# Who is “anti-science”?

Elisabeth Paul, Garrett Brown, Valéry Ridde, Joachim Sturmberg

► To cite this version:

Elisabeth Paul, Garrett Brown, Valéry Ridde, Joachim Sturmberg. Who is “anti-science”? . Public Health in Practice, 2024, pp.100493. 10.1016/j.puhip.2024.100493. hal-04528769

HAL Id: hal-04528769

https://hal.science/hal-04528769

Submitted on 23 May 2024

HAL is a multi-disciplinary open access
archive for the deposit and dissemination of sci-
entific research documents, whether they are pub-
lished or not. The documents may come from
teaching and research institutions in France or
abroad, or from public or private research centers.

L'archive ouverte pluridisciplinaire HAL, est
destinée au dépôt et à la diffusion de documents
scientifiques de niveau recherche, publiés ou non,
émanant des établissements d'enseignement et de
recherche français ou étrangers, des laboratoires
publics ou privés.

<figure><img src="image_1.png" /></figure>
# Who is “anti-science”?

Elisabeth Paul, Garrett Brown, Valéry Ridde, Joachim Sturmberg

► To cite this version:

Elisabeth Paul, Garrett Brown, Valéry Ridde, Joachim Sturmberg. Who is “anti-science”? . Public Health in Practice, 2024, pp.100493. 10.1016/j.puhip.2024.100493. hal-04528769

HAL Id: hal-04528769

https://hal.science/hal-04528769v1

Submitted on 23 May 2024

HAL is a multi-disciplinary open access
archive for the deposit and dissemination of sci-
entific research documents, whether they are pub-
lished or not. The documents may come from
teaching and research institutions in France or
abroad, or from public or private research centers.

L'archive ouverte pluridisciplinaire HAL, est
destinée au dépôt et à la diffusion de documents
scientifiques de niveau recherche, publiés ou non,
émanant des établissements d'enseignement et de
recherche français ou étrangers, des laboratoires
publics ou privés.

<figure><img src="image_1.png" /></figure>
<figure><img src="image_2.png" /></figure>

# Who is “anti-science”?

Elisabeth Paul<sup>a, *</sup>, Garrett W. Brown<sup>b</sup>, Valéry Ridde<sup>c</sup>, Joachim P. Sturmberg<sup>d</sup>

## ARTICLE INFO

**Keywords:**

Science
Health policy
Covid-19
Vaccines

## ABSTRACT

**Objectives:** "Anti-science" accusations are common in medicine and public health, sometimes to discredit scientists who hold opposing views. However, there is no such thing as "one science". Epistemology recognizes that any "science" is sociologically embedded, and therefore contextual and intersubjective. In this paper, we reflect on how "science" needs to adopt various perspectives to give a comprehensive and nuanced understanding of a phenomenon.

**Study design:** Opinion paper.

**Methods:** Based on a targeted literature survey, we first clarify the known limits of traditional scientific methods and then reflect on how the scientific reporting about Covid-19 mRNA vaccines has evolved.

**Results:** The first reports of the Covid-19 mRNA vaccines randomised controlled trial results showed impressive efficacy. Nevertheless, an abundant literature has since depicted a far more nuanced picture of the effectiveness and safety of those vaccines over the medium-term. We organise them around five themes: (i) differentiating between relative and absolute reduction; (ii) taking account of time in reporting effectiveness; (iii) taking account of all outcomes, including adverse effects; (iv) stratifying effectiveness and considering other decision criteria (efficiency, equity, and acceptance); (v) changing the outcome of concern and assessing vaccines' effectiveness on mortality.

**Conclusions:** Science offers a wide range of perspectives on a given study object. Only the process of deliberation amongst scientists and other stakeholders can result in accepted new knowledge useful to support decision-making. Unfortunately, by trying to reduce "science" to simple messages set in stone, scientists can become the worse enemies of science.

## 1. Objectives

Increasing "anti-science" has been reported [1]. Anti-science accusations have long been pervasive in medicine and public health, for example to counter the rise of "alternative medicine" movements [2]. Even within allopathic medicine, anti-science has been used to dismiss contradictory views [3]. Some argue that being anti-science reflects psychological dispositions and social contexts [4]. Anti-science trends were particularly exacerbated during Covid-19 in the United States, and reported to have originated from far-right extremism [5]. But is there really a "science" and an "anti-science"?

## 2. Study design and methods

This opinion paper relies on a targeted literature survey to first clarify the known limits of traditional scientific methods, and then reflect on how the scientific reporting about Covid-19 mRNA vaccines has evolved, to illustrate the wide range of perspectives that science can adopt on a given study object.

## 3. There is no such thing as “one science”

Science aims to understand observed phenomena [6] and achieve clarity [7]. The production of scientific knowledge involves four closely interrelated dimensions: epistemology (relationship with evidence), methods (data collection tools), ontology (nature of the world and

<footnote><sup>a</sup> Université Libre de Bruxelles, School of Public Health, Campus Erasme, Route de Lennik 808, CP 591, 1070, Brussels, Belgium</footnote>

<footnote><sup>b</sup> University of Leeds, School of Politics and International Studies (POLIS), Leeds, United Kingdom</footnote>

<footnote><sup>c</sup> Université Paris Cité, Institut de recherche pour le développement (IRD), INSERM, CEPED, Paris, France</footnote>

<footnote><sup>d</sup> School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Australia</footnote>

<footnote>* Corresponding author.
E-mail address: Elisabeth.Paul@ulb.be (E. Paul).</footnote>
<figure><img src="image_2.png" /></figure>

# Who is “anti-science”?

Elisabeth Paul<sup>a, *</sup>, Garrett W. Brown<sup>b</sup>, Valéry Ridde<sup>c</sup>, Joachim P. Sturmberg<sup>d</sup>

## ARTICLE INFO

**Keywords:**

Science
Health policy
Covid-19
Vaccines

## ABSTRACT

**Objectives:** "Anti-science" accusations are common in medicine and public health, sometimes to discredit scientists who hold opposing views. However, there is no such thing as "one science". Epistemology recognizes that any "science" is sociologically embedded, and therefore contextual and intersubjective. In this paper, we reflect on how "science" needs to adopt various perspectives to give a comprehensive and nuanced understanding of a phenomenon.

**Study design:** Opinion paper.

**Methods:** Based on a targeted literature survey, we first clarify the known limits of traditional scientific methods and then reflect on how the scientific reporting about Covid-19 mRNA vaccines has evolved.

**Results:** The first reports of the Covid-19 mRNA vaccines randomised controlled trial results showed impressive efficacy. Nevertheless, an abundant literature has since depicted a far more nuanced picture of the effectiveness and safety of those vaccines over the medium-term. We organise them around five themes: (i) differentiating between relative and absolute reduction; (ii) taking account of time in reporting effectiveness; (iii) taking account of all outcomes, including adverse effects; (iv) stratifying effectiveness and considering other decision criteria (efficiency, equity, and acceptance); (v) changing the outcome of concern and assessing vaccines' effectiveness on mortality.

**Conclusions:** Science offers a wide range of perspectives on a given study object. Only the process of deliberation amongst scientists and other stakeholders can result in accepted new knowledge useful to support decision-making. Unfortunately, by trying to reduce "science" to simple messages set in stone, scientists can become the worse enemies of science.

## 1. Objectives

Increasing "anti-science" has been reported [1]. Anti-science accusations have long been pervasive in medicine and public health, for example to counter the rise of "alternative medicine" movements [2]. Even within allopathic medicine, anti-science has been used to dismiss contradictory views [3]. Some argue that being anti-science reflects psychological dispositions and social contexts [4]. Anti-science trends were particularly exacerbated during Covid-19 in the United States, and reported to have originated from far-right extremism [5]. But is there really a "science" and an "anti-science"?

