What Florida's surgeon general told me about his controversial vaccine warning

Joseph Ladapo defended his state's study in our October interview. New documents raise more questions about his methods.

Back in October, Florida Surgeon General Joseph Ladapo dropped a Friday night bombshell: he was recommending that young adult men stop taking covid vaccines from Pfizer and Moderna, warning of an “abnormally high risk” of heart-related deaths.

Ladapo’s vaccine warning — extrapolated from a short state analysis — was immediately hailed by vaccine skeptics, who cited it as long-awaited proof that the mRNA shots were dangerous.¹ And he touted Florida’s findings in interviews with Tucker Carlson and others across conservative media.

But in public health, Ladapo’s warning was widely panned, with experts saying that Florida’s vaccine warning wasn’t backed up by the evidence; when I asked Ladapo’s PhD adviser, he rebuked his former student’s methods.

A few days after Ladapo’s vaccine warning, I spoke with him for almost 30 minutes about his vaccine criticism, his state’s study and his path to becoming Gov. Ron DeSantis’ top health official for a story in The Washington Post. (You can read that story here, with no paywall.)

This month, there’s been a new development: Ladapo personally edited Florida’s vaccine study, according to documents obtained by multiple news outlets.

Per Christopher O'Donnell in the Tampa Bay Times:

Matt Hitchings, an infectious disease epidemiologist and professor of biostatistics at the University of Florida, said it seems that sections of the analysis were omitted because they did not fit the narrative the surgeon general wanted to push.

“This is a grave violation of research integrity,” Hitchings said. “(The vaccine) has done a lot to advance the health of people of Florida and he’s encouraging people to mistrust it.”

Per Politico’s Arek Sarkissian:

[T]he researchers who viewed a copy of the edits said Ladapo removed an important analysis that would have contradicted his recommendation. Daniel Salmon, director of the Institute for Vaccine Safety at the Johns Hopkins Bloomberg School of Public Health, called Ladapo’s changes “really troubling.”

“He took out stuff that didn’t support his position,” Salmon said. “That’s really a problem.”

In statements to the press, Ladapo and his team have defended his edits as appropriate. Per Politico’s Sarkissian:

In a statement to POLITICO, Ladapo said revisions and refinements are a normal part of assessing surveillance data and that he has the appropriate expertise and training to make those decisions.

“To say that I ‘removed an analysis’ for a particular outcome is an implicit denial of the fact that the public has been the recipient of biased data and interpretations since the beginning of the mRNA COVID-19 vaccine campaign,” he said. “I have never been afraid of disagreement with peers or media.”

He also said that he determined the study was worthwhile since “the federal government and Big Pharma continue to misrepresent risks associated with these vaccines.”

And on Twitter:

Given the renewed interest in Florida’s study, and Ladapo’s generally limited statements to the mainstream press about it, I thought it might be helpful to hear how he defended the study when pressed on it last year.

Below is a partial transcript from our interview². (I’ve also put up the relevant audio so you can hear for yourself.)

You’ll see that I asked, repeatedly, who worked on the study and how it came together. For me, the revelation that Ladapo personally edited the findings affects how I think about his dodges here.

Monday, October 10

DIAMOND: You put out this study and your guidance on Friday evening. Can you walk me through the behind-the-scenes process, how this all came to be?

LADAPO: … Basically, my observation, the observation of many other people is that there has been so much wovenness (?) between the science of, in COVID-19 from everything from, you know, early on the lockdown policies, to the mask policies, to who should be wearing masks and how many and for how long, and to the vaccines … it's been very unfortunate that that they've been so intertwined, the science and the politics.

And with the vaccines in particular, it's especially unfortunate because, you know, they’re a biological intervention, and it's really important that people have a good, accurate sense of what they might expect when they put something in their body. You know, whatever that thing is, whatever medication that thing is … and that's been an area that just hasn't been addressed objectively. We've had more objective evaluation of effectiveness, not so much of safety. So looking at that was one of, one of my objectives … and that's what we did.

