As reminders…

Alpha–Variant first identified in the UK

Beta–Variant first identified in South Africa

Gamma–Variant first identified in Brazil

Delta–Variant first identified in India

Also as a reminder:

Ebola–

Not much news on the wires and the WHO is running late on updates this week. Which means there are probably no new cases, and we move closer to the end of this particular flare up. But only probably. Hopefully definitively when everyone gets back from a presumed early Thanksgiving break on the Ebola beat?

Coronavirus–

–Cases across much of the US remain elevated. Same with a lot of Europe. Not telling you anything you don’t know there. Aside from the possibility of weather, there may be an even tighter data fit with humidity, and would also explain previous uptrends in warmer months in places like Florida. But the long story short is that transmission of the virus is multifactorial, and while there are variables that may have a larger effect size (i.e. humidity and temperature, density and duration of contact with others etc), there are a lot of variables to SARS-CoV-2 transmission. Including a few we probably don’t know about yet.

–On the booster front, the US has opened COVID boosters to all adults. Fauci and Gottlieb were making the rounds last week as well, certainly laying the groundwork for a “booster to be considered fully vaccinated” push.

“Is there new data supporting the necessity of boosters for all adults?”, I hear you ask Hypothetical Reader.

After all, we are all old enough to remember an entire expert review of the evidence for boosters published in the Lancet just a few months ago, and covered here.

We are all old enough to remember all two months back when the FDA’s own advisory committee recommended boosters for the 65+ and underlying conditions crowd only, a decision the FDA accepted, and we covered here.

Most of the scientific reasoning behind that Lancet article, the FDA AdComm, and FDA decision to limit booster recommendations just two months ago we covered in Sciencepalooza we summarized here.

So why the sudden change?

To be honest, the reason is not entirely clear. The CDC’s press release following the FDA decision to expand boosters to all adults mentions only “review of current data” on immunity. All I could find for the FDA side was unnamed sources stating that recent data showing the mRNA vaccines “increasing immunity” (which should be read as “increasing antibody titers”) following a booster injection. With no link to that data, and no place I can find where it is presented.

In the absence of the data they are apparently talking about, and based solely on those vaguely worded statements coupled with actual publications in the intervening months, I am left with the FDA considering the Pfizer paper we recently discussed as so compelling as to reverse their decision on boosters. Two months later.

The Pfizer paper was discussed here, but to recap quickly, this was on a really small amount of patients, and tested antibody levels 7 days after a booster injection. The problem with that approach, as we mentioned, is that the 7 day time point is inadequate–you needed one a day or two after the booster as well. Because if exposure to the SARS-CoV-2 spike protein is enough to rally a strong immune response from previous vaccination, you will see that in 24-48 hours–and it would likely still persist 7 days later. If, however, as Pfizer conveniently concluded, the immune system really has “forgotten” and needs the booster to re-train the immune system, the rise in antibody titers and T-cell responses would take about 7 days. By testing only at 7 days, the Pfizer study design does NOT discriminate between these equally plausible explanations of their data. However, one would argue that if the rise occurred within 48 hours of the booster, or just spike protein introduction at all, then there is likely sufficient immunity after vaccination to mount a clinically effective response that keeps you out of the hospital. Which is what, real world, we have largely seen happen with “breakthrough” cases.

“Well, maybe there is compelling data of waning immunity in the real world data as the delta wave subsides and a winter wave begins anew?” I hear you ask, Hypothetical Reader. After all, I thought the same thing!

So here is hospitalization rates by vaccination status through the end of September (the most current available data via CDC):

The green line does, indeed go up juuuust a little bit in August (which is where many of the papers highlighted in Sciencepalooza target), suggesting a slightly higher hospitalization rate among the vaccinated and perhaps waning immunity. But then it immediately levels off through the delta wave. As we discussed, and as discussed in the linked Lancet paper mentioned above, most of that rise is attributable to the over 65 crowd and those with underlying conditions. Hence, the FDA’s initial recommendation for boosters limited to those populations–made a mere two months ago.