## 2. Study design and methods

This opinion paper relies on a targeted literature survey to first clarify the known limits of traditional scientific methods, and then reflect on how the scientific reporting about Covid-19 mRNA vaccines has evolved, to illustrate the wide range of perspectives that science can adopt on a given study object.

## 3. There is no such thing as “one science”

Science aims to understand observed phenomena [6] and achieve clarity [7]. The production of scientific knowledge involves four closely interrelated dimensions: epistemology (relationship with evidence), methods (data collection tools), ontology (nature of the world and

<footnote><sup>a</sup> Université Libre de Bruxelles, School of Public Health, Campus Erasme, Route de Lennik 808, CP 591, 1070, Brussels, Belgium</footnote>

<footnote><sup>b</sup> University of Leeds, School of Politics and International Studies (POLIS), Leeds, United Kingdom</footnote>

<footnote><sup>c</sup> Université Paris Cité, Institut de recherche pour le développement (IRD), INSERM, CEPED, Paris, France</footnote>

<footnote><sup>d</sup> School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Australia</footnote>

<footnote>* Corresponding author.
E-mail address: Elisabeth.Paul@ulb.be (E. Paul).</footnote>
possible manipulation of objects), and teleology (purpose of research). Hence there is no single way of looking at the world, there are a multitude of paradigms reflecting the complexity and interweaving of these four dimensions [8]. Even within a discipline, the same data can lead to very different results [9].

Epistemology, also known as the philosophical study of knowledge and its limits, recognizes that any “science” is sociologically embedded and therefore contextual and intersubjective [10]. Science is a methodological approach to explore questions in a knowledge domain. Thus, there is no such thing as a single “science”, rather various disciplines utilise a set of formalised and systematic approaches based on continued interchange between theorising and empirical (experimental) testing of hypotheses. Although a contested concept, an important feature of any “scientific method” is that it remains dialogic, involving interchange, retesting, re-evaluating, validation, and, over time, the formation of intersubjective understanding [11].

Every discipline is associated with several research tools and approaches. Let us first note that neither medicine nor public health is a science: they both are a field of practice relying on a wide variety of evidence and research methods, particularly epidemiology and biostatistics [12]. In medical studies, the gold standard of the randomised controlled trial (RCT) is the basis of evidence-based medicine (EBM). The double-blind RCT allocates volunteers randomly to one of two (occasionally more) groups: the “treatment group” receiving the intervention, and the “control group”, receiving a placebo instead. Randomisation is supposed to result in “fully similar” groups so that the outcomes can be attributed as truly being caused by the intervention. However, the treatment effect of a trial intervention is measured in terms of average changes of each group, with a wide scatter around that average value. Yet, average improvements are a poor guide to clinical decision-making for a particular patient [13]. The current dominant approach of EBM faces important criticisms and contradicts Sackett’s initial design, namely that the best available evidence of research findings should be utilised in conjunction with clinical judgement and patient preferences. [14] In this light, the imposition of RCT findings to the treatment of diseases as the gold standard without also being situated in both the patient’s unique context and a wider set of available evidence risks being a major over-simplification.

Questioning the results of RCTs could be labelled “anti-science” because they have been given a privileged status, negating other forms of knowledge generation [15]. This is unfortunate since many medical breakthroughs have arisen from single observations: Jenner’s cowpox vaccinations, Snow’s understanding of cholera propagation, or Semmelweis’ handwashing to stop puerperal sepsis. Today’s mainstream medical science doctrine relying on a blind application of EBM [16] would have dismissed these findings as anecdotal and thus unscientific. In terms of epistemology, precluding forms of understanding can stifle knowledge creation, even if something is currently understood as incontestable, since it foregoes the need for continued reason-giving and justification as part of any social construction of knowledge.

Since experimental methods are difficult to apply to large populations, public health relies on observational studies and mixed methodologies that often require sophisticated synthesis and theoretical analysis. Of course, the “science of using science” [17] shows that the utilisation of “science” in public health results in widely varying evidence, as any observed effect can simultaneously also be the cause for another effect [18]. Thus, in this field, there are recurring debates about the concept of evidence [19], and the determination of what “works” or is “true” often remains indeterminant and contested.

Concerningly, the moniker “science” is often exploited if it can generate an industrial profit, while a multitude of other important evidence – for instance, on social or commercial determinants of health [20–22] – is conveniently overlooked. Here, understanding the dynamics of how knowledge is socially constructed and used is crucial. This is because health interventions, and what is determined to be science, can often be captured by combinations of favoured scientific

practice, pathway-dependency, vested interests, politics, louder voices, or, regarding our immediate concern, by ideational hegemonies that prohibit wider dialogic knowledge production.

## 4. An illustration: Covid-19 vaccines

The “anti-science” mantra has been used to refer to those people “hesitant” of vaccines [23], and particularly Covid-19 vaccines. But what does science say about Covid-19 vaccines? Below is a reflection on the “scientific reporting” of the two most widely used vaccines utilising the messenger ribonucleic acid (mRNA) platform: BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna).

As for other medical commodities, the double-blind clinical trial is usually brandished as providing the most reliable scientific results regarding these vaccines, even if conducted by the pharmaceutical firms commercialising them. The results from both mRNA vaccines clinical trials were published in the New England Journal of Medicine. Pfizer published interim results on December 31, 2020, showing 95% efficacy in preventing Covid-19 [24]. A follow-up publication, published on November 4, 2021, showed 91.3% vaccine efficacy through 6 months of follow-up [25]. Moderna published interim results on February 4, 2021, showing 94.1% efficacy in preventing symptomatic Covid-19 [26]. Another publication at the completion of the blinded phase, also published on November 4, 2021, showed 93.2% vaccine efficacy in preventing Covid-19 illness [27]. None of these studies identified safety concerns. Real-life estimates of vaccine effectiveness using observational data soon followed the first waves of vaccination. The American Centers for Disease Control and Prevention announced on April 2, 2021 that primary data indicated 90% effectiveness against SARS-CoV-2 infection for both mRNA vaccines [28]. An analysis of the first four months of vaccination campaign in Israel, published on May 5, 2021, estimated the Pfizer vaccine effectiveness after 7 days of second dose to be between 91.5% for asymptomatic infection and 97.5% against severe or critical Covid-19-related hospitalisation [29]. These encouraging results comforted the idea that these vaccines were “miraculous” [30], even while notifications of breakthrough infections started to be reported by the end of the first half of 2021 [31].

However, science is not about miracles, and scientific evidence of efficacy does not equate to effectiveness and broader impacts. Science is about questioning facts and depicting the whole complexity of the natural and social worlds. Let us adopt a broader look at the mRNA Covid-19 vaccines. First, let us note that the design of the “gold standard” clinical studies referenced above was questioned from the start – notably due to the choice of their outcome(s) of concern, that is the indicator(s) measured to assess effectiveness: in this case, symptomatic infection, which is different to measuring severity of or mortality from the disease [32,33]. Later on, the quality of the data of the Pfizer trial was also questioned, notably due to suspicion of data falsification, unblinding of patients, and lack of controls [34]. These two concerns should have reduced the faith in the “95% efficacy” claims made from the trials and opened a debate amongst scientists and decision-makers. This did not widely occur at the time, nor did it question the choice of mass vaccination strategies as the only exit strategy from Covid-19 [35].

Nevertheless, an abundant literature has since depicted a far more nuanced picture of the effectiveness and safety of those vaccines over the medium-term, as summarised below.

