose authority on those who question the veracity of the current received wisdom.

That last paragraph, in which he portrays current science as “dogma” and “received wisdom” is a common framing of science used by not just antivaxxers, but science deniers of all stripes. For example, a fellow surgeon, Dr. Jeffrey Singer, did it when he portrayed scientists as priests and peer review as “scientific gatekeeping” by the “priesthood” of science, as creationists denying evolution like to do, and as antivaxxers like to do when someone like Paul Thacker describes vaccines as “magic” or, as Paul Thacker did, compare masks, vaccines, and public health interventions to religious dogma.

Again, let me emphasize how old and common this trope is among deniers of science (like antivaxxers) and even among deniers of other academic, evidence-based disciplines like history.

This trope takes advantage of a common observation that it sometimes takes science too long to abandon disproven ideas and medicine too long to abandon disproven treatments and practices. Far be it from me to try to claim that there aren’t fads in science that take a long time for some scientists to abandon in the face of evidence or that treatments and operations that physicians and surgeons cling to after evidence no longer supports them. (Indeed, there’s an old joke that some operations and treatments aren’t abandoned until the surgeons and physicians who use them either retire or die.) Medicine and science are messier than the ideal, as are all human endeavors, because they are human endeavors and humans are not perfect! Disproven ideas and treatments, frustratingly, all too often take longer to fade into the oblivion that they deserve than we think that they should. That does not, however, imply that those promoting disproven science (as RFK Jr., whose ideas and talking points Mr. Ackman uncritically parrots, does) have a point.

Finally, as for Mr. Ackman’s lament about “attacking the messenger,” I have some obvious retorts. First, if you promote the same misinformation/disinformation that RFK Jr. has promoted for 18 years, you deserve all the criticism you get. Second, if you parrot someone like RFK Jr., who has been spreading antivaccine misinformation for at least 18 years, you should not be surprised when people wonder if you are antivaccine yourself or if you are associated with belief systems that tend to be antivaccine, like Qanon. RFK Jr. does not stand for science. He does not stand for scientific evidence. He is a conspiracy theorist who has been doing his best to cherry pick and misrepresent studies to spread fear, uncertainty, and doubt about vaccines since at least 2005 and had found a national stage that has provided him with a bigger audience and more attention than every before.

My guess is that Mr. Ackman was probably unfamiliar with these old antivax tropes. Likely, as is the case for so many new antivaxxers, they were new to him and seemed to make sense, if only because he was utterly oblivious and ignorant about the science that had long debunked them. Unfortunately, instead of educating himself among real scientists, which as a billionaire he could easily have done, he just took RFK Jr.’s word for it and then amplified the antivaccine message. He might not have known that that’s what he’s doing, but it is. He can either face up to it and learn about vaccines from actual scientists instead of an antivaxxer like RFK Jr., or he can continue whining about how unfairly he’s been treated on social and legacy media.

I suspect that I know which one he will chose.