The variety of developments worrisome for the way forward for public well being on this nation have been coming so quick and livid that I can’t sustain with them on a weekly posting schedule right here at SBM. I had hoped to jot down about one thing apart from COVID-19 and vaccines, however sadly, there’s been one other improvement prior to now few days. That’s after final week, once I famous that former President and Republican nominee for President Donald Trump had cozied up to Robert F. Kennedy, Jr., who’s been a rabid antivax loon for almost twenty years now (a minimum of), main them each to provide you with a riff on Trump’s “make America nice once more” (MAGA) slogan, specifically “make America wholesome once more” (MAHA). Let’s simply say that it wasn’t the best slogan—MAHA?—and RFK Jr.’s plan was a mix of the not-bad (e.g., concern about regulatory seize) with absolutely the bonkers (e.g., giving half of the NIH funds to analysis into “holistic” therapies) and, tellingly and conveniently sufficient, talked about completely nothing about vaccines. It’s as if RFK Jr. and Trump each thought that we’d completely overlook about RFK Jr.’s twenty years of antivax worry mongering and conspiracy theories. Now, sizzling on the heals of that disturbing information, it’s tough for me to not take discover of the just lately issued Up to date Steerage for COVID-19 Boosters for the Fall and Winter 2024–2025 Season from the Florida Division of Well being, presently run by COVID-19 contrarian and now arguably antivax doctor Dr. Joseph Ladapo, discouraging the usage of mRNA-based COVID-19 vaccines for older folks (and that’s not all) based mostly on misrepresented science and antivax tropes.This steering was despatched by e-mail final Thursday to all licensed healthcare suppliers within the state of Florida.
Earlier than I focus on simply how off-base this “steering” is and what it says concerning the hazard to public well being on this nation, I can’t assist however observe that Dr. Jonathan Howard simply posted a superb abstract of what I’m speaking about once I level to the truth that RFK Jr. has been appointed honorary co-chair of Trump’s transition workforce, ought to Trump win in November. What, precisely, “honorary co-chair” means or entails is unclear, however what is evident is that RFK Jr. has managed to realize appreciable affect within the Trump marketing campaign and can seemingly himself rating a serious cupboard place, the probably place being Secretary of Well being and Human Providers, a very horrifying prospect provided that he would then have management over the Facilities for Medicare & Medicaid Providers (CMS), the FDA, the CDC, and the NIH are components of HHS. In fact, for this to occur, Republicans would additionally should retake management of the Senate, provided that the possibilities {that a} Senate managed by Democrats would ever verify somebody like RFK Jr. for HHS, hypothesis has thus already begun as to who, if Trump wins, would possibly rating management positions in these authorities companies important to medication and public well being. Jonathan and I’ve speculated that contrarian physicians like Drs. Vinay Prasad, Scott Atlas, Jay Bhattacharya, and, sure, Joseph Ladapo is perhaps as much as head the FDA, CDC, and the like. (I feel it much less seemingly that somebody bonkers shall be appointed to the NIH, however that would simply be wishful pondering if Trump retakes energy and RFK Jr. turns into HHS secretary.)
This brings us again to Dr. Ladapo. If you wish to see the route that the federal authorities will seemingly take if Trump turns into President once more and RFK Jr. oversees the appointment of federal officers overseeing public well being companies, such because the FDA Commissioner and CDC Director, look no additional than Florida, the place COVID-19 contrarianism, hostility to public well being, and outright antivax misinformation have taken over the Division of Well being of a big state.
“Up to date steering”? Extra like the identical outdated misinformation
So let’s have a look at what the up to date steering relating to COVID-19 boosters for the winter season says. I observe that, virtually actually (for causes that I’ll focus on shortly) Dr. Ladapo had a substantial amount of affect in these tips. They start with a canine whistle to antivaxxers:
The Florida Division of Well being (Division) is reminding well being care suppliers of the significance of remaining updated with present literature associated to COVID-19 vaccines and boosters, and the significance of offering sufferers with knowledgeable consent.