–If- immunity from vaccination was waning across the entire population, you would expect that green line to keep rising up towards the blue line from the late July to late September time period at the far right–in general. Yes, there were people getting vaccinated as well during that period. The number of people getting vaccinated in that time span did NOT spike though, and was the same steady rise even as the slight increase in hospitalizations per 100,000 was seen in that green line:

So I am pretty confident in saying that the leveling off of the rise in the green line was NOT due to an influx of newly vaccinated, compensating for those whose vaccine immunity was waning. It’s also worth mentioning that in other detailed data sets in the period, such as Washington and Minnesota’s state data, they calculate a ~0.0 per 100,000 mortality rate for vaccinated persons under the age of 65. That’s not a type on my part. The numbers were so low they rounded them off to zero. Again, if vaccine immunity were waning in the below 65 set, we would not expect those to be rounding to zero.

All of this argues that there is little real world data suggesting a medically significant decline in vaccine mediated immunity for those under 65, who are immunocompetent, and not pregnant.

Instead, all we have is the Pfizer paper and FDA vague hand waving in its direction to justify the new expansion of booster eligibility. Meanwhile, the groundwork is being laid on interviews with very important people for “booster to be considered fully vaccinated”.

Somehow persistently lost in all of this is the fact that we have treatment options for acute COVID. Multiple different options in fact, all with well conducted randomized controlled studies showing safety and efficacy. The publications we have covered of these treatment options show an 80%+ reduction in the rate of hospitalization and death from COVID. That’s not the two dose vaccine 90%+, but it’s awfully close. So I am going to word this carefully, and thank you for understanding, but there are public health compliments to vaccination at this point which deserve greater consideration to public health policy that will restrict access, freedoms, even employment based on what may turn out to be a shifting definition of vaccination. If the goal is to preserve public health by driving COVID’s ability to occupy too many hospital beds, at what point do we declare victory on that?

My growing concern, based on the trial flags of shifting definitions of vaccination especially, is that all of this data, and the full range of options to reduce pandemic risk, are NOT being considered in public policies.

–To be crystal clear though, there is SOLID evidence for the FDA’s original recommendation for boosters for those over 65 and/or with high risk conditions for COVID. If you are one of those people, a booster is absolutely a good idea to reduce your personal risks.

If you are not, and choose to get a booster anyways, I understand. You want to feel like you are doing everything possible to reduce your already low personal risks (or another common reason is frequent or expected close contact with people who are at high risk, although evidence is mounting that vaccinated people can still transmit SARS-CoV-2). I get that. Your evaluation of risks to benefits is your call, and I won’t eat your lunch for it.

Where I have a problem is shifting the definition of “vaccinated” when that definition has increasing consequences of freedom of movement, employment (for both the employee and the employer), participation in civic life ranging from restaurants to concerts, and even access to healthcare as there have been some high profile headlines where organ transplant recipients were denied because they were unvaccinated. If that definition had science behind it, instead of what increasingly looks like Science!^TM and some rather…generous… interpretation of data to goalseek a policy decision already made, that would be understandable. Instead, the consistently inconsistent recommendations, messages and justifications only serve to undermine the legitimacy of the CDC and FDA, and the long history of allopathic medicine by association in the minds of our patients with these institutions and their spokespeople. This is the bonfire of their credibilities, and why they invite the “misinformation” they so lament. I suspect there is growing discontent among my fellow MDs as well, asked to justify the latest mysterious shift in COVID recommendations and response from CDC and FDA. If they were trying to compromise the credibility of their institutions, if that was their goal, what would they be doing differently right now?

–Anyways, if you are interested, here is a calculator where you can put in your own age and health background to calculate your chances for adverse COVID outcomes if you get it: https://covid19risktools.com:8443/riskcalculator

You may be surprised at what your risks actually are. And yes, this calculator updates for current data, and no it does not take into account vaccination or acute treatment. You can fudge that by reducing your risk by a factor of 10 if you have two doses of vaccine on board (or are recovered from natural COVID with known antibodies), and whatever percentage less than a factor of 10 you want to estimate for acute treatments. That is not medical advice though, and is provided for informational purposes.

