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Brownstone Institute

Modeling Gone Bad

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From the Brownstone Institute

BY Robert MaloneROBERT MALONE

A new paper documents that the pre-vaccination case fatality rate was extremely low in the non-elderly population.

Age-stratified infection fatality rate of COVID-19 in the non-elderly population

Environmental Research, Volume 216, Part 3, 1 January 2023, 114655

Abstract

The largest burden of COVID-19 is carried by the elderly, and persons living in nursing homes are particularly vulnerable. However, 94% of the global population is younger than 70 years and 86% is younger than 60 years. The objective of this study was to accurately estimate the infection fatality rate (IFR) of COVID-19 among non-elderly people in the absence of vaccination or prior infection. In systematic searches in SeroTracker and PubMed (protocol: https://osf.io/xvupr), we identified 40 eligible national seroprevalence studies covering 38 countries with pre-vaccination seroprevalence data. For 29 countries (24 high-income, 5 others), publicly available age-stratified COVID-19 death data and age-stratified seroprevalence information were available and were included in the primary analysis. The IFRs had a median of 0.034% (interquartile range (IQR) 0.013–0.056%) for the 0–59 years old population, and 0.095% (IQR 0.036–0.119%) for the 0–69 years old. The median IFR was 0.0003% at 0–19 years, 0.002% at 20–29 years, 0.011% at 30–39 years, 0.035% at 40–49 years, 0.123% at 50–59 years, and 0.506% at 60–69 years. IFR increases approximately 4 times every 10 years. Including data from another 9 countries with imputed age distribution of COVID-19 deaths yielded median IFR of 0.025–0.032% for 0–59 years and 0.063–0.082% for 0–69 years. Meta-regression analyses also suggested global IFR of 0.03% and 0.07%, respectively in these age groups.

The current analysis suggests a much lower pre-vaccination IFR in non-elderly populations than previously suggested. 

Large differences did exist between countries and may reflect differences in comorbidities and other factors. These estimates provide a baseline from which to fathom further IFR declines with the widespread use of vaccination, prior infections, and evolution of new variants.

From the data above, Median infection fatality rate (IFR) during the PRE-VACCINATION ERA was:

  • 0.0003% at 0–19 years
  • 0.002% at 20–29 years
  • 0.011% at 30–39 years
  • 0.035% at 40–49 years
  • 0.123% at 50–59 years
  • 0.506% at 60–69 years
  • 0.034% for people aged 0–59 years people
  • .095% for those aged 0–69 years.

These IFR estimates in the non-elderly population are much lower than previous calculations and models had suggested.


Does anyone remember back to early 2020? The dire predictions of a global disaster – of a case fatality rate and of an infectivity rate (R0) that were unheard of in modern times for a respiratory disease? The predictions were that the “novel coronavirus,” as it was called then, was going to be the next Spanish flu. That the only solution was for entire nations to lockdown. This was the modeling that caused governments worldwide to panic. This was the modeling that caused the legacy media to melt down.

One scientist who clearly led this effort and led the world astray with his dire forecasting, was Neil Ferguson, PhD of Imperial College.

Ferguson’s team at Imperial College London has claimed credit for saving millions of lives through the lockdown policies that implemented his models. It is the Imperial College models that projected millions of deaths in the first year in the UK, if stringent lockdowns were not implemented. Once implemented, Ferguson and Imperial college quickly took credit for the “success” of lockdowns.

The estimate of 3.1 million lives saved by Dr. Ferguson was derived from a thoroughly “ludicrous unscientific exercise, whereby they purported to validate their model by using their own hypothetical projections as a counterfactual of what would happen without lockdowns.” Other models and real-world data have discredited Ferguson’s models, but the damage was done. Lockdowns, quarantines, masking, poorly-tested EUA products – such as experimental vaccines have taken their toll on all of us. In the end, what, if any of them were necessary?

