A controversial essay

Oncologist Dr. Vinay Prasad recently ignited a controversy by opining that public health measures to control a virus could one day lead to totalitarianism similar to what occurred in Nazi Germany. In his article, titled “How Democracy Ends: COVID19 Policy Shows a (Potential) Path to the End of America”, he warned that:

When democratically elected systems transform into totalitarian regimes, the transition is subtle, stepwise, and involves a combination of pre-planned as well as serendipitous events. Indeed, this was the case with Germany in the years 1929-1939, where Hitler was given a chance at governing, the president subsequently died, a key general resigned after a scandal and the pathway to the Fuhrer was inevitable.

The backlash was swift and fierce. The chairwoman of his department tweeted, “As a daughter in a family who has known Nazi horrors, I’m appalled by comparisons of this regime with pandemic response. Inflammatory, unhelpful to the discourse, ultimately harmful”. Medical ethicist Art Caplan said that:

The notion that public health will lead us to fascism due to efforts to control COVID is ludicrous, dangerous, and offensive. It’s anti-Semitic, anti-gay, anti-Romani people. It cheapens the deaths of those who died in camps for political objections, or in the case of Jehovah’s Witnesses, religious objections.

Dr. David Gorksi similarly excoriated Dr. Prasad by noting the author:

consciously chose the example of Nazi Germany, no matter how inappropriate it was to his attempt to fear monger about a ‘future scenario’ in which a future President seizes power based on the example of COVID-19 responses. Either he did it just to be inflammatory, in which case he’s dishonest, or because he believes it to be an accurate historical comparison, in which case he’s an ignoramus of history.

Even doctors who defended Dr. Prasad against charges of anti-Semitism felt his article was “poorly conceived and executed.”

The dangers of ignoring 7-foot hoops

To criticisms that Dr. Prasad’s article was historically ignorant and offensive, I would add this: it’s potentially dangerous. This may seem overwrought to anyone who is unfamiliar with the anti-vaccine movement, a movement whose “success” can be seen in falling levels of routine childhood vaccinations and outbreaks of deadly diseases. Dr. Prasad has previously expressed disdain for doctors who counter medical misinformation, comparing it to dunking on a 7-foot hoop. As such, those of us who have long-believed that combating anti-vaccine misinformation was a worthwhile endeavor likely understand some important things about the anti-vaccine movement that he does not.

For example, Dr. Prasad’s “plan” to protect children this May was that to declare that the “Vast majority of kids recover quickly from SARS cov 2. And after all adults are vaccinated their risk of covid will decline precipitously. It’s ok to acknowledge that covid19 is not an emergency for kids”. As I was content to dunk on this 7-foot hoop, I pointed out this “plan” was nothing more than a naïve hope, something that was obvious to anyone with even passing knowledge of the anti-vaccine movement in the USA. Indeed shortly after Dr. Prasad announced his “plan”, adult vaccinations lagged, the Delta variant arrived, and cases, hospitalizations, and deaths in children spiked to their highest levels. Tragically, 252 children have died of COVID-19 in the USA since May, including healthy teens whose lives could have been saved by the vaccine, which is very effective in this age group. As far as I know, Dr. Prasad has neglected to inform his readers of these facts, though he’s always very eager to discuss vaccine myocarditis or rehash the trite argument (discussed here) that COVID-19 can’t be that bad for kids as long as more elderly people die.

The risks of specious comparisons between public health measures and fascism becomes clear when one appreciates the extent to which many anti-vaxxers believe they are grievously persecuted victims and that vaccines pose an existential threat. Some believe vaccines are part of a depopulation agenda, perhaps explaining why vaccines are routinely blamed for causing infertility, a claim promoted Dr. Christiane Northrup. Vaccines are frequently compared to genocide and the Holocaust. Images comparing vaccines to Nazism and vaccine advocates to Hitler are commonplace. Dr. Rashid Buttar said the vaccine was part of a “depopulation plan” and compared Dr. Anthony Fauci to Hitler, saying “the number of deaths caused by Fauci will exceed those of the Holocaust”. Robert F. Kennedy Jr. compared vaccines to the Holocaust and vaccine advocate Dr. Paul Offit to a Nazi war criminal. Now hapless educators are also getting threatened and likened to Nazis (watch this).

