KATHERINE J WU Who doesn't want to boost their immunity, that sounds great. Like why? Why not boost something that we just want more of?
BROOKE GLADSTONE From boosters to breakthroughs? How the words we use to explain our pandemic moment obscure as much as they reveal. From WNYC in New York, this is On the Media. I'm Brooke Gladstone. Also on this show, we tend towards simple stories, and that's what's made the complexity of the pandemic so hard to follow.
SOREN WHEELER If you go up and down and up and down and up and down, you've sort of lost the feeling that we're on a path to something that there's an end point of any kind.
BROOKE GLADSTONE Plus, our greatest medical breakthroughs always come with a cost.
PAUL OFFIT Everything at some level is a gamble. And I think we don't like to think of it that way. I think we like to think there are safe choices, but there really are never safe choices because there's always some risk.
BROOKE GLADSTONE It's all coming up after this.
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BROOKE GLADSTONE From WNYC in New York, this is On the Media, I'm Brooke Gladstone. This week, the FDA authorized booster doses of Moderna and Johnson & Johnson vaccines. This follows the agency's approval of additional shots of the Pfizer vaccine back in August.
NEWS REPORT The FDA says no matter what COVID 19 vaccine you initially received, your booster can be whichever one you choose. A recent study found a small pool of J & J recipients saw a 76 fold increase in antibodies with Moderna, a 35 fold increase with Pfizer and just a fourfold increase with J & J. [END CLIP]
BROOKE GLADSTONE The term booster is just one example of a term that's crossed over from the medical lexicon into the mouths of us non-specialists. Eager to embrace language that clarifies the COVID risk we face. Nowadays, we casually refer to COVID-19 tests, to asymptomatic COVID cases and to the fully-vaccinated, but those usages are not precisely right. Take the word quarantine.
KATHERINE J WU I still see every single week without fail someone saying so-and-so has tested positive and they are going into quarantine. They're not going into quarantine, they're going into isolation.
BROOKE GLADSTONE Katherine J. Wu is a staff writer at The Atlantic, where she covers science. She wrote recently about the long list of words that still, almost no one gets right. Welcome to the show, Katherine.
KATHERINE J WU Thank you for having me. It's great to be here.
BROOKE GLADSTONE In your reporting, you've tracked something you call linguistic leakage, which makes me think of Inigo Montoya. The words don't mean what you think they mean. How does linguistic leakage occur?
KATHERINE J WU Yes, I'm very glad you brought in the Princess Bride reference early. You know, when a word starts off and gains traction in one community, but it's generally pretty siloed off into that community, and then it rapidly moves into another community or into the public at large, but the context doesn't necessarily follow.
BROOKE GLADSTONE In a recent article, you took on booster shots. Where did that term even come from?
KATHERINE J WU This was just something that people used to talk about. Oh, this is something better and improve it, something that takes us up. Something that lifts us.
BROOKE GLADSTONE Booster seat.
KATHERINE J WU Mmhmm.
BROOKE GLADSTONE If somebody is a real booster of a project, they're trying to support it. It always had really good connotations.
KATHERINE J WU Yeah. And when this did migrate into vaccine lexicon, I imagine that made the word quite appealing. You know, who doesn't want to boost their immunity? That sounds great. And Elena Conis at UC Berkeley, who's a medical historian, said she thinks that using words like Booster might have helped public health experts and scientists make additional shots of vaccines that needed them more appealing to the public, like come get your boots. Doesn't that sound amazing?
NEWS REPORT Encouraging developments in the U.S. There's been an unprecedented demand for COVID booster shots in recent days. More than seven million people have gotten an extra dose of vaccine so far. [END CLIP]
BROOKE GLADSTONE But you say that this perky optimism actually obscures what those shots do.
KATHERINE J WU Boosters are not just this unilateral resource, and all the effects are additive, and we can just keep stockpiling protection like toilet paper or dried beans. I added this idea into my piece that maybe boosters would better be described as reminder shots. And here I took some inspiration from what some other languages have done, which I find really fascinating. Spanish speakers sometimes refer to booster shots as refuerzo, which is a term that sort of talks about reinforcement. People who speak Italian say richiamo, which I realize I've never said that word out loud, so maybe that's wrong.
BROOKE GLADSTONE [LAUGHS] sounds right!
KATHERINE J WU And the French say repel. And both of those words signify recollection like a refresher course, something that has been seen before but maybe hasn't been seen for a while. And maybe the body's gotten a little forgetful, and so a booster shot is, 'Oh, I've seen this before, I should still be paying attention to this. This is still relevant,' which is really what a booster shot is supposed to do. It's trying to rescue a response that scientists think has declined over time. Maybe your immune cells have gotten a touch of amnesia. They are no longer taking the coronavirus as seriously, and this is just a way to sort of juice them back up, bring them back to where they were before. That is the primary goal.
BROOKE GLADSTONE You've also said that the framing of the booster shot as a reminder shot or replenishing could be more of a clear eyed way to assess global equity. Boosters by default, top off resources that have already been given.
KATHERINE J WU And I think boosters may not really be that urgent of a situation, especially knowing that we have, on a global scale, a limited supply of vaccines and knowing that we still have so many countries around the world, especially those that are considered lower income countries where most people have not even had the opportunity to get their first dose of a vaccine. It feels a little bit like inviting people for third helpings at a buffet line when some people are still starving outside the restaurant.
BROOKE GLADSTONE Currently, there's a debate over whether a second shot of the Johnson and Johnson vaccine, which was billed as a single shot, should even be described as a booster that I think, Dr. Fauci said. It probably should have been a double shot to begin with.