Bear in mind, everytime you see somebody hostile to vaccines invoke “knowledgeable consent,” what they nearly all the time actually imply is one thing that, through the years I’ve known as “misinformed consent” or, extra just lately, “misinformed refusal.” What do I imply by these phrases? I imply that, underneath the seemingly unobjectionable cloak of a bedrock precept of medical ethics, knowledgeable consent, what is admittedly being fed to you is at greatest a biased—and at worst completely incorrect or made-up—abstract of the proof designed to painting vaccines within the worst doable mild and falsely suggest that the dangers outweigh the advantages. Attempting to supply misinformed refusal in an viewers is, after all, a tactic not restricted to antivaxxers. Quacks use it too, to frighten you away from typical medication.
Now comes the spin designed to impress misinformed refusal, first the semi-reasonable however painted within the worst doable mild:
On August 22, 2024, the US Meals and Drug Administration (FDA) accepted and licensed up to date variations of mRNA vaccines from Pfizer-BioNtech and Moderna. The FDA accepted the vaccine for folks 12 and older and offered emergency use authorization for youngsters 6 months to 11 years outdated. The said goal of those boosters is the Omicron variant which shouldn’t be inflicting a important variety of infections.
The most latest booster approval was granted within the absence of booster-specific scientific trial knowledge carried out in people. Moreover, this booster doesn’t shield towards the presently dominant pressure, accounting for roughly 37% of infections within the United States. There are presently restricted knowledge to tell whether or not these boosters supply any substantial safety towards the virus and subsequent circulating variants. Though randomized scientific trials are usually used to approve therapeutics, the federal authorities has not required COVID-19 vaccine producers to reveal their boosters stop hospitalizations or loss of life from COVID-19 sickness.
Discover the methodolatry, outlined because the profane worship of the double-blind randomized scientific trial (RCT) above all different types of proof and devoid of context relating to whether or not an RCT can be possible or sensible. Principally, while you see somebody invoking RCTs relating to up to date vaccines to focus on variants, you’re very seemingly taking a look at methodolatry that weaponizes EBM towards public well being and vaccines to sow doubt and distrust. The implication is that giant RCTs must be finished when updating a vaccine to focus on the predominant strains of a virus in circulation, when in reality the follow adopted for COVID-19 vaccines is just like what we’ve lengthy finished with influenza vaccines.
It’s, after all, true that if the consultants choosing the strains to incorporate within the yearly replace to the seasonal influenza vaccine choose fallacious, which has often occurred prior to now, the efficacy of the vaccine shall be disappointingly low, in comparison with years once they prognosticate precisely relating to the strains anticipated to flow into that season. One can argue how precisely scientists have chosen the pressure of SARS-CoV-2 to incorporate on this 12 months’s replace to the vaccine, however Dr. Ladapo’s argument goes past that to suggest that the strains chosen have resulted in an ineffective vaccine. Furthermore, one would possibly even query whether or not everybody wants a yearly COVID-19 booster, as Dr. Paul Offit did final 12 months, however that’s not what Dr. Ladapo is doing right here both. Worse, as you will notice, in distinction to what Dr. Offit was arguing, specifically that boosters must be focused to these at highest danger for extreme illness and loss of life from COVID-19, what Dr. Ladapo seems to be doing is discouraging the usage of mRNA vaccines in that very inhabitants, along with younger individuals who, as antivaxxers have lengthy deceptively argued, are at such low danger that vaccines are pointless.
That’s why I distinction the spin that Dr. Ladapo’s division locations on the scenario, which is to suggest {that a} mismatch signifies that the vaccine gained’t work, to a extra sober evaluation from a much less “contrarian” scientist, Andy Pekosz, PhD, a professor in Molecular Microbiology and Immunology, who contributed to an article revealed by the Johns Hopkins Bloomberg Faculty of Public Well being, What to Know Concerning the Up to date COVID Vaccine for Fall, Winter 2024–25:
As in earlier years, there are mRNA vaccines—one from Moderna, one from Pfizer—and a protein-based vaccine, from Novavax. One nuance this 12 months is that the mRNA and protein-based vaccines goal completely different—although carefully associated—variants.
The up to date mRNA COVID vaccines from Moderna and Pfizer are based mostly on the KP.2 pressure, one of many FLiRT variants which have been spreading since early spring. These variants and their sub-variants have precipitated nearly all of infections throughout this summer season’s COVID wave. The protein-based Novavax vaccine is predicated on the JN.1 variant, which accounted for almost all of COVID infections within the first few months of 2024 and is the mother or father pressure from which KP.2 and different presently circulating variants department from.
