I was going to tackle this subject but Josh Marshall did it well and I’ll pass on apiece of it. (This is a subscriber only article and you should definitely subscribe. His stuff is always worth reading.)
I think it’s important for people to understand the difference between expertise in virology, epidemiology and public psychology because we keep getting it screwed up. Marshall looks at this article in the Washington Post which makes the case against giving boosters to the whole population instead of just targeting vulnerable populations. The article is written by people who recently quit the FDA over its decision to ok the boosters. He grants them respect for their expertise in their fields:
But two things stand out to me about their argument. The first is that they are fundamentally arguments based on individual care rather than the interests of society at large. We rightly make lots of decisions on that basis. To use an extreme example, we could probably save lots of lives overall if we did basic research on humans. But we don’t do that. Because our whole culture and framework of ethics puts the interests of individuals at the forefront. Still the different prism is key to understand.
That comes into high relief on the second point, when the authors anticipate the ‘what is the downside?’ argument.
Here’s what they say.
The data does not show that every healthy adult should get a booster. Indeed, the push for boosters for all could actually prolong the pandemic. First, such a campaign diverts focus away from the goal of persuading the unvaccinated to get their shots (and persuading parents to get their eligible children shots). Second, and relatedly, exaggerated descriptions of the waning efficacy of the vaccines undermine public confidence in them, and some people may be less likely to accept vaccines that they regard as less effective than originally advertised.
These aren’t health or clinical downsides. Here we’re in the realm of public psychology, politics and public policy. Those are areas in which I have at least some competence. And these are not good arguments at all. Right now it is frankly absurd to think that making boosters available or pushing for them is somehow a zero-sum calculus with persuading holdouts to get vaccinated.
The second argument has some possible logic to it. But I see very little evidence for it in practice. It also partakes of a pattern of thinking that has been one of the true achilles heels’ of public health expertise over the last two years: a tendency to try to game out people’s reactions to evidence and either downplay that evidence or avoid actions in reaction to that evidence in an effort to prevent the public from making bad decisions.
He brings up the obvious example of masking to show where the scientific experts got it wrong. They resisted recommending masks due to the PPE shortage but they weren’t honest about it instead telling people that they didn’t do any good. Once it became clear they did that horse was already out of the barn. The results of that mistake mistake still reverberate today.
And the psychological reasoning behind that whole discussion was frankly, pretty fatuous:
There wasn’t a lot of good science proving the efficacy of masking at the outset. In the absence of clear studies proving efficacy public health officials resisted making it part of formal guidance. But when some made the point that it was hard to see how some additional filtration wouldn’t be at least somewhat beneficial, the go-to argument was that it would give people a false sense of security. People would use masks poorly, get little benefit and based on that false sense of security either reduce their hand washing or engage in riskier activities. Again, efforts to game out peoples’ secondary actions.
[…]
The early weeks of the Pandemic were, to put it mildly, complicated. Resisting giving public guidance in the absence of strong scientific evidence is certainly a laudable impulse. It becomes more complicated in a crisis situation in which a lot of harm may become before the confirmatory evidence can be developed.
But this gaming out peoples’ action argument is of a different character. There’s a good argument for transparency in general. But more specifically, there’s little reason to believe one’s expertise in virology, or vaccine research or clinical cares give you any real insights into public or mass psychology. It’s just operating out of your lane.
The argument here with boosters – a sort of carom double bank shot argument that pushing boosters will make people lose confidence in vaccines – is really totally speculative and frankly out of touch with most of our experience about vaccine resistance and the politics of vaccination in 2021.
He is 100% correct. They are operating out of their lane.
The idea that we shouldn’t encourage boosters because it “takes the focus” off of getting the anti-vaxxers to get their shots is frankly absurd. There is absolutely no evidence that this will work and a ton of evidence that it will make absolutely no difference. Focus is not the problem. Conspiracy theories and misinformation is.
Moreover, boosters are actually necessary and I think the majority of Americans who aren’t out of their minds would be quite upset if they weren’t able to obtain them:
“Boosters induce a striking in level and breadth of neutralizing antibodies.”
The problem of how to get vaccines into the hesitant and recalcitrant is a real one. I wish there was some way to wave a magic wand to make it happen. But the idea that it would happen if only the politicians would “focus” on getting them or make people lose faith in the vaccines in general to do it is not well-founded.
And, by the way, neither is it well founded to suggest that the west is hogging the vaccines for boosters and leaving the rest of the world unvaccinated out of their selfish desire to protect their own people. While it’s absolutely true that there needs to be much more vaccine distributed to the rest of the world, it’s just not the case that it’s not happening because of limited supply. In fact, South Africa reportedly told Pfizer to suspend shipments of the vaccines recently because they were already over-supplied. Their problem, like ours, is not a matter of supply but rather resistance among the public. (According to Zeynep Tufekci, in this country it’s because of the way pharmaceutical companies treated the HIV epidemic and ended up creating massive mistrust among the public.) On the other hand, many other African countries are truly under-supplied, which is a tragedy that must be dealt with as soon as possible if we don’t want to see a new frightening variant emerge every few months.
None of that will be fixed by denying booster shots to Americans or engaging in elaborate ineffectual, counterproductive psychological games to keep them from thinking the vaccines don’t work. As Josh Marshall says, on this, there needs to be a mixture of scientific experts, public psychology experts and political experts weighing in. As I wrote in my piece this morning, you cannot separate the political from the pandemic, at least not in the US. It’s the politics that are killing massive numbers of people just as much as the virus itself.