–Meanwhile, much gotcha’, such gloat on the internet about the FDA claiming it will need 55 years to release the data under an FOIA request that FDA evaluated when making its approval decision for the Pfizer COVID vaccine. FDA claims this is because it has to go through the 329,000 pages requested to ensure that protected patient health information is removed, as are legitimate trade secrets for Pfizer and BioNTech (i.e. manufacturing details that might let competitors gain an advantage). FDA also says they have a staff of about 10 people to do this, handling “record numbers” of FOIA requests, and I don’t doubt that. In fact, when this kind of trial data is publicized (Europe mandates this, for the record), that information does have to be redacted and it is a process.

That said, this is a common argument by many public institutions in response to FOIA requests. A good example is one of many University of Michigan claims to this effect in response to one of several lawsuits over the U of M’s excuses and delays in FOIA processing, such as a recent one here. And that’s not picking on U of M–it’s memorable to me only because a Michigan Football fan website even called out U of M’s FOIA office.

While this is hashed out, avoid some of the early interpretation without context of some of the few hundred pages that are already released. I saw one very excited twitter thread on a table of early VAERS complaints that had circled ~1,200 deaths out of 42,000 case reports by February 2021 (of which only 26,000 were confirmed). The important context, as we have discussed around VAERS before, is any hint or suggestion of anything around the time of vaccination can be reported as a potential adverse event, requiring follow up to decide how plausibly the vaccine was involved. Is about 1200 people, out of several tens if not hundreds of millions of doses out by February 2021, who happened to die around the time of vaccination, even if entirely unrelated to the vaccine itself, unusual? Probably not. In fact, if the Pfizer vaccine were killing people at a clip of 1 out of 40 adverse events (1200 deaths out of 42,000 case reports by February), wouldn’t we know that with hundreds of millions, if not billions, of doses out now and millions of people who have had some kind of “Pfizer Flu”? There should be literally millions of deaths if this were real. I am not aware of mass die-offs on this scale reported thus far. So again, be very cautious of those without deep experience in what and how some of this data is and is compiled, and who may be susceptible to the very human error of confirmation bias in their interpretation, especially if they decided already that there is some nefarious cover up in the data and are seeking evidence to “prove” the conclusion they already reached.

That said, it would be wonderful if FDA could find some way to speed up release and interpretation of this data. In a highly politicized environment demanding maximum transparency for vaccine campaign effectiveness to control a pandemic, “it will take us 55 years to release data we reviewed in 6 months to make a very important, public decision” is not the ideal response. Even if it might be true at the moment.

–Yes, I did see the articles on the internet questioning again if Fauci’s section of the NIAID funded experiments on dogs in Tunisia looking at transmission of Leishmaniasis. The latest allegation was well researched, and showed that the Ohio State affiliated corresponding author had received a grant from the NIAID matching the number that was attached to the paper on these experiments. As you recall, once the kerfluffle started, a correction was issued by the authors and the journal stating that the project was NOT funded by the NIAID through that grant. Well, the current allegations found the proposal for that grant. This does indeed mention intended use of the money to test an attenuated strain of Leismaniasis in animal models as a possible new vaccine, including specific mention of a “novel canine model” of natural leishmaniasis infection “in Tunisia.”

Smoking gun, right?

Well, to be honest, I’m still not convinced. The crux of that grant is less about the dog model, and more about desire to test the attenuated strain for safety and efficacy in animal models as a run up to a possible human clinical trial.

The paper that caused all the commotion with immobilized dogs in Tunisia being bitten by sand flies carrying this parasite did not use this vaccine that I can find, and really, did not have much to do with the vaccine development at all. Instead, there have been two separate publications by the same Ohio State guy and his colleagues on the attenuated strain vaccine–one in hamsters, one in mice, both conducted humanely. Both studies conclude that the safety and efficacy profile seen in these animal models justifies upcoming Phase 1 human studies.