KATHERINE J WU If we're talking about boosters as something that is replenishing something that has been lost. That's two criteria. First, you have to see loss and then you have to see what was lost being replenished. And it's not totally clear that a second shot of the Johnson and Johnson vaccine would be fulfilling both those criteria. It does seem that people who got the Johnson and Johnson vaccine, they've certainly been well protected for many months, but they might have started out at a kind of lower level of protection than people who got one of the many vaccines the Moderna or Pfizer vaccines. And yet that level has held quite steady over time. So we're actually not seeing very much waning in protection after people get the Johnson and Johnson vaccine. So that criterion seems a little shaky. But if we did add a second dose, what the researchers are seeing is that this baseline level of protection goes up. And so that may be better described as just a straight up second dose. And the idea there is you need two shots to be full up to sort of reach full production to begin with
BROOKE GLADSTONE Another term: fully-vaccinated. What's the definition of being fully vaccinated?
KATHERINE J WU This is an especially important question to be asking now that boosters are rolling out. A lot of people have been confused about whether they are still considered fully vaccinated if they haven't gotten their boosters yet. The short answer is yes. So what is full vaccination? As the CDC is defining it, you are fully vaccinated two weeks after you get the final vaccine dose in a primary series. And the primary series is, for Moderna and Pfizer, those two initial shots of mRNA spaced either three or four weeks apart. And for Johnson and Johnson, for now, it is that single shot - two weeks after that,
BROOKE GLADSTONE Although maybe it should have been two...
KATHERINE J WU Who knows? Honestly, that definition could change by next week. We'll see.
BROOKE GLADSTONE Let's talk about another one. Natural immunity has been weaponized to imply that vaccines are unnatural and thus unsafe. Here's a clip from Fox News.
FOX NEWS Well, it's amazing. Out of hundreds of speeches and hundreds of hours of interviews, a complete absence of any mention of natural immunity disenfranchising a large portion of the unvaccinated natural immunity. [END CLIP]
BROOKE GLADSTONE That's what happens when you have had COVID 19 and you have some antibodies, right?
KATHERINE J WU It's the immunity that manifests itself after you have been "naturally infected" by an actual microbe, a virus, a bacterium, a parasite, or whatever. And that is supposed to be in contrast to the immunity that occurs after you've been vaccinated, which of course, does not involve an actual virus.
BROOKE GLADSTONE Mm-Hmm.
KATHERINE J WU But oh gosh, this one caught me off guard during the pandemic, honestly. I've seen this term very often. I never really thought twice about it. But during this pandemic, I've seen many people say 'I have natural immunity. I shouldn't be getting vaccinated' or natural immunity is superior to post-vaccination immunity. And I think what's interesting to think about here is what the term natural has been leveraged for. You know, we see this as a very positive thing, like it sounds organic, it sounds appealing, it sounds healthy, and it also casts the alternative as unnatural. It makes vaccines sound artificial or unhealthy, and that's absolutely not the case.
BROOKE GLADSTONE Inoculation is an attempt to create what natural immunity would do in a safe environment where you don't actually have to get sick in order to develop those antibodies, right?
KATHERINE J WU Vaccines are a safe mimic of these triggers for protection and what could be better than that? It's like having your cake and eating it, too.
BROOKE GLADSTONE So we've talked about words which carry, to their detriment at times, positive associations like booster or natural immunity, but what about words that the public has come to interpret as really negative, unduly negative – like breakthrough infections.
KATHERINE J WU This is another interesting word where there has long been a sort of research vaccine specific connotation to breakthrough. But there's also been a colloquial one, like think of the way that we talked about breakthroughs in 2019. It was like, ‘oh, scientists make a breakthrough in cancer research.’ It sounded great. And honestly, in the past few months, it has become almost synonymous with vaccine failure, which should not be the case, but that's certainly the narrative that has been built around it.
BROOKE GLADSTONE But isn't it vaccine failure?
KATHERINE J WU All you have to do to qualify as a breakthrough case is test positive for SARS-CoV-2, this new coronavirus, more than two weeks after you have gotten your final dose and vaccine regimen. You have to test positive despite being fully vaccinated. But that seems a little weird, right? Because a positive test is not necessarily trivial, but it is also just a positive test. Our vaccines were designed to block disease, especially severe disease. And that's really just a subset of positive tests.
BROOKE GLADSTONE Exactly. So if you aren't sick and if you happen to have the SARS-CoV-2 virus which causes COVID, that doesn't mean you have COVID. If this were an SAT question, SARS-CoV-2 is to COVID as HIV is to AIDS.
KATHERINE J WU Yes, I think that is a fair comparison of words. Yeah.
BROOKE GLADSTONE And in fact, that's something else that drives you a little bit nuts that they're called COVID tests. When you're really just taking a SARS-CoV-2 test to see if you're carrying it?
KATHERINE J WU Exactly. And I think this is a really important distinction because oftentimes people say, Oh, someone had a breakthrough, how unfortunate that they had COVID. But that's not necessarily the case, because again, breakthrough is a positive test. It means something detected a piece of the virus somewhere in your body, and a test alone can't really distinguish between, Oh, this was full blown, symptomatic COVID 19 or a different case, which was actually, in my view, potentially a very optimistic scenario in which you as a vaccinated person or may be exposed to this virus. It got into your nose a little bit, but your vaccinated immune system was immediately alerted to the presence of the virus and thought, OK, I'm going to take care of this really fast. We're going to destroy all these viral particles so quickly that this person never even gets sick. That sounds wonderful to me.
BROOKE GLADSTONE Yeah, when we talk about words being misused or clouding our collective comprehension of the pandemic, who can we blame? Or is the confusion a team effort?