Elon Musk calls Ferguson an “utter tool” who does “absurdly fake science.” Jay Schnitzer, an expert in vascular biology and a former scientific direct of the Sidney Kimmel Cancer Center in San Diego, tells me: “I’m normally reluctant to say this about a scientist, but he dances on the edge of being a publicity-seeking charlatan” (National Review).

Again and again, year and year, decade after decade, the NHS and world governments, including our own, have turned to Dr. Ferguson for infectious disease modeling. Ferguson gives them what they want. A reason for the bureaucrats, the administrative state to once more step up and be important. One of his doom-and-gloom models can increase federal disaster preparedness budgets to astronomical proportions. That is raw power for the lowly public health official. What is not to like?

Except for a singular factoid:

The implication for Ferguson’s work remains clear: the primary model used to justify lockdowns failed its first real-world test.

Ferguson’s predictions of sky-high high case fatality rates were grossly exaggerated.

The lockdowns were a complete and utter failure.

But this is not Ferguson’s first failed infectious disease modeling stumble upon the world stage. These are two examples of his earlier predictions:

  • Ferguson predicted that up to 150 million people could be killed from bird flu during the 2005 outbreak. This prediction was off by an astounding amount, with a grand total of 282 people dying worldwide from the disease between 2003 and 2009.
  • In 2009, one of Ferguson’s models predicted 65,000 people could die from the Swine Flu outbreak in the UK — the final figure was below 500.  This modeling was what caused so many public health officials to panic, and create a worldwide panic of officials and the populace.

So, why did Boris Johnson and our government turn to his models for guidance early on in the COVID crisis? Why did they accept Ferguson’s assertions that lockdowns would work, without any evidence or public policy guidance indicating that such draconian measures would have any impact whatsoever?

Were they just that naive?


Here is where it gets even crazier. There are those who passionately argue that the modeling that Ferguson did back in early 2020 is proof that 1) the “non-pharmaceutical interventions (lockdowns and masks) worked because (circular logic here) his modeling predictions didn’t come true and 2) that the vaccines worked beyond all measure because again, his modeling predictions didn’t come true.

Yet, here we are. An important new paper (discussed above) documenting that the pre-vaccination case fatality rate was extremely low in the non-elderly population. That means more evidence the Ferguson’s models were wrong (again) and what do we hear from the state-sponsored media?

Crickets.

A colleague of mine who is in the US Senate reported back to me recently that Republican senators were high-fiving each other about the success of Warp-speed based on Ferguson’s modeling data in a recently paper.

You can’t make this stuff up.

Republished from the author’s Substack.

Author

  • Robert Malone

    Robert W. Malone is a physician and biochemist. His work focuses on mRNA technology, pharmaceuticals, and drug repurposing research. You can find him at Substack and Gettr

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Brownstone Institute

Bizarre Decisions about Nicotine Pouches Lead to the Wrong Products on Shelves

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From the Brownstone Institute

  Roger Bate  

A walk through a dozen convenience stores in Montgomery County, Pennsylvania, says a lot about how US nicotine policy actually works. Only about one in eight nicotine-pouch products for sale is legal. The rest are unauthorized—but they’re not all the same. Some are brightly branded, with uncertain ingredients, not approved by any Western regulator, and clearly aimed at impulse buyers. Others—like Sweden’s NOAT—are the opposite: muted, well-made, adult-oriented, and already approved for sale in Europe.

Yet in the United States, NOAT has been told to stop selling. In September 2025, the Food and Drug Administration (FDA) issued the company a warning letter for offering nicotine pouches without marketing authorization. That might make sense if the products were dangerous, but they appear to be among the safest on the market: mild flavors, low nicotine levels, and recyclable paper packaging. In Europe, regulators consider them acceptable. In America, they’re banned. The decision looks, at best, strange—and possibly arbitrary.

What the Market Shows

My October 2025 audit was straightforward. I visited twelve stores and recorded every distinct pouch product visible for sale at the counter. If the item matched one of the twenty ZYN products that the FDA authorized in January, it was counted as legal. Everything else was counted as illegal.