On the finish of the day, laboratory experiments present that all the up to date vaccines obtainable this season can acknowledge circulating COVID variants and due to this fact must be equally efficient in decreasing your likelihood of turning into severely ailing from COVID an infection or needing to be hospitalized.
As you possibly can see, Dr. Ladapo is attempting to steer you that the brand new vaccines are prone to be ineffective as a result of they supposedly goal the “fallacious” strains of SARS-CoV-2 in comparison with the strains which can be presently circulating, when in reality the strains are very comparable, which means that vaccinating towards one will seemingly present enough safety towards the opposite associated strains. Certainly, that’s precisely the rationale cited by FDA’s Vaccines and Associated Organic Merchandise Advisory Committee (VRBPAC) in making its suggestions to producers:
The committee unanimously voted to suggest a monovalent JN.1-lineage vaccine composition. Following the vote, the committee mentioned concerns for the number of a selected JN.1 lineage SARS-CoV-2 pressure (e.g., JN.1 or KP.2) and expressed a robust choice for JN.1.
Throughout this assembly, the advisory committee was knowledgeable of the manufacturing timelines, they usually reviewed the obtainable knowledge. These knowledge included info on the circulation of SARS-CoV-2 virus variants, present vaccine effectiveness, human immunogenicity knowledge of present vaccines towards just lately circulating virus variants, the antigenic characterization of circulating virus variants, animal immunogenicity knowledge on new candidate vaccines expressing or containing up to date spike parts, and preliminary human immunogenicity knowledge on JN.1 candidate vaccines.
Primarily based on the totality of the proof, on June 6, 2024, FDA initially suggested the producers of the licensed and licensed COVID-19 vaccines that the COVID-19 vaccines (2024-2025 Method) to be used in the US starting in fall 2024 must be monovalent JN.1 vaccines.
FDA has continued to watch the circulating strains of SARS-CoV-2. Primarily based on probably the most present obtainable knowledge, together with the latest rise in circumstances of COVID-19 in areas of the nation, the company has additional decided that the popular JN.1-lineage for the COVID-19 vaccines (2024-2025 Method) is the KP.2 pressure, if possible. This modification is meant to make sure that the COVID-19 vaccines (2024-2025 Method) extra carefully match circulating SARS-CoV-2 strains. FDA has communicated this modification to the producers of the licensed and licensed COVID-19 vaccines. The company doesn’t anticipate {that a} change to KP.2 will delay the provision of the vaccines for the US.
I can see right here from this why Moderna and Pfizer based mostly their vaccines on the KP.2 pressure and Novavax caught with the JN.1. It’s easy logistics. As a result of the vaccines by Moderna and Pfizer are mRNA-based, it’s method simpler for them to alter the sequence of the template used to make the mRNA to be included within the vaccine and rapidly ramp up manufacturing than it’s for Novavax, whose vaccine makes use of recombinant protein because the antigen, which takes longer to make as a result of there are the extra steps of creating and purifying the protein product to be packaged within the vaccine.
Let’s have a look at the ultimate “steering” right here, after which within the subsequent part I’ll level out the antivax tropes used to provide you with the “steering”:
Primarily based on the excessive fee of worldwide immunity and presently obtainable knowledge, the State Surgeon Basic advises towards the usage of mRNA COVID-19 vaccines. Any supplier involved concerning the well being dangers related to COVID-19 for sufferers over the age of 65 or with underlying well being situations ought to prioritize affected person entry to non-mRNA COVID-19 vaccines and therapy.
You learn that proper. Dr. Ladapo is advising towards the usage of any mRNA vaccines, interval. I child you not. He’s advising towards them for all people and solely grudgingly say that they is perhaps utilized in older folks and people with underlying power well being situations, , those that have been identified because the starting of the pandemic to be among the many populations on the highest danger for extreme illness and loss of life from COVID-19, however solely after prioritizing “affected person entry to non-mRNA COVID-19 vaccines and therapy.” WTF? Critically, all therapies fro COVID-19 are “non-mRNA,” as a result of solely the Moderna and Pfizer vaccines are mRNA-based, not any therapies for COVID-19 that I’m conscious of. One wonders if he’s implying that docs ought to encourage the usage of ineffective therapies like ivermectin, however I could possibly be studying an excessive amount of into it. Possibly.
