In this final debunk we discuss the problems with the conclusions chapter and the polio chapter.

1. Why did polio epidemics emerge in the United States specifically in the late-19th century?

   The entire premise of the question is wrong; there is evidence of polio dating back to literal ancient times.

2. Why did polio epidemics strike industrialized countries in the first half of the 20th century, when almost none occurred in the developing world?

   First off, with modern science, it is well known that most symptoms of polio are nonspecific. With all medical science in general being less sophisticated the longer back in time we look, it is easy to envision a situation where there was little tracking and testing of disease (the test for the infectious disease needed to be invented too!). The assertion throughout the chapter that polio is caused by pesticides is objectively false. We have the field of virology to thank for discovering the infectious agent responsible for polio (citation Plotkin’s Vaccines). Pesticide associated neurologic damage is a thing, but this is a totally different medical problem. It is well known that polio is endemic to Afghanistan and Pakistan, which means they have continually had circulation for a long time (although records may be sparse, the further back in history we go).

3. Why did polio hit hardest in the summer and early autumn?

   There is no seasonal pattern in tropical climates. The overall mechanism of this does carry legitimate debate, but this specific aspect of the debate does not then weaken the argument to help as many people as possible avoid paralytic polio.

4. Why did most of the early polio outbreaks occur in sparsely populated rural areas rather than in the large and crowded metropolitan areas?

   There probably are many reasons of which many are speculative. Pakistan provides the most cruel reason for this – healthcare workers hoping to increase vaccination rates are at times at risk of actual murder for conducting their duties (at the hands of fundamentalists who also happen to be anti-vaccine). Antivax conspiracy theories have penetrated into far flung rural communities where citizens do not necessarily have the science background to apply critical/ independent thinking to the ideas presented. RFK and the authors should be celebrating this, since these are the fruits of their labor, except remember – if someone gets actual paralytic polio in Pakistan, RFK Jr is certainly not coming to their rescue. He has little support for ethnic minorities – he even made an antivax film specifically targeting the African American population. There is also a widespread antivax hypothesis in poor rural Muslim communities, that polio vaccines are a Western conspiracy to sterilize children (despite no actual studies to show this problem exists). All these communities deserve better than RFK Jr.

5. Why were many of the early polio outbreaks in rural areas accompanied by concurrent outbreaks of paralysis in domestic animals?

   First off, apes can sometimes be infected with human poliovirus, but monkeys cannot be infected in the modern age, and there is no significant animal reservoir for the wild poliovirus (although special subtypes can infect lab animals). The monkeys infected with poliovirus in the old studies were specifically given the infection under special laboratory conditions. The author cited by the book authors, Charles Caverly, did not have the tools to formally isolate the pathogen that maybe affected the animals he described. Most importantly, the authors do not take the time to realize that polio in animals is a completely different disease from polio in humans; it is actually a nutritional deficiency in vitamin B1. English words frequently mean different things in scientific English despite the spelling being the same – knowing the difference is key for people who are actually dedicated to learning biology well.

6. Why were high polio rates observed in European residents of developing countries, while local residents rarely experienced acute flaccid paralysis?

   This partially depends on the poliovirus subtype, as type 1 is most damaging to the nervous system.

7. How does the virus pass from the gut to the central nervous system? What prevents this transition in the vast majority of those infected with the virus?

   It gets there via the bloodstream. The risk factors include the type of human leukocyte antigen, viral dose, inadequate vaccination, nerve injury, removal of tonsils/ adenoids, and a few other factors.

8. Why, contrary to other infectious diseases, are polio patients virtually non-contagious, while the disease is presumably spread so easily by healthy people?

   This statements reflects a failure to read the textbook that they cited. Plotkin’s vaccines clearly describes an infectious period of the patient with polio, as well as the patient with paralytic polio, who specifically is infectious immediately before the onset of paralysis and 1-2 weeks afterwards.

9. How did the Salk vaccine manage to nearly eradicate polio in the US (and other countries), even though at least 20% of the paralysis was not caused by the poliovirus?

   The worldwide goal to eradicate polio requires many steps and detailed by the GPEI. The second part of the statements neglects to discuss that other viruses are capable of causing paralysis that aren’t polio; for example the disease acute flaccid paralysis is caused by a different virus but shares many symptoms with paralytic polio. Again, antivaxxers fail at the most basic reading comprehension.