KATHERINE J WU We don't necessarily need to assign blame. This is an incredibly confusing time, but the faults certainly does not lie with a single party. And I think there are things that we can all do to sort of improve what has been an ongoing communications nightmare since almost day one of this pandemic. I would love to see it if experts, when they're sort of introducing new terms, would just make sure to be really clear about context. You know, you might have heard this word in a colloquial context, but here is what we have used it to mean in science. And here's how those things differ. It would also be great if you know myself and my colleagues, as reporters, as journalists, as writers, we're just really careful about how we use these words, not mixing them up so that we're not implying that certain things are better or worse than they actually are. And I would love it if the public would be open minded to the idea that, you know, definitions can sometimes start out very squishy. That words sometimes have a very difficult time migrating from one field to another.
BROOKE GLADSTONE You've said it's hard to unring a linguistic bell after it's been rung?
KATHERINE J WU Yeah. And I think that's what's key here, right? After we sort of develop an association to a word, it's pretty hard to unlearn it. But right now, especially when we are dealing with something that is so colossal and so high stakes and so unknown, I think we all have to be ready to unlearn some things and learn some very new things that we might not have expected.
BROOKE GLADSTONE Katherine, thank you so much.
KATHERINE J WU Thank you for having me. This was really fun.
BROOKE GLADSTONE Katherine J. Wu is a staff writer at The Atlantic, where she covers science. Coming up, something you need to know about every medical advance or intervention: you have to bet your life to save it. This is On the Media.
BROOKE GLADSTONE This is On the Media, I'm Brooke Gladstone. This pandemic has offered a vivid case study of science supercharged. It's not the first such case, though, and the course of medical progress never did run smooth. Every advance or treatment carries some degree of risk.
PAUL OFFIT Everything at some level is a gamble. And I think we don't like to think of it that way. But there really are never safe choices because there's always some risk.
BROOKE GLADSTONE Dr. Paul Offit was a co-inventor of the rotavirus, a treatment for a severe infection threatening infants and young children, and even as his own vaccine cleared a phase three trial with 70,000 kids and was deemed safe to go into the arms of kids, there wasn't closure.
PAUL OFFIT But even then, you don't breathe a sigh of relief because 70,000 children isn't 70 million children and you're always worried that you're going to find something out afterwards that you wish you'd known before.
BROOKE GLADSTONE But the public, he reasoned, isn't aware of how that feeling informs science. His solution illuminates some of the times things really went sideways. Dr. Offit is the author of the new book You Bet Your Life: From Blood Transfusions to Mass Vaccination, The Long and Risky History of Medical Innovation, where he relates the tragic mistakes behind the miracles of modern science like organ transplants, anesthesia, antibiotics, X-rays, gene therapy and, of course, vaccines. His book featured a story that's been sometimes invoked during the rush for a COVID vaccine. When Jonas Salk declared his polio vaccine safe, potent and effective, five companies rushed in to mass produce it, and one of them cut corners in the filtration and purification process. The year was 1955.
PAUL OFFIT They failed to do what Salk had done, which is to take polio virus and completely inactivate it with a chemical, and as a consequence of 120,000 children were inoculated with live, fully virulent polio virus. 40,000 of those children developed abortive or short lived polio, meaning temporary paralysis. 164 were permanently paralyzed for the rest of their lives and 10 were killed. I think that was probably the worst biological disaster in this country's history.
BROOKE GLADSTONE It became known as the Cutter incident after the California based lab Cutter Laboratories. In the book, you described it as a problem of scaling up, right?
PAUL OFFIT So, when Salk made his vaccine, he took the virus, grew it in monkey kidney cells and then purified the virus away from those cells so that it was pure virus. And then he inactivated it with a chemical and he used a very slow filtration system. It produced a product that was called gin pure, meaning it was just perfectly clear. When it went to scale up, that was considered too slow, so they used a different kind of filtration system, which wasn't as efficient. These polio virus particles would get sort of trapped in this cellular debris, and so the formaldehyde, the chemical used to inactivate the virus, couldn't penetrate that cell debris. And as a consequence, there was live virus in that vaccine. It was really a tragedy of epic proportions.
BROOKE GLADSTONE What should we learn from the run up to a safe and effective polio vaccine?
PAUL OFFIT There's always a human price to be paid for knowledge. Even if you look at the polio vaccine trial. Jonas Salk didn't want to do a trial of his vaccine. He felt he had tested it in 700 children in the Pittsburgh area, he told his wife, Donna, 'Eureka, I've got it.' And he didn't want to inoculate children with a placebo, knowing that every year, 20,000-30,000 children would be paralyzed by polio and that 1500 would die. But nonetheless, the March of Dimes who ran this program insisted on it. And so that was the trial. 420,000 children were inoculated with Jonas Salk's polio vaccine, 200,000 children received placebo, and when it was over, the person who headed the trial, Thomas Francis, stood up at the podium at Rackham Hall at the University of Michigan and said those three famous words: safe, potent and effective. Those three words appeared on the headline of every newspaper in this country. Church bells rang out.
NEWS REPORT an historic victory over a dread disease that dramatically unfolded at the University of Michigan. Here, scientist usher in a new medical age with the monumental reports that prove the Salk vaccine against crippling polio to be... [END CLIP]
PAUL OFFIT So how did he know it was effective? He knew that vaccine was effective because 16 children died from polio in that study, all in the placebo group. He knew it was effective because 36 children were paralyzed in that study, 34 in the placebo group paralyzed for the rest of their life. I mean, those were first and second graders in the 1950s. I was the first and second grader in the 1950s. But for the flip of a coin, those children could have lived a long fulfilling lives. And I think that's the story that often gets lost here. I mean, for example, I'm on the FDA's vaccine advisory committee. When we approved Pfizer's vaccine for 12 to 15 year olds. That was a 2300 child study. After that was approved, I got a lot of pretty angry e-mails from parents saying, 2300 children, really? That's all you want to test. You just did a forty thousand person trial with Pfizer's vaccine in adults. You did a thirty thousand person trial of adults for Moderna's vaccine, and now you're going to test only 2300 children before it's going to be given to millions of children. Is that what you want to do?