Now let’s have a look at the rationale cited. You’ll acknowledge a number of frequent antivax tropes. Certainly, Dr. Ladapo made it very clear that he’s conspiracy mongering in his put up on X, the hellsite previously referred to as Twitter, by which he accuses public well being authorities of “gaslighting” the general public relating to vaccines and dons the mantle of being all about The Actual Science:
“Acknowledge severe security issues”? You imply the minor or nonexistent security issues that antivaxxers have been flogging for almost 4 years? and the “many individuals who imagine they’ve been injured by these vaccines”? You imply like those who’ve been fooled into pondering that their cancers—excuse me, “turbo cancers”—have been brought on by the vaccine?
Critically, regardless that this “steering” appears semi-reasonable if that’s all you learn, Dr. Ladapo can’t assist however give the sport away when he’s on social media. Additionally observe how he says on the finish, “See my newest steering.” Not “see the Florida Division of Well being’s newest steering,” however “see my newest steering.” You’ll be able to see why I discuss with this doc as being all Dr. Ladapo and discuss with it as his. I’m simply taking my lead from the crank himself.
How to not justify “up to date steering”
Proper earlier than the “steering” in daring, Dr. Ladapo means that “they” are both hiding proof or a minimum of not offering ample proof to assuage the fears of the general public (fears that, I observe, have been stoked by antivaxxers) over “severe security issues”:
Moreover, the federal authorities has failed to offer ample knowledge to assist the security and efficacy of COVID-19 boosters, or acknowledge beforehand demonstrated security issues related to COVID-19 vaccines and boosters, together with:
- extended circulation of mRNA and spike protein in some vaccine recipients,
- elevated danger of decrease respiratory tract infections, and
- elevated danger of autoimmune illness after vaccination.
Later within the “steering,” Dr. Ladapo claims as a danger:
Elevated ranges of mRNA and spike protein from the mRNA COVID-19 vaccine persist amongst some people for an indefinite interval, which can carry well being dangers.
‘ve mentioned concern primary above, the “extended circulation of mRNA and spike proteins” in “some” vaccine recipients. I observe that the phrase “some” is doing a number of heavy lifting there. For instance, the half-life of the mRNA for spike protein used within the Pfizer and Moderna vaccines is on the order of a few days, with the spike protein being detectable for at most eight weeks in “some” sufferers. Whereas it’s true that one examine oft-cited by antivaxxers discovered vaccine mRNA fragments within the blood so long as 28 days after vaccination, I observe that this was largely mRNA fragments, which means that the mRNA wouldn’t be anticipated to generate additional spike protein. Certainly, the authors speculated that this discovering may need been on account of gradual leakage of the lipid nanoparticles out of the injection website. In any occasion, opposite to what antivaxxers declare, neither the modified mRNA nor the spike protein coded for by that mRNA persist long run within the human physique, and there’s no proof that their noticed persistence is unsafe.
As for the final two? Concerning the claimed elevated danger of decrease respiratory tract infections related to COVID-19 vaccination, I observe that no research have been cited, not like the opposite issues later within the doc. I do keep in mind research exhibiting a rise in different infectious illnesses related to the lifting of COVID-19 restrictions after the vaccines grew to become obtainable, resembling this one from Israel. Nevertheless, what will increase your danger of subsequent decrease respiratory infections? That’s proper, COVID-19 does, and the danger will increase with every reinfection. As for the final one, there isn’t a sturdy proof linking COVID-19 vaccination to any autoimmune illnesses, later within the “steering” Dr. Ladapo claims:
The mRNA COVID-19 vaccine could also be related to an elevated danger of autoimmune illnesses together with systemic lupus erythematosus (SLE), rheumatoid arthritis, and psoriasis.
However what did that examine really conclude? Not precisely what Dr. Ladapo tried a lot to suggest above:
We report that the chance of creating most AI-CTDs didn’t improve following mRNA vaccination, apart from systemic lupus erythematosus with a 1.16-fold danger in vaccinated people relative to controls. Comparable outcomes have been reported within the stratified analyses for age, intercourse, mRNA vaccine sort, and prior historical past of non-mRNA vaccination. Nevertheless, a booster vaccination was related to an elevated danger of some AI-CTDs together with alopecia areata, psoriasis, and rheumatoid arthritis. General, we conclude that mRNA-based vaccinations aren’t related to an elevated danger of most AI-CTDs, though additional analysis is required relating to its potential affiliation with sure situations.
