MOVIES, YOGURT, AND VACCINE MISINFORMATION

During the past couple of weeks, the attention of the media was chiefly captured by the endless quarrel on compulsory vaccination.  The WHO Regional Office for Europe released data about death for measles in Europe in 2016, which amounts to 35 fatalities,  an outrageous number, considering the vaccine-preventable nature of measles. New legislations enforcing mandatory vaccinations are  in progress in Italy and in France, raising, however, fierce objections not only among anti vax people but also among people merely unhappy with the intrusion of the state into what they consider their private life. Such a point of view seems to be supported by a report issued in early July by the British Medical Association, strongly discouraging compulsory vaccination because it would disrupt the doctor-patient relationship.  In the while, anti vax activists continued their  never-ending polemics  against Big Pharma. Nothing new under the sun; each actor persisted in playing its role in the wider “vaccination comedy”. Yet, playing again and again the same character on the stage is risky. Repetition blinds, prevents seeing novelties. This is well illustrated by three parallel stories, which received far less attention from the media.

The first story is reported by Harriet Hall, “a retired family physician who writes about pseudoscience and questionable medical practices”. Harriet devotes her 11 July comment to What the Health, a successful documentary,  released on March 16, 2017. The documentary claims to provide the evidence that meat and dairy food are responsible for most “modern” deadly diseases, and that all health agencies and scientists know this truth, but they conceal it because they are on the Big Food and Big Pharma’s payroll. The audience of the documentary had a sudden and unexpected spike last June, after it was added to Netflix, as showed by Google trends. After carefully reviewing the movie, Harriet Hall concludes “The “What the Health” movie is not a balanced documentary, but an alarmist, biased polemic. It cherry-picks scientific studies, exaggerates, makes claims that are untrue, relies on testimonials and interviews with questionable “experts,” and fails to put the evidence into perspective. It presents no evidence to support the claim that a vegan diet can prevent and cure all the major diseases. It is simply not a reliable source of health information”. Notwithstanding Harriet’s efforts, it is easy to predict that many people all around the world will continue watching this movie, finding in it the evidence that eating meat and dairy causes cancer and chronic diseases.

The second story is reported by Jonathan A. Eisen, professor at the Genome Center of UC Davis, California. Jonathan wrote a nice post instigated by the echo raised by a paper published  on June 28 on Psychosomatic Medicine, a leading, peer-reviewed,  journal, which has been the official journal of the American Psychosomatic Society​ since 1939. The paper, a bit pompously entitled “Brain structure and response to emotional stimuli as related to gut microbial profiles in healthy women”, claims to demonstrate that there is a causal association between gut bacteria and emotion, which is a misleading statement, because – argues Jonathan – the paper only shows a statistical correlation between some gut microbiome patterns and some behavioral traits.  Not only “behavioral traits” are not emotions (in case, they are just indirect signs of emotions), but turning a correlation into a causal relationship is a fallacy known since Aristotle's time. Eisen comments,  “it could be that people with different thought patterns eat differently.  Or people with different thought patterns exercise differently.  Or just about anything.” Yet, the findings of this paper have been overemphasized by media, e.g., the Huffington Post had the headline “Your Gut Bacteria Really Do Affect Your Emotions”; Science Alert, “Human Emotions Really Are Affected by Gut Bacteria, New Study Suggests”; the Daily Mail, “Gut feelings are real: Some people have stomach bacteria that makes them more anxious and stressed, study shows”; Forbes, “The Fascinating Connections Between Gut Bacteria, Weight and Mood”. The study was promoted by UCLA, the  University of California, Los Angeles, whose annual economic impact totals the equivalent of one percent of the entire California economy. Purposely, Dr. Eisen investigated about recent UCLA press releases, and he discovered that, on June 29, the University Press Office released a statement, claiming that a UCLA team has  “identified gut microbiota that interact with brain regions associated with mood and behavior”. Jonathan concludes that the source of misinformation was that press release. Well done, but he mercifully omits to add that the first author, Dr. Kirsten Tillisch, received funding from Danone Research, the research branch of the famous world food company; also his main co-author, Dr. Emeran Mayer, was on the advisory boards for yogurt product company Dannon and its parent company Danone. Moreover, 3 other persons of the team were employed by Danone Research; while another researcher was employed by Symrise Group, a German multinational  providing “fragrances, flavors, active ingredients (…) for the (…) food, beverage and pet food and baby food industries”. Since 2014, Symrise AG has made massive investments on the probiotic market acquiring two leading companies, the French Dianafood and the Swedish Probi. Finally, the whole study was partly supported by grants from Danone Research. It is difficult to avoid the unpleasant impression that movies such as “What the Health” are not totally groundless. To be sure, they are misleading people about their health, which is a lot worse than covertly advertising probiotic products, which is not that horrible crime. The UCLA team just marketed  its findings and, incidentally, also yogurt consumption. Yet, there are reasons not to be happy with such a way to inform the public, notably in a moment in which we need to strengthen public trust in science.