The goal of the grant was to test the attenuated leishmaniasis vaccine in appropriate animal models. They mentioned dogs in Tunisia in the application, but it appears in what is available so far, that the vaccine was never tested in those dogs. Meaning the inclusion of the grant number in the Tunisia dog experiment may still indeed be an innocent mistake, as the grant for this new vaccine was not used for this tangential experiment. Instead, it looks like they found mice and hamster models (closer to home and less expensive) to get the safety and efficacy data to go into humans that they needed, and didn’t use the dogs in Tunisia at all, despite mentioning that possibility in their grant application.

If we are still applying reasonable doubt and presumption of innocence, well, it’s still plausible to conclude that the NIAID did not inadvertently fund the Tunisia dog experiment.

Of course, follow the flow of the actual money through that grant, and account for where and to whom it has gone, and that would clear this up pretty definitively. I know academic institutions tack on “administrative surcharges” of 10-40%, depending on the institution, to all awarded grants (true story) for all of that rigorous accounting work and oversight. So the records should be there.

It’s also quite reasonable to question why the NIAID, if they knew what the conditions of the Tunisian beagle experiments for this disease were like, approved a grant where that money might be used for studies like that. As the grant application did not describe the exact experimental procedures, it’s possible the reviewers did not know that they dogs were immbolizied to let sandflies bite their faces for days at a time. I think it is reasonable to ask if NIAID knew that and approved anyways, and what the NIAID’s procedures are to ensure that grants which will involve human or animal work are conducted ethically, and review of the experimental design to ensure that humane and ethic conduct prior to approving the grant.

–And yes, it is into this milieu that CDC and FDA write press releases about extending vaccine boosters to all adults, and march their experts into interviews to sound out a shifting state of “full vaccination”, that can easily be read as “we have reviewed the current data and come to a new decision. We won’t tell you what that data is, or where to find it, but know we have reviewed it, and it is concerning enough that we will reverse a decision we made just two months ago.”

At least they still believe in their own credibility.

–This line is here just as a quick reminder that in this same period, FDA had two highly publicized resignations of long serving vaccine experts concerned about political pressures on FDA’s review processes.

–Like I said, I don’t doubt FDA is dealing with record FOIA requests right now.

–In socioeconomic issues…

–Dollar Tree announced this week that henceforward, due to inflation, the price point in all its stores (famous for “everything is a dollar!”) will be $1.25. Management explicitly stated this would be to cover rising freight and distribution costs, as well as higher wages. Supply chain disruptions were identified as the company’s “biggest challenge” in the near term.

Food inflation is expected to persist through 2022 at this point, according to other reports.

–Another major cold wave has settled into a large portion of China, with unusually cold and blustery weather. This is not likely to do their energy prices or grid any favors.

–Speaking of which, fear of an unusually cold winter and weather supply in the US has seen a run on stoves, generators, and firewood already this season, with higher prices and reduced availability of all. US utility companies appear to have enough supplies on hand for an average, and probably a somewhat worse than average winter. There are some that, by report, have expressed concern about supplies of coal and natural gas if there is an “extreme” winter–specifically Texas and parts of the Midwest. What constitutes extreme was not defined in the articles I read. That’s not real great reporting, but if we apply the razor of asking ourselves “why this article? Why now? How does it make me feel? Why does someone want me to feel this way?” makes sense, because by leaving “extreme” undefined, you make a much more anxiety inducing article.

I suspect “extreme” cold is defined as the multi-standard deviation event cold that froze Texas this past February. That was sustained temperatures across the Midwest and Texas that were 25-50 degrees F below average–but the records it broke were centuries old. From what I can find via NOAA, the standard deviation around average temperatures tends to be about 4 degrees, which fits with a 25-50 degree swing breaking 100 year old records.

