Public Health Experts Have Lost the Benefit of the Doubt

The decision by the CDC and FDA to pause the Johnson & Johnson vaccine was a disastrous misstep.

Public health bureaucrats at the Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC) have brought Johnson & Johnson's vaccination efforts to a screeching halt pending an investigation into six confirmed cases of blood clotting among the nearly 7 million people to become inoculated. This decision will inadvertently get people killed, but if you dare to question it, you will be branded an enemy of science by the "trust the experts" mafia.

Make no mistake, the pause represents lethal risk aversion. There is no real question that many, many more people will contract COVID-19 because they did not receive a vaccine quickly enough—suffering hospitalization or even death as a result—than will have an adverse health outcome from the vaccine.

"This decision was made by the CDC and FDA," said Jeff Zients, a White House coronavirus response coordinator. "We're ruled by the science, not any other consideration."

Since the decision to pause the J&J vaccine cannot be defended on any sort of basic life-saving calculus—oral contraceptives carry a greater risk of blood clotting, and the FDA hasn't prohibited them—government health experts and their media mouthpieces are instead arguing that the pause is necessary to stave off a surge in vaccine hesitancy. Anthony Fauci, a member of the White House's coronavirus task force, opined that the pause would reassure vaccine skeptics that the government takes their concerns seriously and has made safety the top priority.

"One of the most important reasons why people have hesitancy is they're concerned about the safety," said Fauci. "The very fact you have two organizations—the CDC and the FDA—looking so carefully at this, making safety the primary concern, in my mind confirms or underscores the situation that we take safety very seriously. I would think at the end of the day it could actually diminish hesitancy by saying, 'Boy those people there are looking at that very carefully and when they say something is safe you can believe it's safe.'"

Fauci has no idea what he's talking about. In fact, there's good evidence that governments damage public confidence in vaccines when they do things like this. The European Union's dubious decision to suspend the use of the AstraZeneca vaccine at a time when the pandemic was raging across Europe (and many countries had pitifully low vaccination rates) substantially undermined public trust in the vaccine.

And even if halting the J&J vaccine did result in some slight gain in terms of public approval, this would need to be weighed against the fact that any delay in vaccination causes death. (Several friends of mine were slated to receive the J&J vaccine yesterday; they showed up to their appointments only to discover that they could no longer get vaccinated.)

Yet anyone who dares criticize Fauci, the CDC, the FDA, or the experts more generally, has been warned to stay in their lane. The best recent example of this is when statistician Nate Silver, a polling guru and editor of FiveThirtyEight, took to Twitter to lambast the vaccine halt on many of the same grounds I laid out here. Silver pointed out that even if the FDA did want to tackle the blood-clotting issue, it did not need to order to a full stop: The agency could have quietly investigated the matter first, or it could have even ordered a pause just for women under the age of 49 (the group affected by the blood clots).

"Even if blood clot deaths were 10-fold higher than observed so far, which is certainly possible, it wouldn't be a close decision," said Silver. "And that's before considering the knock-off (sic) effects on contributing to vaccine hesitancy."

For raising these issues, Silver was sharply criticized by public health experts and those who apparently believe we should never question them.

With all due respect to @NateSilver538, he is not an expert on the psychology of vaccine confidence. He is a poll aggregator and political pundit. He is not an infectious disease specialist, epidemiologist, vaccinologist, virologist, immunologist, or behavioral scientist. pic.twitter.com/HBrI6zj9aa

— Céline Gounder, MD, ScM, FIDSA ???????? (@celinegounder) April 14, 2021

Hi, my name is Nate Silver. I've been fucking up with my usual game of political polling, so I've decided to assert my great flawless mind into the world of infectious disease, because the pandemic needs another loud voice contradicting experts and condemning each move they make.

— Ethan Embry (@EmbryEthan) April 14, 2021

https://twitter.com/andizeisler/status/1382371174382903298

The key problem with @NateSilver538 tweets about J&J withdrawal is that it ignores the requirements of clinical trials and the potential impact of ignoring them, and instead relies on raw statistical analysis. The consequences of doing so could prove disastrous to the entire…1

— Kurt Eichenwald (@kurteichenwald) April 14, 2021

It is Gounder's perspective that really encapsulates the entire view of Team Trust the Experts. In their thinking, whatever the CDC says must be accurate, because it represents the collective wisdom of people in the know. And the only people in the know are epidemiologists.

Note that this stay-in-your-lane mentality runs in only one direction. Public health officials had no problem staking out strong positions on, say, the prevalence of racism in society and which activist strategies might be necessary in order to counteract it. They don't seem to understand that a data and polling expert like Silver might have more expertise than Fauci on what sort of advocacy messages could move the needle on public opinion. Indeed, several non-epidemiologists whose pandemic-related predictions were the most accurate—Zeynep Tufekci and Alex Tabarrok come to mind—were unafraid of contradicting CDC's guidance, and have been proven right time and time again.

Experts are not infallible. The judgment of the CDC should never be beyond questioning. The FDA's very existence has largely proven a barrier to getting people the medicine they need to prevent thousands of deaths: For all of the government's stated concerns about vaccine hesitancy, no entity has done more to prevent people from receiving the shot than the government's own health authorities. If there's one lesson to take away from this pandemic, it's that we should sometimes Listen to the Experts—but also ignore them when they're full of it.