Politics Before Science

The death rate from COVID-19 is higher in the United States than in most other countries. On the network news, the usual explanation given for this is that President Trump has botched the federal government’s response to the pandemic. Recently, on the PBS Newshour, correspondent William Brangham added public television’s voice to the network chorus when he referred to the lower death rates outside the US, saying, “The fact is, those nations don’t have better doctors. They don’t have more effective medications. They simply mounted a more effective response.”

I enjoy the PBS Newshour. I watch it almost every night. And I take it as given that the president’s response to the pandemic has been hamhanded. But to blame Trump, even without naming him directly, for this difference in death rates is simply bad journalism.

There is a better reason.

I’ll explain that reason and how I first learned about it, then how it was subsequently validated by research. A short rant about shaping narratives will be followed by the transcript of an imagined meeting. As always, my aim is to amuse.

* * *

Back in April, I was reading in the New York Times about COVID-19 and BCG, the Bacillus Calmette-Guérin vaccine, which is used to prevent tuberculosis. Over the past century, BCG has prevented as many deaths as the polio vaccine. Every year, more than 100 million children all over the world get the BCG shot. What caught my eye was this: “Countries that did not implement or had abandoned universal B.C.G. vaccination have had more coronavirus infections per capita and higher death rates.”

That is the kind of statement that cries out for googling.

The president’s response to the pandemic has been hamhanded. But to blame Trump, even without naming him directly, for this difference in death rates is simply bad journalism.

First, I found the BCG Atlas, a site that summarizes BCG vaccination policies around the world. Then I went to Our World in Data, a site that tracks COVID-19 death rates by country. And then I made a little chart, since lost, of the BCG vaccination policies of European countries and their COVID-19 death rates. Below is a new version with data from August 20, 2020. On this one, the death rates are from Wikipedia.

On this chart, each European country has been put into one of three groups, “Current,” “Stopped,” and “Never.” “Current” lists the countries that vaccinate all their children with BCG. “Stopped” lists the countries that used to vaccinate all their children, but don’t now. The year each of those countries stopped is noted. “Never” lists the countries that have never mandated vaccinating children against tuberculosis.

BCG and COVID-19

To summarize the chart, then: the average number of deaths per million from COVID-19 for countries in Europe that presently mandate vaccination with BCG is 107. The average for those that used to vaccinate, but stopped, is 257. The average for those that never mandated vaccination at all is 563.

One possible takeaway is that the COVID-19 death rate in the countries that currently vaccinate is less than a fifth of the death rate in the countries that never did.

So, where does the US fit in?

While most countries around the world try to vaccinate all their children with BCG, the United States of America does not now and never has. In the US, BCG is only given when testing indicates that it is necessary, which is very seldom. There just isn’t that much tuberculosis in the United States.

The number of deaths per million in the US from COVID-19 as of August 20, 2020, is 530, a lower rate than Italy’s and slightly below the average of the countries in Europe that have never vaccinated. About what you’d expect, all other things being equal.

Taken at face value, then, these numbers suggest that the higher COVID-19 death rate in the US is in large part due to the lack of a BCG vaccine mandate.

When I made the first chart, back in April, the results were similar, but I knew that it proved nothing. It wasn’t meant to. I’m not a statistician, much less a scientist. I was just following up on the Times article with some back-of-the-napkin stuff.

To test a hypothesis like this, much information must be gathered and analyzed: age, obesity, rates of diabetes and heart disease. Lots of data have to be harvested and crunched in elaborate ways. Wealth, health, education, population density, and other demographic variables have to be taken into account. Even variations in DNA and strains of vaccines may be relevant.

The evidence is in. Countries that vaccinated children with BCG have many fewer deaths from COVID-19 than they would have had otherwise.

I also knew that correlation does not prove causation and that any conclusions drawn about BCG vaccination mandates and COVID-19 death rates would have to be based on a very strong relationship between the numbers.

I got all that, but the chart still piqued my interest.

Since early April, then, I have googled “BCG vaccine” and “COVID-19” with “mortality rate” and similar words probably 50 times. I have read many articles and research reports and squinted at scores of charts and graphs. The evidence confirming what my little chart suggested began to roll in, slowly at first, and then more rapidly.

For example, one of the earliest studies, in the Proceedings of the National Academy of Sciences, was “BCG vaccine protection from severe coronavirus disease 2019 (COVID-19).” It was submitted by a group out of Maryland in early May and published on July 9, 2020. It concluded that while BCG vaccination could not be shown to actually cause fewer deaths from COVID-19, there was a significant correlation between the two. The null hypothesis was rejected. It also recommended using new BCG vaccination to help fight the pandemic only after clinical trials have proven it to be safe and effective.

Then, on July 11, 2020, the journal Vaccines published “Significantly improved COVID-19 outcomes in countries with higher TB vaccination coverage,” a study by a group from Ben Gurion University. After controlling for 23 variables in countries all over the world, they concluded that “the significantly strong correlation between the BCG vaccination and better outcomes for COVID-19 is shown across many countries, covering the majority of the world population.”