The third story has received for now less press coverage, although it is by far the most important.  In early July, a group of Canadian virologists from the University of Alberta announced to have recreated an extinct horsepox virus using synthetic DNA strands. Horsepox viruses are not dangerous for humans, but the research demonstrates that in principle all types of pox viruses could be generated in the same way, including the lethal smallpox. The novelty is not in the technical procedure, because since 2002, we know that it is possible to assemble pox viruses  from scratch, rather it is in the demonstration that this could be done by a “small scientific team with little specialized knowledge half a year and cost about $100,000”, purchasing DNA available on the market,  and without asking for (or by-passing) any authorization or security clearance. This dreadful news passed nearly unnoticed, without anyone - either scientists, regulatory authorities, public health agencies, scientific journals, general press, or social media – realizing the enormity of the event. With the laudable exception of HuffPost UK,  and a couple of online scientific magazines, this news was completely ignored. Yet, this is still half story, the second half is that this news was not at all new. Actually, Canadian virologists had already presented their findings in November 2016, at the WHO Advisory Committee on Variola Virus Research meeting in Geneva, and a report from that meeting has been available on WHO's website since May 2017. When researchers tried to draw  WHO's attention on their experiment, “the first response was, ‘Well let's have another committee to review it,’ and then there was another committee, and then there was another committee that reviewed that committee” tells David Evans, the Canadian team leader, who eventually comments "It became a little bit ludicrous”. Almost in the same period, (on March 2, 2017), Tonix, a pharma company which collaborated with the University of Alberta in this study, announced the “successful synthesis of a potential smallpox-preventing vaccine. This vaccine candidate, TNX-801, is a live form of horsepox virus (HPXV)”. Reading their press release, it was evident that the horsepox virus was recreated from scratch in a quite trivial way. Yet, the story still got unnoticed.  Evans also sent the draft paper describing the study to the Canadian Public Health Agency, as well as to the Food Inspection Agency, only getting the staggering, candid, answer that “these things potentially fall under export legislation”.  The whole chronicle was finally reported by the July 6 issue of Science, which was  the sole media, and prominent scientific journal, which gave to this story the relevance that it deserves. Thus a happy end? Almost. Actually, as Caroline Ash, an editor at Science, honestly admits, the paper of the Canadian team was initially submitted also to Science, which rejected it, because it did not offer “a sufficient gain of novel biological knowledge to offset the significant administrative burden the manuscript represents in terms of dual-use research of concern”, an answer which is a terrific example of bureaucratic miscommunication.


These three parallel stories - the fortune of a pseudoscientific documentary; an oversold study, covertly promoting yogurt consumption; an unnoticed research, showing how it could be easy today to recreate a deadly virus -  illustrate quite well the subtleties of today science communication. It's just a shame that most media, including social media, didn't realise it, getting instead trapped into the bubble of the anti vax quarrel. 

FROM DANGER TO RISK

In a research letter published by Nature in the last week of June, Kevin J. Olival and his team at the EcoHealth Alliance, a New York based global environmental health nonprofit organization, have announced the results of their latest study on “Host and viral traits predict zoonotic spillover from mammals”. Researchers investigated whether it is possible to predict human pandemics of viral origin by focusing on “by phylogenetic relatedness to humans, host taxonomy and human population within a species range”. Their findings suggest that “both the total number of viruses that infect a given species and the proportion likely to be zoonotic are predictable”, consequently “providing a novel framework to assess if a newly discovered mammalian virus could infect people”. The study size was remarkable. Researchers investigated 54 mammalian species (in this preliminary study they focused only on mammalians), say 14% all mammalian species, and identified 586 different viruses. Among these viruses, 263 (44,8%) were shared by animals and humans, including 188 zoonotic viruses, which were transmitted from animals to humans in the past; 73 viruses, previously considered “specific” to humans, were instead found in animals, so providing the evidence of “inverted” zoonosis, say, transmissions from humans to animals.  Overall this study demonstrated the ongoing infective cycle between humans and animals, which strongly supports the notion of “one health”.

