Andrew Huberman spreads misinformation about influenza and flu vaccines

His "science-based" cold and flu prevention podcast episode was anything but.

(Note: this is part one of a multi-piece segment, for the sake of length)

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Andrew Huberman’s strategy to amass millions of followers: excessively long-form content that has to be played almost non-stop in the background, exude confidence, use jargon to sound “science-y”, and repeat academic credentials to appeal to authority.

The problem: his podcast is rife with misinformation that harms public health & science literacy.

His recent solo episode on cold and flu prevention, advertised as “science-backed” was anything but. Instead, he made patently false statements about basic immunology, downplayed evidence-based measures to mitigate and prevent respiratory illnesses, and overhyped measures that aren’t supported by the body of evidence (many of which he profits from directly). While this episode was a particularly egregious example, it is not the only one (watch here for a discussion more broadly about his podcast).

Before we get into it, let’s talk about the importance of expertise. Huberman’s scientific career has been solely in academia. In an academic lab, your field of expertise is narrow out of necessity. His lab focused on vision in the context of neuronal function, and at least for the last 3 years, has not been conducting active research. Neuroscience, specifically a narrow niche of neuroscience related to optic nerve function, does not give one expertise in infectious disease immunology.

He and his team implemented an effective marketing strategy to create broad appeal. If you happen to be one of his fans, understand that it isn’t your fault. The methods used are coordinated psychological tactics - and actually similar to those cult leaders use. He also utilizes pseudoscience: integrate grains of truth alongside unfounded statements to give everything the appearance of credibility.

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What’s the harm?

It misleads people: into doing things that have no benefit or might be actively harmful while dissuading them from interventions that have evidence to support them. It erodes trust in robust evidence-based science, undermines public health, and propagates medical conspiracism. All the while, he makes a lot of money. As someone with a PhD in a science field, he knows full well that what he is saying is wrong. It is reckless, irresponsible, and quite honestly, insulting to every scientist who adheres to the integrity of data-driven methods.

He acknowledges that he doesn’t care about evidence. Instead of conceding gaps and flaws, he doubles down and insinuates that non-expert ‘opinions’ are sufficient data for this supposedly science-based episode. That, my friends, is not how science works.

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Let’s dig into the cold and flu episode.

(Note: this is going to be a multi-part piece for the sake of ensuring each article isn’t excessively long. As I was writing, I realized there is simply too much to get through, so each newsletter will have a theme.)

Huberman makes false statements about flu vaccination, the number one thing that can help prevent the flu.

I pulled this comment below from my Instagram stories when I had made some comments after the episode initially aired, and felt this was a great way to frame the topic of flu vaccines and why this is so problematic.

Yes, when someone with a PhD perceived by millions to be a scientific expert says they do not get vaccinated, that is absolutely discouragement. Here’s why:

He promoted this episode as “science-backed” methods to prevent colds and the flu, but then goes on to say that he does not get vaccinated for the flu, the number one thing that prevents flu. A scientist waving aside the most important thing to prevent the flu in his “science-based” episode on flu prevention - you can’t make the irony up. He also ignores mountains of data and consensus from reputable immunology and infectious disease organizations including the Infectious Diseases Society of American (IDSA), The American Medical Association (AMA), The American Society for Microbiology (ASM), The Centers for Disease Control and Prevention (CDC)). That is discouragement.

He diminished the severity of the flu, likening it to a ‘cold’ and claiming you can’t tell the difference, and made no mention of the annual health burden of the flu.

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Here are the data:

Roughly 8% of the population gets sick with flu every year. This causes between

• 9.4 and 41 million illnesses

• 100,000 – 710,000 hospitalizations

• 4,900 – 52,000 deaths

in the United States annually. Globally, seasonal flu causes 5 million hospitalizations and up to 650,000 deaths every year.

The economic burden of flu is substantial. In the US, there is at least $11 billion dollars of direct economic costs (lost wages, medical expenses) and $87 billion of total costs (business disruption, lost productivity for caregivers) attributable to the flu.

It’s also important to note that these statistics reflect the average vaccination rate of 50%. If more people get vaccinated, these numbers improve. His discouraging flu vaccination will reduce the number of people who get vaccinated, worsening these outcomes.

