corona marginalia: the pro-choice doc

Dr Steven James is a consultant anaesthetist at King’s College Hospital in London where he has been working in the ICU since the beginning of the pandemic in early 2020. During a visit on January 7th by the Health Secretary, Sajid Javid, Dr James made the case that the science isn’t strong enough to support the government policy of mandatory vaccination for all NHS staff. A video recording (embedded below with transcript) of their conversation subsequently went viral:

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Sajid Javid: “What do you what do you think of the new rule to require vaccination of all NHS staff?”

Dr Steven James: “I’m not happy about that.”

Sajid Javid:  “So you’re not happy with that?

Dr James: “So I’ve had covid at some point.”

Sajid Javid: “Yes.”

Dr James: “I’ve got antibodies. I’ve been working on covid ICU since the beginning. I have not had a vaccination. I did not want to have a vaccination.

“The vaccine is reducing transmission only for eight weeks with delta – with omicron it’s probably less – and for that I would be dismissed if I don’t have a vaccine. The science isn’t strong enough.”

Sajid Javid: “That’s your view… [turning to other NHS staff] and your views? Do you have any view on that? [then following no replies, turning back to Dr James] I respect that but there’s also many others with different views.”

Dr James: “Yeah, I understand that there are other views, but there’s another colleague who’s also in the same position.”

Sajid Javid: “Yeah, I understand that obviously and obviously we had to weigh all that up for both health and social care. And there will always be a debate about it.”

Dr James: “But maybe there’s an opportunity to reconsider with omicron and the changing picture, or at least the nuance that will allow doctors who’ve had antibody exposure, who’ve got antibodies, who haven’t had the vaccination to not have it, because the protection I’ve got from transmission is probably equivalent to someone who’s vaccinated.”

Sajid Javid: “Yeah, but at some point that will wane as well.”

Dr James: “But if you want to provide protection with the booster, you’d have to inject everybody every month. If it’s worn off by two months… If the protection’s worn off for transmission after two months, then after a month you’ve still got a bit of protection, so you want to maintain protection you’re going to need to boost all staff members every single month, which you’re not going to do.

Sajid Javid: “Yeah, we take advice on when – how much – you may need…”

Dr James: “But it’s not going to achieve a practical benefit.”

Sajid Javid: “Well we take the very best advice that we can.”

Dr James: “[I] understand but..”

Sajid Javid: “From the people that are vaccine experts.”

Having run out of answers Sajid Javid ends the discussion with a sneaky and deliberate slight. Unaccustomed to receiving push back and especially from someone with specialist training, he finally resorts to an appeal to authority, a logical fallacy known as argumentum ad verecundiam.

The incident has since been hijacked and misrepresented by people within two opposing camps, so it is important to emphasise that Dr James does not hold “an anti-vaxx” position, nor is he expressing one. Instead, he is straightforwardly pointing out that fact that the emergence and spread of the omicron variant has dramatically changed the situation. He is also highlighting the comparatively low protection that vaccines offer to those like himself who already enjoy natural immunity, as well as pointing to the scientifically established waning efficacy of both the vaccines and boosters.

In short he says nothing particularly controversial here and so it is a sign that we are living through exceptional and worrying times that even moderate and well-informed opinions are routinely marginalised as extreme and, in the case of the response to covid, characterised as “anti-vaxx”.

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On Wednesday 12th, Dr James was invited by ITV’s breakfast show Good Morning Britain, to explain why he refuses to be vaccinated. Once again, there was no attempt at all to debate the issue seriously, but a rather blatant effort to shame Dr James and also to set a trap they hoped he might fall into – and which he didn’t.

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Host Richard Madeley began by asking bluntly, “Dr Jones, [this video]’s made you ‘the poster doc’ for the whole ‘anti-vaxx movement’ but that’s not a kind of hat that you want to wear and you’ve come on Good Morning Britain to try and put the record straight so where exactly do you stand on vaccination?”

Dr Steve James responded: “If I’m the voice of anything I’m the voice of a hundred thousand NHS staff, who’ve already lost their jobs. People whose voice hasn’t been heard.

Continuing after an interruption: “Well I’m not ‘anti-vaxx’ because I’ve seen a great, great benefit from vaccines. There’s been a huge reduction in the number of seriously ill patients who’ve come into hospital and vaccination has probably made – or it’s almost certainly made – the largest contribution to that.”

