When Government Decides What You Can Read (Part 1)

Series IntroductionThis three-part series examines two concurrent failures of American pandemic governance (one of overreach, one of abandonment) and argues that a principled analysis requires taking both with equal seriousness. The first failure was the Biden administration’s documented campaign to pressure the largest social media platforms in the United States into suppressing speech that its political operatives found inconvenient. The second is the Trump administration’s effective dismantling, through administrative attrition, of the Office of Pandemic Preparedness and Response Policy, a statutory institution created by a bipartisan act of Congress in direct response to the coordination catastrophes of COVID-19. The series draws on court documents, congressional records, federal agency testimony, White House archives, and contemporaneous reporting to establish both failures in their factual specificity and then situates them within two analytical frameworks: the federalism architecture clarified by Dobbs v. Jackson and NFIB v. OSHA, and Murray Rothbard’s account of how states insulate their conduct from accountability.Part Onedocuments the Biden White House speech suppression campaign. Beginning on the administration’s third day, White House digital operatives, most of them in their late twenties with backgrounds in Democratic Party fundraising and campaign communications rather than medicine or public health, conducted a sustained pressure campaign against Twitter, Facebook, YouTube, Google, and Amazon to remove or demote content the administration disfavored. The targets included the lab-leak theory of COVID-19’s origins (later assessed by the FBI as the most credible explanation), the scientific arguments of Stanford epidemiologist Jay Bhattacharya and Harvard’s Martin Kulldorff, the work of Dr. Robert Malone (a co-inventor of the mRNA lipid nanoparticle transfection technology whose Twitter account was permanently suspended three weeks after his Joe Rogan appearance), and a range of conservative commentators. The campaign was partially outsourced to the Center for Countering Digital Hate, a British nonprofit co-founded by Morgan McSweeney, who would later serve as Downing Street Chief of Staff under Keir Starmer, making this the documented case of a foreign partisan organization providing censorship target lists against American citizens to a White House that acted on them. When the resulting legal challenge, Missouri v. Biden, reached the Supreme Court as Murthy v. Missouri, the Court dismissed it 6-3 on standing grounds, leaving the constitutional merits unaddressed. Justice Alito’s dissent characterized the underlying conduct as presumptively unconstitutional.Part Twoexamines Congress’s response through the PREVENT Pandemics Act (Pub. L. 117-328), passed in December 2022, which mandated the creation of OPPR within the Executive Office of the President, with a presidentially appointed director, interagency coordination authority, and statutory reporting obligations to Congress. The Act placed OPPR on the permissible side of the constitutional line Dobbs drew: federal preparedness coordination, surveillance, countermeasure development, and supply chain resilience are legitimate federal functions; direct operational control of medical practice in the states is not. Part Two also examines the NSC predecessor role played by Dr. Raj Panjabi, whose work on the WHO Pandemic Accord and International Health Regulations raises distinct sovereignty concerns addressed in full, and documents OPPR’s operational record: the H5N1 response coordination across seven agencies, the $766 million Moderna vaccine program (subsequently cancelled), the Bio-5 Biopharmaceutical Alliance, and the Biological Incident Response Playbook.Part Threeexamines what the Trump administration has done with the institution Congress built. The administration never appointed an OPPR director. It never submitted a budget. Gerald Parker, placed at the NSC rather than OPPR, resigned in July 2025 after six months. All six inherited OPPR staff had departed by the end of June 2025. The interagency H5N1 coordination calls were discontinued. The Moderna contract was cancelled. The series concludes with a double indictment that a conservative analytical framework requires: the Biden administration’s censorship campaign was a genuine abuse of executive power, and the Trump administration’s treatment of a congressionally mandated statutory institution as a discretionary program it can quietly defund is not conservatism. Both things are true. Sorting them out requires taking both seriously.SummaryThe foundational question raised by the Biden administration’s COVID-19 social media campaign is not about social media. It is about the proper role of the executive branch in shaping the information environment that citizens use to make decisions about their own lives and health. This installment documents that campaign in full: who ran it, what credentials they had, what they demanded, what the platforms did, which voices were suppressed, the role of a foreign-connected nonprofit in generating target lists, the suppression of the one credentialed scientist most directly implicated by the technology at issue, and the Supreme Court decision that laundered the entire episode into procedural non-accountability.The campaign was run day-to-day by political digital operatives in their late twenties whose professional backgrounds were in Democratic Party fundraising, not infectious disease. Their demands to Twitter and Facebook included removing content the administration classified as misinformation, suppressing posts that were, in Facebook’s own internal characterization, ‘often true,’ and targeting specific conservative commentators by name. The evidence for all of this comes from the discovery process in a federal lawsuit, not from leaks or speculation. The White House emails are in the record. The platforms’ capitulation is documented. The list of suppressed content is specific.The foreign dimension of the campaign is among its most constitutionally troubling features. The Center for Countering Digital Hate, a British nonprofit whose co-founder Morgan McSweeney would later serve as Downing Street Chief of Staff under Keir Starmer, provided the Biden White House with its ‘Disinformation Dozen’ report, which Jen Psaki cited from the podium and which Rob Flaherty used in his pressure emails to Facebook. A foreign partisan organization with direct connections to a foreign head of government’s political operation was providing the inputs that shaped a U.S. government censorship campaign against American citizens. The Supreme Court’s standing dismissal in Murthy v. Missouri means this conduct was neither condemned nor authorized. It was processed out of the legal system. Murray Rothbard would have recognized the mechanism.PART ONEThe Speech Suppression Machine: Anatomy of the Biden White House Pressure CampaignA Government That Decides What Is TrueThe foundational question raised by the Biden administration’s COVID-19 social media campaign is not really about social media at all. It is about the proper role of the executive branch in shaping the information environment that citizens use to make decisions about their own lives and health.The First Amendment represents a foundational American Constitutional commitment: government does not get to decide which ideas are acceptable. That principle exists not because false ideas are harmless but because the alternative, a government empowered to suppress speech it classifies as false or dangerous, inevitably becomes a government that suppresses speech it finds politically inconvenient. The Biden administration’s COVID-19 information campaign is the most thoroughly documented recent example of precisely that trajectory.What is remarkable about this episode is not that it happened, but that we know it happened in such granular detail. The evidence comes not from leaked documents or anonymous whistleblowers but from the discovery process in a federal lawsuit, Missouri v. Biden, which compelled the production of thousands of internal emails between White House officials and the country’s largest technology platforms. Those emails reveal a sustained, aggressive, and at times contemptuous campaign by senior administration officials to bend private companies to the government’s informational preferences.The White House Political Structure Behind the CampaignUnderstanding the pressure campaign requires understanding the specific institutional machinery the Biden administration created to manage it. The COVID-19 Response Team was not a statutory creation but a creature of executive discretion, stood up by Biden’s first executive orders and staffed with political appointees who reported directly to the White House chief of staff’s orbit. It was, in structure, a political operation clothed in the authority of public health.That characterization is not merely rhetorical. It follows directly from the professional backgrounds of the people who ran it. With one partial exception, none of the principal officials who designed and executed the COVID-19 information pressure campaign had any prior experience in pandemic response, infectious disease, or public health emergency management. They were management consultants, healthcare administrators, and political digital operatives who, by a combination of election outcomes and appointment decisions, found themselves holding authority over the federal government’s posture toward an active pandemic. The question of what they did with that authority cannot be separated from the question of what kind of experience shaped their instincts.Jeff Zients: The Manager Without a MapThe team’s most senior official was Jeff Zients, who served as Coordinator of the COVID-19 Response and Counselor to the President. Zients’s entire professional background was in management consulting and private equity. After graduating from Duke University in 1988, he spent years at Bain & Company and Mercer Management Consulting before building a series of corporate advisory firms. He served as chairman, CEO, and COO of the Advisory Board Company, taking it public in a transaction that made him a multimillionaire. He founded Portfolio Logic, an investment firm focused on healthcare services. He was a member of Facebook’s board of directors from 2018 to 2020.His government experience was limited to the Obama administration, where he served as the country’s first chief performance officer, the acting director of the Office of Management and Budget on two occasions, and the director of the National Economic Council. His one notable public health-adjacent achievement was leading the technical rescue of the HealthCare.gov website after its catastrophic launch failure in October 2013. That was a software procurement and project management crisis, not a disease response. ABC News noted at the time of his appointment as COVID coordinator that Zients would face the pandemic’s logistical challenges with ‘no direct experience in public health.’ He was chosen for his reputation as a ‘master implementor,’ in the words of Biden advisers, not for any expertise in infectious disease, virology, epidemiology, or emergency public health operations.ABC News noted at the time of Zients’s appointment that he would face the pandemic with ‘no direct experience in public health.’ He was a management consultant and investment executive, chosen as a logistics fixer.Andy Slavitt: Healthcare Administration, Not Pandemic ResponseAndy Slavitt, who served as Senior Adviser to the COVID-19 Response Team from January through June 2021 and was the primary point of contact with the social media companies during the pressure campaign’s most aggressive early phase, had a more substantive health-sector background than Zients, but it was in healthcare administration, not pandemic preparedness. Slavitt held an MBA from Harvard and had spent a decade as an executive at UnitedHealth Group, where he led a unit that advised on the HealthCare.gov rescue alongside Zients. He then served as acting Administrator of the Centers for Medicare and Medicaid Services under Obama from 2015 to 2017, overseeing the Medicare and Medicaid programs and the ongoing implementation of the Affordable Care Act. He also served on the Obama administration’s Heroin Task Force and on Vice President Biden’s Cancer Moonshot task force.Slavitt’s qualifications for managing a pandemic response were therefore the same as Zients’s, one level down: substantial healthcare policy and administration experience, no pandemic response experience, no infectious disease expertise, and no public health emergency background. He understood how the federal healthcare financing architecture worked. He did not have training in how pathogens spread, how vaccines work, or how public health emergencies are managed at the operational level. His primary role in the pressure campaign appears to have been as the senior political official whose stature gave the demands institutional weight.Rob Flaherty and Clarke Humphrey: Political Operatives at the ControlsThe officials who actually executed the day-to-day pressure campaign were even further removed from any public health background. Rob Flaherty, who served as White House Director of Digital Strategy, had graduated from Ithaca College and worked his way up through Democratic Party digital operations. He was the Biden campaign’s digital director in 2020, having previously worked in digital communications for Hillary Clinton’s 2016 campaign. He was 30 years old at the time of the Biden inauguration. His entire professional identity was in political digital communications, full stop.Clarke Humphrey was Flaherty’s deputy, a Northwestern University journalism graduate who had worked in DNC digital fundraising before becoming Biden’s deputy digital director on the campaign. She was 28 years old on January 23, 2021, the third day of the Biden administration, when she sent a one o’clock in the morning email to Twitter demanding the removal of a tweet by a private citizen about vaccines and the death of Hank Aaron. The email that launched the most documented government censorship campaign in American history was written by a 28-year-old whose deepest prior professional experience was writing DNC fundraising copy.Humphrey was 28 years old with a background entirely in Democratic digital fundraising when she sent a 1 a.m. email on Day Three of the administration demanding Twitter remove a citizen’s post about vaccines.Vivek Murthy: The Credentialed ExceptionThe partial exception to the pattern was Vivek Murthy, who served as Surgeon General of the United States. Murthy had genuine medical credentials: a BA from Harvard, an MD from Yale School of Medicine, a combined Harvard/Yale MBA, clinical training at Brigham and Women’s Hospital and Harvard Medical School, and an academic appointment at Harvard Medical School in internal medicine. He had served as Surgeon General under Obama from 2014 to 2017, worked in HIV prevention and global health, and co-founded VISIONS, a nonprofit focused on HIV/AIDS education. He was a credentialed physician with genuine public health experience.What makes Murthy’s role in the censorship campaign analytically significant is precisely his credentials. He was used, in effect, as a legitimizing mechanism. The Surgeon General’s office issued the advisory on health misinformation that provided the nominally public-health rationale for the pressure campaign. Murthy’s credentials gave the operation a doctor’s imprimatur that Zients, Slavitt, Flaherty, and Humphrey could not provide. The specific irony is that the administration’s response to Robert Malone, one of the most credentialed scientists in the mRNA field, was to invoke Murthy’s credentials to justify suppressing Malone’s. One physician’s titles were deployed to silence another physician’s published scientific concerns. The Surgeon General’s office became, in this episode, a laundering mechanism for what was at its operational core a political communications operation.The Campaign Begins: Day ThreeThe documentary record begins on January 23, 2021, three days after the inauguration. At 1:00 a.m., Clarke Humphrey emailed Twitter to flag a tweet by Robert F. Kennedy Jr. connecting the death of Hank Aaron, who had died four days earlier at age 86, to his recent vaccination. The tweet was controversial and the claim unverified although plausible.  But the mechanism Humphrey used to address it was not a public rebuttal or a media correction. It was a direct communication from a White House official to a private company demanding the removal of a citizen’s speech. Twitter complied.This first interaction established the template that would be used for two years. The White House identifies content it disfavors. A White House official contacts a platform representative, either directly by email or through a dedicated portal that the administration subsequently pressured platforms to create. The platform removes or suppresses the content. The White House notes the compliance and, if it does not come quickly enough, escalates. The escalation emails are in the record. They use phrases like ‘we want to know that we are being heard’ and, in Flaherty’s case, the characterization that Facebook was ‘hiding the ball’ when the platform provided what the White House considered insufficient compliance data.Malone News is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.The Facebook Campaign: Coercion by EmailThe campaign against Facebook was the most extensively documented and the most aggressive. Andy Slavitt’s early 2021 emails to Facebook demanded that the platform share data on which health content was performing well enough to be boosted. The implied threat was regulatory: a company that cooperated with the White House’s informational preferences would not need to worry about the other kinds of attention the White House could direct at it.The most significant single document from the Facebook campaign is the internal Facebook communication, produced in discovery, in which a Facebook employee acknowledged that the company had capitulated to White House pressure to suppress content that was ‘often true.’ The platform’s own assessment was that the content was factually accurate. It suppressed the content anyway because the White House wanted it suppressed. This is censorship. It is the suppression of true speech at the government's direction. It is precisely what the First Amendment was designed to prevent, and the mechanism of routing the demand through a private company does not change the constitutional character of the act.Flaherty’s July 2021 email, in which he expressed frustration with Facebook’s pace of compliance by asking ‘Are you guys fucking serious?’ in response to a data report the White House found inadequate, captures the tone of the campaign’s escalation phase. This was not a government agency sharing concerns with a platform and leaving the decision to the platform’s editorial judgment. This was a government official expressing contemptuous impatience at a private company that was not complying fast enough with a government demand. The email is in the record.The Scope: YouTube, Google, and AmazonThe campaign extended well beyond Facebook and Twitter. White House officials pressured YouTube to remove content that violated what they described as COVID-19 misinformation policies, specifically directing the platform’s attention to content by conservative commentators Tucker Carlson and Tomi Lahren. They pressured Google over its search results, requesting that COVID-19 content that the administration disfavored not be surfaced in search results. They pressured Amazon to remove books from its platform that contained vaccine skepticism.The breadth of the campaign is significant because it demonstrates that this was not a targeted effort to address a specific, acute misinformation problem. It was a systematic effort to shape the information environment across every major platform through which Americans access information. The administration wanted a different information landscape, and it used the institutional weight of the White House to create one. The digital operatives who executed the campaign were doing what digital operatives do: they were running a communications operation. The difference was that they had the federal government behind them rather than a list of campaign donors.What Was Suppressed: The TargetsThe documentary record of what the administration sought to suppress is damning precisely because it demonstrates that the campaign’s targets were political as often as they were medical. The district court in Missouri v. Biden catalogued the suppressed speech with notable specificity: opposition to COVID-19 vaccines; opposition to mask mandates and lockdowns; the lab-leak theory of COVID-19’s origin; true information about vaccine side effects; satirical memes; content by specific conservative commentators including Tucker Carlson and Tomi Lahren; and the accounts and publications of epidemiologists Jay Bhattacharya and Martin Kulldorff.Bhattacharya and Kulldorff are not fringe figures. Bhattacharya was a professor of health policy at Stanford University’s School of Medicine and a senior fellow at the Stanford Institute for Economic Policy Research. Kulldorff was a professor of medicine at Harvard Medical School and a biostatistician who helped develop methods for detecting disease clusters. Both were co-authors of the Great Barrington Declaration, an October 2020 document signed by tens of thousands of medical professionals that argued for focused protection of the most vulnerable rather than broad societal lockdowns. The declaration was a legitimate scientific and policy position, but it was seriously contested by other scientists. It was not misinformation. It was a dissent from the administration’s preferred approach.The lab-leak theory occupies a particularly notable position in this catalogue. Facebook removed posts supporting the lab-leak hypothesis in February 2021, following what internal documents describe as ‘tense conversations with the new administration.’ The theory was classified as misinformation and suppressed. In June 2023, the FBI’s director publicly stated that the FBI had assessed the lab-leak theory as the most credible explanation for COVID-19’s origins. In February 2023, the Department of Energy reached the same conclusion. The hypothesis that the government suppressed as dangerous misinformation in 2021 is now treated by multiple federal intelligence and scientific agencies as most probably correct.Facebook began removing the lab-leak theory in February 2021 following ‘tense conversations with the new administration.’ Months later, the FBI assessed the lab-leak theory as the most credible explanation for COVID-19’s origins.The Foreign Hand: CCDH, the Disinformation Dozen, and the UK Labour ConnectionAmong the most constitutionally significant elements of the Biden censorship campaign is the role played by the Center for Countering Digital Hate, a British nonprofit that served as a critical input provider for the White House’s target selection. CCDH was incorporated in 2018 as Brixton Endeavours Limited, co-founded by Imran Ahmed and Morgan McSweeney. McSweeney was at the time a Labour Party strategist who had worked as an advisor to two Labour shadow cabinet ministers. Ahmed had previously served as an advisor to Labour politicians, including the shadow Home Secretary.In April 2020, two days after Keir Starmer was elected Leader of the Labour Party, McSweeney departed the CCDH board and became Starmer’s chief of staff. He would eventually serve as Downing Street Chief of Staff following Labour’s 2024 general election victory, a position he held until his resignation in February 2026. The organization he co-founded, whose stated mission was to counter digital hate and disinformation, maintained direct relationships with U.S. government agencies. CCDH’s head of policy held documented meetings with the Department of Homeland Security, the White House, the National Safety Council, and the State Department Bureau of Counterterrorism.In March 2021, CCDH published a report titled ‘The Disinformation Dozen,’ claiming that twelve named American citizens were responsible for approximately 65 percent of vaccine misinformation on social media. The report reached Twitter’s trust and safety team within days of publication and was cited by White House Press Secretary Jen Psaki from the podium in July 2021. Rob Flaherty used it directly in his pressure emails to Facebook, citing the Disinformation Dozen framing to justify demands for specific account removals. Facebook’s vice president for global affairs, Monika Bickert, publicly criticized the report’s methodology as ‘free of evidence,’ noting that the claimed attribution figure was off by approximately a factor of three hundred.CCDH was co-founded by Morgan McSweeney, who would become Downing Street Chief of Staff under Keir Starmer. A British partisan operation was providing the Biden White House with its censorship target lists for American citizens.Whistleblower testimony before Congress in 2022 alleged that CCDH had provided Twitter with word lists for content censorship and that the CDC had played a role in compiling those lists. The House Judiciary Committee subpoenaed CCDH in August 2023. America First Legal filed a Foreign Agents Registration Act complaint. As of early 2026, Imran Ahmed was facing potential deportation proceedings. The constitutional dimension is worth stating with precision: a British nonprofit co-founded by the man who would become the British Prime Minister’s chief of staff provided hit lists that a U.S. administration used to suppress the speech of American citizens on American platforms. The First Amendment question this raises is not a hypothetical. It is a documented fact pattern that the Supreme Court declined to adjudicate on the merits.Dr. Robert Malone and the Suppression of Scientific DissentThe suppression of Dr. Robert Malone warrants specific examination because it illustrates the campaign’s willingness to target credentialed scientists whose dissent was rooted in genuine expertise rather than political motivation. Malone’s scientific background is a relevant context that the campaign’s characterization of him systematically obscured.From 1987 through 1989, working at the Salk Institute for Biological Studies, Malone conducted experiments that Nature would later describe as landmark: he demonstrated that lipid nanoparticles could be used to transfect cells with messenger RNA, meaning that synthetic RNA encased in fat particles could enter cells and cause those cells to produce specified proteins. His work with Philip Felgner and colleagues at Vical, documented in a 1989 PNAS paper, a 1990 Science paper, and in patent filings from the same period, established the foundational proof-of-concept (including reduction to practice in mice) for what would eventually become the mRNA vaccine platform. He holds an MD from Northwestern University’s Feinberg School of Medicine and completed postdoctoral training at both UC Davis and Harvard Medical School. He has published approximately 100 peer-reviewed papers, with more than 15,000 citations.It is important to be precise about what Malone actually claimed, because the mischaracterization of his claim became a weapon used against him. Malone did not claim to be the sole inventor of mRNA vaccines. He consistently and specifically claimed to be an original inventor, one of the founding contributors to the technology, whose 1988-89 experiments at the Salk Institute and Vical established the proof-of-concept on which all subsequent mRNA vaccine development rested. That claim is fully consistent with the historical record. Credit for the technology, as deployed in the Pfizer and Moderna vaccines, also goes to Verma, Felgner, Jon Wolff, and, Katalin Karikó and Drew Weissman, whose work a decade later on modified nucleosides to prevent the immune system from rejecting synthetic mRNA contributed to clinical viability. Malone has never disputed those contributions. The question of who deserves how much credit for a decades-long chain of scientific development is a legitimate conversation within the field. What it is not is a basis for characterizing Malone as a fraud, a grifter, or a spreader of misinformation about his own biography.On December 29, 2021, Twitter permanently suspended Malone’s account, citing ‘repeated violations of COVID-19 misinformation policy.’ The platform declined to specify which posts had violated the policy. LinkedIn permanently banned Dr. Malone on the same day, December 29, 2021.  Clearly these coordinated bans were directed by the government.  The permanent bans came approximately two days before Malone’s December 31 appearance on Joe Rogan’s podcast, which drew tens of millions of viewers and in which Malone raised questions about the safety and necessity of mRNA vaccine mandates, particularly for populations at low risk from COVID-19 itself. Many believe that the government had become aware of the upcoming Rogan podcast and was acting to kill Malone’s accounts before the Rogan interview went public.In February 2022, White House Press Secretary Jen Psaki called on Spotify from the podium to take action against the Rogan interview. YouTube subsequently removed the interview. The administration was not suppressing a conspiracy theorist when it moved against Malone. It was suppressing one of the founding scientists of the technology, whose safety and necessity he was questioning.The administration was not suppressing a conspiracy theorist when it moved against Malone. It was suppressing one of the founding scientists of the technology whose safety and necessity he was questioning.The subsequent scientific record bears noting. Concerns about myocarditis risk in young males following mRNA vaccination, which Malone raised and which were among the bases for his Twitter ban, were subsequently validated by the CDC itself. Sweden, Denmark, Finland, and Norway all restricted or recommended against mRNA vaccination in younger males on this basis. These restrictions did not represent the kind of sweeping skepticism Malone’s critics attributed to him. They represented precisely the kind of population-specific, risk-stratified analysis that serious scientists engage in. The administration suppressed that analysis and then watched the CDC and multiple allied health authorities reach conclusions consistent with it.The Legal Resolution: Standing Without AccountabilityMissouri Attorney General Eric Schmitt and Louisiana Attorney General Jeff Landry filed suit in May 2022 against the Biden administration, alleging that the White House and multiple federal agencies had violated the First Amendment by coercing private platforms to suppress speech. The case, Missouri v. Biden, proceeded through discovery that produced the email record described above. District Judge Terry Doughty issued a preliminary injunction in July 2023, cataloguing the suppressed speech and finding that the plaintiffs had shown a substantial likelihood of success on the merits. The Fifth Circuit Court of Appeals, reviewing the record, agreed that the government’s communications with the platforms constituted unconstitutional coercion on multiple specific points.The Supreme Court granted certiorari, heard argument in Murthy v. Missouri, and issued its decision in June 2024. Six justices, in an opinion by Justice Amy Coney Barrett, dismissed the case on standing grounds. The majority held that the plaintiffs had not adequately demonstrated that their specific speech injuries were traceable to specific government actions rather than to the platforms’ independent editorial decisions. The constitutional question of whether the government’s conduct violated the First Amendment was left formally unresolved.Justice Samuel Alito, joined by Justices Thomas and Gorsuch, dissented pointedly. Alito argued that efforts by the government to dictate or suppress speech are ‘presumptively unconstitutional’ and that the majority’s standing analysis failed to grapple with the reality that the government’s campaign had produced concrete, lasting effects on real people’s ability to speak. Alito characterized government censorship of private speech as antithetical to the country’s democratic form of government. The three conservative dissenters understood what the majority’s procedural dodge obscured: this case was about whether the executive branch can use its regulatory and political power to outsource censorship to private companies. The answer, as a constitutional matter, remains unresolved.Rothbard’s Prediction: The Judiciary as Legitimizing InstitutionThe outcome in Murthy v. Missouri would not have surprised Murray Rothbard. In The Anatomy of the State, first published in 1974 and drawing on his earlier work in Man, Economy, and State, Rothbard advanced an analysis of the state’s institutional structure that reads, fifty years later, as an uncomfortable gloss on the Supreme Court’s handling of the censorship case. Rothbard’s central argument was that the state cannot survive by force alone. A government that operated openly as a coercive apparatus, with no claim to legitimacy beyond its monopoly on violence, would eventually face resistance and revolt. The state, therefore, requires an intellectual class whose function is to provide the ideological covering fire that transforms raw power into apparent authority.The judiciary occupies a specific and critical role in Rothbard’s analysis. The constitutional design, Rothbard argued, contains a fatal structural flaw: it asks the state to be the final arbiter of its own power. The Supreme Court is a government institution, staffed by government appointees, funded by government appropriation, and operating within the interpretive framework the government itself has constructed over centuries of precedent. Asking such an institution to consistently rule against the state’s expansion of power is, in Rothbard’s analysis, asking it to act against its own nature and interests. The judiciary does not limit the state; it legitimizes the state by translating governmental power into the language of constitutional principle, making what is essentially political authority appear to flow from neutral legal reasoning.Rothbard argued that asking the state to be the final arbiter of its own power is a fatal structural flaw. The judiciary translates political authority into constitutional principle making coercion appear to follow from neutral law.Rothbard drew explicitly on John C. Calhoun’s earlier critique in A Disquisition on Government, where Calhoun argued that any government empowered to interpret the limits of its own authority will inevitably interpret those limits in its own favor. The remedy Calhoun proposed (concurrent majority and nullification) is not one most conservatives would embrace today, but the diagnostic observation is harder to dismiss. The Supreme Court’s record since the New Deal is, on Rothbard’s reading, precisely what structural theory predicts: a pattern of rulings that, with occasional corrections at the margins, has consistently expanded the scope of federal authority and provided constitutional legitimacy to programs and powers that the founding generation would not have recognized as constitutionally grounded.Murthy v. Missouri fits this pattern with uncomfortable precision. The factual record before the Court was uncontested: senior White House officials had engaged in a sustained, documented campaign to pressure private companies to suppress citizen speech. The First Amendment question this raised was, as Alito’s dissent argued, both serious and clearly presented. The majority’s resolution, dismissing on standing grounds, leaving the constitutional question formally open, and effectively allowing the documented conduct to go unaddressed, is precisely the kind of outcome Rothbard’s framework predicts. The Court did not rule that the government’s censorship campaign was constitutional. It ruled, in effect, that the plaintiffs could not prove the right kind of injury in the right way to answer the question. The state’s conduct was neither condemned nor authorized. It was laundered through procedural doctrine into a form of legal non-accountability.The Alito dissent is worth reading in Rothbardian terms as well. Alito, Thomas, and Gorsuch represent the internal critics within the institution: the justices who are attempting to use the court’s own tools to check rather than legitimize state power. Rothbard would have predicted their marginalization. A three-justice dissent in a six-three ruling does not constrain the executive branch’s future conduct; it produces a law review article. The dissent names the problem with analytical precision and has no operative effect on the government’s capacity to engage in the same conduct in the next crisis with a different cast of officials and a different platform as the vehicle. The constitutional question Alito identified as urgently requiring resolution will not be resolved unless the Court’s composition or its institutional incentives change sufficiently to produce a different majority.The conservative reckoning with Murthy requires taking both the specific outcome and the structural lesson seriously. The specific outcome was the Court's failure to discharge its most basic function in a case where the factual record was unusually complete and the constitutional principle unusually clear. The structural lesson is Rothbard’s: judicial review is a necessary but radically insufficient constraint on executive power. A government that is sufficiently patient, sufficiently willing to use procedural doctrine as a shield, and sufficiently confident of a sympathetic appointment structure can engage in conduct that would be clearly unconstitutional on the merits and face no legal accountability whatever. The First Amendment did not prevent the Biden administration’s censorship campaign. It did not prevent it because the enforcement mechanism the judiciary is, as Rothbard argued, part of the same institutional structure it is supposedly constraining.None of this is an argument for abandoning constitutional litigation as a check on executive power. The Alito dissent matters. The Fifth Circuit’s earlier ruling mattered. District Judge Doughty’s preliminary injunction mattered. Legal accountability, imperfect and incomplete as Rothbard would insist it must be, is better than no legal accountability. But the conservative lesson of Murthy v. Missouri is not that the system worked. It is that the system requires supplements: a Congress willing to use appropriations and oversight power to address what the courts decline to reach, a press willing to report without editorial capture, and a citizenry that understands that the First Amendment is only as strong as the institutions willing to enforce it against the people who control those same institutions.Sources and NotesThis series draws on: court filings and discovery documents in Missouri v. Biden / Murthy v. Missouri (W.D. La. 2022, 5th Cir. 2023, S. Ct. 2024); the House Judiciary Committee’s report “The Censorship-Industrial Complex” (2024); Missouri Attorney General’s litigation documents and press releases; reporting by the Wall Street Journal, CNN, STAT News, the Washington Times, and National Review; testimony before the House Select Subcommittee on the Coronavirus Pandemic (March 2024) and the House Weaponization of the Federal Government Subcommittee (May 2024); official White House fact sheets and archived Biden White House pages; the Supreme Court’s opinion in Murthy v. Missouri, 603 U.S. 43 (2024); the AEI op-ed co-authored by former OPPR staff (August 2025); and Think Global Health analysis of OPPR’s demise (2025). Direct quotations from emails are drawn from court documents and congressional records.Thanks for reading Malone News! This post is public so feel free to share it.ShareIn Part 2 of this series,Congress Builds a Safety NetThe Creation of OPPR, the Constitutional Limits of Federal Health Authority, and What the Office Actually Accomplished