Two of the stores told me they had recently received FDA letters and had already removed most illegal stock. The other ten stores were still dominated by unauthorized products—more than 93 percent of what was on display. Across all twelve locations, about 12 percent of products were legal ZYN, and about 88 percent were not.

The illegal share wasn’t uniform. Many of the unauthorized products were clearly high-nicotine imports with flashy names like Loop, Velo, and Zimo. These products may be fine, but some are probably high in contaminants, and a few often with very high nicotine levels. Others were subdued, plainly meant for adult users. NOAT was a good example of that second group: simple packaging, oat-based filler, restrained flavoring, and branding that makes no effort to look “cool.” It’s the kind of product any regulator serious about harm reduction would welcome.

Enforcement Works

To the FDA’s credit, enforcement does make a difference. The two stores that received official letters quickly pulled their illegal stock. That mirrors the agency’s broader efforts this year: new import alerts to detain unauthorized tobacco products at the border (see also Import Alert 98-06), and hundreds of warning letters to retailers, importers, and distributors.

But effective enforcement can’t solve a supply problem. The list of legal nicotine-pouch products is still extremely short—only a narrow range of ZYN items. Adults who want more variety, or stores that want to meet that demand, inevitably turn to gray-market suppliers. The more limited the legal catalog, the more the illegal market thrives.

Why the NOAT Decision Appears Bizarre

The FDA’s own actions make the situation hard to explain. In January 2025, it authorized twenty ZYN products after finding that they contained far fewer harmful chemicals than cigarettes and could help adult smokers switch. That was progress. But nine months later, the FDA has approved nothing else—while sending a warning letter to NOAT, arguably the least youth-oriented pouch line in the world.

The outcome is bad for legal sellers and public health. ZYN is legal; a handful of clearly risky, high-nicotine imports continue to circulate; and a mild, adult-market brand that meets European safety and labeling rules is banned. Officially, NOAT’s problem is procedural—it lacks a marketing order. But in practical terms, the FDA is punishing the very design choices it claims to value: simplicity, low appeal to minors, and clean ingredients.

This approach also ignores the differences in actual risk. Studies consistently show that nicotine pouches have far fewer toxins than cigarettes and far less variability than many vapes. The biggest pouch concerns are uneven nicotine levels and occasional traces of tobacco-specific nitrosamines, depending on manufacturing quality. The serious contamination issues—heavy metals and inconsistent dosage—belong mostly to disposable vapes, particularly the flood of unregulated imports from China. Treating all “unauthorized” products as equally bad blurs those distinctions and undermines proportional enforcement.

My small Montgomery County survey suggests a simple formula for improvement.

First, keep enforcement targeted and focused on suppliers, not just clerks. Warning letters clearly change behavior at the store level, but the biggest impact will come from auditing distributors and importers, and stopping bad shipments before they reach retail shelves.

Second, make compliance easy. A single-page list of authorized nicotine-pouch products—currently the twenty approved ZYN items—should be posted in every store and attached to distributor invoices. Point-of-sale systems can block barcodes for anything not on the list, and retailers could affirm, once a year, that they stock only approved items.

Third, widen the legal lane. The FDA launched a pilot program in September 2025 to speed review of new pouch applications. That program should spell out exactly what evidence is needed—chemical data, toxicology, nicotine release rates, and behavioral studies—and make timely decisions. If products like NOAT meet those standards, they should be authorized quickly. Legal competition among adult-oriented brands will crowd out the sketchy imports far faster than enforcement alone.

The Bottom Line

Enforcement matters, and the data show it works—where it happens. But the legal market is too narrow to protect consumers or encourage innovation. The current regime leaves a few ZYN products as lonely legal islands in a sea of gray-market pouches that range from sensible to reckless.

The FDA’s treatment of NOAT stands out as a case study in inconsistency: a quiet, adult-focused brand approved in Europe yet effectively banned in the US, while flashier and riskier options continue to slip through. That’s not a public-health victory; it’s a missed opportunity.