10. How did the Salk vaccine manage to completely eliminate the spread of the poliovirus in countries where it was given exclusively, even though the vaccine essentially does not confer herd immunity?

    Again a vaccine does not have to provide perfect herd immunity to be useful to a population. The story of the near-complete elimination of polio spread is also detailed by the GPEI.

At this point, the way that the authors present their arguments is clear. It is well below the standard of performance expected of a PhD or MD-PhD vaccine scientist, which is the type of person the authors desperately want to debate. Scientists frequently debate other scientists, and this is most visibly done during the peer review process. Does peer review have weaknesses? It most certainly does, and this has resulted in retractions of at times, major papers. I’ll happily join in the criticisms of the weaknesses of peer review.

Has “big pharma” at times engaged in outright pharmaceutical malpractice and the hiding of unfavorable trial results? For sure, and even mainstream physicians will join in the harsh criticism that the pharmaceutical companies deserve when they engage in that kind of tomfoolery (as well as applaud the legal penalties). I don’t have a good solution to propose to quickly eliminate “pharma greed” which is a pervasive theme throughout the book. I imagine this would require a wholesale change in corporate law and business schools, which I can’t do on my own.

The intrinsic problem with the authors, or people who are like-minded, asking to debate vaccine scientists is this. The two parties really need to first agree the sky is blue before proceeding. A debate is worthless if one side is totally detached from reality.

I have stated multiple times, that an example of a genuine scientific debate is what is conducted at the World Science Festival. The organizer (who is a physicist), who invites people outside of his specialty, actually studied these other specialties well enough to conduct professional debate with people not in his field. The leaders of the antivaccine community, by their public actions and words, clearly are not starting in the same reality as we are. If someone insists that the proper way to walk into a house is by trying to morph through the brick wall, Harry Potter style, it is really difficult, if not impossible to argue with that person. If someone who espouses the beliefs expressed in the book, wishes to argue with myself or Dr Peter Hotez, the way to do it is clearly spelled out – it requires a good command of the scientific method and the previous literature (or at least a sincere attempt).

As I have spelled out in the prior 9 essays, the authors do periodically make good points and note times where there is legitimate debate. An example of this is the vaccines that have known weaknesses, such as the need to reformulate the influenza vaccine yearly. This problem was arrived at, however, using the principles of sound scientific reasoning and a command of virology/ molecular biology. This conclusion was not produced by Twitter space debates, Rumble videos, or the most common techniques of science denial (a more modern conspiracy relating to COVID vaccines is the insistence that vaccines make you magnetic).

It is clearly too high a bar to demand every parent understand molecular biology as well as a professional in the field, but this is exactly why physicians are trained to speak in technical terminology as well as try to explain things in plain language. There is plenty of free and open discussion, but to engage in standardized scientific debate, the authors of the book need to agree to basic rules of the road. The requirements are the same for everyone. You can ask any primary care physician to explain vaccines in plain language to you – they should be able to do it. If a particular parent wishes to question the science behind vaccines, they are most welcome to do it. If the reader personally found a physician who genuinely attempted to shut down lines of questioning, I can in fact state my opposition to that. I sincerely think most parents ask questions about vaccines through a lens of genuinely wanting to know the answer or needing clarification. However, if a physician sees the need to guide a particular parent to thinking that better exemplifies scientific reasoning, that should not be viewed as a conspiracy, pharmaceutical misconduct, hiding side effects, destroying documents, a personal attack, or being personally compensated by Bill Gates. If a family is in need of more detailed discussion of specific research projects relevant to vaccines, that discussion is most welcome on my Twitter direct messages or with the personal physician. I’ve been in pediatric medicine long enough to encounter vaccine associated side effects, sometimes serious ones – and treated those patients with the same empathy I would, towards everyone else. I also know my pediatric science well enough to know that these events are exceptionally rare. While there are obvious weaknesses in vaccine side effect research, there is more than enough out there that speakers with large platforms should not feel the need to lie to prove their points.

Ultimately, the expression “Turtles All the Way Down”, means that something is not built on a solid foundation. The real turtles in this saga, are authors of the book and all those who think like them.