Hey all, I am working on some longer posts, but in the meantime, here is a short (lightly-edited, sorry mom) post on vaccines:
Underselling the Vaccine
I have written on here no less than 3 times (here, here, and here) about the vaccine rollout and distribution in the United States, which has largely been a hot mess (though worth pointing out that we are doing better than the EU, which is even more of a hot mess). Why have I focused so much on this one topic? Because I think it happens to be the single most important economic policy for 2021, over and above anything related to relief, stimulus, regulation, etc. The faster and wider we can distribute the vaccine, the sooner that economic and health prospects will improve for Americans, especially lower-income Americans suffering the most from COVID. So it is imperative to debate and get this right.
Putting aside questions of prioritization, there has been what I see as a troubling trend in vaccine discourse. Many people are hesitant to take the vaccine for various reasons, some legitimate and some slightly conspiratorial. From what I can tell, many public health officials respond to this hesitancy by being very cautious and not trying to over-promise the vaccine to the general public. The media is largely doing the same by trying to qualify stories of the vaccine’s effectiveness or publishing stories on those who have side-effects. There also seems to be widespread fear that people will throw all caution to the wind if they are oversold on the vaccine. I understand this approach, but it seems wrong to me. It is quite similar to the discourse about “masks” early in the pandemic that led to many not thinking masks were worthwhile, or worse, thinking they were a means of “governmental control.”
I think it is important to be direct with the public about both the “knowns” and “unknowns” of the vaccine but do so with a dose of common sense about what is reasonable “prior” beliefs to have about vaccines (often called “Bayesian reasoning”). We should not automatically assume that we should default to assuming the worst-case is true because we do not 100% know something. I also worry that the messengers (Public Health experts and Media) has consistently gotten wrong how the public will respond to those messages. I think there is a strong reason for optimism on all vaccine fronts right now and that people will actually behave more pro-social, less-risky manner if they know that a really, really good vaccine is just around the corner.
So here is my case (as a non-expert trying to synthesize the best information I have at my fingertips) for optimism:
1) Effectiveness of the Vaccine
It has been widely reported that the two vaccines approved in the US (Pfizer and Moderna) are 95% effective after 2 doses. But I think that number may actually undersell the effectiveness. After all, it implies that the 5% of people’s COVID sickness was similar to all other people. This is not the case; even those who do get COVID with a vaccine are getting very, very mild cases:
The same is true of the Astro-Zenica vaccine not yet approved in the US. The data from Europe is not the best (especially in the over 65-group), but the data we do have shows the vaccine was 80% effective in fighting infections and almost 100% effective at preventing severe infections:
This means even for young, healthy people, you should get a vaccine as soon as you can. After all, young, healthy people can still get really sick if they contract COVID, even if they are unlikely to die.
2) Vaccines and Transmission
It has also been said that vaccines do not stop transmission. While it is true that we do not yet have medical study grade data on transmission-yet, we do have some observational data, and it is good news!
This is not just true in small studies, but from population-level data from Israel, which has vaccinated a super high percentage of its population:
Preliminary data from the hundreds of thousands of Israelis who have received two shots of the vaccine show 98% efficacy and no risk of transmission of the virus. That’s good news for Pfizer. Edelstein says the information that will be shared will be aggregate data, not individual data.
This is really encouraging! And in many ways, it lines up with what we know about COVID. We know that your “viral load” (how much of the virus you are exposed to) is very predictive of how sick you get. It is reasonable to assume that the vaccinated carriers would have a mild enough case to make it very hard to spread. As economist Emily Oster notes:
what we know about other vaccines it seems extremely likely that the vaccine prevents infection to some extent. But, second, even if that isn’t the case, the vaccine prevents symptoms. Asymptomatic people transmit perhaps 75 or 80% less than symptomatic people. This means even if the vaccine had no effect on infection (again, really unlikely) it would lower transmission to others by 75 to 80%.
The risk of transmission from vaccinated people probably isn’t zero, and we certainly do not have the data yet to put a precise number on it, but it’s a LOT LOWER than if you are not vaccinated.
3) More Safe Vaccines Coming on the Market
All indications are that we will soon have more vaccines on the market. As I already mentioned, the AstraZeneca vaccine is approved in Europe, but not the US. US regulators have said they will wait until the company re-runs its phase 3 trials in the US, which it flubbed the first time. There is no reason to think that its successful phase 3 trials in Europe will not be confirmed in the US. Likewise, Johnson and Johnson has a vaccine nearing the end of phase 3 trials, which most experts expect will be very effective and will not require cold storage or 2 doses. It is only because the FDA is run with an ethic of extreme caution (too much if you ask me) that we will not have these vaccines coming sooner rather than later.
4) COVID Variants
While there is good reason to be concerned about the COVID variants circulating, there appears to be no reason to think (yet) that they will make the vaccine ineffective. As Ezra Klein notes:
Early testing shows the vaccines easily neutralize the B.1.1.7 variant, and while there is a South Africa strain that shows some resistance to the vaccine, the level of antibodies the vaccine produces should still be sufficient. If it isn’t, BioNTech says they could produce a targeted booster in about six weeks.
If anything, the COVID variants should make us want to sell the vaccine more. The longer we let COVID spread circulate among unvaccinated people, the more likely more variants will emerge. Viruses cannot mutate if they are eradicated from the populace
5) Side Effects
This is where I believe the media has been misleading in its vaccine coverage. There has been a lot of reporting on vaccine side-effects, but almost no evidence that they are a major issue. For instance, this yahoo article has this title:
Only to contain this quote from Fauci (emphasis mine):
"There have been 21 cases of severe allergic reactions, which brings it to an incidence of about 1 every million…almost invariably in people with a history of severe allergic reactions," Fauci explained. "So yes, there is an adverse event, but it is easily manageable."
Fauci goes on (emphasis also mine):
"[If] you look at when the so-called 'long-term' [effects occur]…the overwhelming majority, more than 90 percent, occur between 30 and 45 days following the dose," he explained, adding, "It would be extraordinarily unusual if you see any unanticipated long-term effects."
In other words: short-term side-effects are rare, treatable (IE people are very likely not going to die from them), and unlikely to come out of nowhere months after being vaccinated. If anything, it appears we are over-reacting to these side effects, like here in California, where we temporarily pulled 300,000 due to allergic reactions.
Now, this doesn’t rule out more long-term side-effects that will be seen later from COVID. We have not seen any yet, and most vaccines do not create long-term side effects, but occasionally they do, like with Swine flu vaccinations in 2009. But in the Swine Flu case, those side-effects were infrequent: 1.6 in every 1 million people who were vaccinated got a rare, treatable, autoimmune disorder. Even the lowest risk group, children 5-9, die of COVID at a rate of 1 in 100,000, so it is important to put that data in context compared to getting COVID.
Conclusion
As a basketball coach, the worst thing that can happen to a team mid-game is giving up. It appears with all that has happened in our country that many of us have “given up” on fighting COVID. And in many ways, I don’t blame people for this decision. But I worry that by only continuing to preach messages of caution and pessimism, we make it impossible to rally and make a collective push to get through the rest of this pandemic as best we can. It deeply saddens me that one can read the news and not be overwhelmed with how tremendously good this one are of COVID is. And hopefully, that can inspire you to keep your head up and do your part to get this vaccine into as many arms as possible.