Summary: The Biden White House Speech Suppression Campaign, the CCDH Connection, and the Failure of Judicial Accountability


Dismantling by Attrition (Part 3)

The Trump administration inherited a functioning, congressionally mandated pandemic planning organization in January 2025. The Office of Pandemic Preparedness and Response Policy had a director, a deputy, more than twenty professional staff, an active interagency coordination structure across seven federal agencies, a $766 million vaccine development program in mid-execution, a completed Biological Incident Response Playbook, and a statutory reporting obligation to Congress. By the end of June 2025, the office was empty. The Moderna contract had been cancelled. The interagency calls had stopped. The playbook sat in a drawer with no institution left to implement it.This installment documents how that happened, evaluates the administration’s stated rationale against the legal and actuarial record, and asks what a principled conservative analysis of both parties’ pandemic governance failures requires. The answer is uncomfortable. The Biden administration’s censorship campaign was a genuine abuse of executive power, documented in detail and insulated from legal accountability by a Supreme Court majority that rendered it procedurally non-accountable. That said, the Trump administration’s attrition of a congressionally mandated statutory institution is not conservatism. It is the administrative state behaving exactly as conservatives have always said it behaves: unaccountable, non-transparent, and indifferent to law when the law is inconvenient. Both things are true. Sorting them out requires taking both seriously.This installment also addresses the specific threat landscape with the precision it requires. H5N1, in its current form, is poorly infectious in humans, and evidence of human-to-human transmission remains negligible. The current outbreak is an agricultural and animal health problem, not an imminent pandemic. The point is not that H5N1 is the next COVID-19. The point is that the institutional infrastructure capable of monitoring whether it becomes more dangerous, coordinating surveillance across USDA, FDA, and CDC, and maintaining the countermeasure programs that would be needed if the virus adapts, is the same infrastructure the current administration has allowed to go dark. Dismantling that capacity, even though the current threat profile is manageable, is the institutional equivalent of canceling flood insurance after a dry summer.Malone News is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.PART THREEThe Trump Administration and OPPR: Legal Constraints and Policy ChoicesThe Stated Intent and the Legal RealityDonald Trump had been explicit during the 2024 campaign about his view of OPPR. He described it as an “expensive solution to something that won’t work” and a “way of giving out pork.” This skepticism is consistent with a broader conservative critique of administrative state expansion: that Congress too readily creates new offices, staffed with unelected bureaucrats, that accumulate authority without accountability and tend to expand their mandates beyond their original justifications.The problem with applying that critique to OPPR is that the legal constraint is real and does not disappear because a president finds an office philosophically objectionable. As Georgetown law professor Lawrence Gostin observed, “if Congress has set up an agency, he can’t dismantle it or transform it into another.” The executive branch has substantial discretion in how it implements statutory mandates: it can staff an office minimally, deprioritize its work, and resist expanding its budget. What it cannot do, without congressional action, is simply abolish a congressionally mandated institution.This legal reality shaped the administration’s approach. Rather than a formal abolition, what occurred was a gradual attrition: the refusal to appoint a director, the failure to replace departing staff, the migration of pandemic preparedness functions to the NSC where they are shielded from public transparency, and the implicit institutional abandonment of a statutory office that the administration lacked the legal authority to formally close.Gerald Parker and the NSC MigrationShortly after inauguration, the White House quietly hired Dr. Gerald Parker, a veterinarian with 26 years of Army service and deep expertise in zoonotic diseases. Parker had served as commander of the U.S. Army Medical Research Institute of Infectious Diseases and had chaired the National Science Advisory Board for Biosecurity under Biden. His background in One Health, the integrated study of human, animal, and environmental health interactions, made him a credible choice for managing the H5N1 challenge.But Parker was placed at the NSC as Senior Director for Biosecurity and Pandemic Response, not installed as OPPR’s director. He was never formally appointed to the statutory position the PREVENT Pandemics Act requires be filled. His work was done within the NSC, whose records are shielded from FOIA requests under the Presidential Records Act. The practical effect was to move pandemic preparedness coordination from a transparent, congressionally accountable statutory office into an executive office that operates largely outside public view.Parker resigned in July 2025 after approximately six months. Reports indicated he had received little institutional support from his superiors. His departure left both the nominal OPPR and the NSC’s biosecurity directorate without senior leadership simultaneouslyThe Shift in H5N1 Policy: Economics Over EpidemiologyThe change in OPPR’s operational posture was visible most clearly in the H5N1 response. OPPR under Biden had prioritized infection surveillance, protection of agricultural workers at the human-animal interface, and maintaining readiness to scale up the medical countermeasure response if the virus showed signs of adapting toward human-to-human transmission. The scientific rationale was straightforward: H5N1’s current low risk to the general public depends on its current inability to transmit efficiently between humans. That could change. Preparation for that potential change is the entire point of pandemic preparedness.The Trump administration reorganized the H5N1 response around a different priority: egg prices. Agriculture Secretary Brooke Rollins announced a $1 billion strategy to combat avian flu, framed explicitly around “delivering affordable eggs” rather than containing a pathogen with pandemic potential. The $590 million contract for Moderna's mRNA vaccine came under review. The interagency coordination calls that Friedrichs had established stopped.The Demise: By AttritionThe Trump administration had inherited six OPPR staff members who had not departed with the transition of political appointees. One by one, without replacement, they left. The last career official in the office departed in late June 2025. By summer 2025, OPPR was empty, the NSC’s biosecurity directorate was empty, and the $766 million Moderna contract had been cancelled. The Playbook for Biological Incident Response sat unused. The interagency coordination infrastructure built during four years of H5N1 response had dissolved.The pattern has a historical precedent that should give conservatives pause. In 2018, the first Trump administration disbanded the NSC’s Global Health Security and Biodefense directorate, the predecessor coordination function. COVID-19 arrived two years later. The connection between those two events is disputed, but the temporal proximity is uncomfortable. Congress responded to that experience by mandating OPPR. The second Trump administration is repeating the same institutional abandonment that preceded the first administration’s most significant pandemic governance failures.The Constitutional and Statutory QuestionsThe legal situation created by the administration’s approach to OPPR is genuinely complex and deserves serious attention from conservatives who care about the separation of powers. The executive branch is defying a statutory mandate not through a formal legal challenge or a request for congressional repeal but through the bureaucratic equivalent of malicious compliance: maintaining the nominal existence of the office while ensuring it cannot function.Congress has tools available. It could condition appropriations on OPPR staffing levels. It could require quarterly reports from OPPR that cannot be produced if the office is empty, triggering automatic reporting of non-compliance. It could hold confirmation proceedings that force the administration to either nominate a director or publicly explain why it is refusing to comply with the statute. It has not used any of these tools. The blame for the current situation is not the executive branch’s alone.The failure of Congress to enforce its own statutory mandate raises a broader institutional question that conservatives have long identified: oversight mechanisms only work if the institution empowered to use them has the political will to do