The problem with America’s Frontline Doctors

Much of the reader mail WORLD has received critiquing our coverage of the COVID-19 vaccines has asked about or suggested we read reports by a group called America’s Frontline Doctors (AFLDS). Supporters claim this group of doctors presents another side to the vaccine debate that is largely ignored by media and the government.

To investigate the trustworthiness of the group’s ideas, I examined some of the points raised by AFLDS’ position paper on COVID-19 vaccines. I found a mix of truth and falsehood: The paper often twisted true statements to promote misleading ideas about vaccine safety.

First, a little background on AFLDS: The group rocketed to notoriety last July after posting a viral video in which several doctors stood on the U.S. Supreme Court steps in white coats to offer arguments against lockdowns. One was Stella Immanuel, known for her unusual views on the spiritual origins of gynecological maladies and her statements about “half human, half E.T.” leaders in the U.S. government. Another was AFLDS founder Simone Gold, who in other videos used the Cedars-Sinai Medical Center ER as a backdrop. Yet according to a statement by the Los Angeles hospital, she has never worked for Cedars-Sinai apart from a three-week stint at an affiliated urgent care clinic in 2015.

After making the videos, Gold largely faded from the spotlight until Jan. 6, when she and AFLDS communications director John Strand joined rioters illegally entering the Capitol. Twelve days later, authorities arrested both in California, and a federal court has since indicted them. (Authorities have so far arrested more than 500 people in connection with the Capitol riot.)

AFLDS’ goals appear to be more political than medical. Bloomberg reported that the original Supreme Court video event was hosted by the Tea Party Patriots. FactCheck.org states that “[AFLDS] appears to be connected to the Tea Party Patriots Foundation,” offering as evidence an archived copy of a web page copyrighted by TPPF and featuring the AFLDS logo alongside that of the Tea Party Patriot’s “Second Opinion Project.”

(In an email after this story was published, TPPF spokesperson TJ Winer said the foundation supported healthcare freedom and the doctor-patient relationship but was “no longer associated with America’s Frontline Doctors.”)

On its website, AFLDS identifies itself as “a project of the Free Speech Foundation,” a 501(c)(3) nonprofit. This nonprofit apparently has no website of its own. (AFLDS did not respond to my query about its organizational affiliations and its vaccine-safety claims.)

Now on to what the group believes, as outlined by its position paper. While space prevents coverage of all of its claims, we can examine the most salient.

Does hydroxychloroquine cure or prevent COVID-19?

The AFLDS write-up hinges on its assertion that hydroxychloroquine cures COVID-19: If a cure exists, the risk-benefit calculus for any given vaccine changes greatly. Here AFLDS mixes correct assertions—hydroxychloroquine is indeed a common drug and patients rarely die from its use at appropriate doses—with its incorrect claims that the drug is effective against COVID-19.

Hydroxychloroquine received a lot of attention early in the pandemic because of its ubiquity and safety profile. The drug’s proponents, which had included President Donald Trump, argued that scientists downplayed hydroxychloroquine due to anti-Trump sentiment. But once scientists began to investigate the drug, quality research showed no benefit for patients who received it.

Interestingly, another “front-line” group, the Front Line COVID-19 Critical Care Alliance, rejects hydroxychloroquine and beats the drum instead for ivermectin, an anti-parasitic drug. (The group claims neutrality on the COVID-19 vaccine.) Ivermectin as a treatment against COVID-19 is being studied in the ongoing British PRINCIPLE trial, and WORLD reported on research into the drug back in February. But strong data supporting its use remain elusive.

Is COVID-19 actually dangerous?

AFLDS asserts that “COVID-19 kills very rarely and is mostly limited to the medically fragile,” pointing out that most younger and healthy COVID-19 patients make a full recovery. That the elderly and infirm fare poorly against the coronavirus is well known. Whether 600,000 COVID-19 deaths in the United States constitute killing “very rarely” is debatable.

This often leads to a discussion of what’s counted as a COVID-19 death. One particularly cynical anti-vaccine cartoon (not, to my knowledge, from AFLDS) features a weeping family asking whether a patient’s lung cancer might have contributed to his death, as a doctor with his nose high in the air replies that it was COVID-19. Leaving aside the cartoon’s emotional manipulation, the doctor would have been reporting correctly the cause of death.