First, science – through the clinical trials of mRNA vaccines – showed efficacy above 90% (see above). Yet, this is calculated in terms of relative risk reduction – that is, the percentage of reduction in adverse outcomes between the vaccinated and the unvaccinated. However, “the most useful way of presenting research results to help your decision-making” [36] is absolute risk reduction – that is, actual difference in risk between two groups. When calculating Covid-19 vaccines’ absolute risk reduction based on the same reported outcome data, it is far less convincing – 1.2% for the Moderna and 0.84% for the Pfizer vaccine [37].
possible manipulation of objects), and teleology (purpose of research). Hence there is no single way of looking at the world, there are a multitude of paradigms reflecting the complexity and interweaving of these four dimensions [8]. Even within a discipline, the same data can lead to very different results [9].

Epistemology, also known as the philosophical study of knowledge and its limits, recognizes that any “science” is sociologically embedded and therefore contextual and intersubjective [10]. Science is a methodological approach to explore questions in a knowledge domain. Thus, there is no such thing as a single “science”, rather various disciplines utilise a set of formalised and systematic approaches based on continued interchange between theorising and empirical (experimental) testing of hypotheses. Although a contested concept, an important feature of any “scientific method” is that it remains dialogic, involving interchange, retesting, re-evaluating, validation, and, over time, the formation of intersubjective understanding [11].

Every discipline is associated with several research tools and approaches. Let us first note that neither medicine nor public health is a science: they both are a field of practice relying on a wide variety of evidence and research methods, particularly epidemiology and biostatistics [12]. In medical studies, the gold standard of the randomised controlled trial (RCT) is the basis of evidence-based medicine (EBM). The double-blind RCT allocates volunteers randomly to one of two (occasionally more) groups: the “treatment group” receiving the intervention, and the “control group”, receiving a placebo instead. Randomisation is supposed to result in “fully similar” groups so that the outcomes can be attributed as truly being caused by the intervention. However, the treatment effect of a trial intervention is measured in terms of average changes of each group, with a wide scatter around that average value. Yet, average improvements are a poor guide to clinical decision-making for a particular patient [13]. The current dominant approach of EBM faces important criticisms and contradicts Sackett’s initial design, namely that the best available evidence of research findings should be utilised in conjunction with clinical judgement and patient preferences. [14] In this light, the imposition of RCT findings to the treatment of diseases as the gold standard without also being situated in both the patient’s unique context and a wider set of available evidence risks being a major over-simplification.

Questioning the results of RCTs could be labelled “anti-science” because they have been given a privileged status, negating other forms of knowledge generation [15]. This is unfortunate since many medical breakthroughs have arisen from single observations: Jenner’s cowpox vaccinations, Snow’s understanding of cholera propagation, or Semmelweis’ handwashing to stop puerperal sepsis. Today’s mainstream medical science doctrine relying on a blind application of EBM [16] would have dismissed these findings as anecdotal and thus unscientific. In terms of epistemology, precluding forms of understanding can stifle knowledge creation, even if something is currently understood as incontestable, since it foregoes the need for continued reason-giving and justification as part of any social construction of knowledge.

Since experimental methods are difficult to apply to large populations, public health relies on observational studies and mixed methodologies that often require sophisticated synthesis and theoretical analysis. Of course, the “science of using science” [17] shows that the utilisation of “science” in public health results in widely varying evidence, as any observed effect can simultaneously also be the cause for another effect [18]. Thus, in this field, there are recurring debates about the concept of evidence [19], and the determination of what “works” or is “true” often remains indeterminant and contested.

Concerningly, the moniker “science” is often exploited if it can generate an industrial profit, while a multitude of other important evidence – for instance, on social or commercial determinants of health [20–22] – is conveniently overlooked. Here, understanding the dynamics of how knowledge is socially constructed and used is crucial. This is because health interventions, and what is determined to be science, can often be captured by combinations of favoured scientific

practice, pathway-dependency, vested interests, politics, louder voices, or, regarding our immediate concern, by ideational hegemonies that prohibit wider dialogic knowledge production.

## 4. An illustration: Covid-19 vaccines

The “anti-science” mantra has been used to refer to those people “hesitant” of vaccines [23], and particularly Covid-19 vaccines. But what does science say about Covid-19 vaccines? Below is a reflection on the “scientific reporting” of the two most widely used vaccines utilising the messenger ribonucleic acid (mRNA) platform: BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna).

As for other medical commodities, the double-blind clinical trial is usually brandished as providing the most reliable scientific results regarding these vaccines, even if conducted by the pharmaceutical firms commercialising them. The results from both mRNA vaccines clinical trials were published in the New England Journal of Medicine. Pfizer published interim results on December 31, 2020, showing 95% efficacy in preventing Covid-19 [24]. A follow-up publication, published on November 4, 2021, showed 91.3% vaccine efficacy through 6 months of follow-up [25]. Moderna published interim results on February 4, 2021, showing 94.1% efficacy in preventing symptomatic Covid-19 [26]. Another publication at the completion of the blinded phase, also published on November 4, 2021, showed 93.2% vaccine efficacy in preventing Covid-19 illness [27]. None of these studies identified safety concerns. Real-life estimates of vaccine effectiveness using observational data soon followed the first waves of vaccination. The American Centers for Disease Control and Prevention announced on April 2, 2021 that primary data indicated 90% effectiveness against SARS-CoV-2 infection for both mRNA vaccines [28]. An analysis of the first four months of vaccination campaign in Israel, published on May 5, 2021, estimated the Pfizer vaccine effectiveness after 7 days of second dose to be between 91.5% for asymptomatic infection and 97.5% against severe or critical Covid-19-related hospitalisation [29]. These encouraging results comforted the idea that these vaccines were “miraculous” [30], even while notifications of breakthrough infections started to be reported by the end of the first half of 2021 [31].

However, science is not about miracles, and scientific evidence of efficacy does not equate to effectiveness and broader impacts. Science is about questioning facts and depicting the whole complexity of the natural and social worlds. Let us adopt a broader look at the mRNA Covid-19 vaccines. First, let us note that the design of the “gold standard” clinical studies referenced above was questioned from the start – notably due to the choice of their outcome(s) of concern, that is the indicator(s) measured to assess effectiveness: in this case, symptomatic infection, which is different to measuring severity of or mortality from the disease [32,33]. Later on, the quality of the data of the Pfizer trial was also questioned, notably due to suspicion of data falsification, unblinding of patients, and lack of controls [34]. These two concerns should have reduced the faith in the “95% efficacy” claims made from the trials and opened a debate amongst scientists and decision-makers. This did not widely occur at the time, nor did it question the choice of mass vaccination strategies as the only exit strategy from Covid-19 [35].

Nevertheless, an abundant literature has since depicted a far more nuanced picture of the effectiveness and safety of those vaccines over the medium-term, as summarised below.

First, science – through the clinical trials of mRNA vaccines – showed efficacy above 90% (see above). Yet, this is calculated in terms of relative risk reduction – that is, the percentage of reduction in adverse outcomes between the vaccinated and the unvaccinated. However, “the most useful way of presenting research results to help your decision-making” [36] is absolute risk reduction – that is, actual difference in risk between two groups. When calculating Covid-19 vaccines’ absolute risk reduction based on the same reported outcome data, it is far less convincing – 1.2% for the Moderna and 0.84% for the Pfizer vaccine [37].
Second, science – through observational data – showed that a third dose of the Pfizer vaccine was 93% (relative) effective against admission to hospital, 92% (relative) effective against severe disease, and 81% (relative) effective against COVID-19-related death. Of note, these results were found after a median follow-up time of only 13 days [38] which is a clinically meaningless timeframe, being a short-term outcome irrelevant to policymaking, and even if “true”, pragmatically impossible to apply as it would require vaccination twice a month.