BROOKE GLADSTONE And what do you say to those parents?
PAUL OFFIT What I say is I say the issue is never when you know everything. The question is, when do you think you know enough? And we could have done a twenty three thousand child study for the 12 to 15 year old, in which case then there wouldn't have been 18 cases of COVID in the placebo group, as was true in the twenty three hundred trial, there would have been a hundred and eighty children who suffered COVID in the placebo group, some of whom would have suffered it severely. When do you know enough knowing that you might be wrong knowing that when you're making a decision based on thousands of children for a vaccine that's not going to be given to millions or tens of millions or hundreds of millions of children throughout the world? Do you know enough? And I guess the purpose of writing this book was to make people aware of the fact that they should have a more reasonable understanding of how this process works so that they don't have expectations that are unrealistic.
BROOKE GLADSTONE What do you think's off kilter here?
PAUL OFFIT I think if you ask people, Do you think we're going to know more about science, more about medicine 100 years from now than we know now? I think everybody would say yes, but when it comes to an issue that they're dealing with now, they want to believe, you know, everything and you don't. So, for example, look at these vaccines that are now used to prevent COVID. We were surprised by the fact that the mRNA vaccines caused myocarditis. Inflammation of the heart muscle. It was rare, maybe one in 20000 people, all in all, but real. We were surprised that the Johnson Johnson vaccine was a very rare cause of clotting, including severe clotting in the brain. Rare, roughly 1 in 500000, but real. Those were surprises. People are always disappointed by that, but would they-- should take the heart, is that one there's systems in place to pick that up. And two, that this is always true. That knowledge always comes with a human price. Always.
BROOKE GLADSTONE How did you feel about warp speed, the fact that it was called warp speed and that this was an unprecedented effort? Nothing like this has ever happened before.
PAUL OFFIT It was remarkable. I mean, we identified the SARS-CoV-2 virus and sequenced it in January of 2020. Eleven months later, we had done two large clinical trials, the Pfizer trial and the Moderna trial with a technology, messenger RNA, that had never been used before. And the vaccines were found to be remarkably safe and remarkably effective. But I think the terminology that surrounded that created the sense that timelines were being skipped or truncated or worse, that vaccine safety guidelines were being ignored. But that really wasn't true. The size of those trials was the size of any typical pediatric or adult vaccine trial. I think the difference was length of time for efficacy. You only really knew it was effective for a few months. You didn't know beyond that. On the other hand, you're not going to do a two or three or four year study to see just how long efficacy lasts in the midst of a pandemic.
BROOKE GLADSTONE You observed, though, that the Cutter incident came back in the news because warp speed did to an extent mimic the 1955 polio vaccine program.
PAUL OFFIT That's right. You were mass producing at the same time that you were doing the studies. Normally, companies don't do it that way. They go sort of phase one trials then phase two trials. Then you do the phase three trials where people get the vaccine or they don't get the vaccine. And if it works, then you mass produce it. These vaccines were being mass produced before you even knew whether they work before you even knew whether they were safe, which is really what happened with the polio vaccine trial. I mean, the length of time that it took to essentially license the polio vaccines in the mid-1950s was two and a half hours.
BROOKE GLADSTONE Shouldn't we then have been squeamish if we remembered the Cutter incident?
PAUL OFFIT Right. But you know, there are no risk free choices. There are just choices to take different risks. So the question is when you knew that this vaccine was coming out, you knew that it was a novel technology. You knew that it had been developed very quickly. And yeah, I think you should have been a little squeamish. The people who got that vaccine early on, especially in the clinical trials, were brave. So people could reasonably say, Look, I see that, that there's a learning curve here. I'm just going to wait till the learning curve is over. But the learning curve is never really completely over.
BROOKE GLADSTONE I kind of love the analogy you offered that describes the different kinds of risk people face when making medical decisions. It begins by imagining you are walking through the woods, right?
PAUL OFFIT And so then you come upon a bridge, which is, you know, a little rickety. But you know, many people have crossed it before, so you're willing to take that risk because everything is a risk. I mean, aspirins are a risk, antibiotics are a risk. Those are the sort of the normal risks. The analogy that I try and make here is that you see things differently if you're being chased by a tiger. You know you're much more willing to take the rickety bridge. Those are the first heart transplants, the first kidney transplants. I think the last 24 hours there was a kidney transplant using a pig kidney. You know, you have 4,000 people currently on the heart transplant waiting list. 1300 of them will die while waiting. You don't know whether you're one of those 1300, so you could say, You know what? Let me try getting a pig heart. Be one of the first to do that. That may solve my problem completely.
BROOKE GLADSTONE As you detailed in your book, there was an effort to transplant animal parts in the past and it never worked,
PAUL OFFIT Especially for blood transfusions. I mean, you know, blood transfusions were done in the 1600s and they were done using barnyard animals as a source of blood. For some people, the blood transfusion actually worked fairly well, although they always suffered transfusion reactions, meaning fever, darkened urine. OK, so now you're in the early 1900s, you figured out blood typing. A, B, O typing. Would you get a blood transfusion now? OK, but remember, you haven't yet figured out the RH typing that so-called if you're O positive. OK, now you're in the 1940s, would you get a blood transfusion now, knowing the hepatitis B virus is now in the blood supply and has been at one point just one of the largest single source fatal outbreaks among the American military. OK, so now you're in the 1970s, you can test for hepatitis B virus. Would you get a blood transfusion now? And what comes into the country – AIDS. The blood supply gets contaminated with human immunodeficiency virus. Okay, we can get a blood transfusion now that we figured out that HIV is in the blood supply and can test for it. And would you get a blood transfusion now, knowing that there are viruses we don't test for, knowing there are viruses we don't know about? There's always some level of risk.