so. The PREVENT Pandemics Act created the oversight architecture. Congress has allowed that architecture to sit dormant while the executive branch hollows out the institution it was designed to oversee.CONCLUSIONRestraint, Accountability, and the Conservative ReckoningLet’s start with what is not in dispute. The Biden White House ran a sustained, documented campaign to pressure the largest technology platforms in the world into suppressing speech its political operatives found inconvenient. That campaign was run day-to-day by people whose qualifications were in Democratic Party digital fundraising, not public health. Its targets were disproportionately conservative: scientists who questioned lockdown orthodoxy, commentators who challenged vaccine messaging, a hypothesis about the virus’s origins that federal intelligence agencies would later assess as most probably correct. The government outsourced censorship to private companies, insulated itself from direct constitutional liability through that intermediary structure, and then watched a 6-3 Supreme Court majority dismiss the resulting lawsuit on standing grounds without reaching the merits. Murray Rothbard would have recognized every move.The Dobbs decision, handed down the same year the censorship lawsuit was filed, provided the constitutional vocabulary for understanding what was structurally wrong with the Biden approach to pandemic governance. The federal government has no general police power over health. Direct control of medical practice in the states is beyond its authority. The decisions made during COVID-19 about what citizens could read, what scientists could publish, and what hypotheses social media platforms were permitted to host were precisely the kind of medical and informational governance that Dobbs, NFIB v. OSHA, and the deeper logic of the Tenth Amendment place outside the federal government’s legitimate reach. The censorship campaign was not merely an ethical failure. It was a constitutional one. The machinery of the executive branch was deployed to control the national information environment in a domain where the executive branch had no business asserting control.The case against that conduct is clear-cut. The case regarding OPPR is harder, and conservatives who want to be taken seriously on the first question must be honest about the second. OPPR was created by a bipartisan act of Congress. It was given a specific statutory mandate. It was staffed by credentialed professionals, and it performed real work: coordinating the H5N1 response across seven federal agencies when no individual agency had the authority to do so; managing a $766 million Moderna mRNA vaccine development program; building the Bio-5 Alliance to address the supply chain fragilities that COVID-19 had exposed; completing the Biological Incident Response Playbook that now sits in a drawer with no institution left to implement it. These were not bureaucratic make-work projects. They were the kind of pre-crisis preparation that has no visible constituency until the crisis arrives.The Trump administration allowed OPPR to go dark not through a formal legal challenge or legislative repeal but through administrative attrition. It never appointed a director. It never submitted a budget. The six inherited staff departed by the end of June 2025. The interagency coordination calls stopped. The Moderna contract was cancelled. The office is, by every functional measure, empty. The president who made this choice is the same president who disbanded the NSC’s Global Health Security directorate in 2018, after which COVID-19 arrived in 2020. Congress responded to that episode by passing the PREVENT Pandemics Act in 2022. The pattern is not ambiguous. The institutional memory is being discarded in the same way it was discarded before, by the same administration, with the same confidence that the next emergency will not come before the political costs of preparedness exceed the political costs of unreadiness.Conservatives who believe in constitutional governance should find this troubling. Pandemic preparedness is not a liberal cause. It is a readiness function, like a standing army or flood control infrastructure. The question is not whether the government should perform it. The question is whether it will.Rothbard’s analysis of the state’s institutional tendency toward self-perpetuation and legitimization applies here with unsettling force, though not in the direction his libertarian framework usually points.The administrative state’s characteristic vice is expansion: the accumulation of authority, the multiplication of mandate, the permanent bureaucratic class that cultivates dependence on its own continued existence. But the administrative state has a second characteristic failure mode that receives less attention: the selective abandonment of functions that have powerful constituencies inside the government but weak ones outside it. Pandemic preparedness has no lobby. There is no industry that profits from the existence of an empty White House office. There is no vocal constituency demanding that the Biological Incident Response Playbook be staffed and exercised. The political economy of preparedness is therefore structurally disadvantaged relative to the political economy of response: the money flows after the emergency, not before it, which means the institutions that exist to prevent the emergency from being catastrophic are perpetually underfunded, understaffed, and vulnerable to the next administration’s indifference.Congress built a mechanism to counteract exactly this tendency. The statutory reporting requirements in the PREVENT Pandemics Act were designed to make the consequences of neglect visible and aviodable before the next infectious disease outbreak. An OPPR that delivered biennial preparedness reviews and five-year outlook reports to Congress was an OPPR that created a public record of gaps, vulnerabilities, and risks, a record that elected officials could be held accountable for ignoring. An empty OPPR produces no such record. The reporting obligation is set out in the statute. The office that would fulfill it does not exist in practice. Congress is being denied information that an Act of Congress requires to be provided. The executive branch is not being challenged on this failure by a Congress that created the mechanism and then forgot to enforce it.The remedies are available and not particularly exotic. Congress can condition appropriations on OPPR staffing levels. It can require quarterly reports that trigger automatic non-compliance findings when they are not produced. It can hold confirmation proceedings that force the administration to either nominate a director or publicly explain its refusal. Senator Burr’s successors on the Senate Health Committee have the same tools he used to create the office. They have not used them. The blame for the current situation belongs to both ends of Pennsylvania Avenue.The reckoning this moment requires is not comfortable. It demands acknowledging that the Biden administration’s censorship campaign represented a genuine abuse of executive power, one that was insulated from legal accountability by the same structural capture of judicial institutions that Rothbard diagnosed and that the Murthy majority demonstrated. It demands acknowledging, simultaneously, that the Trump administration’s approach to a congressionally mandated preparedness institution represents not conservative governance but the same administrative indifference to law that conservatives have spent decades criticizing when the left practices it. And it demands acknowledging that pandemic preparedness properly understood, properly limited to the federal government’s legitimate constitutional role, disciplined against the mission creep that the Biden experience illustrates, is not big government. It is the basic obligation of a government that claims to take national security seriously.The specific threat landscape matters, and precision requires acknowledging it. H5N1 in its current form is poorly infectious for humans, and the evidence for human-to-human transmission remains negligible. The current outbreak is an agricultural and animal health problem of genuine concern, not an imminent pandemic. The point is not that H5N1 is the next COVID-19. The point is that the institutional infrastructure capable of making that determination authoritatively, monitoring viral evolution, coordinating surveillance across USDA, FDA, and CDC, maintaining the supply chain and countermeasure programs that would be needed if the virus did adapt, is the same infrastructure the current administration has allowed to go dark.The value of preparedness institutions is not that they predict the specific threat. It is that they maintain the capacity to respond to threats that cannot be predicted.Dismantling that capacity, even though the current threat profile is manageable, is the institutional equivalent of canceling flood insurance after a dry summer.Thanks for reading Malone News! This post is public so feel free to share it.Share