Third, science – based on the individual clinical trials – showed a good safety profile of Covid-19 mRNA vaccines [25,27]. However, a re-examination of pooled safety data to get more statistical power, showed that the mRNA vaccines were associated with an excess risk of “serious adverse events of special interest” (as defined by the Brighton Collaboration [39]) of 12.5 per 10,000 vaccinated – that is, one in every 800 vaccinated [40]. Such an adverse event rate must be contextualised in relation to risk-benefit estimates, which we regard as an imperative from a research and policy ethics perspective.

Fourth, even with increasingly reported waning effectiveness, science suggests that the Covid-19 vaccines remain effective in preventing severe Covid-19 among at-risk populations [41–45]. Yet, science – in a risk-benefit analysis – also showed that adolescents do not benefit from the Pfizer vaccine, except for non-immune girls with comorbidities [46]. Unstratified effectiveness measured by only a single performance measure, should not be the only criterium to inform clinical and policy decision-making, equally important are considerations of efficiency, equity, and acceptance.

Fifth, while the clinical trials were not designed to evaluate the vaccine's effect on mortality, a systematic review of observational data showed an effect of the vaccines reducing “Covid-19 related death” [47]. Yet, the Pfizer study's supplementary material shows there was one more death (“overall mortality”) in the vaccine than placebo group [25, 48]. Albeit a statistically insignificant result, hiding this finding is not “responsible conduct of research” [49], nor ethically defensible. It indeed may damage the trustworthiness of science, given that the pooled mRNA trial results showed a statistically significant relative “all cause” risk increase for mRNA vaccination (hazard ratio 1.03) [50].

Scientific findings will always be questioned, but one avoidable critique relates to the skewed reporting of study findings, like relative rather than absolute effectiveness, which is misleading, and indeed a form of “anti-science”. As suggested above, scientific method is a means to gaining new knowledge, not truth. Of note, scientific approaches only produce data. It is the process of deliberation amongst scientists (and other stakeholders) [51] that results in accepted new knowledge, which ultimately will be modified by future findings. Only the application of the best available knowledge can lead to “wise decision-making” [52], particularly when facilitated within democratic procedures. In sociological terms, this form of decision-making can better mirror our perceived “lifeworld”, thus enhancing mutual social understanding by better capturing shared experience and collective problem solving [10].

Rather than uncritically continuing to perpetuate the “follow the science” vs “anti-science” dichotomy, let us all look in the mirror and reflect what really constitutes science. If nothing else, this involves the curiosity of deliberating the multiple perspectives arising from the different lenses of inquiry. Being open-minded and critical does not immediately equate to being “anti-science”, as some medical and political thought leaders want us to believe.

## 5. Conclusion

By trying to reduce “science” – which, by definition, explores doubts, complexity, and is in constant evolution – to simple messages set in stone, scientists can become the worse enemies of science. The independence of science should be paramount, however, the pervasive influence of political expediency, industrial interests and corruption in healthcare and medicine does not serve its inquiries [53,54]. To regain public trust in science, it is high time scientists acknowledge the

limitations of their methods and of their results, and to provide decision-makers, populations and healthcare providers with appropriate tools to judge how to best apply particular research results to individuals and communities. Science can never provide insights that allow the imposition of a universal blueprint to all [18]. What it requires is reinvigorated commitments to deliberative science and politics, democratic procedures, open contestation without epithets, genuine reason-giving, and, most importantly, humility.

## Ethical approval

No ethical approval was necessary for this opinion paper.

## Funding

No specific funding source was mobilised for this paper.

## Competing interests

The authors have no competing interest to declare.

## References

[1] P.J. Hotez, Combating antiscience: are we preparing for the 2020s? PLoS Biol. 18 (3) (2020) e3000683.

[2] W. Sampson, Antiscience trends in the rise of the « alternative medicine » movement, Ann. N. Y. Acad. Sci. 775 (1) (1995) 188-197, https://doi.org/10.1111/j.1749-6632.1996.tb23138.x [Internet]. 1 juin (Accessed 5 October 2023).

[3] C. Perronne, Lyme disease antiscience, Lancet Infect. Dis. 12 (5) (2012) 361-362, https://doi.org/10.1016/S1473-3099(12)70053-1 [Internet]. 1 mai. (Accessed 5 October 2023).

[4] A. Philipp-Muller, S.W.S. Lee, R.E. Petty, Why are people antiscience, and what can we do about it? Proc. Natl. Acad. Sci. U. S. A. 119 (30) (2022) e2120755119.

[5] P.J. Hotez, Mounting antiscience aggression in the United States, PLoS Biol. 19 (7) (2021) e3001369.

[6] G.G. Granger, La Science et les Sciences, Presses universitaires de France, Paris, 1993 (Que sais-je ?).

[7] M. Weber, Le savant et le politique, Union Générale D'Éditions, 1963 (Le Monde en 10-18).

[8] K. Niglas, The multidimensional model of research methodology: an integrated set of continua, in: Mixed Methods in Social and Behavioral Research [Internet], second ed., SAGE, Thousand Oaks, CA, 2010, pp. 215-236. Disponible sur: https://apisemanticscholar.org/CorpusID:156929988.

[9] A. Oza, Reproducibility trial: 246 biologists get different results from same data sets, Nature 622 (7984) (2023) 677-678 [Internet]. 12 oct, https://www.nature.com/articles/d41586-023-03177-1?utm_source=Live+Audience&utm_campaign=dc860c9880-briefing-dy-20231016&utm_medium=email&utm_term=0_b27a691814-dc860c9880-51034532.

[10] J. Habermas, Between Facts and Norms: Contributions to a Discourse Theory of Law and Democracy, MIT Press, Cambridge, MA, 1996.

[11] R. Nola, H. Sankey, Theories of Scientific Method: an Introduction, Routledge, London, 2007.

[12] R. Detels, R. Beaglehole, M.A. Lansang, M. Gulliford, éditeurs, Oxford Textbook of Public Health, Oxford University Press, 2009, https://doi.org/10.1093/med/9780199218707.001.0001. Internet. (Accessed 10 November 2023).

[13] I.R. McWhinney, An acquaintance with particulars, Fam. Med. 21 (4) (1989) 296-298.

[14] D.L. Sackett, W.M.C. Rosenberg, J.A.M. Gray, R.B. Haynes, W.S. Richardson, Evidence based medicine: what it is and what it isn't, Br. Med. J. 312 (7023) (1996) 71-72. Disponible sur: https://www.bmj.com/content/312/7023/71.

[15] F. Bédécarrats, I. Guérin, F. Roubaud, Randomized control trials in the field of development - a critical perspective [Internet]. IRD Editions, https://www.edition.s.ird.fr/produit/680/9780198865360/randomized-control-trials-in-the-field-of-development, 2020.

[16] T. Greenhalgh, J. Howick, N. Maskrey, Evidence based medicine: a movement in crisis? BMJ 13 (2014) g3725. ;348.

[17] L. Langer, J. Tripney, D. Gough, The science of using science: researching the use of research evidence in decision-making, Tech. Rep. (2016).

[18] J.P. Sturmberg, J.A. Marcum, From cause and effect to causes and effects, J. Eval. Clin. Pract. 30 (2) (2023) 296-308, https://doi.org/10.1111/jep.13814 [Internet].

[19] M. O'Neill, Pourquoi se préoccupe-t-on tant des données probantes en promotion de la santé? Soc. Prev. Med. 48 (5) (2003) 317-326, https://doi.org/10.1007/s00038-003-2036-4 [Internet].

[20] G. Dahlgren, M. Whitehead, The Dahlgren-Whitehead model of health determinants: 30 years on and still chasing rainbows, Publ. Health 199 (oct 2021) 20-24.