BROOKE GLADSTONE In his New York Times review of You Bet Your Life, Cass Sunstein wrote that in life and in public policy, many people in Europe and the U.S. are drawn to the precautionary principle. Whenever an innovation threatens to cause harm, we should be exceedingly cautious before we allow it. Offit's examples in the history of medical advances demonstrate that in its most extreme forms, the precautionary principle is self-defeating.
PAUL OFFIT The general point is you have to keep trying and don't let a setback make it so that you simply stop pushing forward. So probably the best example for me, because I lived through it, because I'm at the University of Pennsylvania was Jesse Gelsinger. So Jesse Gelsinger was a 19 year old man who lacked a certain liver enzyme that helped him convert food and energy, which meant he was taking 30 pills a day and that he had a restrictive diet, which is hard for a –
BROOKE GLADSTONE Teenager.
PAUL OFFIT A teenager. So he was, he was willing to allow himself to be part of a trial where he received the gene therapy, which was a common cold virus called adenovirus that was genetically engineered so that he couldn't reproduce itself and cause disease. And what happened was very soon after he got that, he had an overwhelming kind of sepsis like response, meaning it looked like he had been infected with a bacteria that had overwhelmed him. That actually ended up helping a lot of people down the line when you saw that he had an overproduction of an immune protein called interleukin six. And at the time, there was nothing to have countered that. Now we have a monoclonal antibody called tocilizumab, which can counter that. Would that really put a chill in gene therapy research? It really set it back a solid 20 years, and I think we should have just learned from that and move forward. Instead, you know, we put all these kinds of federal regulations to make sure it didn't happen again, but of course, it was going to happen again. I mean, you can't really legislate out these kinds of unfortunate problems because as you move forward into new territory, you're always going to be surprised by some of the things that you find.
BROOKE GLADSTONE What was kind of chilling about what happened to Jesse Gelsinger decades ago was that he experienced a cytokine storm, a phrase we learned during COVID. His immune system overreacted. Many people in the early stages of COVID died precisely for that reason.
PAUL OFFIT That's right. And now we know that dexamethasone, which is a steroid that inhibits your ability to develop a vigorous immune response, is helpful. You would think it would be counterintuitive to give something to suppress your immune system during an infection. But that was exactly the right thing to do. But again, we learned as we went.
BROOKE GLADSTONE What are the things that the public ought to keep in mind, then, when taking in coverage of a new medicine or procedure or breakthrough?
PAUL OFFIT I think you should get all the information you can. So on October 26, the FDA's Vaccine Advisory Committee will meet to discuss vaccines for the 5 to 11 year olds. They'll probably be about several thousand children who will have gotten this vaccine, and we'll have data on what their immune response was. We'll have data on safety. We may well not have data on whether or not it worked. We're going to try and say that, well, if you had this immune response, it's likely to work. Is that enough? Is that enough information? Do we know enough then to go forward and give this vaccine to hundreds of thousands or millions or tens of millions of children, but realize that on the other side, you know, we're seeing 150,000 cases in children a week. We're seeing 2,000 children being hospitalized every week. Children now account for more than a quarter of the cases as this Delta variant has reached down into the susceptible population and is causing them to be more likely to be infected than they were when the virus first came into the United States, at which point they only accounted for three percent of infections. So this is now a childhood disease. When do we know enough, remembering that we never know everything, and so that's always the balance that you have to take. I mean, I think that from the standpoint of a parent, if the FDA has reviewed it, if the CDC has reviewed it and they have come forward with the notion that we think we know enough, I think that's fair because remember, if you choose not to get it, you may be one of those unfortunate parents who have to deal with their child in the hospital or worse.
BROOKE GLADSTONE Finally, why did you title your book You Bet Your Life?
PAUL OFFIT Because at some level, we always are betting our life. I mean, if you look, for example, if this is a story just in the news, in the last couple of weeks. You know, aspirin therapy used to be given for everybody who is at high risk of a stroke or high risk of a heart attack, had high levels of bad cholesterol, had high blood pressure and then they sort of modified that through really, it should just be for those people who've already had a stroke or had a heart attack. Because if you take aspirin, you know you increase your risk of bleeding, including severe bleeding, you know, bleeding between your skull and your brain or bleeding behind your eye, etc. So there are risks to taking aspirin. And now even that's being modified. You're always at some level betting your life. And I guess in part, it's because I'm old enough to remember Groucho Marx.
BROOKE GLADSTONE Thank you very much.
PAUL OFFIT Well, thank you, that was fun.
BROOKE GLADSTONE Dr. Paul Offit is a professor of vaccinology at the Perelman School of Medicine at the University of Pennsylvania and author of the new book, You Bet Your Life: From Blood Transfusions to Mass Vaccination, The Long and Risky History of Medical Innovation. Coming up: the shape of stories, according to Kurt Vonnegut. This is On the Media.
BROOKE GLADSTONE This is On the Media, I'm Brooke Gladstone. We've discussed the words that soothe us, the mistakes that alarm us. What about the numbers? Those cannot fail to move us with their cold, hard truths.
NEWS REPORT There have been nearly 238 million cases worldwide since the pandemic began and more than 4.8 million deaths. [END CLIP]
BROOKE GLADSTONE How does that figure make you feel? Shock, sorrow, anything? COVID is still too much with us, and yet many of us are just too spent, too confused to react anymore. Maybe we've simply reached a limit. On the Media correspondent Micah Loewinger looked to the work of one of fiction's greatest practitioners to make sense of how and why we lost the plot.
