Paul Alexander

I’m writing this with great concern, as a prominent member of our global homeopathic community has recently promoted Paul Alexander as an objective, authoritative voice regarding the nature of, and responses to, the SARS-CoV–2 / COVID-19 pandemic.  Alexander does possess credentials as a medically-trained epidemiologist, but it is important to recognize that his voiced opinions regarding SARS-CoV-2 / COVID-19, including the U.S./international response of pandemic transmission mitigation measures, including vaccination, have been more highly motivated by his political support of the previous federal administration than by his epidemiologic wisdom.

I recognize that those of us in the “alternative” communities often find it easy to support iconoclasts who question accepted norms, but in doing so it is important to not merely fall into the trap of embracing alternative dogmas, but rather to look carefully at the evidence.

Alexander promotes a forceful argument that it would have been wise to forgo transmission mitigation measures (masking, distancing, school closures, business & societal restrictions, vaccination), and permit the SARS-CoV-2 virus to widely infect “low-risk” populations (“We want them infected”), while focussing solely on protecting vulnerable populations (the elderly & those with predisposing medical & lifestyle conditions), in order to generate widespread population (“herd”) immunity from natural infection.  And portends to discredit and ridicule those who have promoted these measures as having done so primarily in order to prevent re-election the former U.S. president.  This position was also supported by Sctot Atlas, M.D., a radiology academic lacking in epidemiologic/virologic/infectious disease experience, who served as a medical advisor to the previous administration.

Alexander was involved in promotion of the emergency authorization of  hydroxychloroquine, an agenda of the Trump administration despite evidence of its lack of efficacy and presence of significant adverse potential, for the treatment of COVID-19, having unethically “leaked” distorted cherrypicked data in an effort to support his position, from a study in review for publication which actually failed to provide evidence of efficacy and argued against its use:  

The generation of natural population (“herd”) immunity from natural exposure to a virus is a controversial proposition; certainly the nature of such immunity is often robust, involving immune responses to multiple pathogen-related targets, and is often long-lasting in the case of many known diseases, but:
adaptive immunity following natural infection comes at the cost of illness from infection, which may not be trivial in even “low-risk” populations; although mortality from COVID-19 is largely focussed in the elderly with predisposing medical conditions (obesity/”metabolic syndrome,” hypertension, diabetes, cardiovascular disease), it is not confined to these populations; and the consequences of infection extend beyond just mortality, to include potentially serious disease in children (multisystem inflammatory disease), a potentially crippling burden on the healthcare system, and a potentially severe disease burden of “long COVID” with “neurasthenic,” pulmonary, and cardiovascular inflammatory disease seen even in younger patients with initially mild acute disease.  And the means of protecting vulnerable populations in the midst of a pandemic are not clear.  Who staffs long-term-care facilities?  Who takes care of children in school?   Who staffs hospitals & other medical facilities caring for vulnerable patient populations?

I embrace the notion that natural exposure to chickenpox, and permitting this to exist as a nearly universal endemic disease may be the best public health approach to dealing with the Varicella zoster virus.  It is relatively easy to sequester “at-risk” populations (immune incompetent children with leukemia & those receiving chemotherapy, and those few adults who escape early childhood exposure)); widespread childhood varicella vaccination has actually contributed to our current “epidemic” of shingles in the elderly, by eliminating repeated exposure to infected children, which boosts immunity to  re-expression of latent virus from the dorsal root ganglia.   Initial acute infection with Varicella zoster virus (Chickenpox) is typically a rather benign illness in children conferring effective lifelong protective immunity (likely in part related to repeated subsequent asymptomatic exposure throughout life).  Initial infection in adults can be highly problematic, with varicella pneumonia and encephalitis, suggesting the potential for problems related to potentially less-long-lasting vaccine-mediated immunity.

Measles is more problematic.  Natural exposure may be a viable option in populations with higher living standards, in which acute Measles infection is a relatively benign childhood illness, and in which the primary impact of measles vaccination has been to shift the demographics of acute infection to the more vulnerable demographics of infants and adults.  In populations with poorer nutritional standards (esp. Vit. A deficiency), Measles continues to result in significant childhood mortality & morbidity, and permitting uncontrolled transmission in these populations would be of serious concern.

One would not promote a public health policy of permitting the development of population (“herd”) immunity via natural infection by poliovirus.  I’m sufficiently old to vividly recall the epidemics of the early 1950s in North America.  Fortunately, polio no longer exists in North America & many other parts of the world, most largely due to improvements in wastewater treatment & drinking water provision, and polio vaccination and transmission mitigation measures are useful public health strategies principally in societies which would benefit more significantly from the provision of clean water resources.

But to suggest permitting the unmitigated spread of a new emerging disease with as-yet not fully-appreciated characteristics would be highly irresponsible; much less a disease with documented potential for significant mortality & morbidity even in “low-risk” populations.

Regarding Alexander’s promotion of emergency authorization of hydroxychloroquine for COVID prevention & treatment, I can only suppose that his political ambitions trumped (pun intended) his medical /scientific judgment.  The study he represented as demonstrating efficacy actually demonstrated minimal efficacy in the face of significant risk.  Hydroxychloroquine has long been used in the treatment of malaria, and has found use in the management of inflammatory rheumatic diseases (systemic lupus erythematosus, rheumatoid arthritis, and porphyria cutanea tarda), and in these serious conditions, its risk/benefit ratios are favorable.  But hydroxychloroquine has a has a narrow therapeutic index; there is little difference between toxic and therapeutic doses, with toxicities including retinopathy, along with significant cardiac, neuropsychiatric (including irreversible psychosis), and multiple organ adverse effects.  See, e.g.,   There would need to be a prominent therapeutic effect in order to justify its off-label use in treating or preventing COVID, and the very modest benefits demonstrated in the referenced trial does not rise to this.

There exist iatromechanical reasons to suspect a possible mechanism of hydroxychloroquine in mitigating viral infection.  As a weak base, hydroxychloroquine increases lysosomal pH and inhibits endolysosomal cathepsins in antigen-presenting cells, potentially inhibiting viral entry.  However, SARS CoV-2 (prior to Omicron) does not primarily enter cells via the endosomal route, and arguments from an iatromechanical perspective need to be viewed with caution when dealing with a complex system such as the living organism.


I’d advise readers to consult the following analyses of Alexander’s positions:,,,,,,,