[21] C.M. Hood, K.P. Gennuso, G.R. Swain, B.B. Catlin, County health rankings: relationships between determinant factors and health outcomes, Am. J. Prev. Med.
Second, science – through observational data – showed that a third dose of the Pfizer vaccine was 93% (relative) effective against admission to hospital, 92% (relative) effective against severe disease, and 81% (relative) effective against COVID-19-related death. Of note, these results were found after a median follow-up time of only 13 days [38] which is a clinically meaningless timeframe, being a short-term outcome irrelevant to policymaking, and even if “true”, pragmatically impossible to apply as it would require vaccination twice a month.

Third, science – based on the individual clinical trials – showed a good safety profile of Covid-19 mRNA vaccines [25,27]. However, a re-examination of pooled safety data to get more statistical power, showed that the mRNA vaccines were associated with an excess risk of “serious adverse events of special interest” (as defined by the Brighton Collaboration [39]) of 12.5 per 10,000 vaccinated – that is, one in every 800 vaccinated [40]. Such an adverse event rate must be contextualised in relation to risk-benefit estimates, which we regard as an imperative from a research and policy ethics perspective.

Fourth, even with increasingly reported waning effectiveness, science suggests that the Covid-19 vaccines remain effective in preventing severe Covid-19 among at-risk populations [41–45]. Yet, science – in a risk-benefit analysis – also showed that adolescents do not benefit from the Pfizer vaccine, except for non-immune girls with comorbidities [46]. Unstratified effectiveness measured by only a single performance measure, should not be the only criterium to inform clinical and policy decision-making, equally important are considerations of efficiency, equity, and acceptance.

Fifth, while the clinical trials were not designed to evaluate the vaccine's effect on mortality, a systematic review of observational data showed an effect of the vaccines reducing “Covid-19 related death” [47]. Yet, the Pfizer study's supplementary material shows there was one more death (“overall mortality”) in the vaccine than placebo group [25, 48]. Albeit a statistically insignificant result, hiding this finding is not “responsible conduct of research” [49], nor ethically defensible. It indeed may damage the trustworthiness of science, given that the pooled mRNA trial results showed a statistically significant relative “all cause” risk increase for mRNA vaccination (hazard ratio 1.03) [50].

Scientific findings will always be questioned, but one avoidable critique relates to the skewed reporting of study findings, like relative rather than absolute effectiveness, which is misleading, and indeed a form of “anti-science”. As suggested above, scientific method is a means to gaining new knowledge, not truth. Of note, scientific approaches only produce data. It is the process of deliberation amongst scientists (and other stakeholders) [51] that results in accepted new knowledge, which ultimately will be modified by future findings. Only the application of the best available knowledge can lead to “wise decision-making” [52], particularly when facilitated within democratic procedures. In sociological terms, this form of decision-making can better mirror our perceived “lifeworld”, thus enhancing mutual social understanding by better capturing shared experience and collective problem solving [10].

Rather than uncritically continuing to perpetuate the “follow the science” vs “anti-science” dichotomy, let us all look in the mirror and reflect what really constitutes science. If nothing else, this involves the curiosity of deliberating the multiple perspectives arising from the different lenses of inquiry. Being open-minded and critical does not immediately equate to being “anti-science”, as some medical and political thought leaders want us to believe.

## 5. Conclusion

By trying to reduce “science” – which, by definition, explores doubts, complexity, and is in constant evolution – to simple messages set in stone, scientists can become the worse enemies of science. The independence of science should be paramount, however, the pervasive influence of political expediency, industrial interests and corruption in healthcare and medicine does not serve its inquiries [53,54]. To regain public trust in science, it is high time scientists acknowledge the

limitations of their methods and of their results, and to provide decision-makers, populations and healthcare providers with appropriate tools to judge how to best apply particular research results to individuals and communities. Science can never provide insights that allow the imposition of a universal blueprint to all [18]. What it requires is reinvigorated commitments to deliberative science and politics, democratic procedures, open contestation without epithets, genuine reason-giving, and, most importantly, humility.

## Ethical approval

No ethical approval was necessary for this opinion paper.

## Funding

No specific funding source was mobilised for this paper.

## Competing interests

The authors have no competing interest to declare.

## References

[1] P.J. Hotez, Combating antiscience: are we preparing for the 2020s? PLoS Biol. 18 (3) (2020) e3000683.

[2] W. Sampson, Antiscience trends in the rise of the « alternative medicine » movement, Ann. N. Y. Acad. Sci. 775 (1) (1995) 188-197, https://doi.org/10.1111/j.1749-6632.1996.tb23138.x [Internet]. 1 juin (Accessed 5 October 2023).

[3] C. Perronne, Lyme disease antiscience, Lancet Infect. Dis. 12 (5) (2012) 361-362, https://doi.org/10.1016/S1473-3099(12)70053-1 [Internet]. 1 mai. (Accessed 5 October 2023).

[4] A. Philipp-Muller, S.W.S. Lee, R.E. Petty, Why are people antiscience, and what can we do about it? Proc. Natl. Acad. Sci. U. S. A. 119 (30) (2022) e2120755119.

[5] P.J. Hotez, Mounting antiscience aggression in the United States, PLoS Biol. 19 (7) (2021) e3001369.

[6] G.G. Granger, La Science et les Sciences, Presses universitaires de France, Paris, 1993 (Que sais-je ?).

[7] M. Weber, Le savant et le politique, Union Générale D'Éditions, 1963 (Le Monde en 10-18).

[8] K. Niglas, The multidimensional model of research methodology: an integrated set of continua, in: Mixed Methods in Social and Behavioral Research [Internet], second ed., SAGE, Thousand Oaks, CA, 2010, pp. 215–236. Disponible sur: https://apisemanticscholar.org/CorpusID:156929988.

[9] A. Oza, Reproducibility trial: 246 biologists get different results from same data sets, Nature 622 (7984) (2023) 677–678 [Internet]. 12 oct, https://www.nature.com/articles/d41586-023-03177-1?utm_source=Live+Audience&utm_campaign=dc860c9880-briefing-dy-20231016&utm_medium=email&utm_term=0_b27a691814-dc860c9880-51034532.

[10] J. Habermas, Between Facts and Norms: Contributions to a Discourse Theory of Law and Democracy, MIT Press, Cambridge, MA, 1996.

[11] R. Nola, H. Sankey, Theories of Scientific Method: an Introduction, Routledge, London, 2007.

[12] R. Detels, R. Beaglehole, M.A. Lansang, M. Gulliford, éditeurs, Oxford Textbook of Public Health, Oxford University Press, 2009, https://doi.org/10.1093/med/9780199218707.001.0001. Internet. (Accessed 10 November 2023).

[13] I.R. McWhinney, An acquaintance with particulars, Fam. Med. 21 (4) (1989) 296-298.

[14] D.L. Sackett, W.M.C. Rosenberg, J.A.M. Gray, R.B. Haynes, W.S. Richardson, Evidence based medicine: what it is and what it isn't, Br. Med. J. 312 (7023) (1996) 71-72. Disponible sur: https://www.bmj.com/content/312/7023/71.

[15] F. Bédécarrats, I. Guérin, F. Roubaud, Randomized control trials in the field of development - a critical perspective [Internet]. IRD Editions, https://www.edition.s.ird.fr/produit/680/9780198865360/randomized-control-trials-in-the-field-of-development, 2020.

[16] T. Greenhalgh, J. Howick, N. Maskrey, Evidence based medicine: a movement in crisis? BMJ 13 (2014) g3725. ;348.

[17] L. Langer, J. Tripney, D. Gough, The science of using science: researching the use of research evidence in decision-making, Tech. Rep. (2016).

