Vaccines Are the Safest Medical Procedure We Have. Make Your Wager Wisely.
In the late 1650's the French polymath and renowned scientist Blaise Pascal, having undergone a religious experience that transformed him into something of a zealot, suggested the following logical strategy regarding belief in God: If there is a God, then believing in him will ensure you an eternity of bliss, while not believing in him could earn you an eternal sentence to misery.
On the other hand, if there is no God, believing in him anyway will cost you very little, and not believing in him will mean nothing in the non-existent after life. Therefore, the only sensible bet is to believe in God. This has come to be known as Pascal's wager.
It has a surprising number of applications beyond concerns for a comfortable afterlife. There are many things for which the value of believing something or not can be seen as a cost vs. likely benefit wager, often without regard to the actual truth of the matter. Since science does not profess to have a final truth, and in many areas freely admits its incomplete knowledge, Pascal's wager can provide a useful method of deciding between two alternatives.
For example, it seems that a significant percentage of the population is suspicious of science, or so we are told. We often hear that some large number, approaching or exceeding half of Americans, do not believe in evolution. This seems remarkable on the face of it because there is no viable scientific opposition to evolution and it is widely accepted by biologists and other life-scientists as being fundamental to understanding biology – from genetics to medicine.
What we are not often told is that most of those who answer negatively about believing in evolution nonetheless understand evolution – or at least the basics of it. They are not stupid, ignorant or uninformed. They have simply made a Pascalian wager. What benefit we might ask is derived from believing in evolution rather than a divine creation? Unless you are a professional biologist it is hard to see how this would affect your everyday life. On the other hand professing a belief in Darwinian evolution over the biblical narrative will likely ostracize you from family, friends, co-workers, your church community - in short most of your social infrastructure. Place your bets.
Can we apply any of this to decisions over the current controversy surrounding vaccination – and in particular the newly arrived Covid-19 vaccine?
While it is true that for entirely economic reasons, this is the first vaccine to be produced in this way, the method is not really new and the science that makes it possible has been developing over the last 40 years.
Common Concerns
There are certainly reasons to be concerned about being vaccinated and it would be a gross over-simplification to consider anyone who expresses reticence about taking a vaccine, this new vaccine in particular, as being just plain dumb or scientifically illiterate or gullible. They need be none of these things and still may be suspicious of the vaccine.
One issue is safety. The vaccine, any vaccine, is designed to mobilize your immune system, essentially to fool it into believing that there is an invading virus present and to mount an immune response. That way it will be ready when the real invasion comes, if it comes. This seems pretty sensible and preferable to going to war with an opponent you know nothing about. But still, it is fooling around with Mother Nature and some people are uneasy about that. Although it must be pointed out that the virus is not at all shy about fooling around with your immune system and many other parts of you, so letting it have its way is not good policy either.
What about a vaccine made of genes? This vaccine is being produced by what is being touted as a new method using RNA – genes. While it is true that for entirely economic reasons, this is the first vaccine to be produced in this way, the method is not really new and the science that makes it possible has been developing over the last 40 years. So it's not so radical as the press makes it seem.
But it is true that this method uses RNA, genetic material, to make the vaccine. We hear a lot about gene modification and the potential dangers associated with it. Why then am I going to allow RNA, genes, to be injected into me? The first thing to realize is that this is exactly what the virus does – so whether you get a vaccine or an infection, you are getting genes injected into you. The virus RNA encodes around 12 functional genes (by comparison humans and other mammals have around 25,000 genes). The virus only contains the genes to make a new virus – it does not have any of the capabilities of a normal cell to actually turn those genes into the proteins that make up the complete virus. It hijacks your cells to do this – and that's how it sickens you, by forcing your cells to make new viruses instead of what they should be doing.
Now the new vaccines have taken just one of those genes – the one that directs the production of the now infamous spike protein that appears on the surface of a normal virus – and injects just that one gene into your muscle cells, which then make that one single protein. Your immune system comes along and sees that weird protein and makes antibodies to it. These same antibodies will now recognize the spike protein on the surface of any viral particles that invade your body. We have effectively turned the virus into its own enemy.
The viral RNA that you are getting will decompose over a few days because RNA is not a stable molecule (that, by the way, is why the vaccine needs to be kept frozen) and it will no longer exist in your body. It could only become a permanent part of your genome if it were a DNA molecule instead of an RNA molecule – and even the chances of that happening would be chemically remote. So regardless of how it sounds, this may actually be the safest sort of vaccine to use. In the future it is likely that all vaccines will be made this way.