MICAH LOEWINGER The other day, I was talking with my friend Soren Wheeler, he also works at WNYC, about the dissonance of this moment in the pandemic.
SOREN WHEELER I ran into a neighbor friend after dropping our kids off at school. I have a six year old who's not vaccinated, so like, it's definitely not over for us. She's like, 'Oh, are you guys still worried about that?' And I was like, shocked. But also, I didn't have a dramatic answer to 'are you still worried about it?' I had to be like, 'Well, not really for me in terms of hospitalization because I'm vaccinated and the kids, it's not as big a risk to them and my parents are good and like, but I but I just don't want it to keep going in case there's another mutation.' Even my dramatic feelings that it's not over were sort of abstract and flatter and slower.
MICAH LOEWINGER It's interesting to me that Soren was drawing a blank because he's one of the people most up for the challenge. He's the editor at Radiolab, where he thinks a lot about making hard topics accessible and engaging.
SOREN WHEELER Many of us don't think we want to hear about science, or many of us don't think we want to hear about politics or economics, or just like sort of a dark, dark thing, like a drone strike or something that you're just feel like, 'Oh, I don't want it.' And if you just give people information, you're never going to beat that feeling. That the way to beat that feeling, and make people engage with information, the lubrication to get them to get a new idea into their brain is emotion and emotional change over time.
MICAH LOEWINGER Of course, not all emotional stories are captivating, it's more complicated. Our own standards are mysterious to us. But several years ago, Soren found a sort of cheat code for how to distinguish good stories from bad ones. When he clicked on this esoteric YouTube video of an old lecture.
KURT VONNEGUT Where the hell are we? [END CLIP]
MICAH LOEWINGER This is novelist Kurt Vonnegut, the author of Slaughterhouse Five, Cat's Cradle, and so many other great books.
SOREN WHEELER Vonnegut is a hero of mine, and then at some point I stumbled into this video and it just unveiled something. It's wry and funny, but also just deeply revealing about some basic things about us.
KURT VONNEGUT No reason why those simple shapes of stories can't be fed into computers. They are beautiful shapes. [END CLIP]
MICAH LOEWINGER The lectures about a theory he had about the geometrical shapes of stories, really popular stories. Ones we've heard a billion times.
SOREN WHEELER He's like, sort of like a somewhat curmudgeonly, cynical old, oldish man by this point, and he's on a stage in sort of one of his sloppy suits and he's got a chalkboard.
KURT VONNEGUT This is the G.I. axis. Good fortune. Ill fortune. Sickness and poverty down here. Wealth, and boisterous good health up there. [END CLIP]
MICAH LOEWINGER Vonnegut draws two perpendicular lines: a simple x y axis on the chalkboard. The first line is labeled G for good fortune on the top left corner and I for ill fortune on the bottom left corner. And slicing through the middle of the chalkboard, left to right, is the second line the x axis.
KURT VONNEGUT Now this is the B-E axis. B stands for a beginning, E stands for electricity. [END CLIP]
SOREN WHEELER Just starts explaining, there's just a couple of stories out there. He names the first one 'Man In A Hole'.
KURT VONNEGUT Call, the story Man in Hole, but it needn't be about a man, and it needn't be about somebody getting into a hole. It's just a good way to remember it. Somebody gets into trouble, gets out of it again. [END CLIP]
MICAH LOEWINGER In one motion, he draws a single curve with a shallow tip showing the person's fortune dropping down and swooping back up.
KURT VONNEGUT People love that story. They never got sick of it. [END CLIP]
SOREN WHEELER It's just like, 'boom,' like what I'm doing in my head is like, 'Oh my god, yeah,' that's a whole category of movie that I've seen a thousand times.
MICAH LOEWINGER A 2018 study from Birmingham University used A.I. to analyze over 6000 scripts and found that this is the most profitable arc in all of Hollywood. And when you think about it, there are so many movies that are basically 'Man In A Hole' stories.
SOREN WHEELER Bill and Ted's Excellent Adventure is that.
MICAH LOEWINGER That's a great one. And Harold and Kumar Go to White Castle.
SOREN WHEELER Sure, yeah.
MICAH LOEWINGER Harold and Kumar, average day, they decide they want to get food.
KUMAR No matter what, we are not ending this night without White Castle in our stomachs. Agreed?
HAROLD Agreed. [END CLIP]
MICAH LOEWINGER And then they go on a crazy journey, and it seems like all hope is lost after they're like stuck in the woods and everything has gone to crap.
HAROLD I'm completely on edge right now, man. After all that sh*t that we've been through tonight, I don't know how much more I can take. [END CLIP]
MICAH LOEWINGER And then they managed to find the courage and some crazy, serendipitous events leads to them finally getting to White Castle, getting their burgers.
WHITE CASTLE Looks like you guys had some night, huh?
HAROLD I want 30 sliders, 5 french fries and 4 large cherry Cokes.
KUMAR I want the same, except make mine Diet Cokes. [END CLIP]
MICAH LOEWINGER And so not only do they emerge from the hole, but they're sort of stronger afterward.
SOREN WHEELER You can see on the curve like that the man in the hole ends up higher up than where he or she started, right?
MICAH LOEWINGER Anyway, back to the lecture, Vonnegut begins drawing a second curve, which he calls...
KURT VONNEGUT Boy gets girl, but it needn't be that. Just a way to remember it. Start on an average day, average person not expecting anything to happen a day like any other. Find something wonderful. Just loves it. [END CLIP]
MICAH LOEWINGER Vonnegut draws a curve with an upward slope. The protagonist has found their true love, but then the incline reaches a rounded peak. The moment when the protagonist and we, the audience realize this is all way too good to last.
