Dr. Vinay Prasad embraces antivax “do not comply” messaging

The last three and a half years, during which the COVID-19 pandemic arrived, have been highly educational to me. As much as I thought I knew in early 2020, as news stories about an outbreak of a mysterious infectious pneumonia in China that was found to be due to a novel coronavirus, watching in real time what happened. Although by 2020 I had given up my rather naïve belief from many years ago that mass death from a pandemic of a deadly virus for which a vaccine was developed would fatally erode antivax beliefs among most people and thereby weaken the antivaccine movement, even I never anticipated how massively the pandemic and public health responses to it did exactly the opposite: Strengthen the antivaccine movement beyond anything it had ever achieved before and normalize antivaccine beliefs in our political discourse. By 2020, I had also come to understand how a combination of antivaccine messaging equating “resistance” to vaccine mandates (e.g., “do not comply,” which I will get to in a moment) had shifted the political center of gravity of the antivaccine movement sharply right over the preceding decade, but the pandemic taught me that the situation could get so much worse, with an increasing affinity between antivax beliefs and outright fascism. Perhaps most disturbing, I discovered that the pathway from having contrarian beliefs about public health to becoming a full-on pandemic conspiracy theorist antivaxxer was much shorter and easier than I had ever suspected, as I observed in my year-end post for 2020, later speculating why so many physicians are attracted to “contrarian” beliefs and then so easily slide from these beliefs deeper and deeper into conspiracy theory and science denial prodded by audience capture.

Enter Dr. Vinay Prasad. Again.

Earlier this month, I saw a post by Dr. Vinay Prasad, Orac’s favorite formerly respected rising star in academic medical oncology turned antivax-adjacent, if not fully antivax, COVID-19 “contrarian” entitled Do not report COVID cases to schools & do not test yourself if you feel ill. with a tagline, “Only non-violent resistance can halt irrational public health actors.” It reminded me so much of the “do not comply” messaging that had become such a centerpiece of antivaccine rhetoric before the pandemic and then even more so once COVID-19 vaccines arrived in late 2020 that I had to take a look. True, Dr. Prasad never actually uses the exact phrase “do not comply,” but he uses one so close to it that it might as well be “do not comply.” Indeed, his entire post is a call to resist all public health mandates with respect to COVID-19. Also remember this. Dr. Prasad has an MPH, a Master of Public Health degree. He has studied public health, which makes this post all the more disturbing, coming as it does from someone who should very much know better but no longer does.

Dr. Prasad begins by asking a rhetorical question:

I saw this post today. A school in MoCo, MD (DC beltway) has reimplemented n95 masking for kids. As a side note: there is no n95 mask for kids— as these masks have not been validated in children. In response, one commenter suggests the only solution is to no long report COVID cases to school. Is this a sensible strategy?

Oooh, scary! “They’re coming with masks for your kids” again! I would also point out that most of these antivax parents don’t keep their kids home when they have a cold, because, after all, it’s “just a cold” and “kids get colds.” Just for yucks, I perused the X feeds of @daniela127 and Clay Travis. She turns out to be the founder of a group called Keep NYC Schools Open and her feed is full of antimask and anti-“lockdown” rhetoric that makes me think she’s partying like it’s 2020 again. (Hint: There hasn’t been anything resembling a true “lockdown” in the US and by mid-2021 most states had given up on the COVID-19 mitigation measures that had been implemented.

Predictably, given that Dr. Prasad’s question is a rhetorical question and not a “Betteridge’s Law of Headlines“-sort of question, his answer is yes, no matter how much he has to twist evidence and deny reality:

It turns out the answer is yes. Consider the facts. There is no evidence to suggest community mask mandates slow the spread of COVID in adults. There is no evidence to show they slow the spread of COVID in kids, and the best regression discontinuity studies (Spain) show no effect. Finally, there is no *logic* to slow spread in 2023, given that COVID has already engulfed 90%++ of kids (per CDC’s own Ab screens), and will keep spreading throughout humanity for 10,000 years or until we destroy ourselves. We should no longer aspire to slow spread. No one has shown that improves any outcome.

What about long COVID in kids? There is nearly no evidence to show that this entity warrants concern, and no evidence that any of these measures improve kids quality of life.

“Nearly” is doing a lot of heavy lifting here with respect to “no evidence.” While it is true that existing evidence is not as clear as we like, it is not true that there is “nearly” no evidence. For example, this meta-analysis (the very highest form of evidence, according to evidence-based medicine fundamentalists like Dr. Prasad) from May 2023 concludes:

Nearly one quarter of pediatric survivors suffered multisystem long COVID, even at 1 year after infection. Ongoing monitoring, comprehensive prevention and intervention is warranted for pediatric survivors, especially for individuals with high risk factors.