Then, of course, there is the issue of who is running this whole vaccine program – the government and the pharmaceutical industry. These are the guys who brought you opioid addiction, death by Vioxx, soaring drug prices, the worst health care system in the developed world, regulations where you don't need them and none where you do – am I really going to trust this cast of so-called "inept villains," as some believe, to dictate my personal health choices? Do we know for sure that the claims of efficacy are real or just made up to sell some worthless procedure? It would not be the first time. (I would not, on the other hand, worry about Bill Gates having a chip inserted into you along with the vaccine – if you use any social media, navigational tools, or purchase anything online, then Bill Gates already knows more about you than he will get from any injectable chip. So that train has left the station.)
The main upside to vaccines is that because they use your already existing defense system, they are surprisingly safe.
The Vaccine Wager
All this and a few lesser issues are worth a pause for sure. But we must also look on the positive side of the ledger. Why trust science? Modern medicine and the science behind it has eliminated or dramatically lessened such scourges as smallpox, polio, cholera, chicken pox, measles, rabies and dozens of other killer pathogens that had previously wiped out enormous numbers of people, in some cases significant parts of entire generations. Don't we depend on science for much of the comfort and safety of our everyday lives? Isn't science the way we heat our homes, drive to work, fly around the world, have dependable food? Yes, there is the bomb – but there is also anesthesia.
When it comes to viruses, the only tool we have to fight them is vaccination. The only tool. Antibiotics are for bacteria, a completely different sort of creature. Sanitation beyond personal hand washing is ineffective. Vaccines trick the immune system into recognizing the virus earlier than it would otherwise and protect normal cells from invasion by the virus. Tricking the immune system is understandably problematic for people who believe that their body knows best if it's just kept healthy. This virus, as we have seen from the array of infected people that includes apparently healthy folks, unfortunately does not subscribe to that belief.
By a similar sort of reasoning, some people make the plausible error of calculating that the vaccine is 95% effective but the survival rate is 99%, so why not just let my natural resistance take care of this? Indeed, that might not be unreasonable thinking if we were talking about the common cold, but this virus has shown itself to be a tricky character and we are not yet able to predict who gets a serious case and who a mild one. With those sorts of stakes, you shouldn't wager on either of those numbers because they have nothing to do with you as an individual. Like flipping a coin, there is only a 1% chance of it coming up heads 6 times in a row. But if it has come up heads 5 times in a row the probability of it coming up heads on the next flip is … still 50/50.
An even larger unknown is whether there may be long-term effects associated with SARS-Cov-2, as is the case for many viruses. The 1918 influenza virus has been linked to a subsequent 2-3 fold increase in Parkinson's disease by a mechanism we still don't understand. The virus that gives children chicken pox will hide out in a person's body for 40 years or more and then emerge as a painful, sometimes debilitating, case of shingles. The 99% survivability rate of this virus is meaningless if 20 years from now it causes some devastating pulmonary or brain disease.
The main upside to vaccines is that because they use your already existing defense system, they are surprisingly safe. Safer than antibiotics which have numerous side effects because they are not part of our normal make up and are cell killers – mostly bacterial cells, but they are not so perfectly targeted that they don't leave some collateral damage in their wake. All drugs and treatments have side effects, but vaccines in general have the fewest. This vaccine in particular has undergone many more than the usual safety measures - multiple independent review boards, massive press and public attention, governmental and non-governmental oversight, the most diverse trial cohorts ever assembled. Nothing here was rushed, no shortcuts were taken.
So here's the vaccine wager. Vaccines are the safest medical procedure we have. They are also among the most effective, but that's curiously not important for the bet. My claim about their safety is because vaccines are in a special class of medical tools. They are the only medical procedure or drug that is given to healthy people. Every other treatment we use medically is aimed at some existing pathology - from a cold to cancer.
Vaccines therefore have to reach a higher standard of safety than any other medical treatment. You can't take healthy people and make them sick. Vaccines have fewer side effects than virtually any other drug you wouldn't even think twice about taking – aspirin, for instance, which can cause internal bleeding, gastric ulcers, stroke. But since you are sick when you take those drugs you are willing to make the bet that the benefits will outweigh the possible side effects.
With vaccines the wager is much simpler – it is indeed more like Pascal's original wager. It may or may not be highly effective (some vaccines are only 60% effective) but they are so safe that taking them poses little risk, whereas not taking them subjects you (and others) to considerable risk, i.e., getting the virus. Like believing or not in an afterlife, the smart money is with Pascal, who I think would have reasoned himself right to the head of the vaccination line.