[18] J.P. Sturmberg, J.A. Marcum, From cause and effect to causes and effects, J. Eval. Clin. Pract. 30 (2) (2023) 296-308, https://doi.org/10.1111/jep.13814 [Internet].

[19] M. O'Neill, Pourquoi se préoccupe-t-on tant des données probantes en promotion de la santé? Soc. Prev. Med. 48 (5) (2003) 317-326, https://doi.org/10.1007/s00038-003-2036-4 [Internet].

[20] G. Dahlgren, M. Whitehead, The Dahlgren-Whitehead model of health determinants: 30 years on and still chasing rainbows, Publ. Health 199 (oct 2021) 20-24.

[21] C.M. Hood, K.P. Gennuso, G.R. Swain, B.B. Catlin, County health rankings: relationships between determinant factors and health outcomes, Am. J. Prev. Med.
50 (2) (2016) 129–135, https://doi.org/10.1016/j.amepre.2015.08.024 [Internet]. 1 févr.

[22] A.B. Gilmore, A. Fabbri, F. Baum, A. Bertscher, K. Bondy, H.J. Chang, et al., Defining and conceptualising the commercial determinants of health, Lancet 401 (10383) (2023) 1194–1213, https://doi.org/10.1016/S0140-6736(23)00013-2 [Internet]. 8 avr.

[23] J.K. Ward, P. Guille-Escuret, C. Alapetite, Les « antivaccins », figure de l'anti-Science, Déviance Soc. 43 (2) (2019) 221–251 [Internet], https://www.cairn.info/revue-deviance-et-societe-2019-2-page-221.htm.

[24] F.P. Polack, S.J. Thomas, N. Kitchin, J. Absalon, A. Gurtman, S. Lockhart, et al., Safety and efficacy of the BNT162b2 mRNA covid-19 vaccine, N. Engl. J. Med. 383 (27) (2020) 2603–2615, https://doi.org/10.1056/NEJMoa2034577 [Internet]. 31 déc.

[25] S.J. Thomas, E.D. Moreira, N. Kitchin, J. Absalon, A. Gurtman, S. Lockhart, et al., Safety and efficacy of the BNT162b2 mRNA covid-19 vaccine through 6 months, N. Engl. J. Med. 385 (19) (4 nov 2021) 1761–1773, https://doi.org/10.1056/NEJMoa2110345 [Internet].

[26] L.R. Baden, H.M. El Sahly, B. Essink, K. Kotloff, S. Frey, R. Novak, et al., Efficacy and safety of the mRNA-1273 SARS-CoV-2 vaccine, N. Engl. J. Med. 384 (5) (2021) 403–416, https://doi.org/10.1056/NEJMoa2035389 [Internet]. 4 févr.

[27] H.M. El Sahly, L.R. Baden, B. Essink, S. Doblecki-Lewis, J.M. Martin, E.J. Anderson, et al., Efficacy of the mRNA-1273 SARS-CoV-2 vaccine at completion of blinded phase, N. Engl. J. Med. 385 (19) (2021) 1774–1785, https://doi.org/10.1056/NEJMoa2113017 [Internet]. 4 nov.

[28] M. Thompson, J. Burgess, A. Naleway, et al., Interim estimates of vaccine effectiveness of BNT162b2 and mRNA-1273 COVID-19 vaccines in preventing SARS-CoV-2 infection among health care personnel, first responders, and other essential and frontline workers — eight U.S. Locations, december 2020–march 2021, MMWR Morb, Mortal. Wkly. Rep. 70 (2021) 495–500 [Internet]. 2 avr. https://www.cdc.gov/mmwr/volumes/70/wr/mm7013e3.htm?SID=mm7013e3_w#suggestedcitation.

[29] E.J. Haas, F.J. Angulo, J.M. McLaughlin, E. Anis, S.R. Singer, F. Khan, et al., Impact and effectiveness of mRNA BNT162b2 vaccine against SARS-CoV-2 infections and COVID-19 cases, hospitalisations, and deaths following a nationwide vaccination campaign in Israel: an observational study using national surveillance data, Lancet 397 (10287) (2021) 1819–1829, https://doi.org/10.1016/S0140-6736(21)00947-8 [Internet]. 15 mai.

[30] R. McKie, The vaccine miracle: how scientists waged the battle against Covid-19, Guardian (2020) [Internet]. 6 déc. https://www.theguardian.com/world/2020/dec/06/the-vaccine-miracle-how-scientists-waged-the-battle-against-covid-19.

[31] T. Kustin, N. Harel, U. Finkel, S. Perchik, S. Harari, M. Tahor, et al., Evidence for increased breakthrough rates of SARS-CoV-2 variants of concern in BNT162b2-mRNA-vaccinated individuals, Nat. Med. 27 (8) (2021) 1379–1384, https://doi.org/10.1038/s41591-021-01413-7. Disponible sur.

[32] P. Doshi, Will covid-19 vaccines save lives? Current trials aren't designed to tell us. BMJ (2020) m4037 [Internet]. 21 oct, http://www.bmj.com/content/371/bmj.m4037 abstract.

[33] P. Doshi, Clarification: Pfizer and Moderna’s “95% effective” vaccines—we need more details and the raw data, Br. Med. J. (2021) [cité 12 avr 2021]. Disponible sur: https://blogs.bmj.com/bmj/2021/02/05/clarification-pfizer-and-modernas-9-5-effective-vaccines-we-need-more-details-and-the-raw-data/.

[34] P.D. Thacker, Covid-19: researcher blows the whistle on data integrity issues in Pfizer's vaccine trial, BMJ 375 (2021) n2635 [Internet], https://www.bmj.com/content/375/bmj.n2635.

[35] E. Paul, G.W. Brown, A. Kalk, V. Ridde, Playing vaccine roulette: why the current strategy of staking everything on Covid-19 vaccines is a high-stakes wager, Vaccine [Internet]. 16 août 39 (35) (2021) 4921–4924. Disponible sur: https://www.sciencedirect.com/science/article/pii/S0264410X21009233.

[36] L. Irwig, J. Irwig, L. Trevena, et al., Relative risk, relative and absolute risk reduction, number needed to treat and confidence intervals, in: Smart Health Choices: Making Sense of Health Advice [Internet], Hammersmith Press, London, 2008. Disponible sur: https://www.ncbi.nlm.nih.gov/books/NBK63647/.

[37] P. Olliaro, E. Torreele, M. Vaillant, COVID-19 vaccine efficacy and effectiveness—the elephant (not) in the room, Lancet Microbe 2 (7) (2021) e279–e280, https://doi.org/10.1016/S2666-5247(21)00069-0 [Internet]. 1 juill.

[38] N. Barda, N. Dagan, C. Cohen, M.A. Hernán, M. Lipsitch, I.S. Kohane, et al., Effectiveness of a third dose of the BNT162b2 mRNA COVID-19 vaccine for preventing severe outcomes in Israel: an observational study, The Lancet [Internet]. 4 déc 398 (10316) (2021), https://doi.org/10.1016/S0140-6736(21) 02249-2 [cité 5 oct 2023].

[39] Brighton Collaboration, COVID-19 AESI list 5th update – october 2022 [Internet], https://brightoncollaboration.us/covid-19-aesi-list-5th-update-october-2022/, 2022.

[40] J. Fraiman, J. Erviti, M. Jones, S. Greenland, P. Whelan, R.M. Kaplan, et al., Serious adverse events of special interest following mRNA COVID-19 vaccination in randomized trials in adults, Vaccine 40 (40) (2022) 5798–5805. Disponible sur: https://www.sciencedirect.com/science/article/pii/S0264410X22010283.

