The continuing failures of our pandemic response should be a moment for a national reflection and calm discussion on how to reset our public-health goals.
Our current approach to dealing with the pandemic is mired in partisanship, top-down edicts, and politicization. There must be a better way.
T he latest Covid-19 coronavirus wave blindsided a large portion of the United States. For most of 2021, political and health-policy leaders had been echoing a similar message: The end of the pandemic is near. President Joe Biden, on this past July Fourth, went so far as to coax Americans to declare their independence from the coronavirus.
His “mission accomplished” statement could not have backfired worse. Since Biden’s midsummer exultation, the country has been hit by two new massive waves of coronavirus. The first, starting in the summer, was a new Delta variant of the virus that caused havoc throughout the deep South, predominantly in Florida and Texas. From the beginning of July to the end of September, over 100,000 Americans lost their lives to the virus.
During this period, states that escaped the summer wave, especially in the Midwest and Northeast, celebrated their own success in controlling Covid. After all, their high vaccination rates and mitigation policies appear to have stifled Delta completely. And while many of us warned that those states should be preparing for the next wave, they instead spent months claiming a moral high ground that never existed.
Then fall arrived, and the changing seasons brought reality back to much of the country. The new Omicron wave that had hit South Africa and the United Kingdom had arrived on our shores, and all the vaccination and mitigation policies in the world were not going to stop it. From October 2021 to the present, over 140,00 additional Americans died, this time mostly from midwestern and northeastern states.
The continuing failures of our pandemic response should be a moment for a national reflection and calm discussion on how to reset our public-health goals. Instead, it has largely seen more politicization of the pandemic, to the detriment of everyone. The continued resistance to vaccinations from the Right was only exacerbated by the pigheaded resolution of the Left to adhere to mitigation techniques that continue to prove futile.
The Delta and Omicron waves should shock our scientific community into the new realization that many of our assumptions about the pandemic are simply incorrect. The concept of herd immunity, which drove much of our policy for the past year, has largely been thrown out the window. We are now left mostly with mitigation procedures simply to reduce the burden on our hospitals and health-care providers and continue the messaging on vaccinations.
Arrogance further reduced our readiness. In the summer, much of the country had time to prepare for the next attack of the virus. During this time we could have been increasing our supply of drugs and tests to prepare for the cold-weather onslaught, but instead we wasted our time with political grandstanding.
First, we need to differentiate between population-based policies and individual health-care decisions. These are not one and the same: The risk/benefit ratio is far different for an individual versus a large population. Dr. Aaron Carroll of Indiana University does a nice job explaining the difference in a recent editorial in the New York Times:
Physicians tend to be conservative in their practice of medicine. We fear a bad outcome disproportionately and will do almost anything to prevent it. Although doctors often credit the threat of being sued for the practice of defensive medicine, extra tests and procedures are often ordered because making a mistake would be devastating, both to the patient and to our own understanding of ourselves as healers. This mentality also leads to the thinking that every test and treatment must be the best. Physicians cannot tolerate anything less, because we are who will be held to account if anything goes wrong.
But blown to the scale of a whole country, that kind of focus on individuals has often led us in the wrong direction during the pandemic. Much of my frustration at the response to Covid is that too many officials in senior positions at the Food and Drug Administration and the Centers for Disease Control and Prevention seem to be thinking this way — if something isn’t close to perfect or doesn’t maximize the safety of each individual person, it’s not worth it at all. Some of the greatest initial and continuing failures of public health policy have stemmed from this view.
This issue has been most apparent in the Biden administration’s approach to new Covid therapies and vaccinations. The fear of side effects is largely driving the debate within the FDA and elsewhere today, even as thousands of Americans die every single day. The administration slowed purchases of GlaxoSmithKline’s monoclonal antibody this fall, thinking that the pandemic was abating, only to face a new wave in which the federal government was caught flat-footed by its lack of the medicine. Pfizer’s new antiviral Paxlovid, which reduces symptoms by up to 90 percent, was delayed for months for no good reason. Only after the Omicron surge hit the northern states hard this Christmas did the Biden administration act by purchasing 10 million doses — far too late to help those suffering during this wave of disease.
That should surprise no one. This past spring, the administration took the Johnson & Johnson vaccine off the market for several weeks because of risks of thrombosis. The risks were real, but Europe and other regions have shown that those risks were manageable. By taking the vaccine off the market, the FDA helped increase fear of vaccines overall, making the jobs of health-care professionals all the more difficult.