Many anti-vaxxers falsely believe that vaccines and vaccine mandates violate the Nuremberg Code, and some have even taken to wearing yellow Stars of David as a perverse symbol of their imagined persecution. Dr. Bob Sears made this horrific analogy in 2015. Given their eagerness to minimize the Holocaust, it’s not surprising that anti-Semitism is rife in the anti-vaccine movement. Comparisons between Nazism and vaccines are frequent enough that the Auschwitz Memorial felt compelled to respond thusly:

Anti-vaxxers also are fond of comparing vaccination to rape, and memes glorifying violence against vaccinators are common. None of this is particularly extreme in anti-vaccine circles. It’s normal and has been so for many years. This material is shocking only to doctors who felt it was beneath them to pay attention.


The following illustration, which predates COVID-19, illustrates the raw paranoia behind much of the anti-vaccine mindset. (Note the “Zion” star on the officer’s uniform.)

This paranoia is nothing new, of course, and in fact, fears about vaccines even predate Edward Jenner, as anyone who knows the name Benjamin Jesty is aware.

Future fantasies versus current realities: Part 1

Though they often camouflage their agenda with seemingly unobjectionable calls for “bodily sovereignty“, “medical freedom“, or “parental rights“, there has always been a strong undercurrent of violent rhetoric in the anti-vaccine movement. Drs. David Gorski and Steve Novella have discussed this several times previously (here and here), and as the rhetoric has moved off social media and into the real world, it’s worthwhile to take stock of what actually has been happening on the ground recently. It’s not pretty. Exhausted healthcare workers have gone from heroes to literal punching bags.

  • Hundreds of public health officials have resigned or retired rather than face abuse and threats. According to news reports, “Some have become the target of far-right activists, conservative groups and anti-vaccination extremists who have coalesced around common goals: fighting mask orders, quarantines and contact tracing with protests, threats and personal attacks”. According to a survey from The New York Times, “Public health agencies have seen a staggering exodus of personnel, many exhausted and demoralized, in part because of abuse and threats”. They report “more than 500 top health officials who left their jobs in the past 19 months”.
  • Dr. Anthony Fauci needed “personal security from law enforcement at all times, including at his home”. According to news reports, “he and his family have required continued security in the face of harassment and death threats from people angry over his guidance on the coronavirus pandemic”. Dr. Peter Hotez has been doxxed and subject to coordinated campaigns of harassment for his vaccine advocacy. According to Dr. Hotez, the hate mail he received “was filled with all sorts of Nazi imagery, Nuremberg hangings and terrible, terrible stuff. It was pretty upsetting”. Prior to the pandemic, Dr. Richard Pan was assaulted in the street for advocating for vaccines. Dr. David Gorski has been the victim of harassment campaigns.
  • A Nature survey of 321 scientists found that “more than two-thirds of researchers reported negative experiences as a result of their media appearances or their social media comments, and 22% had received threats of physical or sexual violence. Some scientists said that their employer had received complaints about them, or that their home address had been revealed online. Six scientists said they were physically attacked”. Dr. Novella discussed this here.
  • Anti-vaxxers have protested outside hospitals in Canada and elsewhere. According to news reports, “A crowd rallying against vaccination for Covid-19 clogged the streets outside a Vancouver hospital this week, haranguing and, in one case, assaulting health care workers, slowing ambulances, delaying patients entering for treatment, and disturbing those recovering inside”.
  • Pro-fascist groups opposed to vaccines have staged violent rallies in Italy. This included storming an emergency room and attacking a nurse and police officers.
  • In Russia, an actor wore a yellow star at an awards ceremony and spoke of “waking up in a world where [COVID-19 vaccination] became an identification mark”. In France, “demonstrators carried signs evoking the Auschwitz death camp or South Africa’s apartheid regime”. Across the world, Jewish stars are used as a symbol of anti-vaxxer “persecution”.