They also point to the importance of BCG-induced resistance to COVID-19 on overall contagion rates and, ultimately, on mortality rates, regardless of whether vaccination resulted in immunity for any given individual. While their research also suggests that resistance to COVID-19 created by BCG may fade after 15 years, it leaves no doubt that more childhood BCG vaccinations means fewer COVID-19 deaths.

On August 5, 2020, an American study titled “Mandated Bacillus Calmette-Guérin (BCG) vaccination predicts flattened curves for the spread of COVID-19” appeared in Science Advances. After elaborately crunching all the numbers then available, a complex analysis concluded that “the total number of COVID-19-related deaths in the United States as of 29 March 2020 would have been 468 — 19% of the actual figure (2467) — if the United States had instituted the mandatory BCG vaccination several decades earlier.”

On August 11, 2020, a Japanese study appeared in the Journal of Infection. “Impact of routine infant BCG vaccination in young generation on prevention of local COVID-19 spread in Japan” gathered together all the meticulous BCG vaccination and COVID-19 records in Japan, prefecture by prefecture. After crunching these numbers very hard, they reached their conclusion: “Our findings suggest that routine infant BCG vaccination coverage in young generation had a significant impact on prevention of local COVID-19 spread in Japan.”

The evidence is in. Countries that vaccinated children with BCG have many fewer deaths from COVID-19 than they would have had otherwise. Just how BCG accomplished this feat isn’t yet clear, but a consensus is emerging that the immune systems of the vaccinated children were primed to resist infection from this new version of the coronavirus at the same time, but in a slightly different way, than they were primed to resist tuberculosis bacteria. It seems that the children became resistant to COVID-19 rather than immune, making the aggregate effect on herd immunity an important part of today’s significantly reduced death toll in countries that vaccinated. However BCG accomplished it, many fewer people have died, as shown in study after study, in country after country.

I read other articles and research papers about BCG suppressing COVID-19 from Australia, Serbia, and Indonesia. I saw it on TV in India. It seemed to be common knowledge outside the US. An international internet squabble broke out about whether people who’d missed childhood vaccination should get a BCG shot now. Experimental trials were launched. There was even an online argument about whether people hospitalized with COVID-19 might benefit from BCG. There was a lot of global coverage, but that central conclusion about childhood vaccination decreasing the death rate that I first saw in the Times back in April never made it to the modern American equivalent of the front page. Not that I saw, anyway.

That we are losing “far more Americans than these other nations” does not seem surprising, and I am still trying to coax meaning from the phrase “more of their citizens are alive than ours.”

As the evidence mounted, I was hoping to hear about the connection between BCG and COVID-19 on the PBS Newshour. I thought the story that a BCG vaccination mandate would have saved the lives of tens of thousands of Americans might have been of interest to the American public. It was particularly surprising when the study projecting the 80% reduction in deaths was published and PBS didn’t pick up the story. Imagine the headline: “BCG vaccination would have reduced COVID-19 deaths in the US by 80%.” It would have been a big story, a Frontline episode, perhaps. But PBS was silent.

And then, on August 28, 2020, as I said at the start, on the PBS Newshour, I heard William Brangham say,

“I’d like to show you this graphic here that gives you a better measure of this. We are still losing more Americans to this virus than other nations. This is a coronavirus deaths [sic] per million in developed nations. That red line at the top, that is the US’s rate. All those other little lines at the bottom on the right-hand side are other modern nations, very similar to us, Canada, Australia, the European Union, South Korea. You can see that red line is far above them. We are losing far more Americans than these other nations. And the fact is, those nations don’t have better doctors. They don’t have more effective medications. They simply mounted a more effective response. And on this chart, you can see the results. More of their citizens are still alive than ours.”

We’re almost to the rant.

But first, those “little lines at the bottom” should be sorted according to their BCG mandate history.

Canada is in the “stopped” category. Although it didn’t have a national mandate, as recently as the 1970s, Newfoundland, Saskatchewan, and Quebec all had BCG vaccination programs. Quebec’s went on into the 90s.

Australia is a “stopped” country as well, having had a BCG mandate until the mid-80s.

The European Union is not a country, of course. As my chart shows, it is a collection of “current,” “stopped,” and “never” countries. By making it a single line on the graph, this important distinction is lost. More about that later. Perhaps it’s best to categorize it as “stopped.”

South Korea is a “current” country that vaccinates all of its children with the BCG vaccine.

In other words, the only “country” on the graphic that has never inoculated its children with the BCG vaccine is the US.

As an aside, that we are losing “far more Americans than these other nations” does not seem surprising, and I am still trying to coax meaning from the phrase “more of their citizens are alive than ours.”

We’re all teed up for the rant.

Everybody knows that PBS leans left. It’s hardly a secret. But they’ve usually done their semi-progressive soft-shoe routine with style.

Much has been written about the dishonesty of Donald Trump. Much of it is true. For years now, I have admired the restraint shown by the PBS journalists as they respond to his sometimes stunning bullshit. They have been so civilized. The half-raised eyebrow, the suppressed guffaw, the polite interruption — they deserve medals for their gentile stoicism. Call it the Woodruff Award. More importantly, in the face of his relentless onslaught, they have sought not just to cling to decorum, but to keep up the appearance of honest journalism, of separating opinion from fact, emotion from reason, and wishful thinking from hard reality. It cannot have been easy.