Experts in public health need to reposition their thinking on how best to approach the continuing scourge of Covid. Our primary tool, vaccination, is still an excellent way to prevent deaths and hospitalizations, and continuing to advocate vaccines and boosters is essential. However, vaccines have failed in one regard: transmission. Although it appears that vaccines provide some protection from transmitting the disease, the benefit is not very large and clearly isn’t enough to stop future waves of the virus from rolling through our most susceptible populations.
Second, we need to stop overpromising on the benefits of vaccines. We have routinely asserted that vaccines would stop infections, stop future waves of disease, and maybe even provide lifelong immunity. All these claims are substantially wrong. We should focus on the few absolute benefits we know of: that those who are vaccinated have lower rates of hospitalization and death. All other claims should be held off until we have better data supporting them.
We should also admit that, as with every decision in medicine, there are risks and benefits to vaccines as well. Health care is always about judging which trade-offs are worthwhile and which aren’t. Although some may disagree, I think it’s clear that the benefits of vaccinations outweigh any known risks. However, large-scale distrust, partly because of experts overstating or downright lying about these issues, has undermined our case for universal vaccinations. Instead, openly discussing the rare side effects and the overall benefit, and then coaxing (not forcing!) people to vaccinate, will build confidence in the system.
So what policy changes do we need to succeed in the face of the continuing pandemic?
First, we need better communication and messaging. Our health-care experts also need to learn how clear, concise, and trustworthy public messaging is critical to success. Drs. Anthony Fauci and Rochelle Walensky have done a poor job this year in that respect, continuing the failures of the prior administration.
The CDC and others need to simplify their public recommendations and stop shifting policy at every whim. Their explanations for their policies, their policy changes, and their often contradictory recommendations have undermined their credibility, and for good reason. It is far past time for President Biden to seriously consider finding a new point person on the pandemic, because the evidence is clear that his current front men are failing him.
It would be helpful if our leading scientists openly, honestly, and loudly admitted their mistakes. Too many of them make excuses for getting major policies wrong during the last two years, whether it was about masks, testing, vaccines, or travel restrictions. The reality is that getting things wrong is part of the scientific method; but being dishonest about it is not. Let us admit we have all made mistakes along the way, and now use the best evidence in front of us to reframe our policy choices in an honest, open way. The more we can admit our faults, the more the public is likely to accept that we really have their best interests at heart.
Simplifying our strategies would make communicating them much easier. First and foremost, promote the efficacy and safety of vaccines. Use every voice you can; former president Donald Trump’s voice joining the fray of late is a positive addition. Be honest about the downsides of vaccines, but show how they are still far exceeded by the benefits. We also need to dial back the politicization of vaccines.
As a vaccine proponent, I certainly am disturbed by the number of people who hesitate to receive the shot. But at the same time, these are our fellow Americans. It is long past time to stop treating them as the enemy and start treating them more like family members that we want to keep alive and healthy. The demonization is hurting our messaging on the pandemic. The Omicron variant has shown that both the vaccinated and unvaccinated are still at risk, and that we need one another to work together with compassion and understanding to do better.
Access to testing needs to improve dramatically, and right now. We cannot predict what a new variant of the virus may present. However, the more testing that we have available, the better. This is not about case numbers; this is about giving people the tools to make smarter decisions about their own lives. If someone who is in doubt can run to the bathroom and get tested in minutes, they can then decide what steps they need to take. The biggest failure of testing is that we have taken that power away from the individual. We need to empower every citizen now, today.
Lastly, school closures need to be made a relic of the past. We have data from around the globe that schools are not a major source of transmission. Opening schools, with masking as needed, should be our primary goal moving forward. Schools should always be the last public venue to be closed. If restaurants and bars are open while schools are closed, your public leaders are failing you.
Although everything related to the coronavirus has become overtly political, these policy changes need not be. President Biden has a solemn duty to follow the Constitution, while at the same time focusing on strategies that can save the most lives going forward. This is still possible, but not if we rely on failed measures and mitigation techniques that keeping proving to be ineffective. It is time to start from scratch, look at the battlefield of Covid as it is and not as we wish it to be, and formulate a new plan that can successfully lead America through the rest of this pandemic.