Summary: The Trump Administration, the Death of OPPR, and the Reckoning Both Parties Have Avoided


What the Whooping Cough Numbers Actually Show

The United States government recommends that pregnant women receive the Tdap vaccine (tetanus, diphtheria, and acellular pertussis) during every pregnancy. It also recommends that parents, grandparents, and caregivers of newborns get vaccinated, a strategy known ascocooning.The rationale is straightforward: whooping cough kills infants, infants cannot be vaccinated until two months of age, and these two strategies may provide a protective bridge during that gap.What is less straightforward is the evidence behind these recommendations, and what it actually tells us about benefit, cost, and risk. A detailed comparative review article attached below this summary examines both strategies side by side using the metrics that clinicians and health economists use internally but that public health communication routinely omits: absolute risk reduction, number needed to vaccinate, cost per outcome prevented, and number needed to harm. The findings are more nuanced than the official messaging suggests.This summary presents those findings in plain language, with objective, fact-based analysis of both the strategies being promoted and the institutional confidence with which they are marketed and endorsed by CDC and ACIP.THE PROBLEMWhy Newborns Are Vulnerable, and Why the Numbers MatterWhooping cough is most dangerous in the first three months of life. The standard childhood vaccination schedule does not begin until two months of age, leaving every newborn unprotected for their most vulnerable window. In the United States between 2013 and 2022, 57% of pertussis-related deaths occurred in infants younger than two months.But before we assess any solution, we need to know how large the problem actually is in absolute terms: not in relative terms, not in emotional terms, but in raw numbers. The current risk figures in the contemporary United States are:These are not large numbers. In a country of roughly 3.6 million births per year, approximately 1,800 infants contract pertussis in the first eight weeks, roughly 2,000 are hospitalized for it across the full first year, and somewhere between 5 and 18 infants die from it annually. That is devastating for the families involved, but rare in population terms. This context is not a reason to dismiss the strategies. It is a reason to evaluate them honestly.STRATEGY ONECocooning: The Idea That Never Really WorkedThe cocooning strategy was endorsed by the Advisory Committee on Immunization Practices in 2005. The idea is intuitive: vaccinate everyone in close contact with the newborn, and you create a protective ring of immune people around the baby. In theory, it is compelling. In practice, it has largely failed.Why It Fails in TheoryFor cocooning to work, two things must be true. First, enough of the infant’s infections must originate from vaccinated contacts for the vaccination to make a difference. Studies estimate that household contacts account for 35% to 75% of infant infections, a wide and uncertain range. The remaining 25% to 65% come from casual contacts that cocooning cannot reach at all.Second, the adult whooping cough booster (Tdap) must maintain sufficient protection long enough to matter. Here the evidence is discouraging. Studies show the booster provides roughly 69% protection in the first year, falling to less than 9% after four years. Parents vaccinated at the birth of their first child offer almost no protection by the time a second child arrives.Why It Fails in PracticeTo achieve meaningful herd protection through cocooning, vaccination coverage among all close contacts would need to reach 92% to 94%. No published program has come close to this. Real-world data from Switzerland found vaccination rates among parents ranged from 61% to 69%, dropping to 18% among uncles, 13% among aunts, and just 7% among grandparents. The coverage required for the theory to hold does not exist in the real world.By 2011, the ACIP itself acknowledged that cocooning alone was insufficient to prevent pertussis morbidity and mortality in newborns. That conclusion, rendered more than a decade ago, has not prevented continued official endorsement of the strategy as a supplement.The Numbers: What Cocooning Would Cost to Prevent One Death“To prevent one infant pertussis death through parental cocooning, more than one million parents would need to be vaccinated under low-incidence conditions.”Skowronski et al., Clinical Infectious Diseases, 2012This figure, derived from Canadian provincial surveillance data using a transparent formula, is not an outlier. It reflects the mathematical reality of multiplying a very low absolute baseline mortality rate (less than 0.0005% per birth) by a strategy that addresses only a fraction of sources. A parallel Italian analysis reached the same conclusion.Published cost-effectiveness analyses confirm this picture. In the most detailed US comparison, Terranella and colleagues found cocooning costs approximately $1,172,825 per quality-adjusted life year (QALY) saved, which is roughly seven times the standard US willingness-to-pay threshold of $100,000 to $159,429 per QALY. A Spanish cost-benefit analysis found a return of just $0.04 for every $1.00 spent on cocooning.A federal class action lawsuit illustrates precisely this gap between advertising claim and scientific reality. InDeCostanzo v. GlaxoSmithKline(E.D.N.Y., filed 2020), lead counsel Aaron Siri of Siri & Glimstad LLP brought a class action against GlaxoSmithKline (GSK) over the company’s “Big Bad Cough” advertising campaign for its Boostrix Tdap vaccine. The campaign ran from 2015 to 2020 and featured anthropomorphic wolves, including a grandparent who transforms into a wolf upon cradling a newborn grandchild, conveying that unvaccinated adults are a mortal threat to infants. Plaintiff Lori DeCostanzo alleged that GSK’s advertising falsely implied that Boostrix would prevent recipients from becoming infected with and transmitting pertussis bacteria, when in fact acellular pertussis vaccines are known to reduce symptoms in the vaccinated person without reliably blocking asymptomatic colonization or onward transmission. A New York district court denied GSK’s motion to dismiss in 2022, finding it plausible that GSK had a “special relationship” duty to give consumers correct information and that the plaintiff had suffered a cognizable injury. GSK settled the case in 2026 without admitting wrongdoing, offering class members $10 to $50 in compensation. The settlement notice explicitly clarified that the plaintiff did not challenge the safety or efficacy of Boostrix in protecting vaccine recipients; the case was solely about the transmission-blocking claims that underpinned the cocooning marketing strategy. That distinction is precisely the one the scientific literature had already drawn: acellular pertussis vaccines protect the recipient but do not reliably protect others.Bottom line on cocooning:The strategy is theoretically reasonable but practically undeliverable at the required coverage levels and economically indefensible as a primary infant-protection measure in low-incidence settings. Its continued recommendation as a supplement is defensible only if the costs to individuals and healthcare systems are acknowledged honestly.STRATEGY TWOMaternal Vaccination: Better Evidence, but Read the Small PrintMaternal Tdap vaccination during the third trimester of pregnancy is a fundamentally different strategy. When a pregnant woman receives the vaccine between 27 and 36 weeks of gestation, her immune system produces pertussis antibodies that cross the placenta and enter the fetus. The baby is born already carrying its mother’s immunity, protecting it from day one, before its own vaccination series begins at two months.The evidence for this strategy is meaningfully stronger than for cocooning. Multiple large studies from the United States, United Kingdom, and Wales have found it effective. It is logistically simpler, requiring vaccination of one person at a predictable antenatal visit rather than a household network of uncertain composition. And it protects the infant not just from household contacts but from any source of infection, because the protection is conferred directly on the baby.All of this is true. But the way effectiveness is communicated by government agencies and medical bodies deserves scrutiny.The Headline vs. the RealityOfficial communications uniformly reportrelative effectiveness:the vaccine is “78% effective” at preventing pertussis cases in infants under 2 months and “91% effective” against hospitalization. These figures, derived from high-quality studies, are accurate. They are also systematically incomplete without the corresponding absolute figures.A relative risk reduction tells you how much smaller the risk becomes as a percentage. An absolute risk reduction tells you how many fewer people actually experience the outcome. When baseline risk is low, as it is for infant pertussis in the contemporary United States, even large relative reductions correspond to small absolute changes. This is not a flaw in the vaccine. It is a mathematical reality that belongs in every patient conversation.What these numbers mean in practical terms: if you vaccinate 3,333 pregnant women who would otherwise be vaccinated postpartum, you prevent approximately one infant pertussis case in the first eight weeks. Vaccinating 217,000 pregnant women prevents approximately 1 infant death from pertussis. These are population-level benefits, not individual-level guarantees, and they should be communicated as such.Patients told 'this vaccine prevents 91% of hospitalized cases” and patients told ‘vaccinating 1,923 pregnant women prevents one hospitalization’ are receiving the same information in very different forms. The first framing produces compliance. The second produces informed consent.THE COSTS AND RISKSThe economic picture for maternal vaccination is substantially more favorable than for cocooning, but still requires honest presentation. Recent US decision-analytic models estimate strategy costs ranging from $7,601 to $414,523 per QALY saved, depending heavily on model assumptions and on whether the benefit of protecting the vaccinated mother herself is included.The lower figure ($7,601/QALY) comes from analyses that count both infant protection and maternal protection as benefits. The higher figure ($414,523/QALY, exceeding the standard US threshold of $100,000–$159,429/QALY) comes from models that evaluate the strategy solely for infant protection, the stated purpose of the recommendation. The difference is not trivial. Policymakers and patients should know which framing underlies the cost-effectiveness claim.The estimated cost per infant death prevented (the most emotionally resonant outcome) is approximately$14 million to $22 millionfor maternal vaccination and>$65 million to $100 millionfor cocooning. These are order-of-magnitude estimates based on US vaccine costs ($65–$100 per dose, including administration) and modeled NNV figures. They are not small numbers, and they are almost never disclosed in public health communications about these programs.The Safety Signal That Should Be on the Consent FormOne large observational study (Layton et al., 2017) following over one million pregnancies found a small statistical association between maternal Tdap and two adverse outcomes that are rarely mentioned in patient-facing materials:Chorioamnionitis(inflammation of the fetal membranes): 3.3% in vaccinated women versus 3.0% in unvaccinated women. Absolute risk difference: 0.3 percentage points. Implied number needed to harm (NNH): approximately333.Postpartum hemorrhage:2.9% in vaccinated versus 2.4% in unvaccinated. Absolute risk difference: 0.5 percentage points. Implied NNH: approximately200.IMPORTANT CONTEXT: These signals have not been replicated in randomized controlled trials. Multiple independent studies, including a large British national program evaluation, have not confirmed them. The most plausible explanation is detection bias: vaccinated women have more prenatal healthcare contact and are therefore more likely to have these conditions diagnosed. The Canadian regulatory review concluded there is no confirmed increased risk. The signals are probably not real causal effects. But they should be disclosed to patients regardless, because patients cannot make informed decisions about information they are not given.If the chorioamnionitis signal were confirmed as causal, the NNV-to-NNH calculation becomes uncomfortable for the mortality endpoint specifically: NNV of 217,000 to prevent one infant death, versus NNH of 333 to cause one chorioamnionitis case. That ratio (652:1 in favor of harm for those two endpoints) does not mean the vaccine is harmful overall; chorioamnionitis is not equivalent to infant death. But it is precisely the kind of number that informs risk-benefit conversations, and it belongs in those conversations.THE COMPARISONHead to Head: What the Evidence Actually ShowsTHE BOTTOM LINEMalone News is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.Read more

Summary: A plain-language review of two vaccine strategies for protecting newborns, with the costs included