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Flu vaccines offer additional benefits

There’s a bizarre perception when it comes to vaccines: either they’re 100% effective or not at all. Why? Nothing is 100% effective. Seatbelts aren’t. Airbags aren’t. These are risk mitigation measures that everyone accepts to be effective, but not in every instance. Vaccines must be viewed in the same way.

Even if vaccination doesn’t prevent every instance of infection with the flu virus or every illness, there are still substantial benefits. Vaccination means many people won’t get infected with flu viruses. If you’re not infected, you can’t transmit the virus to others. Even if vaccination doesn’t prevent infection outright, it can reduce viral load which means people may not carry a high enough viral load to infect others. Reduced viral load can also mean milder illness. Milder illness means many people won’t be so sick they need to be hospitalized. Not having severe illness means many people won’t die.

Huberman didn’t just say he didn’t get the flu vaccine, he ignored all of the above and undermined vaccines. The only attention Huberman paid to flu vaccines in over 2 hours of talking, was a ‘wave of the hand’ that the ‘so-called’ flu shot is roughly 40-60% effective. 

That 40-60%? That refers to symptomatic illness, which means flu vaccines prevent 7.5 million illnesses in the US every year. That’s pretty incredible. Flu vaccines have further benefits: they prevent 3.7 million medical visits, 105,000 hospitalizations, and 6,300 deaths - and that’s with vaccination rates rarely exceeding 40-50% of the eligible population. 

Flu shots reduce hospitalizations by about 50%, and risk of ICU admission by around 80%. Because vaccines reduce illness severity even if you get infected, that can be the difference between managing illness at home or needing hospitalization for many. Flu vaccination can reduce the risk of death in children by 75%. Flu vaccines offer protection during pregnancy and prevent poor pregnancy outcomes. Flu vaccines reduce all-cause mortality by 15-20%, including related cardiac and respiratory deaths.

If it wasn’t clear by now: the flu vaccine has enormous benefits.

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He correctly states that the goal is to contain the propagation of flu viruses. He says there are a ‘number of ways’ this can be done, and that the ‘best’ is to not come into contact with someone carrying a virus, which is true.

Outside of being a shut-in, how do we do that? Vaccination. But that’s not what he says. He spends an inordinate amount of time fixating on unfounded modes of transmission (but we will save the detail for the next piece). Suffice it to say for now, touching your eyes is not the primary mode of transmission for the flu.

He claims flu shots are completely ineffective against strains not in the quadrivalent vaccine formulation. He says “you’re hedging a bet” that you’ll be exposed to the right flu virus that is in the vaccine.

This is false. Anyone who understands immunology knows that, but since he doesn’t, he is misleading people.

First, what bet? You’re not missing out if you don’t get exposed to the flu. If you don’t, that’s great! But vaccination protects you IF you get exposed. There is no detriment to you or your immune system if you don’t ‘use’ the protection developed after vaccination in a given season. More importantly:

The flu vaccine protects against strains of influenza virus that aren’t in the vaccine.

Since 2012, the annual flu shot is quadrivalent: it targets 4 strains of influenza viruses. There are hundreds of potential flu viruses, classified by type (A, B, C, D), and subtypes (Flu A), or lineage (Flu B). Flu A subtypes are classified by 2 proteins on the outside: hemagglutinin (HA) and neuraminidase (NA): there are 18 HA and 11 NA subtypes, and within these, there’s variability. One H1N1 influenza isn’t going to be identical as another H1N1 (because of mutations that occur via antigenic drift and antigenic shift). Researchers monitor the dominant flu strains to determine the optimal flu vaccine composition for a given year. This year, there are H1N1, H3N2, B/Austria, and B/Phuket viruses in the flu vaccine.

When we get vaccinated, our memory immune system is activated by our innate immune system which leads to generation of B- and T-cell memory responses. The cool thing is, while we develop a very specific response to the virus in question, it is also very broad. It is called a polyclonal response. And this is because antigens - the components of a pathogen that elicit antibody production by B cells (in this case the NA and HA proteins), aren’t seen as a single structure by our immune system.

Instead, little pieces of antigen called epitopes are what are seen by our immune system. And you have dozens, potentially hundreds, of different B cells and T cells that create large populations of clones that develop memory to each of these different epitopes. So even if the flu virus you encounter isn’t a perfect match for one included in the vaccine, if those antigens share similarities in some of those epitopes, you’ll have protection from any of the memory immune cells and antibodies that recognize those epitopes. This ensures that you will have protection even if a virus changes, because of these redundancies and overlap in our immune defenses.