Richard Madeley interrupts again, pressing him about “why did you say that to Javid?” and Dr James continues:

“So there’s a difference between me giving my own personal opinion about why I wouldn’t have a vaccine and whether vaccines in general are good. So you know as a doctor, I’m not anti-surgery, it doesn’t mean that surgery is what I need to have. So for a population it’d be good to offer certain treatments, [but that] doesn’t mean that everybody needs to have those treatments.”

Richard Madeley again: “So why haven’t you been vaccinated?”

Dr James: “Personally I’m a fit and well man. I’m not elderly. I was exposed to covid on multiple occasions in hospital settings and I wasn’t getting sick, and I thought, ‘well the vaccines are out there now, they’ll go to the elderly and the vulnerable’. And I was surprised to see that there wasn’t a point where instead of offering it to everyone, we’re now going to start offering it to people in a more nuanced way.”

Richard Madeley: “But being fit and young and well is no defence against covid. Young, fit people have died from it.

Dr James: “I haven’t seen anyone who’s young and fit and well and has died of covid. Now, there are always going to be exceptions, but young, fit and healthy people also die at other things. So I thought I would just sit and wait and see.

“Yesterday, the Director of the CDC [Rochelle Walensky] announced that more than 75 percent of deaths in the US have been in people with four or more comorbidities, so at about 25 percent, a lot of them have got three, have got two, have got one. * I still haven’t seen anybody who’s died in my hospital – not saying it hasn’t happened – but [no-one] who hasn’t got any comorbidities or any issues.

Co-host Susanna Reid then asks: “You won’t get vaccinated and you’ve explained why you believe you don’t need to. Just want to establish: you say you’ve been exposed to covid. Have you actually had covid?”

Dr James responds: “I haven’t had a symptomatic episode that I know to be covid… but I’ve got antibodies that show…”

Continuing after a few clarifications regarding how the antibody test had been conducted privately and was not something offered by the NHS: “If you’re carrying antibodies to a virus you’ve developed an immune system’s memory. You develop that memory because you’ve been exposed to it.”

Susanna Reid replies: “So it’s the kind of Novak Djokovic defence against vaccination isn’t it?”

This is an odd statement. First, it is irrelevant. Second, how can the word ‘defence’ be applicable in these cases? Defence implies guilt!

Susanna Reid then cuts him off as he tries to make a reply and continues: “Dr James, you are not going to get vaccinated. You’ve said. You’ve had that argument with the Health Secretary. Of course that comes with a penalty within the NHS, because from April if you aren’t vaccinated you’ll lose your job. Are you prepared to simply lose your work for the sake of taking a vaccination which we know, and you have explained, is enormously beneficial?”

Here again, there is an implicit presumption of guilt, since the prospect of punishment is tacitly endorsed. And I find this staggering. If at the beginning of the pandemic you had said western governments will introduce programmes of mandatory vaccination you would have been labelled a “conspiracy theorist” and dismissed, which is also measure of just how far and how swiftly the Overton Window is being expanded. Returning to the discussion…

Dr James: “So the benefit is for people who are likely to have a serious consequence. So the benefit isn’t there for me.”

Continuing: “For me it’s a point of principle that a hundred thousand members of my profession, who have made careful and valued assessments for themselves in the majority of cases, that they are now being forced to have a vaccine – to have a medical intervention which up until the current epidemic was outlawed in public health acts – even in health crises these things weren’t going to be allowed; and now the government’s changed its mind… but the government’s reports from the House of Commons Select Committees from the House of Lords, they say the scientific evidence isn’t strong enough.

Richard Madeley: “Well, are you arguing this purely from, if you like, a civil rights point of view, or are you also suggesting, as I think you might have done in that exchange with Javid, that you don’t trust the vaccine all the way: you don’t think it’s been researched fully enough. Am I right to summarise it that way?

In fact, Madeley is simply putting words in his mouth with a leading question presumably in the hope of eliciting a decisive if unintentional anti-vaxx statement. But again he fails.

After a further clarification of the question, Dr James says: “So my concern is the civil liberties side. I think the vaccines prove to be very safe, however very safe over the period of time we’ve looked at it. So I’d like to look at it for a longer period of time.”