This meta-analysis was based on 40 studies covering 12,424 individuals and noted that the prevalence of any persistent symptoms at one year was 26%, and that persistent symptoms at one year included “generalized symptoms,” as well as respiratory, neurologic, and psychiatric symptoms, with dyspnea (shortness of breath), and headache being the most widely reported specific symptoms. Now maybe the ever eminent, EBM fundamentalist Dr. Prasad doesn’t think that it’s a big deal that one-quarter of children who catch and recover from COVID-19 report persistent and sometimes debilitating symptoms, dismissing the evidence from studies finding these results as “nearly no evidence” but most pediatricians who actually have to deal with suffering children are not so dismissive. Also, note that I picked only one study, a meta-analysis, because it’s recent and synthesizes existing evidence. There are a number of others out there that Dr. Prasad dismisses as “nearly no evidence” that long COVID in children “warrants concern.” Basically, for Dr. Prasad’s message to resonate, it has to be coupled with a message that COVID-19 is no big deal to kids, that it’s basically harmless, and that kids should just naturally catch it. Does that message sound familiar too? It should. It’s the same false message that antivaxxers have been repeating about measles and other childhood vaccine-preventable diseases since time immemorial.

Again, remember that Dr. Prasad has an MPH. He should know better. Instead, he uses his degrees to persuade his audience that COVID-19 is no big deal. I also note that, even if 90% of children have had COVID-19, thanks to the evolution of the virus to evade postinfection immunity acquired from prior variants, disease due to the new variants can spread. One can argue about what is reasonable, science-based, and effective in terms of infection mitigation, but Dr. Prasad’s nihilistic “let everyone catch COVID-19 again and again and again” approach is none of these. Consistent with this is his dismissing any evidence that is not from a randomized controlled clinical trial in order to claim that there is “no evidence” that masks prevent community spread of COVID-19. There actually is evidence. We can argue about how strong the evidence for and against masking to prevent the spread of COVID-19 is, how to interpret evidence from conflicting studies, and when or if it’s enough to justify mask mandates, but it is simply dismissively incorrect to claim that there is “no evidence.” That is Dr. Prasad’s methodolatry talking, in which any evidence that does not come from a perfectly conducted randomized controlled clinical trial doesn’t count and is therefore dismissed as “no evidence.” One is tempted to say that Dr. Prasad is every bit as “deranged” in his methodolatry as he accuses the parents of Montgomery County, MD of being in terms of their supposedly unthinking allegiance to Anthony Fauci and masks.

Then, Dr. Prasad, being Dr. Prasad, does exactly what he complains about on social media. He goes negative and portrays parents who are still concerned about COVID-19 as deranged and in the thrall of religion-like views. In other words, he portrays them as fanatics in order to dismiss them:

Given these facts, the policy of the Rosemary Hill Elementary school is not just unjustified— it is harmful. Requiring children to wear a useless mask to prevent the unpreventable— is deranged thinking. Given the voting patterns of MoCo, it likely reflects the persistent derangement among liberal democrats that the mask was given to us by Moses when he descended the mountain.

Dr. Prasad has been promoting this message for quite a while now. Indeed, doing a quick search of this blog, I found that he was promoting exactly this message a year ago, when he portrayed ongoing concern about the harms of COVID-19 and a desire among many to avoid catching the disease if they possibly can as irrational anxiety and fear. At the time, I pointed out how this sort of portrayal of public health advocates as fearful and of catching an infectious disease as unavoidable—even inevitable (or, as Dr. Prasad puts it this time, “unpreventable”)—is exactly the same sort of narrative that antivaxxers have used for decades about measles and other vaccine-preventable diseases.

One wonders what Dr. Prasad thinks of antivaxxers who said exactly the same thing about measles back in the day, that it’s a “harmless childhood disease that is dangerous to only a very few, that it’s impossible to avoid getting it, that “natural immunity” is better. Dr. Prasad obstinately keeps claiming that he’s “not antivax,” but then goes and keeps repeating antivax messaging the twas old when the pandemic hit in 2020. Either he’s ignorant about this messaging (possible, but no longer likely given how often people have. tried to explain it to him), in denial that that is what he’s doing (possible), or doesn’t care (the most likely possibility).

Which brings us to Dr. Prasad’s embracing yet another in a long line of antivax messaging that he’s embraced.

Dr. Prasad embraces his inner antivaxxer by telling parents, “Do not comply.”

