He has blood on his hands. Even as the worst of the health crisis ignited by the SARS–CoV–2 virus fades, there has yet to be any accountability for the directives of the public official who contributed to the death of thousands of Floridians: State Surgeon General Dr. Joseph Ladapo.
Like a bizarre character from the fictional books of Florida writer Carl Hiaasen, who once depicted a crazed governor fleeing into the Everglades and living on roadkill, Ladapo remains clueless about the danger of infectious respiratory diseases, how they spread, and how they can be prevented. And no one and no organization, let alone Florida's governor who has turned his attention to a run for the White House, has brought him to account.
A Nigerian-born, Harvard Medical School-educated surgeon, Ladapo emerged as a national figure by writing op-ed articles in the Wall Street Journal early in the pandemic questioning the safety of COVID vaccines, claiming the risks often outweighed the benefits. Lapado later joined a petition opposing the FDA's rapid Emergency Use Authorizations of the Pfizer-BioNTech and Moderna mRNA vaccines. He's become a star among the science-rejecting wing of the Republican Party, and most recently featured in a fawning interview by Megyn Kelly after the release of his autobiography.
Putting it another way, via disinformation, Florida's surgeon general has been promoting medical malpractice, and there is no indication that he is letting up. Two months ago, Ladapo sent a letter to FDA Commissioner Robert Califf and CDC Director Rochelle Walensky filled with erroneous claims about dangers of the mRNA vaccines. Some of the data in the letter appeared to be completely fabricated.
It was clear that Ladapo fails to understand or has deliberately taken out of context the purpose and mode of reporting of vaccine side effects, or "adverse events," to the federal Vaccine Adverse Event Reporting System (VAERS). Ladapo cited numbers of adverse effects from the vaccines reported to VAERS, but as spelled out clearly on the CDC website:
VAERS is the nation's early warning system that monitors the safety of vaccines after they are authorized or licensed for use by the U.S. Food and Drug Administration (FDA). VAERS is part of the larger vaccine safety system in the United States that helps make sure vaccines are safe. The system is co-managed by CDC and FDA.
VAERS accepts and analyzes reports of possible health problems — also called "adverse events" — after vaccination. As an early warning system, VAERS cannot prove that a vaccine caused a problem. Specifically, a report to VAERS does not mean that a vaccine caused an adverse event (emphasis in original).
The CDC emphasizes that last point repeatedly. "VAERS is not designed to determine if a vaccine caused or contributed to an adverse event. A report to VAERS does not mean the vaccine caused the event."
Ladapo's condemnation of the mRNA vaccines is based almost entirely on the reports to VAERS that he takes out of context.
FDA and CDC fire back
The FDA's Califf and CDC's Walensky did not allow Ladapo's misapprehensions and misrepresentations go unchallenged. They sent him a scathing four-page letter, condemning his assertion that COVID-19 vaccines are "harmful." Leaving no doubt as to their irritation. Here are some excerpts, all of which are verbatim and retain the emphasis in the original:
- The claim that the increase of VAERS reports of life-threatening conditions reported from Florida and elsewhere represents an increase of risk caused by the COVID-19 vaccines is incorrect, misleading and could be harmful to the American public.
- Reports of adverse events to VAERS following vaccination do not mean that a vaccine caused the event.
- Adverse events must be compared to background rates in the population.
- In addition to VAERS, FDA and CDC utilize complementary active surveillance systems to monitor the safety of COVID-19 vaccines.
- Based on available information for the COVID-19 vaccines that are authorized or approved in the United States, the known and potential benefits of these vaccines clearly outweigh their known and potential risks.
- Additionally, not only is there no evidence of increased risk of death following mRNA vaccines, but available data have shown quite the opposite: being up to date on vaccinations saves lives compared to individuals who did not get vaccinated.
- According to the most recent data, those up-to-date on their vaccination status have a 9.8-fold lower risk of dying from COVID-19 than those who are unvaccinated and 2.4-fold lower risk of dying from COVID than those who were vaccinated but had not received the updated, bivalent vaccine.
Califf and Walensky admonished Ladapo directly (emphasis in original):
As the leading public health official in [the] state, you are likely aware that seniors in Florida are under-vaccinated, with just 29% of seniors having received an updated bivalent vaccine, compared to the national average of 41% coverage in seniors. It is the job of public health officials around the country to protect the lives of the populations they serve, particularly the vulnerable. Fueling vaccine hesitancy undermines this effort. ... Unfortunately, the misinformation about COVID-19 vaccine safety has caused some Americans to avoid getting the vaccines they need to be up to date. (Emphasis in original.)
Their letter concluded:
Misleading people by overstating the risks, or emphasizing the risks without acknowledging the overwhelming benefits, unnecessarily causes vaccine hesitation and puts people at risk of death or serious illness that could have been prevented by timely vaccination.