This is because “cause of death,” as popularly understood, focuses on the “last straw” that prevented a patient from surviving any longer. Death certificates often include “underlying” and “contributing” causes. As the College of American Pathologists notes in an excellent write-up, an underlying cause is “the disease (condition) that initiated the train of morbid events leading directly to death.” A contributing cause is one that was less directly related.

The U.S. Centers for Disease Control and Prevention notes that in its count of COVID-19 deaths, “COVID-19 is listed as the underlying cause on the death certificate in 92% of deaths.” The “cause of death” might then be viral pneumonia, with COVID-19 infection being the underlying cause: If the patient had not contracted COVID-19, he would not have developed pneumonia, and the virus is therefore what caused the death.

Are the vaccines “experimental”?

Here AFLDS moves from assertion-by-innuendo to plainly incorrect statements, saying that the vaccines “are now being approved for experimental use” and demanding the public refer to them as “experimental vaccines.”

The vaccines are not “approved for experimental use,” but rather carry an Emergency Use Authorization. In other words, the U.S. Food and Drug Administration balanced the benefit of longer-term data against the risks of delaying vaccine distribution. Each vaccine had to pass through so-called phase 3 studies involving very large numbers of patients—30,000 for Moderna and 43,000 for Pfizer/BioNTech.

AFLDS’ proposal—that COVID-19 be treated with hydroxychloroquine—has far less evidence for its efficacy than the vaccines do. However, AFLDS does not call its own proposal “experimental.”

The group also asserts that since the vaccines from Moderna and Pfizer are based on new mRNA technology (involving neither live nor weakened viruses), they are not actually vaccines according to what AFLDS calls “the settled meaning of the term.” Yet that “settled meaning” has long allowed for new technologies: Dictionary.com back in 2016 defined vaccine as “any preparation used as a preventive inoculation to confer immunity against a specific disease.” The vaccines aren’t experimental, but they are indeed vaccines.

Do the vaccines work?

Yes, including against the Delta variant. A June study released by Public Health England found that two doses of the Pfizer vaccine were 96 percent effective in preventing hospitalization from the variant. The AFLDS paper tries not to address effectiveness directly, but does so unintentionally in this complaint: “Notably, the vaccine trials had too few positive [COVID-19] cases to assess with statistical significance any benefit in secondary outcomes such as decreased mortality or hospitalization.”

Actually, the vaccine trials had plenty of positive COVID-19 cases—almost all of which were among the placebo groups. AFLDS effectively admits here that there’s no pleasing it: In its view, either a vaccine doesn’t prevent cases from developing, in which case it’s ineffective, or it does prevent cases from developing, in which case it can’t be studied sufficiently.

It is also worth noting here that 95 percent efficacy—or even 99 percent efficacy—is not the same as perfect, 100 percent efficacy. More than 160 million Americans are fully vaccinated, but if even 5 percent of them experienced a “breakthrough” case of COVID-19, that would still equal 8 million people. Thus, reports of “thousands of people infected after vaccination” indicate only that the original efficacy statistics were largely accurate.

Is this just a way for companies to make money?

AFLDS argues that “the very exciting profit anticipated by the pharmaceutical companies” motivated them, and others have pointed to Wall Street presentations by companies like Pfizer and Moderna as further evidence that the companies hope for returns on their investments.

But what does that prove? Under capitalism, entrepreneurs accept economic risks in hopes of making a profit: Many promising vaccine candidates failed, and the money invested in their development went to waste. Merck, for example, wrote off $305 million after neither of its two COVID-19 vaccines proved effective in a phase 1 trial. Even some successful candidates, like Novavax, may have proved their worth too late to pay off. In short, capitalism fostered an environment where companies tried various approaches and rewarded those that found successful ones in time to help.

Do the vaccines cause “pathogenic priming” or “antibody-dependent enhancement”?

It’s possible to create a vaccine that makes infections worse instead of better. But these vaccines don’t do that. Again, AFLDS accidentally refutes itself by comparing the COVID-19 vaccines to a respiratory syncytial virus (RSV) vaccine from long ago:

This same thing happened in the 1960’s with Respiratory Syncytial Virus (RSV)—they gave the vaccine to 35 children and initially it looked like it worked well. But when those children were exposed to the wild virus, they got much sicker and then two of the kids died, which became a scandal.

The RSV problem came to light in a study with just 35 people. In America alone, over 330 million doses of COVID-19 vaccines have reached patients. We’d know by now whether COVID-19 vaccines lead to a similar problem. They do not.