  • In Australia, “Anti-vaccine and extreme right-wing groups have led violent rallies” and “Prominent fascists were among the crowd”. In Germany, an “anti-lockdown, anti-vaccine movement with links to the far right has recruited hundreds of children into a private online group”. Anti-vaccine protesters there yelled “Hands off our children”.
  • Anti-vaccine rallies have turned violent in Los Angeles and anti-vaxxers have disrupted vaccination sites there. They did the same thing in Georgia. In New York City, they attacked a COVID-19 testing station.
  • Prior to the pandemic, an anti-vaccine protester hurled blood in a menstrual cup at California lawmakers to protest vaccine mandates.
  • A man in Maryland killed his brother, a pharmacist, and sister-in-law because they were “killing people with the Covid shot”.
  • A principal in Arizona, was confronted by men carrying zip ties, and was threatened with a “citizen’s arrest” after the child of one of the men was told to quarantine because of a possible exposure to the virus. That principal received threats such as, “Next time it will be a barrel pointed at your Nazi face”.
  • According to news reports, “A parent in Northern California barged into his daughter’s elementary school and punched a teacher in the face over mask rules. At a school in Texas, a parent ripped a mask off a teacher’s face during a ‘Meet the Teacher’ event”.
  • In Georgia, “A customer who argued about wearing a face mask at a Georgia supermarket shot and killed a cashier on Monday and wounded a sheriff’s deputy who was providing security at the store”. This is an extreme example of a sadly common occurrence.
  • A pharmacist in Wisconsin destroyed COVID-19 vaccines as he believed that the “Covid-19 vaccine was not safe for people and could harm them and change their DNA”.
  • Doctors in Idaho “have been accused of killing patients by grieving family members who don’t believe COVID-19 is real”. A hospital spokesperson said, “Our health care workers are almost feeling like Vietnam veterans, scared to go into the community after a shift”. Hospitals are installing extra “panic buttons” to protect their workers from assaults.
  • According to news reports, “The Hawaii lieutenant governor watched in horror as protesters showed up outside his condo, yelled at him through bullhorns and beamed strobe lights into the building to harass him over vaccine requirements.”
  • In Canada, a man “…punched a nurse in the face multiple times, knocking her to the ground after she administered a Covid-19 vaccine to his wife without his permission”. Nurses have also been attacked in Guatemala by anti-vaccine residents of a village.
  • Anti-vaxxers have harassed children and their parents. In the UK, one yelled at a mother, “She’ll have immunity, you shouldn’t be getting the vaccine since you have natural immunity. You shouldn’t be using her as a lab rat”. In California an anti-vaxxer yelled at children walking to school, “They’re trying to rape our children with this poison. They’re going to rape their lives away”. Another compared masking to “child abuse”.
  • Several years ago, leading anti-vaxxer Del Bigtree said, “Do you think it’s a good idea to let the government own your baby’s body and right behind it your body? That is the end for me. Anyone who believes in the right to bear arms. To stand up against your government. I don’t know what you were saving that gun for then. I don’t know when you planned on using it if they were going to take control of your own body away. It’s now. Now’s the time”.
  • Rep. Marjorie Taylor Greene suggested that citizens use their “Second Amendment rights,” to greet community members knocking on doors to encourage vaccination. Rep. Madison Cawthorn suggested that such vaccination campaigns could be a pretense to “take” people’s guns and Bibles.
  • Tucker Carlson said the Pentagon’s vaccine mandate was an attempt to weed out “men with high testosterone”, that it was anti-Christian, and that the military is “doing PR for Satanists”. He also said that “Buying a fake vaccination card is an act of desperation by decent, law-abiding Americans who have been forced into a corner by tyrants”.
  • Some people apparently believe that “COVID-19 vaccines are called Luciferase, have the patent number 060606 and come from a digital program called Inferno”. Republican officials in Florida and New Hampshire have likened the vaccine to Satanism as have several religious leaders in the US and Bolivia. The imagined connection between vaccines and Satan is also not new.

  • According to news reports, “Anti-vaccine demonstrations across Ohio in recent weeks are drawing extremists that include conspiracy theorists, white supremacists and people who misappropriate the Holocaust”. In Washington “anti-mask protesters that included the Proud Boys attempted to gain entry” to three schools, forcing them to lockdown.
  • In Los Angeles, “city leaders approved an ordinance Tuesday that would bar protests within 300 feet of the residence belonging to the person being targeted, a move that came following months of demonstrations outside the homes of public and elected officials”.
  • In Texas, “a man has been charged after allegedly threatening to gun down a Maryland doctor who urged the public to take the coronavirus vaccine”.
  • Countless school board meetings have been disrupted by anti-vaxxers, often linked with the Proud Boys and other right-wing extremist groups. According to news reports, “Drawing false equivalence between COVID regulations and Nazi fascism is popular among anti-vax, anti-mask groups, including some local teachers and school board members”.
  • In California, “A breast cancer patient says she was sprayed with bear mace, physically assaulted, and verbally abused outside a cancer treatment center in West Hollywood, Los Angeles by far-right activists who were angry over the clinic’s mandatory mask policy”.
  • Dr. Simone Gold, founder of the anti-vaccine group America’s Frontline Doctors, was arrested for her role in the 1/6 insurrection.