Surprisingly enough, the results of this study have been immediately reported and amplified by world leading media, including The Economist, Time, Wired, Science Magazine, International Business Times, Wall Street Journal, Spiegel, BBC News, CNN News. It is rare to see such an interest for a news which could seem, at a first glance, of interest only for biologists and epidemiologists.  Why so many media were “thrilled” by this study? The Economist provides a possible answer, “maps”. The research team was as smart as to distillate their results into very catching graphics, “heat maps showing places where the actual and predicted number of zoonotic viruses least resemble one another, and which therefore have the highest risk of springing a nasty surprise on the world”.  Brief, “having maps like these – continues The Economist - is important because they can help researchers choose the most fruitful places to conduct studies into zoonotic transmission and (…) increase the chance that the next SARS or AIDS might be spotted, almost before it has emerged”. This is then the first lesson to be learned, in the information society – like in the illiterate medieval Europe – images are much more effective than words if one aims to reach a wider audience. In the medieval Europe, where most people could not read, the Church, which included most educated people of that epoch, sponsored artists to educate the mass by images. We should then thank illiteracy for the windows of the Chartres Cathedral and Giotto’s paintings. Although one can hardly recognize today Giottos, effective tools for communicating scientific discoveries are welcome.

Yet, there is probably a deeper reason why this news has had such an impact on media, something novel happened recently, deeply changing the nature of epidemics and pandemics. Once, epidemics and pandemics were considered non-insurable risks. The Insuranceopedia  defines non-insurable risk “a risk an insurance company deems too hazardous or financially impractical to take”, which is a right definition but still insufficient. A more precise definition is provided by the Financial Time Lexicon, “A risk for which an insurance company will not provide cover because it cannot calculate the chance of it happening”. More precisely, a non-insurable risk is a risk whose odds of coming to be cannot be calculated, and therefore the insurance company cannot work out a premium that must be paid. Typical non-insurable risks are political, reputational, and regulatory risks, whose odds are unpredictable because they depend too much on human contingency and randomness; also “acts of God”, the legal formula used in the English–speaking countries to indicate natural disasters, are non-insurable. For insurance purposes, acts of God are events that cannot be foreseen, avoided, or anyway prevented.  Today, however, some acts of God are considered insurable (e.g., flood, earthquake, volcanic eruptions, and so) either because they turned out being the consequence of human intervention (e.g. environmental disasters) and consequently preventable, or because their chance of occurrence can be inferred from statistics of similar past events. Epidemics and pandemics have been always considered totally unpredictable and unpreventable, consequently uninsurable. Given that the definition of risk entails that 1) the odds of a negative event can be calculated; and 2) the negative event may be avoided through preemptive action, epidemics and pandemics should  be considered – rigorously speaking -  dangers, threats, but not risks. This holds true till to 2014.

In 2014, the Munich Reinsurance Company (Münchener Rück), a world’s leading reinsurance company, started a strategic partnership with Metabiota, a San Francisco-based global company that “has pioneered the use of near-real-time data collection and comprehensive risk analytics for epidemics”. In 2015, in the midst of MERS epidemics, Munich Re, on the basis of data provided by Metabiota, accepted to reinsure the Korean government, which wanted to offer a full insurance coverage to all international travelers and tourists. This decision contributed to prevent massive travel cancelations and consequent economic loss. In May 2016, the World Bank in collaboration with the World Health Organization initiated the Pandemic Emergency Financing Facility (PEF), a global insurance scheme for epidemics and pandemics risks, offered to 77 low income countries. The PEF covers most zoonotic viruses involved in potential pandemics, including new Orthomyxoviruses (new influenza pandemic virus A), Coronaviruses (SARS, MERS), Filoviruses (Ebola, Marburg) and other zoonotic diseases (Crimean Congo, Rift Valley and Lassa fever). PEF financing is triggered when the infection reaches a certain level of contagion, calculated on the basis of WHO data on the number of deaths, the speed of the disease spread and whether the disease crosses international borders. Munich Re, Swiss Re and GC Securities  accepted to reinsure the World Bank for this program, so making it feasible.  Finally, in 2017, Munich Re made pandemics  and foodborne infectious diseases  strategic priorities.