Two-and-a-half year-old Huckleberry, a blue merle Australian shepherd, pulls hard at her leash; her yelps can be heard by skiers and boarders high above on the chairlift that carries them over the ski patrol hut to the top of the mountain. Huckleberry is an avalanche rescue dog — or avy dog, for short. She lives and works with her owner and handler, a ski patroller at Breckenridge Ski Resort in Colorado. As she watches the trainer play a game of hide-and-seek with six-month-old Lume, a golden retriever and avy dog-in-training, Huckleberry continues to strain on her leash; she loves the game. Hide-and-seek is one of the key training methods for teaching avy dogs the rescue skills they need to find someone caught in an avalanche — skier, snowmobiler, hiker, climber.
Lume’s owner waves a T-shirt in front of the puppy. While another patroller holds him back, Lume’s owner runs away and hides. About a minute later — after a lot of barking — Lume is released and commanded to “search.” He springs free, running around the hut to find his owner who reacts with a great amount of excitement and fanfare. Lume’s scent training will continue for the rest of the ski season (Breckenridge plans operating through May or as long as weather permits) and through the off-season. “We make this game progressively harder by not allowing the dog watch the victim run away,” explains Dave Leffler, Breckenridge's ski patroller and head of the avy dog program, who has owned, trained and raised many of them. Eventually, the trainers “dig an open hole in the snow to duck out of sight and gradually turn the hole into a cave where the dog has to dig to get the victim,” explains Leffler.
By the time he is three, Lume, like Huckleberry, will be a fully trained avy pup and will join seven other avy dogs on Breckenridge ski patrol team. Some of the team members, both human and canine, are also certified to work with Colorado Rapid Avalanche Deployment, a coordinated response team that works with the Summit County Sheriff’s office for avalanche emergencies outside of the ski slopes’ boundaries.
There have been 19 avalanche deaths in the U.S. this season, according to avalanche.org, which tracks slides; eight in Colorado. During the entirety of last season there were 17. Avalanche season runs from November through June, but avalanches can occur year-round.
High tech and high stakes
Complementing avy dogs’ ability to smell people buried in a slide, avalanche detection, rescue and recovery is becoming increasingly high tech. There are transceivers, signal locators, ground scanners and drones, which are considered “games changers” by many in avalanche rescue and recovery
For a person buried in an avalanche, the chance of survival plummets after 20 minutes, so every moment counts.
A drone can provide thermal imaging of objects caught in a slide; what looks like a rock from far away might be a human with a heat signature. Transceivers, also known as beacons, send a signal from an avalanche victim to a companion. Signal locators, like RECCO reflectors which are often sewn directly into gear, can echo back a radar signal sent by a detector; most ski resorts have RECCO detector units.
Research suggests that Ground Penetrating Radar (GPR), an electromagnetic tool used by geophysicists to pull images from inside the ground, could be used to locate an avalanche victim. A new study from the Department of Energy’s Sandia National Laboratories suggests that a computer program developed to pinpoint the source of a chemical or biological terrorist attack could also be used to find someone submerged in an avalanche. The search algorithm allows for small robots (described as cockroach-sized) to “swarm” a search area. Researchers say that this distributed optimization algorithm can help find avalanche victims four times faster than current search mechanisms. For a person buried in an avalanche, the chance of survival plummets after 20 minutes, so every moment counts.
An avy dog in training is picking up scent
Sarah McLear
While rescue gear has been evolving, predicting when a slab will fall remains an emerging science — kind of where weather forecasting science was in the 1980s. Avalanche forecasting still relies on documenting avalanches by going out and looking,” says Ethan Greene, director of the Colorado Avalanche Information Center (CAIC). “So if there's a big snowstorm, and as you might remember, most avalanches happened during snowstorms, we could have 10,000 avalanches that release and we document 50,” says Greene. “Avalanche forecasting is essentially pattern recognition,” he adds--and understanding the layering structure of snow.
However, determining where the hazards lie can be tricky. While a dense layer of snow over a softer, weaker layer may be a recipe for an avalanche, there’s so much variability in snowpack that no one formula can predict the trigger. Further, observing and measuring snow at a single point may not be representative of all nearby slopes. Finally, there’s not enough historical data to help avalanche scientists create better prediction models.
That, however, may be changing.
Last year, an international group of researchers created computer simulations of snow cover using 16 years of meteorological data to forecast avalanche hazards, publishing their research in Cold Regions Science and Technology. They believe their models, which categorize different kinds of avalanches, can support forecasting and determine whether the avalanche is natural (caused by temperature changes, wind, additional snowfall) or artificial (triggered by a human or animal).
With smell receptors ranging from 800 million for an average dog, to 4 billion for scent hounds, canines remain key to finding people caught in slides.