In journalism, of course, there is a constant temptation to guide the narrative, to steer the conversation, to direct the flow of the news toward conclusions consistent with the beliefs of the news organization. This is natural, and occasionally succumbing to the temptation, if only unconsciously, is probably unavoidable. It is part of human nature and we are all human.

I know that PBS leans left. Everybody knows. It’s hardly a secret. But they’ve usually done their semi-progressive soft-shoe routine with style. They’ve taken the time to make a polemic sound like the reluctant outcome of unbiased, careful research. They’ve mastered the art of deniable slant. They’ve made a real effort to ape fairness, cherry-picking carefully crafted Pew Center facts to gently shape the narrative. Objectivity may be a chimera that can’t be captured, but PBS has tried to creep as close to the beast as they can without compromising their beliefs.

So.

As I watched William Brangham present his graphic, I was reminded of my first trip to Berkeley in the ’60s, when a street hustler tried to lure me into a quick game of three-card monte. Find the queen and win ten bucks. He even employed a shill.

Did Mr. Brangham know what he was doing when he called the European Union a country? Did he know that the United Kingdom, which is actually a country in Europe, and Sweden, Spain, Belgium, and Italy, which are actually countries in the EU, have higher COVID-19 death rates than the US, or that Greece, which is also a country in the EU, did its best to vaccinate all of its children and has only 22 COVID-19 deaths per million people, while Belgium, which never vaccinated its children at all, has 967 deaths per million? If he did know that the death rate in Belgium was 44 times higher than in Greece, did he really think that the difference was due to the fact that the feckless Belgians had not “mounted a more effective response” to the coronavirus than the prescient Greeks? Did Mr. Brangham know that the only “country” on the graphic he presented that has never mandated the vaccination of its children with the BCG vaccine at all is the United States? Did Mr. Brangham even know about the effect of BCG vaccination on COVID-19 mortality?

If he did know these things, and he used that graphic anyway, then I have a suggestion: stop playing three card monte with the truth, Mr. Brangham. I’ll tell you where the queen is. She’s in Brussels. Go con someone else.

It is so disappointing. This is the kind of coverage that the American people have come to expect from Jake Tapper, or maybe Chuck Todd, but not William Brangham.

Maybe I’m being too hasty, and too harsh. What if he didn’t know these things? It is possible that William Brangham, despite having covered the pandemic for months, has never heard of the BCG vaccine at all. He may have missed the article in the Times, and may not have been following the research into COVID-19. And he may know very little about Greece and Belgium, or geography itself, for that matter. He may actually believe that Europe is a country where Americans are dying from COVID-19. He may not know what he’s doing at all. If that’s the case, then I apologize. I had no idea.

There is, however, another possibility.

What if PBS has simply decided to drop the act?

* * *

The following is the transcript of a recording of what seems to be an editorial meeting. It was made in secret. Only this fragment survives. It was apparently made about ten weeks before the 2020 elections. At the time, the polls showed Trump far behind, by almost the same distance as in 2016. The voices on the tape are tense, quavering slightly with what may be fear.

VOICE ONE:

It’s like a bad dream. He can’t win again. He just can’t. We have to help. We have to do more. (Soft sobbing in the background.)

VOICE TWO:

But what else can we do? We’ve tried everything.

VOICE THREE:

We could say that the huge death toll from COVID-19 in the US is his fault. (A pause. A dry cough.)

VOICE TWO:

But that’s not true.

VOICE THREE:

They say it on the networks all the time. We don’t have to use his name.

VOICE TWO:

But our journalistic standards are higher than theirs. It would be wrong.

VOICE THREE:

What is more important right now, Judy, the truth or getting that man out of the White House? (Indistinct murmuring. Several voices.)

VOICE TWO:

(Sighs.) You’re right. We have a higher loyalty. But who would do it? It would ruin their reputation.

VOICE ONE:

I’ll do it.

VOICE TWO:

Oh, William, you’re sure? You’d probably have to go work for MSNBC.

VOICE ONE:

Yes, I’m sure. It would be worth it.

The tape ends here, in what is either a burst of static or applause.

* * *

I did not vote for Donald Trump in 2016. Neither did I vote for any of the other presidential candidates. I didn’t feel that I had been given much of a choice. There doesn’t seem to be much of a choice this time around, either. I hadn’t planned to vote this year. The evil of two lessers, if you see what I mean.

But when William Brangham takes off the nonpartisan gloves and puts on a pair of James Carville knuckle-dusters and transforms himself into an enforcer for the Democrats, we are no longer boxing by the Marquis of Queensbury rules. There are no more neutral corners. Not even feigned ones.

Mr. Brangham’s tactics may have backfired. By imitating Mr. Trump’s dishonesty, he has reduced the contrast between the two sides and, as a result, the President suddenly looks less objectionable. Mr. Brangham may have inadvertently nudged me toward Trump’s corner.

Heck of a job, William.