Predictably, after that lead, Dr. Prasad goes full anti-public health and antivax (because the two go together) by telling parents, “do not comply.” And, yikes! The things he tells them not to comply with:

The commenter suggests that the only option left for remaining sensible people is to not longer comply in the system that yields this outcome. Here are some practical suggestions:

1. If you child is sick— do not test that child for COVID.
2. When they look good enough for school, send them in.
3. If you are sick— do not test yourself for COVID. (after all, Paxlovid data almost surely doesn’t apply to you — new post coming).
4. If anyone is sick, do not tell your employer or school.
5. Stop reporting these illnesses, and encourage your colleagues to cease reporting.
6. Decline any further COVID19 vaccination, unless RCTs show benefit in your age group
7. Complain to your employer about any mandates or declination forms.

In my estimation— it is the only logical course left. The strategy makes sense. It’s time to go dark with all COVID data. If enough people don’t participate, the irrationality will stop. Eventually.

Again, remember that Dr. Prasad has an MPH. He has an advanced degree in public health! Yet, he’s telling his readers to stop complying with any request or mandate made by public health authorities, not only that, to go completely “dark” with respect to providing data to public health authorities that will help them deal with infectious diseases—or even track the prevalence of infectious diseases.

Moreover, I rather suspect that Dr. Prasad likes the reactions that his post engendered on X, the platform formerly known as Twitter, such as:

And:

Seriously, this response seems rather appropriate:

So is this approving comment after Dr. Prasad’s post:

Vinay’s so red-pilled now it’s awesome. I mean the original meaning, ie not trusting authority.

That about describes Dr. Prasad these days, a term that is frequently used by the far right and conspiracy theorists to describe those who were once believers in the “conventional” narrative but have since “taken the red pill” à la The Matrix and now supposedly know reality as it truly is. Of course, the obvious subtext to such an attitude is obvious. If you don’t bother testing, reporting, or collecting data on incidence (and, of course, the prevalence of long COVID), then COVID-19 is no longer a problem, other than the pesky death that it still causes among the vulnerable, which, I’m sure, Dr. Prasad will find a way to deny soon enough. It’s all basically a convenient strategy to turn denial of epidemiology and public health science into a self-fulfilling prophecy.

As for Clay Travis, although the vast majority of his feed is about sports, he also finds time to demonstrate how fully antimask he is::

He’s also unhappy about high school football games being canceled due to spiking COVID-19 cases:

He’s also approvingly amplifying Robert F. Kennedy, Jr.’s antivax lies:

No wonder Dr. Prasad finds these people’s views attractive, given that he, too, has started echoing some of RFK Jr.’s antivax tropes, such as the “no saline placebo” trope and the demand for new randomized controlled clinical trials of all new vaccines versus saline placeboes, even if doing such a trial would be unethical because it would require leaving the control group unprotected and treated according to less than the standard of care with respect to prevention of common infectious diseases. That is, of course, yet another  longstanding antivax trope that Dr. Prasad has embraced, even as he labors under the delusion that he has not become at least antivax-adjacent, if not fully antivax.

“Do not comply”: Old antivax messaging embraced by Dr. Prasad and other COVID-19 contrarians

It turns out that there is no real mystery as to why this sort of messaging is being embraced by useful idiots for the antivax movement like Dr. Prasad. COVID-19 cases are increasing, leading, not unreasonably, to suggestions that maybe bringing back mask mandates (and vaccine mandates) is a good idea. I first saw it from Dr. Robert “inventor of mRNA vaccines” Malone, a physician who soon turned COVID-19 crank and antivaxxer but now writes things like—you guessed it!—Do not comply, in which he argues:

Furthermore, as the CDC again requires more testing in hospitals, schools and workplaces, cases counts will rise. Once that happens, we can expect more mask mandates on airplanes, trains and public spaces. These are hard to resist – we have to travel for work. We have vacations planned. We have places to go and we need to go into public buildings. How do we fight this?

You guessed it again! Do not comply! Florida Governor Ron DeSantis has also been using this phrase with respect to COVID-19 public health mitigations.