Geneva Convention and Forever Wars

What has changed in modern warfare is not just technology. It is constraint.The rules governing armed conflict, shaped in large part by theGeneva Conventions, place real limits on how force can be applied. These limits are not theoretical. They operate in real time, at the level of the individual soldier, the pilot, the commander, making a targeting decision. They shape what can be done, when it can be done, and often whether it can be done at all.You cannot strike unless you can distinguish the combatant from the civilian. You cannot proceed if the anticipated civilian harm is judged disproportionate to the military objective. You are expected to accept a degree of tactical risk to reduce risk to noncombatants, ergo civilians.In practice, this translates into hesitation, verification, legal review, and delay. It means fewer overwhelming blows and fewer moments where force is applied in a way that collapses the opponent’s system all at once.Historically, wars were often ended by a concentration of force. Infrastructure was destroyed, supply lines were severed, and the enemy’s ability to sustain itself, both militarily and socially, was broken. That pathway has narrowed, and if the Geneva conventions are followed, it results in “forever wars.” The result is not necessarily defeat but something subtler and more corrosive. It is the erosion of the ability to end a conflict quickly and decisively. In the end, the countries at war may actually face more death and destruction, not less, as wars stretch out endlessly.What replaces unrestricted warfare is incrementalism. Ground is taken, secured, and then contested again. Progress is measured in small gains that must be constantly defended. The same roads, the same towns, the same ground are fought over repeatedly. Control becomes temporary, conditional, and reversible. The United Nations keeps watch to ensure that the more powerful nations don’t overstep their authority. God forbid an unequal display of war power were to emerge. It is all about equity.Into that environment steps the irregular fighter. Not a uniformed army standing in formation, but a fluid presence embedded within the civilian population. There are no fixed front lines and no clear boundary between the battlefield and daily life. Weapons are concealed, identities shift, and engagement happens on their terms. A shot, an explosion, and then a disappearance back into the fabric of the town or village.Asymmetric warfare is a type of war between nations whose relative military power, strategy, or tactics differ significantly. Before the recent amendments to the Geneva Conventions, such wars would have been finished rather quickly.  Waging successful asymmetric warfare is how the United States gained independence from the most powerful war machine of the era, Great Britain.Guerrilla tactics or warfare focus on avoiding head-on confrontations with enemy armies, typically because of reliance on inferior arms or forces, and instead engage in limited skirmishes to exhaust adversaries, wear down their political will, and force them to withdraw. Organized guerrilla groups often depend on support from either the local population or foreign backers who sympathize with their efforts.This is not incidental. It is strategic. These tactics exploit the very protections that constrain conventional forces. If you cannot clearly distinguish a combatant, you cannot lawfully engage, because of the Geneva Convention constraints. If engagement risks civilian harm, you hesitate or accept consequences that extend far beyond the battlefield. The civilian environment becomes a form of cover, not only in the physical sense but also in the legal and political senses.What follows is a different kind of war. Not one defined by decisive battles, but by persistence. Small-unit engagements, ambushes, improvised explosives, and raids that achieve limited objectives and then dissolve the warfighter unit. Territory is cleared and then contested again. Control is never absolute. It is negotiated, temporary, and constantly challenged.The Geneva system, particularly the 1949 Conventions and the 1977 Additional Protocols, did not create guerrilla warfare. But they did change the incentives that shape it. Once a legal regime strongly protects civilians, hospitals, detainees, infrastructure, and prisoners, a state army that follows those rules has fewer brutal options available. It cannot level entire districts, execute captives, or treat every military-age male as a target without consequence.An insurgent or irregular force operates under a different logic. It can blend in with civilians, use civilian infrastructure, and force the stronger army into a dilemma. Hold fire, or strike and incur political and legal costs. The humanitarian logic of the law is clear and, in many ways, necessary. But the military side effect is less often acknowledged. Some conflicts become longer, more indecisive, and more politically exhausting.Afghanistan provides the clearest recent example. The Taliban did not present itself as a conventional army to be destroyed. It was integrated into the population, spread its forces, and relied on time, religious beliefs, and propaganda as strategic advantages. The war became one of containment rather than conclusion. Corruption, weak governance, and external sanctuary all played critical roles, but the operational environment mattered as well. The allied coalition could not apply the kind of overwhelming force that historically ends rural insurgencies quickly. The result was a long war that ended not with a decisive victory, but with exhaustion and collapse.Iraq followed a similar trajectory, though in a more fragmented form. The initial invasion was rapid and decisive. What followed was not. The insurgency regenerated faster than it could be eliminated because it did not exist as a fixed target. Urban warfare, sectarian fragmentation, and civilian entanglement made large-scale decisive action increasingly costly. The conflict stretched, shifted, and persisted, even after formal victory was declared against ISIS.The Geneva framework is ill-suited to the modern battlefield. It narrows the pathways to decisive victory and expands the conditions under which conflict can persist.It is in this context that the current debates should be understood. There is a growing tendency to claim that President Donald Trump is committing war crimes in the current Iranian conflict. I disagree with this logic. What has changed is something more consequential. The way the Geneva Conventions are being interpreted, the way they are being applied, and most importantly, the willingness to subordinate them to the outcome.  The Trump administration is exercising military power decisively and granting greater operational latitude to battlefield commanders to achieve military objectives more rapidly and definitively.Over the many decades since the decisive Allied victory in WWII, American warfighting has drifted into a constrained model built on the assumption that if you fought carefully enough, precisely enough, and with sufficient regard for civilian infrastructure, you could achieve both moral legitimacy and strategic success. The protracted and ultimately failed US military adventures in Vietnam, Iraq, and Afghanistan should have challenged that assumption. What these military and diplomatic failures demonstrated instead is that when one side follows the rules rigidly, and the other side exploits them, the result is not a cleaner war. It is a longer and ultimately more destructive war. The United Nations, by reinforcing those norms, contributes to that dynamic.  Despite its charter, in the many decades since its creation, the UN has completely failed to prevent war.  What it has achieved is the prolongation of armed conflict and civilian suffering by facilitating asymmetric, guerrilla warfare.  And this should surprise precisely no-one.  By its very structure, the UN is biased towards less militarily and economically powerful nation-states.  By promoting policies that favor “equity”, the UN advances the interests of less developed (often socially primitive, socialist, or communist) nation-states.The core principle of the Geneva framework is distinction. Separate the civilian from the combatant, the hospital from the barracks, the water system from the weapons depot. That principle works when both sides operate as states with defined militaries, clear lines of demarcation, and a mutual commitment to international rules of engagement. It begins to break down during asymmetric warfare, when the adversary embeds itself within civilian systems or builds its strategy around proxies, militias, and urban cover. That is no longer an exception. Under the influence of the Geneva Conventions, asymmetric warfare has become the dominant model.What has changed in recent strategy is not the abandonment of rules, but their reprioritization. Instead of treating them as the governing objective, they are treated as one constraint among many, and not always the top priority. That is a fundamental shift in posture.You can see it in the willingness to target systems that were once considered politically or legally untouchable in the post WWII era of warfare. Energy infrastructure, transport networks, economic chokepoints, and other foundational systems are increasingly viewed through a different lens. If they sustain the state, they sustain the war. And if they sustain the war, they become part of the battlefield.This reflects a rejection of the incremental model that has defined much of the last sixty years. Limited strikes, calibrated responses, and carefully managed escalation were intended to prevent wider conflict. In practice, they often prolonged or prevented conflict resolution, paradoxically increasing civilian suffering.The emerging approach is more direct. Apply pressure across systems. Escalate earlier. Force a choice. Continue on the current path and absorb systemic damage, or step back. It is coercion, not containment.  A battle strategy focused on efficiently winning once a decision to move from diplomacy to armed conflict has been made.Critics are not wrong to be concerned. Once a major power begins to reinterpret these boundaries, others will follow. The distinction principle weakens, the core Geneva Conventions position that one must always distinguish between combatants and civilians, and only intentionally target clearly defined combatants and military objectives. Reciprocity takes hold. Protections erode at the margins.But the counterargument is just as clear. A system that cannot produce decisive outcomes does not prevent suffering. It stretches it out. It rewards the side most willing to operate in the gray space and to hide within civilian systems. It turns war into a slow bleed rather than a sharp shock.That is the tension at the center of modern conflict. Current international law was built for a different kind of war. What we face now is hybrid, decentralized, and embedded. The rules did not disappear. The battlefield changed around them.Under President Trump, the Geneva Conventions have been reframed. Because wars fought by attorneys, rather than skilled armed forces focused on rapid, decisive resolution of conflict, will never provide a clean outcome.  War is war; to end such a conflict cleanly and surgically, war fighters (and battlefield commanders) must be given permission to act decisively.ShareMalone News is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.Thanks for reading Malone News! This post is public so feel free to share it.Share

Summary: Modern "legal" rules of engagement create more civilian suffering, death and destruction


G-O-F banned or not?

President Trump signed an Executive Order today shutting down federally funded gain-of-function research abroad. It is unclear just how much farther the Executive Order goes beyond that.The executive order isn't up on the White House website yet, so the exact wording of the EO isn’t known.However, a transcript of the video below is as follows:Transcript:This relates to gain-of-function research. Gain-of-function research is a type of biomedical research where pathogens are adulterated viruses or adulterated to make them more potent or to change the way that they function.Many people believe that gain-of-function research was one of the key causes of the COVID pandemic that struck us in the last decade.What this executive order does, first of all, is provide powerful new tools to enforce the ban on federal funding for gain-of-function research abroad.It also strengthens other oversight mechanisms related to that issue and creates an overarching strategy to ensure that biomedical research in general is being conducted safely and in a way that ultimately protects human health more.A Brief AnalysisWe don’t have the text of the Executive Order, but based on the transcript above, it seems this does not address commercial- or privately funded G-O-F research. In other words, it does not apply to GOF research that is not funded by the US government, whether conducted in the USA or abroad.What it does do, according to the transcript above, is: “provide powerful new tools to enforce the ban on federal funding for gain-of-function research abroad” and provide some new oversight mechanisms, but these aren’t laid out in detail.It is also unclear whether this ban applies to federally funded domestic research, so stay tuned for the Executive Order!In the meantime, the White House has launched a new webpage on the origins of the virus. Although it marks a significant step forward in accountability, it overlooks the entire Ralph Baric link, the important question of whether SARS-CoV-2 was first developed in his lab in North Carolina, and the central role of UC Davis in managing much of the funding and coordination through USAID sponsorship.Nonetheless, the site is quite interesting, and very satisfying to see the federal government finally take a stand against the Natural Origins theory.The White House webpage says all the quiet parts (about the origin of the virus) out loud. Below are images cut from that site:House Oversight ReportFauci was pardoned by Biden. Will there be further investigation and possible prosecution of Andrew Cuomo, Ralph Baric, or the UC Davis crew for their roles in this?  They were not pardoned.And what about the censorship and fundamental breaches of the First Amendment by public health officials and other Biden administration political appointees?  The Supreme Court weasled out of addressing this question by asserting “lack of standing”, effectively giving the Biden administration a pass on their lawless behavior.It is one thing to point fingers, but an entirely different thing to actually investigate and prosecute wrongdoers.  Nice to be validated after all the lying, slander, and defamation, but not enough.  It is time to act.Malone News is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.Thanks for reading Malone News! This post is public so feel free to share it.ShareJGM

Summary: Executive Order "shutting down" Federally funded gain-of-function research abroad