I could go on.

In contrast, I am aware of just a single instance of violence against an anti-vaxxer, when a Proud Boy was shot in the ankle during an anti-vaccine demonstration. Even in this instance, it’s not even clear he was shot because of his anti-vaccine views. As is appropriate in the USA, anti-vaxxers walk down the street as freely as those who volunteered to be in vaccine trials (like me). Anti-vaxxers may not be able to enter certain venues, and some have lost their job, which is significant, but vaccinators aren’t attacking people in the street, or injecting people against their will. Unvaccinated people aren’t being rounded up or branded or forced to wear distinguishing badges. In fact, public health experts are exquisitely concerned about protecting anti-vaxxers’ feelings, worrying that “shaming and blaming the unvaccinated could backfire”. There are constant reminders, including from Dr. Prasad, not to shame the unvaccinated.

Anti-vaxxers know they are in no real danger from a totalitarian police state, which is why, despite their noxious comparisons to Holocaust victims, they are not hiding like Anne Frank. Not only are they not cowering in fear, many anti-vaxxers feel emboldened to loudly and publicly threaten and attack anyone they don’t like. Jews were forced to wear yellow stars to make them to stand out. Anti-vaxxers are choosing to wear them as a pathetic means to draw attention to themselves. Their outrage theater isn’t just offensive, it’s also incredibly stupid.

Future fantasies versus current realities: Part 2

I’m not a historian, but the paranoia, threats, and street violence does seem eerily reminiscent of the violence that ushered in fascist regimes. As the above examples show, around the world anti-vaxxers long-associated with “wellness” and “natural health” are increasingly linked with QAnon adherents, white supremacists, and right-wing extremists – an unholy union termed conspirituality – to be part of a glorious crusade against “medical tyranny” (there’s a great podcast devoted to this topic). Anti-vaccination ideas are baked into right-wing white-nationalist movements. Simply put, the anti-vaccine movement has been red-pilled.

Even though it didn’t happen with previous pandemics, I suppose it’s conceivable that some dictator in the year 2090 will end American democracy under the pretense of trying to control a virus. But we need to be clear that right now democracy in America seems to be hanging on by a thread, and the “patriots” who violently tried to execute politicians and overturn the 2020 election are the same people who violently oppose vaccines, masks, and basically any attempt to control the virus. The men who tried to kidnap the governor of Michigan were members of a far-right paramilitary militia called the Wolverine Watchmen, not the Michigan branch of Voices for Vaccines.

When Dr. Prasad writes, “The key lesson of the coronavirus pandemic is not that the fall of democracy is inevitable, but rather that our policy preferences, and polarization, have set the stage for a series of events where it is possible democracy falls”, these people might only protest on grounds they’ve been plagiarized and that Dr. Prasad is late to the ballgame. They completely agree with his thesis that public health measures could lead to Hitler and have been saying as much for years. The right-wing, anti-vaxx media sphere is full of hysterical articles such as “Biden Announces New COVID Response, Including Vaccine Mandates, That Doubles Down on Totalitarian Tactics” and “Vaccine Mandates Are Totalitarian.” An anti-vaccine doctor claimed that vaccinating children against COVID-19 “violates human rights, Constitutional rights, bill of rights with extreme experimentation!” Every anti-vaxxer rally laments the supposed end of freedom in America due to vaccines and mandates.

Given that some anti-vaxxers really believe vaccines are a form of population control that will soon be forcibly injected into screaming babies by a Jewish police state, their aggressive behavior makes perfect sense. From their twisted viewpoint, resisting vaccination by any means necessary isn’t just permissible, it’s downright heroic. They are the good guys, standing up for innocent children against Big Pharma, the Deep State, and their nefarious “forced vaccination” agenda. Anti-vaxxers in California, Oregon, and Canada have compared their “resistance” to that of Civil Rights icon Rosa Parks. Anti-vaccine organizations honestly feel they are standing up for liberty and the American way against totalitarian public health measures.

