The middle of a pandemic - in many ways an entirely new pandemic than the one we faced a year ago - is not necessarily the time to reimagine the public health institutions of the United States. But we need to do it at some point. There is very good evidence that legacy institutions and practices were unequal to the task of fighting a global pandemic. The extraordinary caution of the FDA in giving full approval to mRNA vaccines has meant that institutions like the military or school districts can't require them. Sure, there are a few people who were waiting for full approval, too, but the real import of full approval is mandates.
The initial confusion of the CDC guidelines in 2020 ought to be somewhat forgiven. It's a novel coronavirus. Still, that was not the agency's finest moment. A bit of that was Trump, but overall the medical establishment moves slowly. Because of the risk associated with tending to sick people - think of the ridiculous list of side effects accompanying every advertised treatment for plaque psoriasis - doctors and public health officials like to make 150% sure that a new treatment abides by the Hippocratic standard of "first, do no harm."
Doing no harm, however, can do harm when we are talking about a pandemic. When I was in the hospital, I got the usual treatment of Remdesivir and steroids, but I also got an emergency use dose of an rheumatoid arthritis drug that - correlation is not causation notwithstanding - coincided with my recovery. The doctor said that they aren't even sure why it works, but it apparently does. That's flexible, adaptive medicine.
This interview with Leana Wen, MD, touches on this issue.
Following the science means you don’t manipulate scientific data, and your decisions are based on science. But public health is not just about science and knowing the right data. It’s about values. It’s understanding how to communicate those data to stakeholders. It’s getting the buy-in of others around you, and effective communication that earns people’s trust is essential to achieving your outcomes. And so the CDC is great at the science. They have been impeccable about the getting the data. But the interpretation of the data into policy cannot just involve the CDC. And, in fact, it needs to involve many stakeholders, both within the federal government and with local and state health departments, businesses, unions and so forth. If those entities were consulted around the guidance for fully vaccinated people, we wouldn’t be in the situation that we’re in now. Because any of them would have pointed out that the honor system would not have worked.
We can't allow the "honor system" to get us out of this pandemic. Wen continues:
I worry about this a lot. You’ve seen what happened in Tennessee with the vaccine director being fired for trying to promote covid vaccines to adolescents. And even more disturbing, I think is that now, Tennessee health officials are being prohibited from promoting vaccines to children. Not just covid vaccines, but all other childhood immunizations. I mean, public health is now under attack in a way that it has not been before.
I don't know what we do about the significant but small minority of anti-vaxxers in our country (or anywhere, really). But I have an idea.
Being anti-vax is like being a drunk driver. There is a pretty good chance that you won't die driving drunk. However, driving drunk significantly increases the odds that you kill, maim or injure yourself or others. No one thinks that driving shitfaced is an expression of Murican Freedumb. It's just...wrong. People still do it, but we dramatically increased the penalties for endangering the public by driving drunk. Since 1982, and the advent of anti-drunk driving campaigns, drunk driving deaths have fallen by 52% and fallen by 82% among people under the legal drinking age. Do people still drive drunk and kill themselves and others? Sadly, yes.
But using the combined force of the law and public stigma, we've made a difference. Sure, mandating vaccines won't get us to 100% vaccination, anymore than strong anti-drunk driving laws ended all drunk driving. However, it will absolutely make a difference.
I'm convinced - 100% convinced - that I'm alive because I was vaccinated. I was an outlier within an outlier (although Delta is a new beast and a new pandemic) but I'm mostly fine and getting better each day. If I wasn't vaccinated, I shudder to think where I would be right now. The people who are poisoning themselves with horse dewormer...well...Instant Darwin gonna getcha, I guess.
The way out of this pandemic is vaccination. Delta has shown us that traditional herd immunity thresholds will not be enough. We need shots in arms (and shots in arms around the world; maybe we could spend some of that money we lit on fire in Afghanistan to get shots in arms throughout Latin America and Africa).
As we exit the pandemic - into the reality of endemic Covid - we need to assess what we did well and what we pooched. That examination must include looking at other countries responses. Americans hate to borrow practices from overseas, but other countries did much better than us. We need to be more adaptable and quick witted.
Covid will not be the last pandemic of our lifetime. We can't afford to fuck up as bad as we have, at times, again.
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