John Ioannidis: the data critic and the search for truth
John Ioannidis, a Stanford epidemiologist and statistician, has long been known for his critiques of the validity of much of scientific research. During the pandemic, his role was that of an "external" analyst who questioned initial mortality projections and the effectiveness of lockdown measures. His analyses, often labeled as counter-current, were not driven by anti-scientific prejudice, but by the need to base decisions on solid data, not on predictive models that could prove to be wrong.
When it comes to vaccines, Ioannidis is the co-author of a study that estimated the millions of lives saved by COVID-19 vaccination. However, he also raised questions about the methodology of other studies and criticized communication which, in his opinion, was not always sufficiently transparent about data uncertainties. He represents the voice that demands rigor and intellectual honesty, even when the pressure for quick answers is at its highest.

Susan Monarez: the crisis manager and the communication challenge
Susan Monarez, with extensive experience in national security and crisis management [2], represents the other side of the coin. Her role is not to produce data, but to interpret and translate it into clear, manageable messages for the public and political decision-makers. Monarez symbolizes the figure of the communicator who must navigate a sea of complex and often contradictory information, all while maintaining public trust.
Her challenge is immense: she has to explain concepts like vaccine efficacy, potential side effects, and the evolution of a virus in accessible language, knowing that every word can be used to fuel misinformation. Her work focuses on risk communication, a delicate task that must balance transparency and clarity without generating panic or distrust.

Data and perception: the truth behind the vaccine numbers
To fully grasp the dynamic between science and communication, it's helpful to examine the numbers with a critical approach. The Ioannidis study [1] provided a perspective based on specific data:

Vaccines saved approximately 2.53 million lives and gained about 14.8 million life-years globally.

Their impact was most significant on the over 60 population, who accounted for 90% of the lives saved. In contrast, the contribution for children and adolescents was minimal, representing only 0.01% of lives saved, and for young adults aged 20 to 29, it was 0.07%.

In practical terms, the study estimated that one life was saved for every 5,400 vaccine doses administered.

These figures, while impressive, were considered "more cautious" compared to other estimates. For example, an analysis by researchers at Imperial College London and published in The Lancet estimated that vaccines prevented almost 20 million deaths in the first year alone [3]. This figure, about ten times higher than Ioannidis', reflects different methodological approaches, but the crucial point remains the same: vaccination had a substantial and life-saving benefit globally.
The debate over these numbers, which might seem like an academic dispute, actually embodies the pandemic's greatest challenge: how to communicate science honestly and transparently. The gap between the estimates of Ioannidis and other scholars shows that even in science, there are margins of uncertainty that must be handled with caution in public communication. Unfortunately, politics has not always helped.

Politics, profit, and false myths: when science is under attack
The ground on which figures like Ioannidis and Monarez operate is made even more treacherous by misinformation [5, 6], but also by a legitimate skepticism towards corporations. It is a fact that the pharmaceutical industry is a for-profit business, and its primary interest is profit. There is a real basis for suspecting that private interests might amplify the perceived need for prevention and treatment, going beyond what's real. Therefore, it is a fundamental duty of states and their health institutions [3] to act as watchdogs, ensuring that the industry's gain does not come at the expense of public health.
However, this suspicion, while valid, must not lead to dismantling the entire healthcare system that has proven to save millions of lives. Old false myths, such as the debunked link between vaccines and autism, are being resurrected and amplified by "no-vax" movements, often with the help of social media. These attacks are not limited to spreading false news; they undermine the credibility of institutions crucial for public health, such as the Centers for Disease Control and Prevention (CDC).
The problem is made worse when politics gets involved. In many cases, positions on vaccines are no longer based on science but become a matter of ideological alignment. Understanding that bad news and conspiracy theories increase audience and, consequently, support, some politicians ride on false myths. This creates a vicious cycle where distrust fuels misinformation, which in turn further undermines trust in the system.

In an era when vaccines have been shown to save millions of lives [1, 2], the biggest battle is not against viruses, but against the "contagion" of distrust that threatens to jeopardize public health. Science and communication are two sides of the same coin: one cannot function without the other, and their synergy is the only way to rebuild a relationship of trust with the public.

Bibliography

Ioannidis, J. P. A., et al. "Global Estimates of Lives and Life-Years Saved by COVID-19 Vaccination During 2020–2024: An Interim Analysis." JAMA Health Forum, vol. 5, no. 6, 2024.

Center for Strategic and International Studies (CSIS). "Susan Monarez." 

Watson, O. J., et al. "Global impact of the first year of COVID-19 vaccination: a mathematical modelling study." The Lancet Infectious Diseases, vol. 22, no. 5, pp. 605-618, 2022.

"Vaccini: tra falsità e verità." RAI, 12 maggio 2021.

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*Board Member, SRSN (Roman Society of Natural Science)
Past Editor-in-Chief Italian Journal of Dermosurgery