[41] T. Brosh-Nissimov, E. Orenbuch-Harroch, M. Chowers, M. Elbaz, L. Nesher, M. Stein, et al., BNT162b2 vaccine breakthrough: clinical characteristics of 152 fully vaccinated hospitalized COVID-19 patients in Israel, Clin. Microbiol. Infect. 27 (11) (nov 2021) 1652–1657.

[42] L. Brinkley-Rubinstein, M. Peterson, R. Martin, P. Chan, J. Berk, Breakthrough SARS-CoV-2 infections in prison after vaccination, N. Engl. J. Med. 385 (11) (2021) 1051–1052, https://doi.org/10.1056/NEJMc2108479 [Internet]. 9 sept.

[43] M. Bergwerk, T. Gonen, Y. Lustig, S. Amit, M. Lipsitch, C. Cohen, et al., Covid-19 breakthrough infections in vaccinated health care workers, N. Engl. J. Med. 385 (16) (2021) 1474–1484, https://doi.org/10.1056/NEJMoa2109072 [Internet].

[44] P. Nordström, M. Ballin, A. Nordström, Effectiveness of covid-19 vaccination against risk of symptomatic infection, hospitalization, and death up to 9 Months: a Swedish total-population cohort study, Disponible sur: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3949410, 2021.

[45] H. Chemaitelly, L.J. Abu-Raddad, Waning effectiveness of COVID-19 vaccines, Lancet 399 (10327) (2022) 771–773, https://doi.org/10.1016/S0140-6736(22) 00277-X [cité 6 avr 2022].

[46] A. Krug, J. Stevenson, T.B. Høeg, BNT162b2 vaccine-associated myo/pericarditis in adolescents: a stratified risk-benefit analysis, Eur. J. Clin. Invest. 52 (5) (2022) e13759, https://doi.org/10.1111/eci.13759 [Internet]. 1 mai.

[47] K. Rahmani, R. Shavaleh, M. Forouhi, H.F. Disfani, M. Kamandi, R.K. Oskooi, et al., The effectiveness of COVID-19 vaccines in reducing the incidence, hospitalization, and mortality from COVID-19: a systematic review and meta-analysis, Front. Public Health 10 (2022) [Internet], https://www.frontiersin.org/articles/10.3389/fpubh.2022.873596.

[48] T. Rohban, BNT162b2 vaccine booster and covid-19 mortality, N. Engl. J. Med. 386 (10) (2022) 1000, https://doi.org/10.1056/NEJMc2120044 [Internet]. 10 mars.

[49] Fonds de recherche du Québec, De l'importance de la conduite responsable en recherche en temps de pandémie. https://frq.gouv.qc.ca/de-limportance-de-la-conduite-responsable-en-recherche-en-temps-de-pandemie/, 2020.

[50] C.S. Benn, F. Schaltz-Buchholzer, S. Nielsen, M.G. Netea, P. Aaby, Randomized clinical trials of COVID-19 vaccines: do adenovirus-vector vaccines have beneficial non-specific effects? Iscience 26 (5) (2023) https://doi.org/10.1016/j.isci.2023.106733 [Internet]. 19 mai.

[51] E. Robert, D. Rajan, K. Koch, A. Muggleworth Weaver, D. Porignon, V. Ridde, Policy dialogue as a collaborative tool for multistakeholder health governance: a scoping study, BMJ Glob. Health 4 (Suppl 7) (2020) e002161, https://doi.org/10.1136/bmjgh-2019-002161.

[52] J.P. Sturmberg, Knowledge Translation in Healthcare – Towards Understanding its True Complexities; Comment on “Using Complexity and Network Concepts to Inform Healthcare Knowledge Translation, Int. J. Health Policy Manag. 7 (5) (2018) 455–458. https://dx.doi.org/10.15171/ijhpm.2017.111.

[53] J. Lexchin, J.C. Kohler, M.A. Gagnon, J. Crombie, P. Thacker, A. Shnier, Combating corruption in the pharmaceutical arena, Indian J. Med. Ethics 3 (3) (2018) 234–239, https://doi.org/10.20529/IJME.2018.022.

[54] S. Chattopadhyay, Corruption in healthcare and medicine: why should physicians and bioethicists care and what should they do? Indian J. Med. Ethics 10 (3) (2013) 153–159. https://doi.org/10.20529/IJME.2013.049.
50 (2) (2016) 129-135, https://doi.org/10.1016/j.amepre.2015.08.024 [Internet]. 1 févr.

[22] A.B. Gilmore, A. Fabbri, F. Baum, A. Bertscher, K. Bondy, H.J. Chang, et al., Defining and conceptualising the commercial determinants of health, Lancet 401 (10383) (2023) 1194-1213, https://doi.org/10.1016/S0140-6736(23)00013-2 [Internet]. 8 avr.

[23] J.K. Ward, P. Guille-Escuret, C. Alapetite, Les « antivaccins », figure de l'anti-Science, Déviance Soc. 43 (2) (2019) 221-251 [Internet], https://www.cairn.info/revue-deviance-et-societe-2019-2-page-221.htm.

[24] F.P. Polack, S.J. Thomas, N. Kitchin, J. Absalon, A. Gurtman, S. Lockhart, et al., Safety and efficacy of the BNT162b2 mRNA covid-19 vaccine, N. Engl. J. Med. 383 (27) (2020) 2603-2615, https://doi.org/10.1056/NEJMoa2034577 [Internet]. 31 déc.

[25] S.J. Thomas, E.D. Moreira, N. Kitchin, J. Absalon, A. Gurtman, S. Lockhart, et al., Safety and efficacy of the BNT162b2 mRNA covid-19 vaccine through 6 months, N. Engl. J. Med. 385 (19) (4 nov 2021) 1761-1773, https://doi.org/10.1056/NEJMoa2110345 [Internet].

[26] L.R. Baden, H.M. El Sahly, B. Essink, K. Kotloff, S. Frey, R. Novak, et al., Efficacy and safety of the mRNA-1273 SARS-CoV-2 vaccine, N. Engl. J. Med. 384 (5) (2021) 403-416, https://doi.org/10.1056/NEJMoa2035389 [Internet]. 4 févr.

[27] H.M. El Sahly, L.R. Baden, B. Essink, S. Doblecki-Lewis, J.M. Martin, E.J. Anderson, et al., Efficacy of the mRNA-1273 SARS-CoV-2 vaccine at completion of blinded phase, N. Engl. J. Med. 385 (19) (2021) 1774-1785, https://doi.org/10.1056/NEJMoa2113017 [Internet]. 4 nov.

[28] M. Thompson, J. Burgess, A. Naleway, et al., Interim estimates of vaccine effectiveness of BNT162b2 and mRNA-1273 COVID-19 vaccines in preventing SARS-CoV-2 infection among health care personnel, first responders, and other essential and frontline workers — eight U.S. Locations, december 2020–march 2021, MMWR Morb, Mortal. Wkly. Rep. 70 (2021) 495-500 [Internet]. 2 avr. https://www.cdc.gov/mmwr/volumes/70/wr/mm7013e3.htm?SID=mm7013e3_w#suggestedcitation.

[29] E.J. Haas, F.J. Angulo, J.M. McLaughlin, E. Anis, S.R. Singer, F. Khan, et al., Impact and effectiveness of mRNA BNT162b2 vaccine against SARS-CoV-2 infections and COVID-19 cases, hospitalisations, and deaths following a nationwide vaccination campaign in Israel: an observational study using national surveillance data, Lancet 397 (10287) (2021) 1819-1829, https://doi.org/10.1016/S0140-6736(21)00947-8 [Internet]. 15 mai.