DIAMOND: So having read your op-eds in the [Wall Street] Journal … having read your memoir, I know that you have questions about vaccines and how they are taught, what we know about them. I guess with this specific study, was there a decision three weeks ago to say, "Hey, we should do this analysis." Was there something longer — I guess I'm looking for detail on how this specific analysis was put together.

LADAPO: I'm a little confused. Because … there's nothing unusual about this … if there's a public health intervention that you're, that you're implementing, you're supposed to do this. I mean, there's nothing unusual about this.

In fact, things that make you even more inclined to do this sort of thing is just what we have observed, which is that cardiac-related complications in in the young men in particular and boys are markedly increased … if that's not a safety signal, you know, I need to go to school and learn more about safety signals. So this is nothing unusual … the part that was unusual is that we had to do it, that this wasn't already done by the CDC, by other organizations that have the data and the resources to do it. We should do this. There's nothing … This should have been done by anyone who had the ability to do it in terms of the data and the technical expertise.

DIAMOND: You say "we were the ones who had to do it." The study has no names on it. Who did the study?

LADAPO: So that's interesting. So, you know, these are, these are these, these are these sort of cheesy attempts to do what people want to do, which is to find some way to deny the findings of the study, right? "Oh, there are no names on it. Oh, it wasn't peer reviewed." … if I wrote a paper on parachutes and didn't put my name on it and advised people to use them … people who don't like parachutes and don't think you should use them would have similar questions. [Ladapo is interrupted by one of his children.]

DIAMOND: I’m going to assume that wasn't one of your co-authors … I take your point, doctor, that the findings can outweigh the authorship. But just again, if [Ladapo’s PhD adviser] David Cutler writes a paper that means something different than if a Harvard undergrad writes a paper.

LADAPO: … It's the Department of Health that wrote the paper, so we have biostatisticians. We have epidemiologists … I mean, it's like a fake issue, that in some ways, it's amusing that people want to get wrapped up in it because that's fine. Because guess what, that has nothing to do with the substantive material in the paper. Then the analysis, what matters is whether the individuals, you know, whether the data is reliable, whether the methods are appropriate, and whether the individuals who implemented the study have the technical expertise to do [that?]. And all of that is true.

These are individuals who work at the Florida Department of Health, and they have the technical expertise. We're not the only state that could do this. Other states that have similar data could ask, could ask and answer the same questions.

DIAMOND: I want to go back to something you said about how your team is doing something that CDC and others have not. Why are you so sure that you and your team have identified risks with the mRNA vaccines that have been missed by so many other experts over these past few years?

LADAPO: … You know, I would love to have a beer with you and hear more about how you feel about … It sounds like you think that everyone's been doing a really good job during this pandemic.

DIAMOND: I'm just asking the question. I've written articles about how many failures the federal government has had over these past two and a half years. In this case, you are coming up with as you just said, a few minutes ago, a finding that you think CDC and others should have found earlier.

LADAPO: Actually, it's not a finding that we came up with, it was the analysis is what matters. The findings are secondary to the analysis.

Like the findings or what you know, the findings are whatever the findings are. The analysis that that's what we did that was unique, right? Because that we don't know, what no one knows what the analysis would show, right? So that's, that's the part that's unique. The findings are the findings, right? And if there wasn't any risk, it wouldn't … there were groups that didn't show any evidence of any, any significant evidence of cardiac risk. There were groups that showed a benefit, for example, people are … so this has gotten people so excited, that there are actually some favorable things in the paper. You know, for example, in the older than 60 year old group, there's an overall mortality benefit … that is something that obviously is a favorable thing.

But again, this intertwining of politics and science, all people want to focus on … is the thing that they don't like, and that makes the study bad even though, you know, there's every reason to believe that, that that finding is, is a representation of what is actually happening in nature.

1. No other state or U.S. health agency had come to a similar conclusion.

2. With a few [?] marks where I wasn’t sure what was said.