I am not a weather expert. If you choose to hedge with your own energy supplies, like a generator or wood, just realize prices are high right now, and the math says a repeat of that kind of “extreme” cold is unlikely anytime soon. Not impossible, but very unlikely.

–In a related note, coal mining companies have reported they have sold, via futures contracts, nearly all the coal they expect to be able to mine in 2022 and part of 2023. That said, I am not sure how unusual that kind of futures activity is for a commodity like coal, where those futures are routinely sold by producers to stabilize the price of the amount of coal they plan to produce so they are not whipsawed by the sudden shifts in price commodities like coal can sometimes see. So I don’t know if by the end of 2021, they have already sold on futures contracts all of their coal for 2022 as part of their routine practice, or if this reflects very high demand at the moment. Maybe a bit of both?

–Ran into my buddy in food distribution to area schools at the gym again. Supply issues have not really abated in the last couple months. One of the biggest current problems is the law of unintended consequences. Earlier this year, the USDA expanded a program to pay for school lunch at all public schools and childcare centers through the end of the year, and the USDA would simply reimburse the school systems. This has led to unprecedented demand though, even in relatively affluent school systems, where school lunch demand would not normally be so high as parents would buy and prepare “brown bag” lunches for kids to take to school. Now even affluent families get free school lunch, and apparently enough of them are deciding that time and money saved packing brown bag lunches or not having to send money to school with the kids to buy lunch is worth it, and having their kids take advantage of the free school lunch too. This has resulted in a bit of a reverse robin hood, as already strained supplies now have to be stretched not only to school systems that need it, but also to systems that have higher demand than ever, even if the number of students who would have qualified for free or subsidized lunch before is not quite so high.

Put another way, if you can afford to buy lunch for your kid, you may secretly be doing a huge solid to disadvantaged kids elsewhere in your state by continuing to do so. That lets the already strained school lunch supply go to those school systems and kids where that might be the only guaranteed meal those kids get that day.

Something to chew on, no pun intended.

–In other unintended consequences, during the pandemic, overdose deaths in the US rose by 28.5% and topped 100,000. Fentanyl, largely produced in China and smuggled in via Mexico, is a big cause. For a more nuanced and well-researched take, there is a good opinion piece from the director of opoid policy research at Brandeis here with ways in which the pandemic may have also contributed to this increase.

–If you have not been following the news in Europe, the continent is becoming convulsed with massive demonstrations against COVID restrictions and requirements. Many have been peaceful, but the most chippy has been in Rotterdam, Netherlands over the weekend, with reports of shots fired and police cars torched over the course of several nights.

Remember Varys’ riddle. And from where governments derive their just powers. This is the price of the bonfire of institutional credibilities.

–China continues to deal with elevated COVID cases across a broad geographic region. This has prompted the unusual step of physician groups in China demanding an end to the “No COVID” policies that so famously has seen brutal shutdowns, forced police removal of positive patients and close contacts to quarantine facilities, and even the famous sealing shut apartment complexes where positive cases were found. China’s top public health officials in Chengdu, site of recent lockdowns, stated the program results in “an overuse of medical resources, growing public panic, and the disruptions of people’s normal life and work… we should consider the sustainability of these measures.”

Yangzhong Huang, writing out of New York fro the Council on Foreign Relations stated that the CCP seems to believe the only two options are “zero cases or . . . a worst-case scenario where the entire healthcare system is overwhelmed and social stability is undermined.”

–On a…unrelated?… note, Australia reported an active COVID outbreak in the outlying town of Binjari. Ten patients and close contacts were relocated by the Australian military to COVID quarantine camps the Australian government had previously built, but not really used much. Granted, Binjari is sufficiently isolated that hospitals are not especially close and military transport may have been quicker. But Binjari and many other towns in that province are now under hard lockdown, where citizens are not allowed outside their homes in all but the most emergent of situations. Oh, and the 10 evacuated people? All Australian aborigines.

