Dr. Philp McMillan,  John McMillan

Virologist Geert Vanden Bossche recently launched a fierce rebuttal against FDA Commissioner Dr. Marty Makary; something far more significant than a scientific disagreement. This was the spectacular collapse of any remaining consensus on pandemic management.

The controversy erupted after Makary’s appearance on morning television, where he claimed that SARS-CoV-2 “is now going to become the fifth coronavirus that’s seasonal” and behaves “like a common cold virus.” For Vanden Bossche, these statements weren’t just wrong; they were dangerously naive.

Two Irreconcilable Worldviews

The gulf between Makary and Vanden Bossche cannot be bridged by data alone because they’re operating from fundamentally incompatible frameworks for understanding the virus itself.

Makary’s worldview treats SARS-CoV-2 as a problem largely solved. His assertion suggests a natural progression toward harmlessness, where the primary remaining challenge is extricating ourselves from overreactive policies, hence his push to eliminate “blanket recommendations” for vaccination.

Vanden Bossche’s framework could not be more different. Where Makary sees stabilization, Vanden Bossche sees acceleration. The virus isn’t becoming benign; it’s evolving under unprecedented selective pressure from mass vaccination. “These vaccines are neither safe nor effective and only accelerate immune escape and immune dysfunction in C-19 vaccinated populations,” he argues.

This darker view finds support in the current epidemiological reality: highly vaccinated populations combined with continued circulation of mutant variants create what experts increasingly recognize as the worst possible outcome for pandemic control.

The Virologist’s Warning

Vanden Bossche’s response was swift and unforgiving. In his article “Just when you thought it couldn’t get any worse,” he dismantled Makary’s position with surgical precision, emphasizing how immune selection pressure drives viral evolution.

If Vanden Bossche is correct, the vaccines aren’t just failing; they’re actively creating conditions for more dangerous variants to emerge. This justifies his fury at Makary’s “mind-blowingly reckless decision to only pull the COVID-19 shots for healthy kids and pregnant women” while maintaining recommendations for others.

The Policy Pivot

Makary’s position represents a dramatic shift in public health messaging. By advocating for “shared clinical decision-making” between patients and doctors, he’s attempting to move away from institutional guidance. His critique of the Advisory Committee on Immunization Practices as a “kangaroo court” that rubber-stamps vaccines based on “marketing and ease” rather than data suggests a fundamental loss of faith in existing institutions.

But this pivot creates a nightmare scenario for practicing physicians. Just when the science has become most complex and contentious, doctors are suddenly expected to provide individualized guidance without institutional support. If they make the wrong recommendation, they face potential liability at the worst possible moment.

The Therapeutic Void

Perhaps the most troubling aspect of this debate is what it obscures. While experts argue over vaccine policy, a therapeutic vacuum has emerged. Many interventions dismissed early in the pandemic may have significant value, but the public won’t consider them because they’ve been thoroughly discredited. People face an all-or-nothing choice: accept vaccines with acknowledged limitations and risks, or remain completely unprotected.

Dr. Philip McMillan, a clinician and researcher, emphasizes this point: “There are options out there that you can use. And if you’re listening, it’s a pretty good chance that you know what I’m talking about. This is vitamin D.” Yet such basic interventions remain largely absent from official guidance.

The contradiction at the heart of current policy becomes apparent when examining Makary’s logic. If SARS-CoV-2 has truly become just another common cold virus, why maintain any vaccine recommendations at all? We don’t vaccinate against other endemic coronaviruses. Yet if the virus remains dangerous enough to warrant continued vaccination for some groups, how can we justify treating it as benign?

Beyond the Binary

The Bayesian principle applies to our current predicament. Just as a physician needs prior knowledge to interpret an HIV test correctly, understanding COVID risk requires acknowledging the complex interplay between viral evolution, population immunity, and individual vulnerability.

Different populations face vastly different risk-benefit calculations. Consider someone with leukemia who is immunosuppressed and lives in an environment with high COVID circulation. For such patients, even an imperfect vaccine might represent the best available option. A healthy child with robust natural immunity faces entirely different calculations. Current policy frameworks fail to acknowledge these distinctions meaningfully.

Vanden Bossche’s critique gains additional weight when considering population-level effects. His argument about accelerating “immune escape and immune dysfunction” isn’t merely about individual risk—it’s about collective evolutionary pressure that could spawn more dangerous variants, transforming vaccination from a personal health decision into a question of population dynamics that individual doctor-patient consultations cannot adequately address.

Natural experiments already underway support this concern. Countries with minimal vaccination, like Haiti with its 2.7% vaccination rate, show little to no COVID circulation. The contrast with highly vaccinated nations where variants continue circulating suggests Vanden Bossche’s warnings merit serious consideration.

The Credibility Collapse

Underlying this entire debate is a catastrophic loss of institutional credibility. When Makary attacks his own agency’s advisory committee, he’s not restoring trust—he’s completing its destruction.

The data disputes exemplify this breakdown. Makary’s dismissal of CDC hospitalization statistics as “contaminated with a lot of false positives” may have merit, but it also means no numbers can be trusted. If official statistics are unreliable and expert committees are corrupt, what foundation remains for public health decisions?

Vanden Bossche’s suggestion that Makary “should pack up and head back to the operating room” reflects more than personal animosity. It represents the complete breakdown of scientific discourse into warring camps, each questioning not just the other’s conclusions but their basic competence and good faith.

Toward Honest Complexity

The path forward cannot be found in either Makary’s oversimplification or institutional rigidity. It requires acknowledging uncomfortable truths that challenge all camps: the virus continues evolving in concerning ways, current vaccines have significant limitations, suppressed therapeutics deserve reconsideration, and individual circumstances vary dramatically.

Most critically, it demands admitting uncertainty. The interaction between viral evolution, population immunity, and individual vulnerability creates a complex dynamic system that defies simple solutions. Pretending otherwise serves no one.

As Dr. McMillan notes, “I don’t know how we’re going to get out of it. But I don’t know if we have the leadership to do it either.” This honest acknowledgment of our predicament is more valuable than false certainties.

Public health authorities must provide frameworks for navigating complexity, not escaping it—offering comprehensive toolkits including all interventions, acknowledging population-level effects while respecting individual variation, and communicating honestly about what we know and don’t know.

Reference: FDA: Just when you thought it couldn’t get any worse…