What They Don't Tell You About the Shingles Vaccine

THE DISEASEFirst, shingles is genuinely unpleasantTo fairly evaluate any vaccine, you have to start with the disease it prevents. Shingles is caused by the same virus that gave you chickenpox as a child — it never fully leaves your body. It retreats into your nervous system and can reactivate decades later, typically producing a painful, blistering rash that appears in a band on one side of your torso, face, or limbs.For most people, the rash resolves in two to four weeks. But for a significant minority,  roughly one in five people who get shingles, rising to nearly one in three among adults over 60, the pain doesn’t stop when the rash heals. This complication is called postherpetic neuralgia, or PHN. It’s a chronic nerve pain that can persist for months, years, or sometimes permanently, and is described by those who have it as burning, electric, and constant. It is associated with depression, sleep disruption, and social withdrawal.Most cases of shingles are mild to moderate and resolve within a few weeks, with 10–20% becoming “severe” in a meaningful clinical sense.I have personally had shingles fifteen plus years ago, an unusual and rather nasty variant called intra-abdominal shingles.  Inside your abdomen.  I did not have medical insurance, and so I delayed treatment until I could not stand the pain.  As a consequence, I developed a particularly nasty postherpetic neuralgia- a paralytic polio-like syndrome that caused a partial paralysis of the left side of my abdomen.  Suffice to say, this created problems as an advanced equestrian.  I quite literally lost my core.  That said, I personally consider that a “natural” booster, and have never accepted the shingles vaccine.  My body, my choice.About 10–18% of shingles cases progress to PHN, which is the main long-term issue. There is no “cure” for PHN, as no drug will cure it. The treatments available are nerve-calming drugs, like gabapentin, antidepressants used as pain medications, and lidocaine patches, which help some people, but roughly 40 to 50 percent of PHN patients never achieve adequate pain relief from any available therapy. BTW - stating that there is “no cure” is medically acceptable language, but it lacks nuance.  Most people do improve and even achieve complete recovery, gradually over time.  But there is no treatment that will “cure” PHN - drugs will only help with the symptoms, so this is a significant nuance.This matters for understanding the vaccine because preventing shingles also means preventing any chance of developing PHN. But how effective is the vaccine at actually doing that for any individual?Thanks for reading Malone News! This post is public, so feel free to share it.ShareTHE NUMBERS97% effective. What does that actually mean?The figure comes from two large clinical trials called ZOE-50 and ZOE-70, which together enrolled about 30,000 adults across 18 countries. Participants were randomly assigned to receive either Shingrix or a saline injection, then followed for roughly three to four years to see who developed shingles.Here are the actual results for adults aged 60 to 69, the age group with the highest shingles rates:Source: ZOE-50 trial (Lal et al., N Engl J Med, 2015). Modified vaccinated cohort, mean follow-up 3.2 years.Now you can see both numbers at once. The vaccine group’s rate was about 3% of the placebo group’s rate; that’s where “97% effective” comes from. It’s the ratio. It’s a relative measure.But look at the placebo column. Only 3.5 out of 100 unvaccinated people in this age group developed shingles over roughly three years. That means 96.5 out of 100 would not have gotten shingles anyway, with or without the vaccine.“97% effective” means the vaccine reduced the rate among those who would have gotten shingles. It does not mean 97 in 100 vaccinated people are protected from something that would otherwise have happened to them.The absolute benefit,  the actual reduction in cases attributable to vaccination, was about 3.4 cases prevented per 100 people vaccinated over three years. That translates to a “number needed to treat” (NNT) of approximately 30 people you need to vaccinate in this age group to prevent one case of shingles over a three-year period.HOW TO READ NNTIf the NNT is 30, it means that for every 30 people vaccinated, 29 received no direct benefit from the vaccine over the trial period (because they wouldn’t have developed shingles anyway), and 1 was protected from a shingles case. The other 29 still took on whatever risks or side effects the vaccine entailed. NNT doesn’t tell you which person you’ll be; it tells you the odds.How NNT varies by ageOne of the genuinely useful features of Shingrix is that its relative efficacy doesn’t fall off with age the way the older vaccine did. The percentage reduction in risk is roughly similar whether you’re 55 or 80.But, and this is important, the absolute benefit varies by age because older people face a higher baseline risk of shingles. More cases to prevent means more absolute benefit per vaccinationRelative efficacy from primary trial publications. Absolute reduction calculated from published incidence rates x trial follow-up duration. Real-world NNTs are likely somewhat higher than these trial-population figures.Notice: the relative efficacy is almost identical across all ages. But the absolute numbers diverge because the baseline disease rate varies. A 97% reduction in a low-risk group gives you less absolute benefit than a 91% reduction in a high-risk group.This is not a trick or a critique of the vaccine; it’s just how mathematics works.But it does mean that when you read “97% effective,” you should immediately ask: 97% of what? Of whom? Over how long?THE SIDE EFFECTSThe side effects from the vaccine are real, and the trials likely undercounted themShingrix has a strong adjuvant, a chemical booster that makes your immune system respond more intensely. This is how it achieves such high efficacy even in older adults. The tradeoff is a higher rate of side effects than most vaccines.In the trials, 78 to 84 percent of vaccinated people reported at least one reaction within 7 days, compared with about 30 percent in the placebo group. Most were mild: sore arm, tiredness, headache. But a meaningful proportion were severe enough to disrupt daily life. This is measured as “grade 3” reactions — fever over 39°C, muscle pain that prevents normal activity, and injection-site pain at rest.The “number needed to harm” (NNH) for a grade 3 reaction, meaning one serious enough to stop you doing normal things for a day or two, was:•Ages 50–69:approximately 1 in 11 vaccinated people•Ages 70+:approximately 1 in 25 vaccinated peopleOlder adults have fewer severe reactions, not because the vaccine is gentler, but because their immune systems respond less intensely to stimulation. This is, slightly counterintuitively, the same reason the relative efficacy is a few percentage points lower in the oldest group.Here’s the comparison that actually matters: across the three-year trial window, for every case of shingles prevented in the 60–69 age group, approximately 2.7 people experienced a grade 3 reaction. Those reactions lasted one to two days. Shingles and its complications can last far longer.However, there is an important asterisk on all the side effect data: the trials were not fully blinded.THE BLINDING PROBLEMIn a fully “double-blind” trial, neither the participant nor anyone treating them knows whether they received the real drug or the placebo. Shingrix couldn’t achieve this because the vaccine, when mixed, looks visibly different from clear saline. The nurse preparing the syringe knew what they were drawing up.More importantly, the vaccine causes such distinctive reactions, a cluster of fever, fatigue, and muscle aches within 24 hours, that many participants who received it almost certainly figured out they were in the vaccine group. Research consistently shows that people who know (or strongly suspect) they got the active treatment tend to report more symptoms on diary cards. This means the side-effect numbers from the trial are probably somewhat higher than they would be in a perfectly blinded study. No one knows by how much.THE EVIDENCE TRAILEvery single trial was paid for by the company selling the vaccineThis is worth saying plainly, without drama: all of the clinical evidence for Shingrix, every pivotal trial, every extension study, every long-term follow-up analysis, was funded by GlaxoSmithKline, the vaccine’s manufacturer. Several named authors on the key publications were GSK employees at the time. Medical writing for the main publications was paid for by GSK. The decision about when to submit results for publication was made by GSK.None of this is unusual. This is standard practice in the pharmaceutical industry, and it’s the only realistic way to fund trials of this size. But it does mean you’re relying on a company with a direct financial interest in a positive result for every piece of evidence about the product’s efficacy and safety. No independent, publicly-funded pivotal trial of Shingrix exists.Industry funding doesn’t automatically mean the results are wrong. The trials used randomization, independent adjudication panels, and safety monitoring committees. Post-marketing studies conducted without GSK involvement have found broadly similar effectiveness figures. But those corroborating studies have their own limitations, and “broadly similar” still means lower effectiveness than the headline trial numbers. Real-world effectiveness tends to be 10 to 15 percentage points lower than controlled-trial efficacy because real patients are older, sicker, and on more medications than the trial cohort.The long-term data has a significant flawGSK extended the trials with a follow-up study called ZOE-LTFU, which tracked participants for up to 11 years post-vaccination. The results looked good: roughly 88% relative efficacy maintained through year 11.The problem: by the time the extension started, the original placebo group had already been offered the vaccine (because the main trial was over).There were no unvaccinated controls left. So the researchers had to calculate efficacy by comparing vaccinated participants against a projected placebo group based on earlier data, essentially asking: how many cases would we have expected if these people had never been vaccinated, using the old placebo rates?This approach has real limitations. It assumes shingles rates didn’t change over time. It doesn’t account for the COVID-19 pandemic (which affected immune system dynamics and social mixing). It assumes the people who stayed in the study for 11 years are representative of everyone who started. None of these assumptions can be verified. GSK itself acknowledged in the publication that this methodology “could overestimate efficacy.”IF YOU DO GET SHINGLESThe treatments for shingles work, if you get them quicklyIf you do develop shingles, three antiviral medications: valacyclovir, famciclovir, and acyclovir, can reduce its severity and duration if you start them within 72 hours of the rash appearing. That window matters a great deal. After 72 hours, the benefit drops off significantly.These antivirals reduce the severity of the shingles episode but don’t reliably prevent PHN. Once that nerve pain develops, treatment becomes much harder.IF YOU DEVELOP PHNThe first-line treatments are gabapentin and pregabalin (anticonvulsants used as nerve pain drugs), tricyclic antidepressants like nortriptyline, and lidocaine patches applied to the skin. These help some people meaningfully. But approximately 40 to 50 percent of PHN patients don’t get adequate relief from any of them. Opioids are sometimes used but carry dependence risks that are especially significant in older adults. There is no cure.THE BOTTOM LINESo, should you get it?This content is for paid subscribers only:Read more

Summary: The headline number is 97% effective. The number that actually matters to you is closer to 3%. Both are true. Here's what's going on — and why the distinction matters.