This is then the second lesson to be learned from the EcoHealth Alliance’s study. Advanced genomics, big data, and predictive analytics are not only changing our scientific and operational approaches to epidemics and pandemics, but they are also deeply changing the very notion of infectious outbreaks, which are now entering, in their own right, the world of predictable and preventable “risks”.  The impact of this event is much wider than one could guess, also implying important communication consequences.  

NATURAL OR SAFE?

In early June, Kavin Senapathy - author and public speaker on health, medicine, food, and parenting - has published a nice article devoted to a – minor, but, in its own way, epochal – event. Johnson's Baby, the brand of baby cosmetics and skin care products owned by the American multinational company Johnson & Johnson, has created  and distributed a commercial video, promoting its products by declaring “Natural may be the trend, but safe will always be our bar. Some natural ingredients that work for adults are too harsh for babies skin. We’ll never sacrifice safety to be all natural.” 

"Given the natural-is-best craze permeating the market for food, cleaning products, cosmetics, personal care and even cat litter,-asks herself Kavin -  why go against the all-natural grain?” The question is more than legitimate, considering Johnson & Johnson well-established marketing strategy.  Since 1897 - when the brand was created to commercialize a talc based baby powder, the Johnson's Baby Powder - Johnson & Johnson has had its own marketing strategy based on communicating an image of healthy and soft products.  As early as 1913, the company invented the catchphrase "Best for the Baby – Best for You", contributing to instill into the public the idea that baby products are safer, smarter and smoother than corresponding products for adults. In 1953, Johnson & Johnson launched the “No More Tears baby shampoo”, which was a true revolution not only in soaps (being based on a new class of cleansing agents, never used in the past), but it was also a real breakthrough in promotional campaigns. Since then, Johnson & Johnson – notably its subsidiary Johnson's Baby – has betted on consumer awareness and natural products that do not have any chemicals inside. Johnson & Johnson is member of the American Green Power Partnership; its promotional campaigns usually aim to inspire healthy living styles (e.g., “Having a Baby Changes Things” and “The Campaign for Nursing’s Future”); and natural products and environmental friendly packaging have become two pillars of corporate policies. This is why the slogan “At Johnson’s, being natural is never more important than being safe” is not only a “refreshing change from the all-natural marketing norm” – as Kavin comments – but it bodes well that it could herald a real revolution.

The idea that everything natural is better, safer, healthier and more environmentally friendly, is a popular misconception, which does not need even to be disproved. It is apparent that natural substances might be – and often are – as harmful, unhealthy and dangerous for the environment, as synthetic substances. Yet, “due to the widespread assumption that artificial ingredients are somehow more harsh or harmful than natural ones, companies have been reformulating products to eliminate synthetics while others build niche brands based on the fallacy”. In the last decades, such a fallacy has largely informed anti GMO and anti-Vax movements, and has contributed to feed the current, global, wave of “anti-scientism” and mistrust towards scientists, health institutions, and drug companies.  The suspicion of synthetic substances is producing paradoxical consequences, for instance these people mistrust vaccines - which are one of the most “natural” medical interventions -  and ignore the danger entailed by infectious diseases, one of the chief “natural killers” in human communities.  Yet, it is not easy to oppose the zeitgeist, as it is illustrated by another, apparently minor, event happened.

Since the mid-1970s, a chemical weed killer, marketed by Monsanto as RoundUp, has become the world most widely used pesticide, being an effective and apparently safer alternative to traditional weed killers. In 2015, the WHO Agency for Research on Cancer (IARC) declared RoundUp a probable carcinogen (category 2A), causing inter alia the postponing of relicensing in the EU and a harsh public campaign against Monsanto led by Greenpeace. On June 14, 2017, Reuters investigation revealed that Aaron Blair, the scientist who led the IARC’s review panel, “had access to data from a large study that strongly suggested that Roundup did not cause cancer after all—but he withheld that data from the RoundUp review panel”. When this odd story emerged, both Blair and the IARC justified themselves by claiming that data (whose existence they admitted being fully aware) was published only after the IARC report and the agency has a policy against using unpublished data. No matter here whether such a self-defense is tenable (in this writer's opinion,  it is not), and whether they were instead driven by untold conflicts of interest, I mentioned this story only to illustrate the power of the stereotype dictating that Monsanto, as well as other chemical giants, are by default producing dangerous and unhealthy items, even that they are “criminal” companies. Admittedly, may be just this once,  Monsanto was not at all the villain of the story, rather the victim.