SOREN WHEELER And then it goes bad. They lose it almost always, because to get the person they love, they'd like made up some stupid lie, or they said they were somebody they weren't. They go down and they lose the girl.
MICAH LOEWINGER Our character is heartbroken, and Vonnegut's curve drops down to a deep low on the good slash ill fortune axis. But then -.
SOREN WHEELER Usually in the last five minutes of the movie, they get the girl or the boy back and they're happy.
MICAH LOEWINGER And so the curve shoots way back up to finish the story. Vonnegut's curve ends up looking like an 's' flipped on its side. Neutral to happy, to sad, to happy again. People like that. Vonnegut's next story, he tells us, is a little bit more complicated.
KURT VONNEGUT We love to hear this story. Every time it's retold, somebody makes another million dollars. You're welcome to do it. We're going to start way down here. Who is so low? It's a little girl. What's happened? Her mother has died. Her father has remarried. A vile-tempered, ugly woman with two nasty daughters, big daughter.
[LAUGHING CONTINUES UNDER]
SOREN WHEELER So Cinderella.
MICAH LOEWINGER Yeah.
KURT VONNEGUT Anyway, there's a party at the palace that night, she can't go. OK, so the fairy godmother comes. Gives her shoes, gives her stocking, gives her mascara, gives her a means of transportation, goes to the party, has a swell time. [END CLIP]
SOREN WHEELER This is the first time that, like you notice that he's introducing a whole nother aspect into these curves, which is slope. Because if you're going from beginning, middle and end, then what you're dealing with this time is so how steeply it goes up has to do with how fast it happens. Fairy Godmother comes along and he does this little staircase thing he's like.
[MUSIC BEGINS IN CINDERELLA TRANSFORMATION]
SOREN WHEELER Gives her some mascara, gives her some shoes, gives her a dress. Boom, boom. Hits of good fortune in this little staircase. And then she goes to the ball. And so now she's up, crossing past the line and up into the happy zone, dancing with the prince.
CINDERELLA So this is love. mhmmhmm So this is love... [END CLIP]
SOREN WHEELER So, yeah, yeah. And then he does this thing where the line starts going down and he goes dong dong.
KURT VONNEGUT Brrring, brrring, brrring. Now there's a slight inclination to that line, as I've drawn it because it takes perhaps 20 seconds, 30 seconds for a grandfather clock to strike 12.
HANDSOME PRINCE Oh no, wait, you can't go now. It's only--
CINDERELLA Oh, I must, please, please I must.
[FADES INTO NEXT CLIP]
KURT VONNEGUT Does she wind up at the same level? Of course not. She will remember that dance for the rest of her life. Now she pooped along on this level till the prince comes, the shoe fits, she achieves off-scale happiness.
MICAH LOEWINGER Vonnegut's curve shoots to the top right corner of the chalkboard. And then he draws a little infinity sign.
SOREN WHEELER That is every fairy tales last line, which is ‘and they lived happily ever after,’ you know?
MICAH LOEWINGER Now, obviously, not all good stories need to have a happy ending. There are many different types of narratives out there. These just happen to be a few of the most popular ones, the ones that put a spell on us.
SOREN WHEELER The whole thing is like, look how simple we are. People never get sick of it. Our brain wants that over and over and over and over again. Like our brain still scans it as unexpected. We saw something go from good to bad and then good again?
MICAH LOEWINGER And maybe that sounds a little depressing to think that we're kind of trapped in this cycle of paying to see and feel that emotional experience playing out over and over. Trapped by a desire for that repetition, that familiarity. But Soren thinks it's actually quite instructive. For him and the producers at Radiolab. These are blueprints for how to satisfy and sustain a listener's attention and blueprints for what not to do.
SOREN WHEELER I mean, I always used to argue that like, I don't think Radiolab has ever said yes to a story that crossed the line once.
MICAH LOEWINGER So just one turn of fortune?
SOREN WHEELER Right. Like, Oh, here's Mary, she was super happy and going along, and then she got an illness and got really sick. And if you just leave me down there, man, I'm like, Oh, why did I listen to this? There's just a level of complication below which it didn't feel worth it.
MICAH LOEWINGER But it also seems like the opposite can be true. What happens when there are too many changes in fortune?
SOREN WHEELER Oh, sure. If you go up and down and up and down and up and down and up – by right around here, you've lost any element of surprise, probably. You've also sort of lost the feeling that we're on a path to something that there's an end point of any kind, which is the whole reason we listen to stories is just to get to an end point and then have a thought or feel different afterwards. You've lost the idea that there's any meaning to be made out of this.
MICAH LOEWINGER Yeah, you're going to numb their receptors.
SOREN WHEELER Right, yes.
MICAH LOEWINGER You know, I also encountered this video. I was binging Vonnegut's books, and then I started listening to old interviews with him on YouTube, and that's how I came across this video. And once I saw the shapes, they were kind of burned into my mind.
SOREN WHEELER Right.
MICAH LOEWINGER Then when the pandemic hit, there was this moment where the shapes of the pandemic became a universal language.
NEWS REPORT Flatten the curve, flatten the curve. We did it. We flattened the curve.
NEWS REPORT We didn't just flatten the curve. We bent the curve. [END CLIP]
SOREN WHEELER I'm right there with you. It was completely striking, and I was instantly thinking about all the curves, both literal in terms of the rise of cases, but also like a pandemic as a story, right? A pandemic should have a beginning, middle and end as COVID is rising. What we're doing is we're plummeting down Vonnegut's line, down from health and wealth, down into like poverty and sickness and death.