Do the vaccines cause infertility or miscarriage?

AFLDS cites a case report of a pregnant woman who contracted COVID-19 and suffered a miscarriage at five months gestation. Without informing readers that severe illness of any type can cause miscarriage, AFLDS concludes that “getting COVID-19 has been associated with a high risk of mid-pregnancy miscarriage because the placenta fails—but the vaccine may do the exact same thing—but not for just the few weeks of being sick—but forever.”

We know that patients who recover from COVID-19 often have antibodies to spike protein, the same protein targeted by the vaccines. Those antibodies stick around, so logic dictates that if antibodies to spike protein cause infertility, then humankind has a major problem indeed—regardless of whether those antibodies come from COVID-19 infection or from a vaccine. Thankfully, as a write-up from Henry Ford Health System explains, antibodies to spike protein do not cause infertility.

Online misinformation about the connection between COVID-19 vaccines and miscarriages has included misquoting of a New England Journal of Medicine article about the Pfizer and Moderna mRNA vaccines. This study enrolled nearly 4,000 pregnant women who received a vaccine, including those vaccinated just before conceiving (that is, any time after 30 days before their last menstrual period). It reported that among 827 participants whose pregnancies concluded during the brief study, 712 had a live birth, 104 had a miscarriage, one had a stillbirth, and 10 had an ectopic pregnancy or abortion.

Inevitably, someone simply divided one number by another and announced the vaccine itself carried a 1-in-8 risk of miscarriage. This ignores a crucial fact: Roughly 20 percent of all early pregnancies do tragically but ordinarily end in miscarriage. During the short study period, 2.6 percent of NEJM study participants miscarried, and roughly 80 percent neither miscarried nor delivered, but maintained their pregnancies. That reflects that the vaccines studied did not raise the risk of miscarriage. The American College of Obstetricians and Gynecologists offers a similar analysis on its website.

AFLDS is right about one thing here: Pregnant women are far more likely to suffer harm from COVID-19 than their nonpregnant peers. But far from being a reason to avoid the vaccine, it’s a reason to get it.

Have the vaccines caused 45,000 deaths?

AFLDS asserts in a lawsuit against the Biden administration that the vaccines have caused 45,000 deaths, stating that the U.S. government’s Vaccine Adverse Event Reporting System (VAERS) “reported 9,048 deaths associated with the Vaccines.” AFLDS claims a computer programmer compared this figure with Medicare and Medicaid data about deaths within three days of vaccination and concluded the death figure should be multiplied by five.

It’s not possible to corroborate the claimed analysis of Medicare and Medicaid data, since the Centers for Medicare & Medicaid Services hasn’t publicly released its 2021 data yet and almost all COVID-19 vaccinations took place in 2021. So we’ll focus on the first claim, about 45,000 supposed deaths.

As of July 19, VAERS reported 6,207 deaths. This would still be an unprecedented number, but there’s a catch. The vaccines’ Emergency Use Authorization requires that all deaths after vaccination be reported to VAERS, “regardless of causality.” In plain English, that means that VAERS wants to know about any deaths that happened after vaccination, whether or not the vaccine was believed to be related to them, for future research.

This makes sense, because VAERS did catch a rare complication from a now-recalled rotavirus vaccine in 1999. (Today’s rotavirus vaccine is not associated with that problem.) But it also means that we can’t simply count the deaths reported to VAERS as “deaths caused by the vaccine.” They could be deaths from anything.

The takeaway …

People I know personally, including some who are high-risk themselves or who share a household with a high-risk individual, have skipped getting COVID-19 vaccines after hearing unfounded claims like those above. This disinformation, according to the Alliance for Securing Democracy at the German Marshall Fund of the United States, is also amplified online by China and Russia. Their goal: to gain market share for their own products, both vaccines and philosophies. Their autocratic governments, by fostering tension and disagreement in the West, hope to portray democracy as chaotic and unreliable.

We, as Christians, are called to be truth-tellers. This does not mean being undiplomatic or using the truth as a bludgeon. Still, the fact remains that, unlike at the beginning of the pandemic, we now have significant evidence and knowledge about the nature of the virus that has ravaged the world and about the vaccines that are helping the country reopen.

—WORLD has updated this story with a response from Tea Party Patriots Foundation spokesperson TJ Winer.