As blunt as the Califf-Walensky letter was, it was less harsh than my response would have been. Ladapo seems immune to any data or opinions except from a handful of anti-vaccine zealots in the medical community. Even if he doesn't trust federal officials, there are other reliable sources. An analysis by The Commonwealth Fund, a nonprofit that conducts independent healthcare research, estimated that COVID-19 vaccinations in the U.S. prevented more than 3 million additional deaths, 18.5 million additional hospitalizations, and 120 million more cases from December 2020 through November 2022.
There's more. Ladapo's announcement last October that young men should not get the COVID-19 vaccine, which purportedly showed that the risk of cardiac-related deaths increased significantly for some age groups after receiving a vaccine, was based on a state analysis that appears to be manipulated in part.
The Tampa Bay Times uncovered evidence that early drafts of the analysis showed that a COVID infection could increase the risk of a cardiac-related death far more than vaccination, but that critical information was missing from the final version put out by the Florida Department of Health.
Ladapo's recommendation and the state's analysis have been excoriated by professors and epidemiologists at the University of Florida where he is a professor. Matt Hitchings, an infectious disease epidemiologist at the university, said that sections of the state analysis appear to have been omitted because, he believed, they did not fit the narrative the surgeon general was pushing. "This is a grave violation of research integrity," he said.
Florida, the third most populous state in the U.S., has the highest percentage of seniors, and is woefully under-vaccinated — unquestionably, in large part, because of the anti-vaccine advocacy by the state's surgeon general — making him partly responsible for many of the roughly 90,000 COVID deaths in Florida during the pandemic. Because of the legal principle of qualified immunity, Ladapo is unlikely to see the inside of a courtroom, but there are several sanctions that he deserves.
Consequences of promoting disinformation
The first is an obvious one: Governor Ron DeSantis should fire Ladapo for actions that have harmed the citizens of Florida. Ladapo's unorthodox views that are contradicted by mainstream science were an issue in his previous job as a professor at UCLA. In early 2020, Ladapo began writing op-eds for The Wall Street Journal on the emerging COVID-19 pandemic and, notwithstanding a lack of specialization in infectious diseases, promoting unproven treatments, including hydroxychloroquine and ivermectin, that have been proven ineffective and even dangerous.
Just last week, H. Holden Thorp, the editor-in-chief of the prestigious journal Science, excoriated Lapado for his blatant misrepresentations that likely cost the lives of thousands of patients.
Prior to his move to Florida, he wrote an op-ed in the Wall Street Journal that cited a preprint that was withdrawn and another that was never published in a peer-reviewed journal to suggest that ivermectin and hydroxychloroquine were effective against COVID-19. Numerous, rigorous randomized control trials have shown this to be false, but Ladapo contended that the scientific community was using fear to prohibit treatment with these drugs.
Contrary to overwhelming evidence to the contrary, he soon began questioning the safety of vaccines. While Ladapo was on the UCLA faculty, dozens of professors there signed a petition denouncing him for his unorthodox and dangerous views. A UCLA colleague sent an e-mail to the chancellor with the subject line "Why does UCLA employ Dr. Ladapo?" urging the university to issue a formal renunciation. Ladapo's superiors sought unsuccessfully to vet his articles before publication.
"My boss complained that she was spending half her time dealing with complaints about me," Ladapo wrote. "I basically became an outcast in my department."
Second, citing professional misconduct, the University of Florida College of Medicine should strip him of his faculty position, which he assumed in 2021 when named Florida's Surgeon General. He's been a disaster since. In 2022, he self-celebrated his failure to grasp basic science in Transcend Fear, his widely-ridiculed memoir that featured a glowing forward from vaccine-rejectionist crank Robert F. Kennedy, Jr.
A faculty committee found numerous "irregularities" in Ladapo's hiring that "appeared to violate the spirit, and in review, the exact letter, of UF hiring regulations and procedures, particularly in the vital role faculty play in evaluating the qualifications of their peers."
Third, the website of the Florida Board of Medicine says that it "was established to ensure that every physician practicing in this state meets minimum requirements for safe practice" and that it "will license, monitor, discipline, educate, and when appropriate, rehabilitate physicians and other practitioners to ensure their fitness and competence in the service of the people of Florida." Ladapo does not meet that standard; his medical license should be suspended.
Fourth, any national organizations that have awarded Ladapo board certifications should withdraw them due to his professional misconduct and malpractice.
This should not be a partisan issue. Republicans and Democrats should be united in their outrage. To reaffirm a commitment to independently vetted science, Florida's Attorney General should investigate whether Ladapo's actions meet the required elements for civil or criminal negligence.
As Drs. Califf and Walensky wrote in their letter, "It is the job of public health officials around the country to protect the lives of the populations they serve." Ladapo has done exactly the opposite.
Henry I. Miller, a physician and molecular biologist, is the Glenn Swogger Distinguished Fellow at the American Council on Science and Health. He was the founding director of the FDA's Office of Biotechnology. Find him on Twitter @HenryIMiller