If the goal is to help adult smokers move to lower-risk products while keeping youth use low, the path forward is clear: enforce smartly, make compliance easy, and give good products a fair shot. Right now, we’re doing the first part well—but failing at the second and third. It’s time to fix that.

Author

Roger Bate

Roger Bate is a Brownstone Fellow, Senior Fellow at the International Center for Law and Economics (Jan 2023-present), Board member of Africa Fighting Malaria (September 2000-present), and Fellow at the Institute of Economic Affairs (January 2000-present).

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Addictions

The War on Commonsense Nicotine Regulation

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From the Brownstone Institute

Roger Bate  Roger Bate 

Cigarettes kill nearly half a million Americans each year. Everyone knows it, including the Food and Drug Administration. Yet while the most lethal nicotine product remains on sale in every gas station, the FDA continues to block or delay far safer alternatives.

Nicotine pouches—small, smokeless packets tucked under the lip—deliver nicotine without burning tobacco. They eliminate the tar, carbon monoxide, and carcinogens that make cigarettes so deadly. The logic of harm reduction couldn’t be clearer: if smokers can get nicotine without smoke, millions of lives could be saved.

Sweden has already proven the point. Through widespread use of snus and nicotine pouches, the country has cut daily smoking to about 5 percent, the lowest rate in Europe. Lung-cancer deaths are less than half the continental average. This “Swedish Experience” shows that when adults are given safer options, they switch voluntarily—no prohibition required.

In the United States, however, the FDA’s tobacco division has turned this logic on its head. Since Congress gave it sweeping authority in 2009, the agency has demanded that every new product undergo a Premarket Tobacco Product Application, or PMTA, proving it is “appropriate for the protection of public health.” That sounds reasonable until you see how the process works.

Manufacturers must spend millions on speculative modeling about how their products might affect every segment of society—smokers, nonsmokers, youth, and future generations—before they can even reach the market. Unsurprisingly, almost all PMTAs have been denied or shelved. Reduced-risk products sit in limbo while Marlboros and Newports remain untouched.

Only this January did the agency relent slightly, authorizing 20 ZYN nicotine-pouch products made by Swedish Match, now owned by Philip Morris. The FDA admitted the obvious: “The data show that these specific products are appropriate for the protection of public health.” The toxic-chemical levels were far lower than in cigarettes, and adult smokers were more likely to switch than teens were to start.

The decision should have been a turning point. Instead, it exposed the double standard. Other pouch makers—especially smaller firms from Sweden and the US, such as NOAT—remain locked out of the legal market even when their products meet the same technical standards.

The FDA’s inaction has created a black market dominated by unregulated imports, many from China. According to my own research, roughly 85 percent of pouches now sold in convenience stores are technically illegal.

The agency claims that this heavy-handed approach protects kids. But youth pouch use in the US remains very low—about 1.5 percent of high-school students according to the latest National Youth Tobacco Survey—while nearly 30 million American adults still smoke. Denying safer products to millions of addicted adults because a tiny fraction of teens might experiment is the opposite of public-health logic.

There’s a better path. The FDA should base its decisions on science, not fear. If a product dramatically reduces exposure to harmful chemicals, meets strict packaging and marketing standards, and enforces Tobacco 21 age verification, it should be allowed on the market. Population-level effects can be monitored afterward through real-world data on switching and youth use. That’s how drug and vaccine regulation already works.

Sweden’s evidence shows the results of a pragmatic approach: a near-smoke-free society achieved through consumer choice, not coercion. The FDA’s own approval of ZYN proves that such products can meet its legal standard for protecting public health. The next step is consistency—apply the same rules to everyone.

Combustion, not nicotine, is the killer. Until the FDA acts on that simple truth, it will keep protecting the cigarette industry it was supposed to regulate.

Author

Roger Bate

Roger Bate is a Brownstone Fellow, Senior Fellow at the International Center for Law and Economics (Jan 2023-present), Board member of Africa Fighting Malaria (September 2000-present), and Fellow at the Institute of Economic Affairs (January 2000-present).

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