[30] R. McKie, The vaccine miracle: how scientists waged the battle against Covid-19, Guardian (2020) [Internet]. 6 déc. https://www.theguardian.com/world/2020/dec/06/the-vaccine-miracle-how-scientists-waged-the-battle-against-covid-19.

[31] T. Kustin, N. Harel, U. Finkel, S. Perchik, S. Harari, M. Tahor, et al., Evidence for increased breakthrough rates of SARS-CoV-2 variants of concern in BNT162b2-mRNA-vaccinated individuals, Nat. Med. 27 (8) (2021) 1379-1384, https://doi.org/10.1038/s41591-021-01413-7. Disponible sur.

[32] P. Doshi, Will covid-19 vaccines save lives? Current trials aren't designed to tell us. BMJ (2020) m4037 [Internet]. 21 oct, http://www.bmj.com/content/371/bmj.m4037 abstract.

[33] P. Doshi, Clarification: Pfizer and Moderna’s “95% effective” vaccines—we need more details and the raw data, Br. Med. J. (2021) [cité 12 avr 2021]. Disponible sur: https://blogs.bmj.com/bmj/2021/02/05/clarification-pfizer-and-modernas-9-5-effective-vaccines-we-need-more-details-and-the-raw-data/.

[34] P.D. Thacker, Covid-19: researcher blows the whistle on data integrity issues in Pfizer's vaccine trial, BMJ 375 (2021) n2635 [Internet], https://www.bmj.com/content/375/bmj.n2635.

[35] E. Paul, G.W. Brown, A. Kalk, V. Ridde, Playing vaccine roulette: why the current strategy of staking everything on Covid-19 vaccines is a high-stakes wager, Vaccine [Internet]. 16 août 39 (35) (2021) 4921-4924. Disponible sur: https://www.sciencedirect.com/science/article/pii/S0264410X21009233.

[36] L. Irwig, J. Irwig, L. Trevena, et al., Relative risk, relative and absolute risk reduction, number needed to treat and confidence intervals, in: Smart Health Choices: Making Sense of Health Advice [Internet], Hammersmith Press, London, 2008. Disponible sur: https://www.ncbi.nlm.nih.gov/books/NBK63647/.

[37] P. Olliaro, E. Torreele, M. Vaillant, COVID-19 vaccine efficacy and effectiveness—the elephant (not) in the room, Lancet Microbe 2 (7) (2021) e279-e280, https://doi.org/10.1016/S2666-5247(21)00069-0 [Internet]. 1 juill.

[38] N. Barda, N. Dagan, C. Cohen, M.A. Hernán, M. Lipsitch, I.S. Kohane, et al., Effectiveness of a third dose of the BNT162b2 mRNA COVID-19 vaccine for preventing severe outcomes in Israel: an observational study, The Lancet [Internet]. 4 déc 398 (10316) (2021), https://doi.org/10.1016/S0140-6736(21) 02249-2 [cité 5 oct 2023].

[39] Brighton Collaboration, COVID-19 AESI list 5th update – october 2022 [Internet], https://brightoncollaboration.us/covid-19-aesi-list-5th-update-october-2022/, 2022.

[40] J. Fraiman, J. Erviti, M. Jones, S. Greenland, P. Whelan, R.M. Kaplan, et al., Serious adverse events of special interest following mRNA COVID-19 vaccination in randomized trials in adults, Vaccine 40 (40) (2022) 5798-5805. Disponible sur: https://www.sciencedirect.com/science/article/pii/S0264410X22010283.

[41] T. Brosh-Nissimov, E. Orenbuch-Harroch, M. Chowers, M. Elbaz, L. Nesher, M. Stein, et al., BNT162b2 vaccine breakthrough: clinical characteristics of 152 fully vaccinated hospitalized COVID-19 patients in Israel, Clin. Microbiol. Infect. 27 (11) (nov 2021) 1652-1657.

[42] L. Brinkley-Rubinstein, M. Peterson, R. Martin, P. Chan, J. Berk, Breakthrough SARS-CoV-2 infections in prison after vaccination, N. Engl. J. Med. 385 (11) (2021) 1051-1052, https://doi.org/10.1056/NEJMc2108479 [Internet]. 9 sept.

[43] M. Bergwerk, T. Gonen, Y. Lustig, S. Amit, M. Lipsitch, C. Cohen, et al., Covid-19 breakthrough infections in vaccinated health care workers, N. Engl. J. Med. 385 (16) (2021) 1474-1484, https://doi.org/10.1056/NEJMoa2109072 [Internet].

[44] P. Nordström, M. Ballin, A. Nordström, Effectiveness of covid-19 vaccination against risk of symptomatic infection, hospitalization, and death up to 9 Months: a Swedish total-population cohort study, Disponible sur: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3949410, 2021.

[45] H. Chemaitelly, L.J. Abu-Raddad, Waning effectiveness of COVID-19 vaccines, Lancet 399 (10327) (2022) 771-773, https://doi.org/10.1016/S0140-6736(22) 00277-X [cité 6 avr 2022].

[46] A. Krug, J. Stevenson, T.B. Høeg, BNT162b2 vaccine-associated myo/pericarditis in adolescents: a stratified risk-benefit analysis, Eur. J. Clin. Invest. 52 (5) (2022) e13759, https://doi.org/10.1111/eci.13759 [Internet]. 1 mai.

[47] K. Rahmani, R. Shavaleh, M. Forouhi, H.F. Disfani, M. Kamandi, R.K. Oskooi, et al., The effectiveness of COVID-19 vaccines in reducing the incidence, hospitalization, and mortality from COVID-19: a systematic review and meta-analysis, Front. Public Health 10 (2022) [Internet], https://www.frontiersin.org/articles/10.3389/fpubh.2022.873596.

[48] T. Rohban, BNT162b2 vaccine booster and covid-19 mortality, N. Engl. J. Med. 386 (10) (2022) 1000, https://doi.org/10.1056/NEJMc2120044 [Internet]. 10 mars.

[49] Fonds de recherche du Québec, De l'importance de la conduite responsable en recherche en temps de pandémie. https://frq.gouv.qc.ca/de-limportance-de-la-conduite-responsable-en-recherche-en-temps-de-pandemie/, 2020.

[50] C.S. Benn, F. Schaltz-Buchholzer, S. Nielsen, M.G. Netea, P. Aaby, Randomized clinical trials of COVID-19 vaccines: do adenovirus-vector vaccines have beneficial non-specific effects? Iscience 26 (5) (2023) https://doi.org/10.1016/j.isci.2023.106733 [Internet]. 19 mai.

[51] E. Robert, D. Rajan, K. Koch, A. Muggleworth Weaver, D. Porignon, V. Ridde, Policy dialogue as a collaborative tool for multistakeholder health governance: a scoping study, BMJ Glob. Health 4 (Suppl 7) (2020) e002161, https://doi.org/10.1136/bmjgh-2019-002161.

[52] J.P. Sturmberg, Knowledge Translation in Healthcare – Towards Understanding its True Complexities; Comment on “Using Complexity and Network Concepts to Inform Healthcare Knowledge Translation, Int. J. Health Policy Manag. 7 (5) (2018) 455-458. https://dx.doi.org/10.15171/ijhpm.2017.111.

[53] J. Lexchin, J.C. Kohler, M.A. Gagnon, J. Crombie, P. Thacker, A. Shnier, Combating corruption in the pharmaceutical arena, Indian J. Med. Ethics 3 (3) (2018) 234-239, https://doi.org/10.20529/IJME.2018.022.

[54] S. Chattopadhyay, Corruption in healthcare and medicine: why should physicians and bioethicists care and what should they do? Indian J. Med. Ethics 10 (3) (2013) 153-159. https://doi.org/10.20529/IJME.2013.049.