With data from two sites in British Columbia and one in Switzerland, researchers built computer simulations of five different avalanche types. “In terms of real time avalanche forecasting, this has potential to fill in a lot of data gaps, where we don't have field observations of what the snow looks like,” says Simon Horton, a postdoctoral fellow with the Simon Fraser University Centre for Natural Hazards Research and a forecaster with Avalanche Canada, who participated in the study. While complex models that simulate snowpack layers have been around for a few decades, they weren’t easy to apply until recently. “It's been difficult to find out how to apply that to actual decision-making and improving safety,” says Horton. If you can derive avalanche problem types from simulated snowpack properties, he says, you’ll learn “a lot about how you want to manage that risk.”
The five categories include “new snow,” which is unstable and slides down the slope, “wet snow,” when rain or heat makes it liquidly, as well as “wind-drifted snow,” “persistent weak layers” and “old snow.” “That's when there's some type of deeply buried weak layer in the snow that releases without any real change in the weather,” Horton explains. “These ones tend to cause the most accidents.” One step by a person on that structurally weak layer of snow will cause a slide. Horton is hopeful that computer simulations of avalanche types can be used by scientists in different snow climates to help predict hazard levels.
Greene is doubtful. “If you have six slopes that are lined up next to each other, and you're going to try to predict which one avalanches and the exact dimensions and what time, that's going to be really hard to do. And I think it's going to be a long time before we're able to do that,” says Greene.
What both researchers do agree on, though, is that what avalanche prediction really needs is better imagery through satellite detection. “Just being able to count the number of avalanches that are out there will have a huge impact on what we do,” Greene says. “[Satellites] will change what we do, dramatically.” In a 2022 paper, scientists at the University of Aberdeen in England used satellites to study two deadly Himalayan avalanches. The imaging helped them determine that sediment from a 2016 ice avalanche plus subsequent snow avalanches contributed to the 2021 avalanche that caused a flash flood, killing over 200 people. The researchers say that understanding the avalanches characteristics through satellite imagery can inform them how one such event increases the magnitude of another in the same area.
Avy dogs trainers hide in dug-out holes in the snow, teaching the dogs to find buried victims
Sarah McLear
Lifesaving combo: human tech and Mother Nature’s gear
Even as avalanche forecasting evolves, dogs with their built-in rescue mechanisms will remain invaluable. With smell receptors ranging from 800 million for an average dog, to 4 billion for scent hounds, canines remain key to finding people caught in slides. (Humans in comparison, have a meager 12 million.) A new study published in the Journal of Neuroscience revealed that in dogs smell and vision are connected in the brain, which has not been found in other animals. “They can detect the smell of their owner's fingerprints on a glass slide six weeks after they touched it,” says Nicholas Dodman, professor emeritus at Cummings School of Veterinary Medicine at Tufts University. “And they can track from a boat where a box filled with meat was buried in the water, 100 feet below,” says Dodman, who is also co-founder and president of the Center for Canine Behavior Studies.
Another recent study from Queens College in Belfast, United Kingdom, further confirms that dogs can smell when humans are stressed. They can also detect the smell of a person’s breath and the smell of the skin cells of a deceased person.
The emerging avalanche-predicting human-made tech and the incredible nature-made tech of dogs’ olfactory talents is the lifesaving “equipment” that Leffler believes in. Even when human-made technology develops further, it will be most efficient when used together with the millions of dogs’ smell receptors, Leffler believes. “It is a combination of technology and the avalanche dog that will always be effective in finding an avalanche victim.”
Living with someone changes your microbiome, new research shows
Some roommate frustration can be expected, whether it’s a sink piled high with crusty dishes or crumbs where a clean tabletop should be. Now, research suggests a less familiar issue: person-to-person transmission of shared bacterial strains in our gut and oral microbiomes. For the first time, the lab of Nicola Segata, a professor of genetics and computational biology at the University of Trento, located in Italy, has shown that bacteria of the microbiome are transmitted between many individuals, not just infants and their mothers, in ways that can’t be explained by their shared diet or geography.
It’s a finding with wide-ranging implications, yet frustratingly few predictable outcomes. Our microbiomes are an ever-growing and changing collection of helpful and harmful bacteria that we begin to accumulate the moment we’re born, but experts are still struggling to unravel why and how bacteria from one person’s gut or mouth become established in another person’s microbiome, as opposed to simply passing through.
“If we are looking at the overall species composition of the microbiome, then there is an effect of age of course, and many other factors,” Segata says. “But if we are looking at where our strains are coming from, 99 percent of them are only present in other people’s guts. They need to come from other guts.”