Did Australia see Austria’s lockdown of the unvaccinated and say “Hold my Fosters, mate?” Or just poor timing and poor optics? You be the judge.

–Your think piece this week. Guess whose speech this is:

“Of course, we must be aware of the danger and be ready to counter it, and not just one threat but many diverse threats that can arise in this era of change. However, it is no less important to recall a second component of the crisis – opportunities that must not be missed, all the more so since the crisis we are facing is conceptual and even civilisation-related. This is basically a crisis of approaches and principles that determine the very existence of humans on Earth, but we will have to seriously revise them in any event. The question is where to move, what to give up, what to revise or adjust. In saying this, I am convinced that it is necessary to fight for real values, upholding them in every way.

Humanity entered into a new era about three decades ago when the main conditions were created for ending military-political and ideological confrontation. I am sure you have talked a lot about this in this discussion club. Our Foreign Minister also talked about it, but nevertheless I would like to repeat several things.

A search for a new balance, sustainable relations in the social, political, economic, cultural and military areas and support for the world system was launched at that time. We were looking for this support but must say that we did not find it, at least so far. Meanwhile, those who felt like the winners after the end of the Cold War (we have also spoken about this many times) and thought they climbed Mount Olympus soon discovered that the ground was falling away underneath even there, and this time it was their turn, and nobody could “stop this fleeting moment” no matter how fair it seemed.

In general, it must have seemed that we adjusted to this continuous inconstancy, unpredictability and permanent state of transition, but this did not happen either.

I would like to add that the transformation that we are seeing and are part of is of a different calibre than the changes that repeatedly occurred in human history, at least those we know about. This is not simply a shift in the balance of forces or scientific and technological breakthroughs, though both are also taking place. Today, we are facing systemic changes in all directions – from the increasingly complicated geophysical condition of our planet to a more paradoxical interpretation of what a human is and what the reasons for his existence are.

…

The coronavirus pandemic has become another reminder of how fragile our community is, how vulnerable it is, and our most important task is to ensure humanity a safe existence and resilience. To increase our chance of survival in the face of cataclysms, we absolutely need to rethink how we go about our lives, how we run our households, how cities develop or how they should develop; we need to reconsider economic development priorities of entire states. I repeat, safety is one of our main imperatives, in any case it has become obvious now, and anyone who tries to deny this will have to later explain why they were wrong and why they were unprepared for the crises and shocks whole nations are facing.

Second. The socioeconomic problems facing humankind have worsened to the point where, in the past, they would trigger worldwide shocks, such as world wars or bloody social cataclysms. Everyone is saying that the current model of capitalism which underlies the social structure in the overwhelming majority of countries, has run its course and no longer offers a solution to a host of increasingly tangled differences.

Everywhere, even in the richest countries and regions, the uneven distribution of material wealth has exacerbated inequality, primarily, inequality of opportunities both within individual societies and at the international level. I mentioned this formidable challenge in my remarks at the Davos Forum earlier this year. No doubt, these problems threaten us with major and deep social divisions.

Furthermore, a number of countries and even entire regions are regularly hit by food crises. We will probably discuss this later, but there is every reason to believe that this crisis will become worse in the near future and may reach extreme forms. There are also shortages of water and electricity (we will probably cover this today as well), not to mention poverty, high unemployment rates or lack of adequate healthcare.

Lagging countries are fully aware of that and are losing faith in the prospects of ever catching up with the leaders. Disappointment spurs aggression and pushes people to join the ranks of extremists. People in these countries have a growing sense of unfulfilled and failed expectations and the lack of any opportunities not only for themselves, but for their children, as well. This is what makes them look for better lives and results in uncontrolled migration, which, in turn, creates fertile ground for social discontent in more prosperous countries. I do not need to explain anything to you, since you can see everything with your own eyes and are, probably, versed on these matters even better than I.