MICAH LOEWINGER And when the daily cases began to drop at the end of that first wave last year, the emotional tenor of the country and the coverage seemed to improve too. At least for a moment.
NEWS REPORT Northern New York state today, the governor saying all indications on the medical front continue to be encouraging hospitalizations down, new COVID cases down.
NEWS REPORT There is some good news, some sparks of hope. We're seeing cases falling, hospitalizations down...
NEWS REPORT Case numbers are going up, they're going up. 40 states are showing COVID rates that are going up.
NEWS REPORT New numbers this morning are pointing to a brighter picture in the U.S., the national rate of new COVID 19 infections and hospitalizations, both of those numbers are going down. [END MONTAGE]
MICAH LOEWINGER If you pull up a graph of the pandemic, you can see this ebb and flow of cases along the rippling Vonnegut curve.
SOREN WHEELER Up and down and up and down and up and down.
MICAH LOEWINGER Yeah, but I don't know, is that a good story?
SOREN WHEELER No. I mean, why are you asking that question? You know, it's not a good story.
MICAH LOEWINGER I know it's not a good story, but I'm just trying to make the point.
SOREN WHEELER Yeah, no. It's a bad story. Yeah, nobody wants to hear that story. I wouldn't put that story on the air. I wouldn't go to a movie theater to watch that story.
RACHEL PILTCH-LOEB I guess from my perspective, it's been a little bit of a sad and terrifying story.
MICAH LOEWINGER That's Rachel Piltch-Loed preparedness fellow at the Harvard T.H. Chan School of Public Health.
RACHEL PILTCH-LOEB It's a scary story from the perspective of what does it mean for our public health infrastructure? What does it mean for the next time this comes around?
MICAH LOEWINGER I want to see if this made sense from a kind of epidemiological perspective. So I sent her an email summarizing my conversation with Soren about the pandemic, and Vonnegut's shapes
RACHEL PILTCH-LOEB I conceptually liked the thought a lot. I mean, the idea that we, as humans have narrative filters that we put on the world. And I think one of the challenges of the pandemic has been, we don't really know the trajectory of what's going to happen.
MICAH LOEWINGER Were there moments where there may have effectively been an over promise or where people may have perceived an imminent end to the pandemic?
RACHEL PILTCH-LOEB What was presented as a turning point in the story nationally was the vaccine availability and rollout, and we basically came up with a policy that was not necessarily founded in a particular piece of evidence besides the desire to make it true, which was if you're vaccinated, no other public health measures are necessary. Then we were faced with the Delta variant and people thought that the story had ended, so to speak. Vaccines are rarely 100 percent effective at preventing merely infection. That's not what they're designed to do. They're designed to prevent the impact of the infection, which is certainly what these vaccines do. We then had to start retelling a new set of policies, a new set of explanations, etc. And I think that that pivotal time really is where more people were lost and kind of began down their own path of 'I'm going to try and figure out what works for me'.
MICAH LOEWINGER We lost the plot.
RACHEL PILTCH-LOEB Yeah. It created this perception that the vaccines were the savior in the story, right? Our expectations of it were not realistic because the reality is that there is no panacea for a pandemic.
MICAH LOEWINGER Yeah, and I would say that that's probably not even unique to a pandemic or any kind of public health crisis. I mean, it's funny when we use terms like national narrative or whatever. When we watch a movie, we can take away different conclusions, but we're all watching the same movie. You know, we're all reading the same book. And one place where maybe my theory breaks down and where it's not so analogous is that we're not really witnessing the same story.
RACHEL PILTCH-LOEB We're talking about kind of a global story, a national story, a community story and a personal story, meaning my experience is probably pretty different from from yours or from somebody else who's had a different experience personally with the virus, who maybe lives in a different part of the country, certainly in a different part of the world. So this story is still ongoing. We need to look really introspectively to figure out how to change the story for the next time.
SOREN WHEELER As much as like the simple stories are crack for the human brain, there's got to be a way to making us all a little bit more friendly to like the complicated stories and make complexity something to be revelled in and curious about, and fun and not dangerous or whatever. Or at least just recognize that none of the stories in our lives do the Vonnegut thing right? That's what we got to the movie theater for, but have a different version of us, a different habit of mine that we apply to the life around us, and especially to questions of public good.
MICAH LOEWINGER I'd like to end with a piece of advice that Vonnegut often used to tie up his lectures, something he learned from his uncle Alex.
KURT VONNEGUT What Uncle Alex found objectionable about so many human beings is that they so seldom noticed it when they were happy. And so we would be sitting under an apple tree, for instance, on a July afternoon drinking lemonade and practically buzzing like honey bees and uncle Alex would stop everything and say, Wait a minute, stop. If this isn't nice, I don't know what is! [END CLIP]
MICAH LOEWINGER We've spent this hour focused on the words that medicalised our hopes and fears and the tragic histories of life saving breakthroughs. It's been a messy narrative with no chance of ever ending up like Cinderella in that zone of infinite bliss. But as Vonnegut observed, some of the best stories don't make that landing and don't need to. As we watch our current storyline rise and fall and rise and fall, I'm thinking Uncle Alex may be pointing to the best ending we could ask for. For On the media, I'm Micah Loewinger
BROOKE GLADSTONE On the Media is produced by Leah Feder, Micah Loewinger, Eloise Blondiau, Rebecca Clark-Callender and Molly Schwartz, with help from Juwayriah Wright and WNYC Archivist, Andy Lanset. Our technical director is Jennifer Munson. Our engineer this week was Adriene Lily. Katya Rogers is our executive producer. On the Media is a production of WNYC Studios, I'm Brooke Gladstone.