Nate Silver tweets about something that's been making the rounds on Twitter this morning:
Interesting that people in the public health sphere seem to be pretty agnostic on what effect the J&J pause will have on vaccine hesitancy (maybe leaning toward it being a slight positive) while the sentiment of people who cover politics/media is toward it being a clear negative. https://t.co/ZiUsDvj2lD
— Nate Silver (@NateSilver538) April 13, 2021
Basically, the question is what effect the CDC's halt of the J&J vaccine will have on the public. There are two options:
- It's bad because it will produce an increase in the general distrust of vaccines.
- It's good because it sends the message that the CDC is sensitive to even tiny risks and will only approve vaccines that are absolutely safe.
I'm in the first camp, but the second one absolutely has merit. The problem is that there doesn't seem to be any actual evidence either way. We're all just guessing.
For what it's worth, here's how my thought process goes:
- First, keep in mind that "the public" is mostly very average and non-rational and doesn't follow the news closely. They are not NOT NOT like you and your friends and the folks you follow on Twitter.
- The CDC's announcement will probably have no effect on people who are already vaccine boosters. They'll just shrug and figure it's no big deal.
- Nor will it have an effect on confirmed vaccine skeptics. It will give them one more reason to be skeptics, but that's all.
- The effect will be solely on people at the margins. Keeping point #1 firmly in mind, they will not think hard about this. They will not read newspaper articles about it. At most they'll see headlines or hear brief radio reports or something like that. Their only takeaway will be a vague version of "vaccine has problems."
- In a few days, the CDC will presumably declare the J&J vaccine safe. Or maybe safe except for middle-aged women. Or something.
- What will the marginal person think of this? My guess is that they'll remember only that there's been some "controversy" about whether vaccines are safe. On the margins, then, a few of them will move toward the vaccine skeptic camp.
Maybe I'm wrong! But in the political world, at least, there's a lot of experience demonstrating that all you have to do is set up something as "controversial" and most people will never remember anything else.
How could we test this? Survey evidence about vaccine hesitancy might be useful, but it would have to be very precise. What's more, if anyone is doing this the results won't be available for months.
When the J&J vaccine is re-approved, we could measure how many people start saying they don't want it.
Or sometime next week we could deploy a survey that just asks people what they think about the J&J vaccine. Unfortunately, this wouldn't be very useful unless we have a previous survey on the same subject.
Any other ideas?
I think a great deal more ink will be spilled, and innocent pixels mutilated, over what a tiny number of lunatic noisemakers do and say, than on broader and infinitely more important public health consequences like whether materially fewer people sign up for vaccinations.
The media -- "news" as well as social -- are increasingly primarily about entertainment and only distantly secondly about information, and conflict makes for great entertainment. We'll hear endlessly about the "controversy" and little or nothing about the boring old facts.
Increasingly, I'm of the opinion that anyone stupid enough not to get vaccinated deserves what they -- and their families and their almost certainly like-thinking friends -- get. The primary risk to innocent people in those situations are the service workers with whom the idiots come into contact, and as the vaccine becomes more widely available, those workers are increasingly likely to be protected anyway. As for the idiots, let them eat "personal responsibility."
If anything blows it, it's bad reporting. It's not a halt, it's a pause to assess the best therapies to combat the very rare side-effect. If anything, this should be evidence of a concern for safety.
"FDA has paused J&J for a few days while they disseminate info about how to treat this super rare clot if it occurs. Report with context. Please!"
https://twitter.com/arlenparsa/status/1381957971660451845?ref_src=twsrc%5Etfw
Exactement. The Press has done this horrible disservice to the public and itself. I just read the MJ piece on taser use, and weapons confusion. We have armed, legally protected, untrained or undertrained police in our midst. We have untrained or undertrained journalists in our Press. The case is the same, how are the undrained and definitely undertrained public to know different? Shameful.
Also Ashish Jha did a rough estimate :
Chance of dying from Coronaviris: 1:1.5 million (high risk folks mostly vaccinated).
Chance of dying from bloodclot about 1:1 million (can't just cut it in half).