Adding: “But as my mum said to me last night – she said, ‘you know if Kings [College Hospital] is going to lose 1400 members of staff then how’s the NHS going to survive?’

“And you’ve got to look at the practicality of…”

Susanna Reid cuts him off again, and says: “Dr James, what I don’t understand is you’re prepared to lose your job and put your department under pressure, as a result of you losing a job – because I don’t know how easy it can be to get an anaesthetist with your sort of training and qualifications in there – despite the fact you believe the vaccine is safe and effective.  I’m not sure I understand it.”

She then turns to GMB’s resident medical expert, Dr Hilary Jones, prompting him with this intentionally loaded question, “Dr James says he doesn’t want to be a poster boy for ‘the anti-vaxx’ movement, I can’t see how he avoids that frankly.”

Following a pre-scripted “telling off” in which Dr Jones then overlooks entirely the central issue of civil rights and government overreach in order to heap shame on Dr James, even to the point of castigating him for contracting the virus and inadvertently spreading it to patients when it was already established that he had worked on a covid ICU throughout the pandemic which means his initial infection had very probably occurred long before any vaccines were manufactured and made available.

And rather than permitting Dr James the opportunity to rebut the accusations directly, Richard Madeley finally turns to him and says: “That was an effective telling off from one of your fellow professional doctors. He says that your behaviour is, if you like, selfish. What you’re doing is for your own interests and good and to support your political views in terms of human rights and civil rights, but you’re putting patients at risk. You’ve actually put patients at risk.”

Dr James replies: “Ten percent of the NHS staff are essentially in the same position as me. I’m not a fringe person. I’m having an expression of my voice – a voice which hasn’t been heard. I’ve got thousands and thousands of positive comments from people. Hundreds of doctors and nurses have contacted me saying thank you.

“Let’s open this debate up. The debate has not been held. Many groups of doctors [and] of other politicians have said the science isn’t strong enough and you know if we don’t have a debate, if it’s a single story, it’s a single narrative, that’s not science. Science is questioning…” [final words are cut off.]

I would like to add my own praise and support for Dr Steven James. As a highly-trained medical professional, it actually takes tremendous courage to speak out freely and to address these vital matters head on with equanimity and authority. A lack of debate only further inflames an already febrile political climate in which public attitudes are becoming ever more deeply divided and entrenched.

Moreover, the tightening clampdown on free speech, which is detrimental both to civil liberties and democracy, is being exacerbated by establishment press and mainstream media outlets that hold monolithic and dictatorial lines whether about covid or other related and unrelated issues. As Dr James says, “Science is questioning…” before being abruptly cut off. As a scientist myself, I’d add that inherently this is the nature of science.

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Additional:

On the same day as ITV’s Good Morning Britain took Dr James to task for defying official government policy, an alternative interview with Freddie Sayers from UnHerd was also uploaded on Youtube and is embedded below.

The contrast between the two approaches is illuminating. Avoiding conflict and cheap manipulative tricks, Sayers manages to come across as impartial and respectful. But this isn’t a softball interview and many of the questions really do probe awkwardly in James’ broader opinions and motives:

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* Please note: The announcement made by Rochelle Walensky on ABC’s breakfast show Good Morning America on Tuesday 11th has since been updated. Speaking with host Cecilia Vega, Walensky says in the original clip: “The overwhelming number of deaths — over 75 percent — occurred in people who had at least four comorbidities. So really, these are people who were unwell to begin with. And yes: really encouraging news in the context of omicron.”

However, her statement caused outrage amongst some groups, and the CDC then accused the broadcaster ABC of omitting this crucial context. In response ABC has since replaced its online clips with an unedited version of the same interview: “In that one, the CDC director prefaces her reply to Vega by touting “a really important study of 1.2 million vaccinated people, which found that only a minuscule fraction of them — 0.003 percent — died of covid-19. Of the small number who did die, she noted, most of them had underlying health conditions.”

From an article entitled “A Rochelle Walensky interview sparked outrage. But the CDC says ABC omitted crucial context” written by Paul Farhi, published in the Washington Post on January 12, 2022. https://www.washingtonpost.com/lifestyle/media/walensky-abc-interview/2022/01/12/b5744ad4-73be-11ec-bc13-18891499c514_story.html

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