See what I imply?
Many among the many remainder of the “dangers” come straight out of the fever swamp of COVID-19 antivax nonsense. I’ll begin with a few of the most egregious earlier than transferring to the simply exaggerated, beginning with—you guessed it!—”turbo most cancers” and the claims that the mRNA vaccines “completely alter your DNA”:
Potential DNA integration from the mRNA COVID-19 vaccines pose distinctive and elevated danger to human well being and to the integrity of the human genome, together with the chance that DNA built-in into sperm or egg gametes could possibly be handed onto offspring of mRNA COVID-19 vaccine recipients.
Oh, no! The vaccines are going to deprave our DNA! Really, no they don’t seem to be, and the examine cited by Dr. Ladapo above was an notorious one by Kevin McKernan, who has finished his greatest to torture science to reveal that someway, towards all of what we learn about molecular biology and what it takes for DNA to combine into the genome, that nasty and supposedly “huge” DNA contamination from the vaccine is affecting your DNA. It’s not, and I mentioned that very examine in gory element a very long time in the past. It’s utter nonsense. That Dr. Ladapo would cite such ideologically-motivated horribly dangerous “science” to assist his “steering” ought to let you know all you would possibly wish to know.
However let’s have a look at some extra claims:
- “The mRNA COVID-19 vaccines current a danger of subclinical and scientific myocarditis and different cardiovascular situations amongst in any other case wholesome people.”
Right here’s the attention-grabbing factor. As anybody who’s paid consideration to the actual challenge of an elevated danger of myocarditis after vaccination with the mRNA vaccines is aware of, that danger happens primarily in younger folks, in significantly younger males, who almost all make a full restoration, not the over-65 inhabitants who’re most vulnerable to extreme illness and dangerous outcomes in the event that they catch COVID-19. As Dr. Paul Offit put it relating to Dr. Ladapo’s try and frighten everybody, together with older folks, away from the mRNA-based vaccines:
“It’s simply such a harmful recreation he performs,” stated Offit, who has served on the FDA’s unbiased vaccine advisory committee. “You solely have a roughly 1,000 instances better probability of dying [from Covid] if you happen to’re over 65 than if you happen to’re underneath 18.”
“The mRNA vaccines are remarkably protected,” he added.
As for POTS, sure, there’s a small elevated danger of POTS after vaccination, however the danger of POTS is way greater after COVID-19; particularly a latest examine in Nature Cardiovascular Analysis concluded that COVID-19 an infection is related to a five-fold better danger of POTS than COVId-19 vaccination. I can’t assist however discover how Dr. Ladapo cited this actual examine however failed to say this or that the percentages ratio for post-vaccination POTS was 1.10, fairly low. Humorous that. Really, no, it’s not humorous. It’s predictable provided that Dr. Ladapo is an antivax crank.
I can also’t resist letting Dr. Peter Hotez additionally chime in:
In different phrases, Dr. Ladapo is both mendacity by admission or simply plain mendacity, though one does have to permit for the chance that he’s a real believer and his ideology has blinded him to what the totality of proof exhibits.
Lastly, there’s this:
All through the pandemic, research throughout geographic areas discovered that the mRNA COVID-19 vaccines are related to unfavorable effectiveness after 4 to 6 months. As efficacy waned, research confirmed that COVID-19 vaccinated people developed an elevated danger for an infection.
I can’t assist however observe that the primary examine cited concluded:
Effectiveness towards COVID-19 hospitalization and loss of life was 70–80% after the second dose and >90% after the booster dose. mRNA-1273 vaccine safety confirmed comparable patterns. mRNA vaccines present comparable, reasonable, and short-lived safety towards symptomatic BA.1 and BA.2 Omicron infections, however sturdy and sturdy safety towards COVID-19 hospitalization and loss of life.