Image adapted from J Immunol Methods. 2018 October ; 461: 23–29. doi:10.1016/j.jim.2018.07.007

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His justification for not getting vaccinated were irresponsible and ignore key aspects about infectious diseases. He talked about why he personally isn’t high risk and doesn’t go places where he might encounter people that would infect him, while simultaneously saying he gets sick at least every 18-24 months. He is seemingly unconcerned about his ability to transmit a communicable illness to others. Unless he is homebound (which is unlikely), he is encountering plenty of people.

He knows what the outcome will be when he makes false statements and proclaims he doesn’t get the flu shot. He doesn’t outright say ‘don’t get the flu shot’ to shield himself from legal liability, but this is the same strategy other anti-vaxxers use. The worst part is he has the power to improve outcomes from the flu if he encouraged vaccination, but instead, he does the opposite, which will reduce vaccine uptake and worsen health outcomes.

He says the math doesn’t fit for him to get a flu vaccine and tells his listeners to do the same. What math?

• Flu vaccines are overwhelmingly safe.

• They are recommended for EVERYONE 6 months and older, including high-risk groups: immunocompromised, pregnant, and older adults.

• Flu vaccines have been used for almost 80 years. They have an extremely favorable reactogenicity profile. Even individuals with egg allergies can safely receive them.

On the other side of the math, the flu kills people. The virus can be spread to others and cause serious illness, hospitalization, and death, as well as economic impacts (lost wages, medical bills). Plus, flu shots are almost always free in the US. Even if you are uninsured, almost every state has a program through their health department to provide vaccines. The math is a no-brainer.

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I will get into more of this in the next piece, but this is worth noting quickly. He repeatedly conflates the flu with colds. “Common cold” is a catchall term for an array of mild respiratory viruses (not just rhinoviruses, either, contrary to what he states). Colds and the flu are not one and the same. He makes this claim to diminish the severity of the flu and the importance of vaccination. 

Colds and the flu share some similarities but have key differentiators. While the large umbrella of ‘cold viruses’ and influenza viruses all cause respiratory illness with some shared symptomatology, they can be differentiated, even though he repeatedly claimed that ‘you cannot tell’ whether you have a cold or flu.

First: there are diagnostic tests, including rapid Flu A and Flu B tests that easily differentiate these different viruses.

Second: symptoms of the flu (influenza virus infection), are generally more severe with more rapid and abrupt symptom onset. Flu symptoms more often include fever - often high, body aches, fatigue, muscle weakness, headache, and frequently include cough, sore throat, and chills. Symptoms of colds generally appear more gradually and rarely include fever, headache, and chills. Colds typically present with runny nose, stuffy nose, congestion, sore throat, and sneezing. Nearly everyone contracts at least one cold virus per year, with children potentially contracting up to 12 annually.

Influenza causes serious and fatal illness and has substantial societal impacts.

Conversely, colds rarely lead to serious health problems, complications, or death (with rare exceptions or with certain viruses in certain populations (i.e. RSV in infants)).

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There is lots more to say, but for now, I’ll end on this: after vaccination, the next best thing to reduce contact with respiratory viruses is wearing a mask, particularly in high-risk or high-exposure situations. He made zero mention of mask wearing. He talks briefly about hygiene in the context of hand sanitizer but no mention of hand washing (the superior method of cleaning your hands).

After he diminished the public health burden of flu and minimized impact of vaccines, he exaggerated benefits of things that aren’t scientifically supported to prevent respiratory illnesses or reduce disease severity, including sauna, cold plunges, fermented foods, nasal breathing, and various supplements (and now, a message from his sponsor: AG1). During this segment, he made factually incorrect statements about immunology (more to come on that) and cherry-picked in vitro, animal, or poorly designed human studies to support his claims, while omitting the decades of actual robust clinical and real world evidence.

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This entire “cold and flu prevention” episode is one piece of disinformation after the other, masquerading as fact. Huberman’s active promotion of disinformation will reduce vaccine uptake, further erode science literacy, and ultimately cause more preventable illness and death. 

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Part 2 of this will be published in the coming days, and will focus on more virology and immunology errors, as well as the data related to the interventions he touts in his episode. All of my content is freely available, so please feel free to share with anyone that you feel may benefit! Science literacy helps everyone.