COMPULSORY VACCINATION AND HEALTH COMMUNICATION

Anti-vaccine movements, and how to prevent their nefarious influence, have been again in the limelight in the last weeks.   Recent measles outbreaks in the US and the EU have been directly related to vaccine skepticism, and vaccine objection has been considered within the wider political context of emerging “populist” movements. Yet, as Donald Trump’s presidency is not likely to affect in depth vaccine policies in the US, similarly it is arguable that Emmanuel Macron’s victory in France could improve vaccination coverage in the EU (and notably in France). Actually, it is misleading to use traditional political criteria to analyze the anti-vax polemics. The traditional  political polarity between conservatives and liberals is hardly tenable in this field, as it is witnessed also by the strict association between anti-vaccine and anti-GMO movements, which are usually considered part of the larger ecologist and  liberal camp.

The main difficulty with anti-vaccine people is that they are usually impermeable to scientific evidence. Countering antivaccination attitudes by providing scientific evidence is not only ineffective, but it even risks to be counterproductive. Anti-vaccine theories are conspiracy theories, and it is always very difficult, if not impossible, to change the mind of someone who believes in a conspiracy theory. Finally, conspiracy theories are delusive constructions and, as most delusions, they cannot be modified by rational arguments. People suffering from paranoiac beliefs tend to interpret evidence against their beliefs as a proof of cover-ups, consequently as a proof that they are right. This means that any direct attempt to debunk a conspiracy theory risks to reinforce it. Indeed, one of the most frequent communication mistake is to accept framing the anti-vax quarrel in terms of “debate” between different points of view. Such an approach implies two very negative consequences. First, it is totally ineffective with anti-vax activists, who are usually unaffected by rational arguments; second, it implicitly provides some scientific legitimacy to anti-vaccine theories, and risks to disseminate them in larger sections of the population.   Also,  showing that vaccine related harm is negligible in comparison to vaccine related benefits, is hardly a good strategy. It is well known that people tend to overestimate harm caused by their actions, and underestimate harm caused by omission, or doing nothing.  Most people will always consider “worse” the risk (no matter how small) entailed by vaccination in comparison with risk entailed by non-vaccination (omission).

Scholars and experts in health communication have thus suggested that  highlighting information about the dangers of infections might be more effective to convince people to vaccinate themselves and their infants, than explicitly “marketing” vaccines. A new class of risk of misinformation is finally emerging, it concerns “arbitrary and unfair behavior by scientific journals”.     

The increasing pressure towards the promotion of open access journals and  online publication of electronic papers, is facilitating the birth of a new generation of predatory publishers, which pay very little attention to scientific quality, dramatically lowering peer review standards. These open access journals have the tendency to accept papers, which have been rejected by more established journals.  They tend to realize very late the  poor quality of published papers, even worse, their subsequent reaction is often totally inadequate. It was the case, for instance, of the  Journal of Translational Science, which published in April 2017 a paper discussing a correlation between vaccination and autism in 666 children, concluding that there is a statistic evidence of such a correlation.  This paper was statistically inadequate and scientifically very weak. A decent publisher would have never accepted it. Indeed, after a couple of weeks, in early May, the publisher realized it, and the paper was retracted from the journal website, but with no explanation or explicit  notice. Such a move was still worse than the initial publication, because it is unavoidably destined to generate suspects and fuel conspiracy theories. Brief, a very poor paper, which should have never been published, not only was published, but it is probably destined to become a  “proof” of anti-vax conspiracy theories, because of its “mysterious” retraction.Peso el tacon del buso (the patch is worse than the hole) reads an old Venetian proverb.