As I noted earlier, prosperous leading powers have other pressing social problems, challenges and risks in ample supply, and many among them are no longer interested in fighting for influence since, as they say, they already have enough on their plates. The fact that society and young people in many countries have overreacted in a harsh and even aggressive manner to measures to combat the coronavirus showed – and I want to emphasise this, I hope someone has already mentioned this before me at other venues – so, I think that this reaction showed that the pandemic was just a pretext: the causes for social irritation and frustration run much deeper.

I have another important point to make. The pandemic, which, in theory, was supposed to rally the people in the fight against this massive common threat, has instead become a divisive rather than a unifying factor. There are many reasons for that, but one of the main ones is that they started looking for solutions to problems among the usual approaches – a variety of them, but still the old ones, but they just do not work. Or, to be more precise, they do work, but often and oddly enough, they worsen the existing state of affairs.

…

Furthermore, the technological revolution, impressive achievements in artificial intelligence, electronics, communications, genetics, bioengineering, and medicine open up enormous opportunities, but at the same time, in practical terms, they raise philosophical, moral and spiritual questions that were until recently the exclusive domain of science fiction writers. What will happen if machines surpass humans in the ability to think? Where is the limit of interference in the human body beyond which a person ceases being himself and turns into some other entity? What are the general ethical limits in the world where the potential of science and machines are becoming almost boundless? What will this mean for each of us, for our descendants, our nearest descendants – our children and grandchildren?

These changes are gaining momentum, and they certainly cannot be stopped because they are objective as a rule. All of us will have to deal with the consequences regardless of our political systems, economic condition or prevailing ideology.

Verbally, all states talk about their commitment to the ideals of cooperation and a willingness to work together for resolving common problems but, unfortunately, these are just words. In reality, the opposite is happening, and the pandemic has served to fuel the negative trends that emerged long ago and are now only getting worse. The approach based on the proverb, “your own shirt is closer to the body,” has finally become common and is now no longer even concealed. Moreover, this is often even a matter of boasting and brandishing. Egotistic interests prevail over the notion of the common good.

Of course, the problem is not just the ill will of certain states and notorious elites. It is more complicated than that, in my opinion. In general, life is seldom divided into black and white. Every government, every leader is primarily responsible to his own compatriots, obviously. The main goal is to ensure their security, peace and prosperity. So, international, transnational issues will never be as important for a national leadership as domestic stability. In general, this is normal and correct.

We need to face the fact the global governance institutions are not always effective and their capabilities are not always up to the challenge posed by the dynamics of global processes. In this sense, the pandemic could help – it clearly showed which institutions have what it takes and which need fine-tuning.

The re-alignment of the balance of power presupposes a redistribution of shares in favour of rising and developing countries that until now felt left out. To put it bluntly, the Western domination of international affairs, which began several centuries ago and, for a short period, was almost absolute in the late 20^th century, is giving way to a much more diverse system.

This transformation is not a mechanical process and, in its own way, one might even say, is unparalleled. Arguably, political history has no examples of a stable world order being established without a big war and its outcomes as the basis, as was the case after World War II. So, we have a chance to create an extremely favourable precedent. The attempt to create it after the end of the Cold War on the basis of Western domination failed, as we see. The current state of international affairs is a product of that very failure, and we must learn from this…”

Guess who this is yet?

Vladimir Putin, last month at the annual meeting of the Valdai Discussion Club, where Vlad will typically just riff for a few hours. So it’s a good place to see how Russia and Putin are seeing the world. And you do read those who disagree with you, right? So is Vlad’s view on the current world situation similar to how you see it? And did you catch the part in the second to last paragraph where he all but stated the Pax Americana is over?

–Your chances of catching Ebola are equivalent to the chances you knew the Ghislaine Maxwell trial had started. Last week. Yeah, remember her? Epstein’s main co-conspirator?

–Your chances of catching coronavirus are equivalent to the chances that you should enjoy your Thanksgiving with friends and family (for those of you stateside or observing elsewhere), and enjoy your weekend if one of our international readers!

<Paladin>