Ed: should be 1.1 million on 2nd number
It's probably not a coincidence that the AZ-Oxford and J&J vaccines both use adenoviruses for delivery and both seem to have a very small risk for unusual blood clots in very specific parts of the body. One of Russia's upcoming SARS-CoV-2 vaccines contains two different adenoviruses in case some folks previously obtained immunity against one.
Pausing J&J comes with little downside; they were already set for a large decline in delivery of doses on account of contamination. Knowing the likely pathway of AZ-Oxford's vaccine, it shouldn't be too difficult to examine the J&J vaccine's effects.
If you're administering the J&J vaccine, wouldn't you want to know what the risks were, so that you could educate those "on the margins" who were receiving it?
Additionally, if you're a doctor, wouldn't you want to know everything about what's going on, so that you could make a proper diagnosis and deliver the proper treatment?
The real situation to compare to is what if the CDC didn't pause, but then the story got out that there was an issue. What would have been the reactions of those on the margin then? I think that's what the CDC was comparing to. Assume the information is true, or at least there are enough amplifiers of the news to convince folks that it's true, and that that information is either going to come out on your terms, or someone else's.
But let's assume that it is true, and further that the death rate really is 1 in a million or so. We're looking at if we just used the J&J to vaccinate *all* of the remaining 200 million unvaccinated, 200 people will die. That's less than half of the number who died from COVID yesterday.
I remember not long ago some in the Former Administration touting a herd immunity strategy that would have accepted literally 10,000 times that number to achieve the same outcome.
At any rate, Poisson statistics I understand. Figuring out whether this really is an increase in blood clot rate is an answerable question. Trying to understand the PR strategy that maximizes vaccination rates and minimizes deaths seems much harder in comparison.
175 million correction
There is one more question that needs to go into the decision making here: What if we dismiss this--admittedly tiny--problem and later it still turns out to be more serious than it appears at first and the vaccine needs to be stopped anyway. Such a scenario would boost vaccine hesitancy far more than a pause of a few days required to make the soundest possible judgement (for any vaccine, not just this particular one).
It needs to be pointed out that the blood clots in question are a specific, very rare and unusually dangerous form of blood clots which requires special treatment because it is in the brain. While the risk is small the consequences are dire.
Its black women having the problems. Most likely due to bad diet.
One question they will probably look into: Do the 6 blood clot victims share more features than just their gender? I am thinking for example of cardiovascular risk factors like overweight, high blood pressure etc.
To add on to this: All 6 victims are women of middle age (loosely defined but still). Which raises the risk for that group from 6 in 7 million to 6 in probably less than 3 million. If they have more in common than just age and gender the risk to some subgroup might become much more serious than we now think (e.g. in Midgard* is right and the victims are all black the risk is up to 6 in a few hundred thousand, i.e. definitely something to take seriously).
And given that we have the mRNA vaccines which do not show this risk we could protect the vulnerable group easily.
* Not sure if Midgard is being sarcastic here or what the comment is intended to convey. But it serves as a nice example for me.
mRNA vaccines have been implicated in deaths though. Organ failure. Something the JJ vaccine has not.
It's a result of the virus.
Just forget about it and start shipping the J&J vaccines to Mexico and wherever else, and cover the rest of our population with the mRNA vaccines. That should be doable in short order, and the J&J vaccine is more suitable for shipping to the outer reaches of developing countries anyway.
Seems like you could do something with vaccines administered vs. vaccines available, and compare that ratio before and after the announcement. One might expect that ratio to go down if hesitancy has increased. Perhaps this could be normalized using the data from the Pfizer and Moderna vaccines.
The important question (to me) is which handling of this would have been best?
Their options:
1) Don't tell anyone about the clotting, investigate quietly.
2) Tell people, but don't halt vaccine use.
3) Tell people, halt only for women/people under 55.
4) Halt the vaccine
I think 2-4 ALL would increase vaccine skepticism. #1 wouldn't IF NOBODY FOUND OUT, but that is a very risky proposition. If it did come out that there might be a problem but CDC was keeping it quiet, it could be catastrophic. And that's a pretty big secret to keep.
Would 2-4 have been better? I think any of those options would have created pretty big headlines, and that's what people notice. I think 2 or even 3 would have been better choices, but I still doubt there'd be much difference in impact on vaccine hesitancy between announcing there's a problem and continuing to use vs announcing there's a problem and temporarily halting.