In such a discouraging scenario, a positive note is, however, coming from Italy and Germany. In these very days, both countries are enacting legislations, which are making several child vaccination compulsory. Parents, who refuse to vaccinate their children, risk to be fined and children to be prevented to attend the school. Many criticisms have been raised against mandatory vaccination, and it is difficult to escape the unpleasant impression that coercion is  the last, rude, resource of those who are not able to convince.  Such an impression is, however, misleading. It would be naïve to interpret legislations mandating child vaccination  only, or chiefly, in terms of coercion. Although legal coercion can play a (minor) role in reducing parental reluctance to vaccinate, no one could really imagine that in  democratic, pluralistic, societies, it could be ever possible to enforce such a legislation by using the police force, without evoking very strong negative social reactions. Making some vaccinations compulsory is rather a way to emphasize their significance. We are all used to consider something compulsory more important than anything which is only recommended on voluntary basis. In our culture, legal compulsion is often the hallmark of social importance.  Making some child vaccination compulsory is then one of the most effective, and simplest, means to communicate unambiguously that we consider vaccinations effective and valuable.    

RISK COMMUNICATION OR COMMUNICATION RISKS?

Innovate UK has recently awarded a team led by Dr Michael Jarvis at the University of Plymouth UK with a £408,000 grant to develop a new vaccine against zoonosis.

About 75% of newly emerging diseases and 60% of all known human infectious diseases are likely to be zoonosis.  The main idea of this new project is to develop a self-disseminating vaccine vector, called Zoonosis Barrier Vaccine (ZBV), targeting pathogens in the animal species from which they are emerging. By exploiting CRISPR/Cas9 technology, the team will aim to construct engineered viruses, which express target antigens from relevant Emerging Infectious Disease (EID) pathogens. Recombinant viruses will be then inoculated in few animals. They will spread through the whole host populations, producing EID-specific immunity in the targeted populations.

For now, the team will develop a ‘proof-of-concept’ vaccine vector, designed to halt the spread of Rift Valley Fever Virus (RVFV) and Q Fever (QF) among ruminant populations (i.e., sheep, goats and cattle).  The vaccine will prevent zoonotic transmission by using an attenuated bovine herpesvirus. The recombinant herpesvirus – which will replicate only for a short period of time for safety reasons - will infect domestic and wild animals, stimulating also immunity against RVFV and QF.  

The Zoonoses Barrier Vaccine strategy presents several advantages.  Self-disseminating vaccines allow addressing both domestic and wild animals. The transmission of infectious diseases between wild and domestic animals is particularly relevant to EIDs, as most EIDs originate from wildlife. The vicious circle of infections and re-infections between domestic and wild animals is likely to play a pivotal role in EID epidemiological cycles. Moreover, many emerging zoonotic pathogens are poorly adapted to the human hosts in their initial phases, this offers the opportunity to halt the zoonotic transmission by targeting the animal populations, and decreasing the “probability of complete adaption to the human host with global significance”. Finally, the approval requirementsfor animal vaccines are lower than those for human  vaccines, so reducing time to commercial availability. 

The Zoonoses Barrier Vaccine project presents, however, some Significant communicational challenges. Infecting wild and domestic animals with recombinant viruses is the typical project, expected to fuel conspiracy theories. People might also fear a sorcerer's apprentice phenomenon, with recombinant viruses that escape from human control and become dangerous for humans and animals.  Negative reactions can be also related to ecological considerations connected to the spread of engineered virus vectors in the natural environment. Finally, one should not underestimate the risk that some people may feel outrageous that livestock products for human consumption (including meat, milk, and eggs) could be theoretically “contaminated” by recombinant viruses. 

Researchers should carefully consider these communicational aspects. They should develop effective communication plans, to explain the rationale of their project and the way in which they intend to mitigate potential risks (even the most unlikely ones).  It is extremely important that full information on the Zoonosis Barrier Vaccine project is publicly available, in a format understandable to the public. Social media should be carefully monitored; worries, fears, myths, concerning the project should be immediately identified and addressed with appropriate counter-campaigns. Reasons of worry should be proactively addressed as they emerge. Finally, it is paramount that economic interests are completely and fully disclosed, without any ambiguity. People trust in scientists more than one usually imagine, but they do not  put up with researchers who are perceived not to be fully transparent. Suspects (even remote) of conflict of interest could have devastating effects on future research in this field.