If we could better understand this process, we might be able to control and use it; perhaps hospital patients could avoid infections from other patients when their microbiome is depleted by antibiotics and their immune system is weakened, for example. But scientists are just beginning to link human microbiomes with various ailments. Growing evidence shows that our microbiomes steer our long-term health, impacting conditions like obesity, irritable bowel syndrome, type 2 diabetes, and cancer.
Previous work from Segata’s lab and others illuminated the ways bacteria are passed from mothers to infants during the first few months of life during vaginal birth, breastfeeding and other close contact. And scientists have long known that people in close proximity tend to share bacteria. But the factors related to that overlap, such as genetics and diet, were unclear, especially outside the mother-baby dyad.
“If we look at strain sharing between a mother and an infant at five years of age, for example, we cannot really tell which was due to transmission at birth and which is due to continued transmission because of contact,” Segata says. Experts hypothesized that they could be caused by bacterial similarities in the environment itself, genetics, or bacteria from shared foods that colonized the guts of people in close contact.
Strain sharing was highest in mother-child pairs, with 96 percent of them sharing strains, and only slightly lower in members of shared households, at 95 percent.
In Italy, researchers led by Mireia Valles-Colomer, including Segata, hoped to unravel this mystery. They compared data from 9,715 stool and saliva samples in 31 genomic datasets with existing metadata. Scientists zoomed in on variations in each bacterial strain down to the individual level. They examined not only mother-child pairs, but people living in the same household, adult twins, and people living in the same village in a level of detail that wasn’t possible before, due to its high cost and difficulties in retrieving data about interactions between individuals, Segata explained.
“This paper is, with high granularity, quantifying the percent sharing that you expect between different types of social interactions, controlling for things like genetics and diet,” Gibbons says. Strain sharing was highest in mother-child pairs, with 96 percent of them sharing strains, and only slightly lower in members of shared households, at 95 percent. And at least half of the mother-infant pairs shared 30 percent of their strains; the median was 12 percent among people in shared households. Yet, there was no sharing among eight percent of adult twins who lived separately, and 16 percent of people within villages who resided in different households. The results were published in Nature.
It’s not a regional phenomenon. Although the types of bacterial strains varied depending on whether people lived in western and eastern nations — datasets were drawn from 20 countries on five continents — the patterns of sharing were much the same. To establish these links, scientists focused on individual variations in shared bacterial strains, differences that create unique bacterial “fingerprints” in each person, while controlling for variables like diet, demonstrating that the bacteria had been transmitted between people and were not the result of environmental similarities.
The impact of this bacterial sharing isn’t clear, but shouldn’t be viewed with trepidation, according to Sean Gibbons, a microbiome scientist at the nonprofit Institute for Systems Biology.
“The vast majority of these bugs are actually either benign or beneficial to our health, and the fact that we're swapping and sharing them and that we can take someone else's strain and supplement or better diversify our own little garden is not necessarily a bad thing,” he says.
"There are hundreds of billions of dollars of investment capital moving into these microbiome therapeutic companies; bugs as drugs, so to speak,” says Sean Gibbons, a microbiome scientist at the Institute for Systems Biology.
Everyday habits like exercising and eating vegetables promote a healthy, balanced gut microbiome, which is linked to better metabolic and immune function, and fewer illnesses. While many people’s microbiomes contain bacteria like C. diff or E. coli, these bacteria don’t cause diseases in most cases because they’re present in low levels. But a microbiome that’s been wiped out by, say, antibiotics, may no longer keep these bacteria in check, allowing them to proliferate and make us sick.
“A big challenge in the microbiome field is being able to rationally predict whether, if you're exposed to a particular bug, it will stick in the context of your specific microbiome,” Gibbons says.
Gibbons predicts that explorations of microbe-based therapeutics will be “exploding” in the coming decades. “There are hundreds of billions of dollars of investment capital moving into these microbiome therapeutic companies; bugs as drugs, so to speak,” he says. Rather than taking a mass-marketed probiotic, a precise understanding of an individual’s microbiome could help target the introduction of just the right bacteria at just the right time to prevent or treat a particular illness.
Because the current study did not differentiate between different types of contact or relationships among household members sharing bacterial strains or determine the direction of transmission, Segata says his current project is examining children in daycare settings and tracking their microbiomes over time to understand the role genetics and everyday interactions play in the level of transmission that occurs.
This relatively newfound ability to trace bacterial variants to minute levels has unlocked the chance for scientists to untangle when and how bacteria leap from one microbiome to another. As researchers come to better understand the factors that permit a strain to establish itself within a microbiome, they could uncover new strategies to control these microbes, harnessing the makeup of each microbiome to help people to resist life-altering medical conditions.