Public health’s honesty problem

Definitely one of the biggest frustrations throughout the pandemic has been those in public health trying to perform mass psychology without really knowing what they doing.  A lot of “Oh, we can’t say X (even if it’s the truth) because then people might Y.”  Of course, the end result is not that people do what the public health experts want, but, rather many come not to trust the public health experts because they are, at least on occasion, provably dishonest.  I think a good rule of thumb should be for goverment officials to never, never lie to the public unless it is absolutely necessary (presumably narrow matters of genuine national security) and certainly not in matters of science and health.  

Ryan Cooper with a great take on all this recently:

The United States’ COVID pandemic performance is among the worst in the world — particularly given our unparalleled advantages. We lead the planet in confirmed infections and deaths, and while India probably has had more of both that went uncounted, that’s cold comfort when its population is more than four times larger than ours.

One reason for this tragic failure is the dishonesty of American public health bureaucrats. They have repeatedly lied to the public, playing politics with the pandemic, and in the process undermined both the fight against COVID-19 and confidence in their own credibility. Their deception almost certainly got people killed, and it continues to do so this month, as the Omicron variant spreads and booster shots go unused.

 

This practice of shading the truth or telling straight-up falsehoods in service of some half-baked political end started from the first moments of the pandemic. Back in February and March 2020, National Institute of Allergy and Infectious Diseases (NIAID) chief Anthony Fauci was all over the media downplaying masks. “If you look at the masks that you buy in a drug store, the leakage around that doesn’t really do much to protect you,” he told USA Today that spring. “Now, in the United States, there is absolutely no reason whatsoever to wear a mask.” In an interview with 60 Minutes in March, he said, “Right now in the United States, people should not be walking around with masks.”

It turns out Fauci almost certainly didn’t believe what he was saying. In an interview with InStyle several months later, he admitted that trying to preserve the mask supply for doctors and nurses was his first motivation. “We were told in our task force meetings that we have a serious problem with the lack of PPEs and masks for the health providers,” he said…

A year later, other public health officials seem to have replicated Fauci’s deception on the subject of booster shots — and the consequences here may be graver still. By August of this year, the Biden administration was extremely alarmed about reports of waning immunity among the vaccinated, and in September, officials started plans to recommend booster shots to all adults.

But key bureaucrats and scientists dragged their feet. The Food and Drug Administration vaccine advisory panel refused to endorse an emergency use authorization, with panel members citing a series of bizarre objections in an interview with CNN. “The stated goal of this vaccine has been to protect against serious illness,” Dr. Paul Offit said. This is false — the point of any vaccine is to reduce negative health outcomes of any kind as far as possible, ideally by stamping out transmission entirely through herd immunity. It’s good that two doses of mRNA vaccine likely still protect against severe COVID from the Omicron variant, but it’s even better to cut the risk of symptomatic infection by about 40 percentage points with a booster. 

FDA officials Dr. Philip Krause and Marion Gruber complained they didn’t have enough science to back boosters yet, which is total nonsense. By September at the latest there was strong initial data from Israel and the U.S. itself. Dr. Cody Meissner of Tufts University School of Medicine argued unvaccinated people should get priority, which is just a non sequitur — those two goals don’t trade off at all, because America has had plenty of vaccine supply for months.

Perhaps these arguments aren’t compelling because they aren’t honest. A more plausible motivation comes through in August comments from infectious disease specialist Céline Gounder, who was a pandemic adviser for Biden. “It’s really inequitable and it’s not in our interest because you’re leaving much of the world unprotected, where you’re going to have the emergence of other variants,” she told Politico, pushing to send vaccine supplies overseas instead of giving boosters to Americans. “I feel like this is very short-term thinking. It’s very individualistic, nationalist thinking.”

[Don’t get me started on Gouder!]

This makes much more sense. Just like Fauci told a noble lie to conserve PPE, officials overseeing booster decisions almost certainly fudged the science in the service of an ulterior motive: getting vaccines to poorer countries.

Just like saving PPE for doctors and nurses, this is a legitimately good goal. Poorer countries should have been getting a larger share of vaccines from the start. But it’s not the business of public health bureaucrats to decide where vaccines are allocated (that’s for elected officials to decide), and it’s especially not their business to try to steer policy by lying to the public.

Fudging the science did not, in fact, help poorer countries get more doses — but it certainly delayed booster distribution here. After weeks of argument and pressure, the CDC finally approved boosters for all adults in late November, yet it only recommended them for people over 50, ignoring research which recommends their universal use.

Anyway, more good stuff in there if you read the whole thing.  I would love for public health officials to learn a lesson about honesty from all this, but, sadly, I don’t actually think that will be one of our big lessons learned. 

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