Furthermore, the findings of “unfavorable vaccine efficacy” are seemingly an artifact of biases associated to measuring the true versus noticed ranges of an infection in some observational research by which publicity and testing of people differ based mostly on vaccination standing, as this commentary describes:
Totally different sources of bias produce unfavorable VE by influencing both (1) the true ranges of an infection or symptomatic an infection by vaccination standing (e.g., by variations in publicity) or (2) the noticed ranges of an infection or symptomatic an infection by vaccination standing (e.g., by variations in testing) (Determine 1). Though the biases associated to (1) trigger true underlying (symptomatic) an infection variations that exist even given good sampling, biases associated to (2) trigger a notion of variations that don’t replicate the actual (symptomatic) an infection ranges current within the inhabitants. Though each classes of bias are vital to debate within the broader context of VE research, their relevance for a selected examine will depend upon the kind of VE being measured. The biases associated to (1) and (2) can each affect VE measurements of an infection and symptomatic an infection; the biases associated to (2) are much less prone to play a job when measuring VE towards extreme outcomes (e.g., intensive care unit admission, intubation, and loss of life) as a result of testing for these outcomes is unlikely to vary throughout vaccinated and unvaccinated people [14].
I like to recommend studying the entire commentary, because it factors out how these biases can provide a false look of “unfavorable efficacy,” and this determine is price taking a look at too, because it summarizes the problems:
One notices that antivaxxers all the time cherry choose these research and ignore the general totality of the proof, which exhibits that COVID-19 vaccines are protected and efficient and cut back your likelihood of extreme illness that can lead to loss of life. It’s no shock that Dr. Ladapo does the identical factor. Neither is it any shock that he implies that the next will assist as a lot or greater than the vaccines:
Enhancing habits and general well being assist handle and cut back the chance of coronary heart illness, sort 2 diabetes, and weight problems, danger components for severe sickness from COVID-19.
The State Surgeon Basic and the Division proceed to encourage Floridians to prioritize their general well being by:
- Staying bodily energetic,
- Minimizing processed meals,
- Prioritizing greens and wholesome fat, and
- Spending time outdoor to assist needed vitamin D ranges.
This is similar type of false dilemma that antivaxxers have lengthy used. Positive, you’ll be more healthy if you happen to keep bodily energetic and prioritize wholesome consuming, though staying outdoors is a two-edged sword if you happen to don’t additionally keep away from extreme solar publicity that may improve your danger of pores and skin most cancers. As for all of this supposedly decreasing your danger of COVID-19, this can be a trope that COVID-19 contrarians have been spewing earlier than there was even a vaccine, when, as an example, Dr. Aseem Malhotra attacked Krispy Kreme for offering free doughnuts to frontline healthcare staff within the UK and claimed that “metabolic optimization” might remedy COVID-19. The whole lot outdated is new once more. Too dangerous most individuals, together with a lot of my colleagues, don’t acknowledge that.
Florida public well being pseudoscience: Coming quickly to the federal authorities?
When Florida Governor Ron DeSantis first appointed Dr. Ladapo as Florida’s Surgeon-Basic and due to this fact the particular person in command of the Florida Division of Well being and the state’s whole public well being equipment, many people have been justifiably alarmed, an alarm that has been completely validated by his efficiency since his appointment. In spite of everything, Dr. Ladapo was a founding member of America’s Frontline Docs, which made a reputation for itself in that horrible first summer season of the pandemic by touting hydroxychloroquine as a miracle remedy for COVID-19 and later turned to telehealth grift promoting prescriptions for ivermectin to remedy COVID-19, and a signatory of the Nice Barrington Declaration, the doc revealed by contrarian scientists introduced collectively by a proper wing assume tank to advocate a social Darwinist “let ‘er rip” method to the pandemic with poorly outlined “centered safety” for these most in danger for extreme illness and loss of life from the pandemic.
Furthermore, this “up to date steering” is way from the primary time that Dr. Ladapo has tried to mislead utilizing the same old denialist strategies of cherry choosing proof and even outright misrepresenting it. Final 12 months, he was busted for altering a Florida Division of Well being examine for mendacity with statistics to make it look as if the vaccine was extra harmful than COVID-19 for males underneath 40. Earlier this 12 months, per its inclusion on this “steering,” Dr. Ladapo was parroting McKernan’s dangerous science that massively exaggerated the issue of DNA contamination of the vaccine.
Given the latest developments by which Donald Trump has cozied as much as RFK Jr. and (apparently) promised him a cabinet-level place in his administration, ought to he win in November, it’s very straightforward to foresee what is going to occur to medication, public well being, and science basically if Trump turns into President once more. You want look no additional than Florida, besides that it might even be worse than Florida. In spite of everything, Dr. Ladapo isn’t the one physician hostile to vaccines and public well being science who would seemingly discover a management place in a second Trump administration. There may be ample purpose to be afraid, very afraid.