This explains why, using typical Orwellian language, one such group claims to be “pro-informed consent, pro-democracy, pro-debate, pro-information exchange, pro-First Amendment, pro-science, pro-parental rights, pro-bodily sovereignty, and pro-conscientious decision-making”. Their supposed mission is to ensure that “America still stands for health freedom”. Another anti-vaccine, “health freedom” organization claims that “Government has the responsibility and duty to protect health freedom and to make no law or public policy abridging health freedom or its fundamental principles”. They warn that, “When health care options are eliminated through restrictive laws and regulations, choices are eliminated and access to health becomes meaningless”. Most anti-vaccine groups use this sort of melodramatic language, claiming that the road to Hitler is paved with masks and vaccines. This is bread and butter stuff for them. You can even buy an anti-vaxx sign that outlines the slippery slope to totalitarianism that could have been the template for Dr. Prasad’s essay.

All of this horribleness predates Dr. Prasad’s essay of course. But a highly-credentialed doctor with the imprimatur of a top medical school and a large platform isn’t helping anything when his oppression fantasy legitimizes the fears of paranoid, aggressive people, priming them to perceive themselves as victims of a police-state. Dr. Prasad isn’t making life easier for his embattled colleagues in the ER when he echoes anti-vaxx conspiracies by tweeting that hospitals “admit less sick patients” to maximize “their ‘non-profits'” and the number of patients hospitalized with COVID-19 is therefore a “fear monger tactic,” not a marker of a dangerous virus.  As pediatricians face harassments and threats for suggesting masks, he criticized the American Academy of pediatrics by saying, “there is no organization left in America that actually seeks to defend the interests of children.”

Dr. Jennifer Gunter said Dr. Prasad’s article was “an audition to be the Surgeon General of QAnon”, and it’s possible he was trying to be purposefully provocative for attention and precious podcast invitations. However, as Dr. Prasad’s ignorance of 7-foot hoops is a source of great pride for him, he may have been genuinely caught off guard by the strong reaction his essay elicited from doctors who are familiar with and threatened by these low hoops. He may be blissfully unaware of the Holocaust minimization and anti-Semitism that is rampant in anti-vaccine circles. He may not know that some Jewish doctors have been targeted this pandemic. It’s painful for vaccine advocates who lost family in the Holocaust to be compared to Nazi executioners.

Personally, as a Jewish dunker of 7-foot hoops, I was less offended by his article than I was worried by how suspicious, volatile people may receive it. Even though he claimed it was merely warning about a future, hypothetical scenario, it’s extremely validating for anti-vaxxers when a respectable, mainstream physician parrots their message, confirming that their fears of totalitarianism are legitimate and grounded in reality. Some sincerely believe their brave advocacy is the only thing preventing the nightmarish scenario Dr. Prasad describes. Others believe Dr. Prasad’s totalitarian state has already arrived, and the time for peaceful protest has passed. Like him, they believe reports of people hospitalized with COVID-19 are nothing but a “fear monger tactic”. The fact that anti-vaccine propaganda has killed hundreds of thousands of Americans this year doesn’t bother anti-vaxxers a bit because they think the death toll is inflated too.

I fully agree with Dr. Prasad that democracy is fragile and we need to guard against totalitarianism. However, there’s no need to engage in fanciful speculation about imagined, future dangers to American democracy when it is gravely threatened right now by the very people who are likely to feel vindicated and even emboldened by his message. There are real-world consequences to fallacious comparisons between public health measures and Nazism, and these consequences will be borne by the people who interact with enraged citizens every day. Contrarian academics seemingly divorced from frontline patient care will continue their media appearances unabated, their main worry being that YouTube might “silence” them by removing one of their videos. In contrast, vaccine advocates with actual responsibilities need to worry if the angry protestors outside their home will stay outside. There are a lot of angry, dangerous people out there, and some have been inspired to commit horrific acts of violence by what they read online.

Everyone is responsible for their own actions. But the next time an educator, public servant, or healthcare provider is threatened or attacked by a “freedom-loving” anti-vaxxer, it’s reasonable to wonder who convinced the assailant that masks and vaccines are in fact a ruse to pave the way for the next Hitler.

Author

  • Dr. Jonathan Howard is a neurologist and psychiatrist based in New York City who has been interested in vaccines since long before COVID-19.

Posted by Jonathan Howard

Dr. Jonathan Howard is a neurologist and psychiatrist based in New York City who has been interested in vaccines since long before COVID-19.