I wondered if any of the doctors who claim not to be antivaccine are aware of how much antivaxxers have used “do not comply” and/or “I do not comply” as messaging. For example, this was a thing on Facebook in 2019 in response to California trying to close the loopholes in its school vaccine mandate:

Sound familiar? (I note that it’s become more and more difficult to find the “do not comply” narrative in searches of time periods before 2020 given how overwhelming the narrative has become since the pandemic.) How about this:

In fact, the “do not comply” narrative goes way back, for instance, at least to the 1880s

And, even if the words “I do not comply” aren’t there, the sentiment was expressed often by fans of Jenny McCarthy 15 years ago:

There are many variations of the “do not comply” narrative that portray the poor oppressed antivaxxer as a freedom fighter willing to kill, if necessary. I realize that Dr. Prasad said that “nonviolent” resistance is the way, but it’s just a hop, skip, and a jump to ditching the “nonviolent” part and many of his fans are not so fastidious.

Here’s Del Bigtree, for example, in 2016:

If we do not fight now, then there will be nothing left to fight for. And I think that is where everyone in this room, I pray you realize how important you are in this historic moment. We will never be stronger than we are right now. We will never be healthier than we are right now. Our children are looking like this, a generation of children, as we’ve said on The Doctors television show this is the first generation of children that will not live to be as old as their parents. Are we going to stand…are we going to sit down and take it? Or are we going to stand up and say: This is a historic moment, that my forefathers, those from Jefferson all the way to Martin Luther King, the moments where people stood up and something inside of them said I’m going to stand for freedom and I’m going to stand for it now. That is in our DNA. It is pumping through me, and I pray that you feel it pumping through you, because we must look back. Our grandchildren will look back and thank us for having stood up one more time and been the generation that said, “We the People of the United States of America stood for freedom, stand for freedom. We will die for freedom today.

OK, this is definitely overwrought but not quite violent rhetoric yet. It skirts the edge of violence but maintains a bit of plausible deniability with respect to accusations of inciting violence. Similarly, Dr. Prasad’s rhetoric is seeking to channel comparisons to nonviolent resistance like that advocated by Martin Luther King, Jr., just as Del Bigtree did here. In other words, he’s equating not reporting cases of a potentially deadly respiratory virus—indeed, actively resisting public health efforts to slow the spread of that respiratory virus—to nonviolent resistance to Jim Crow and racist government policies of the sort used by the civil rights movement decades ago.

Amusingly, as I was finishing this post yesterday, an antivaxxer by the name of Rick Stanley, who for some reason has included me on his email list, sent me a post by the pseudonymous COVID-19 crank and antivaxxer The Vigilant Fox entitled Happy ‘Do Not Comply’ Day, with the tagline, “Thanks for resisting.” To get an idea where Fox, who is less than knowledgeable about science but apparently vigilant for any conspiracy theory that he or she encounters, is coming from, the post includes a figure with the ten stages of genocide:

After ranting about a speech that President Joseph Biden gave two years ago in which he chastised the unvaccinated for prolonging the pandemic, the supposedly vigilant one wrote:

I realized I was witnessing Germany 2.0 unfolding before my very eyes and knew it had to be stopped before things got worse. I decided then that I could no longer be a spectator and started taking steps toward creating the account you see today, Vigilant News.

What ensued after Biden’s speech was one of the most hate-filled propaganda campaigns in human history. Here’s a look back at what they did to the noncompliant in the name of “health.”

One of the most hate-filled propaganda campaigns in human history? More so than the Nazi campaign against the Jews? Worse or as bad as the propaganda campaign in Rwanda against the Tutsis that led to genocide? Or the propaganda campaigns in Communist China during the Cultural Revolution that led to the deaths of millions? Seriously? The Fox certainly lacks…a sense of proportion. Seriously, he/she/it seems to view the cherry picked examples of the “horrors” visited upon the unvaccinated as equivalent to a second Holocaust. However, I do thank the Fox, whoever he/she/it is, for providing me with an example even more extreme than Del Bigtree’s equating antivaxxers to the Founding Fathers willing to die for freedom.

This is the rhetoric that Dr. Prasad is invoking.

I doubt that Dr. Prasad will take me seriously if he reads this. In fact, I suspect that he’ll find a reason to deny that he is sounding anything like Del Bigtree, but he is. Given his embrace of antivax rhetoric, arguments, and messaging with respect to not just COVID-19 vaccines but also RCTs of older vaccines, concern about disease being “irrational anxiety,” and victimhood whenever he is properly called out for his misinformation and opposition to public health, I’m finding it increasingly difficult not to label him as just plain antivax. Actually, it’s impossible. For whatever reasons, Dr. Prasad has joined the antivax movement. He’s joined the fantasy that he’s a brave freedom fighter combatting the encroaching tyranny of government and public health, when in reality he’s just a misinformation pusher who’s been captured by his audience and now must push increasingly outlandish misinformation and conspiracy theories about COVID-19 and vaccines in order to keep his Substack popular.