Covid-19 Politics

[filghy2]

The FDA panel has decided to recommend booster shots at this stage only for 65+ and other high risk groups. https://www.yahoo.com/entertainment/...203847937.html

It sounds like expert opinion is somewhat divided on the case for booster shots, and maybe also on the mixing of vaccines. That is not surprising because it involves weighing the risks of giving approval when there may be incomplete information against the potential benefits in combating the pandemic. Even with the same clinical information, different experts might come to different judgements on that balance. "Following the science" doesn't always give a clear-cut answer.

I understand that it is generally desirable for the regulators to be able to make decisions without political pressure, although a degree of pressure is unavoidable because of the consequences. The FDA were under a lot of political pressure to give early approval to vaccines last year. Maybe that was undesirable, but if there had been no pressure would they have been as willing to give emergency approval as early as they did?

My sense is that regulators are generally inclined to err on the side of caution because the consequences are asymmetric. If they approve and there are problems they get the blame, but if they don't approve then nobody sees the counterfactual. Sometimes this can cause problems.

For example, the advisory panel in Australia contributed to vaccine hesitancy earlier this year through their advice on AstraZeneca, which was then the only widely available vaccine here. The problem was that their advice seemed to focus too narrowly on the very low risk of blood clots from AZ, and not enough on the broader risks of Covid. As a result, we've struggled to deal with the Delta outbreak over the past 2-3 months because the initial vaccination rate was low.

[broncofan]

That is not surprising because it involves weighing the risks of giving approval when there may be incomplete information against the potential benefits in combating the pandemic. Even with the same clinical information, different experts might come to different judgements on that balance. "Following the science" doesn't always give a clear-cut answer.

Doctors in clinical practice frequently prescribe drugs off-label based on their judgment as to risks and benefits and can use the existing evidence as a guidepost without rigid mandates. In a pandemic it's understandable that regulators want to be more careful about decision-making without a strong evidence base. A bunch of scientists saying they don't think there should be a problem boosting with a different vaccine is not as compelling as a study showing it. Scientists saying using half the dose of moderna might be almost as effective and save vaccine isn't as good as data. I can see why caution is taken when an error can cause systematic harm and loss of confidence in vaccines.

There's also the fact that the booster decision isn't a "pure" medical decision. It's one dealing with the scarcity of supply and best allocation given that constraint. There's also the different goals that we have for vaccine use. One being to stem transmission and another to prevent hospitalization and death. Both are valid of course but it's a complex issue. I doubt we're going to be transparent about the fact that our regulators are probably thinking in completely nationalistic terms and the only opportunity cost is vaccinating unvaccinated Americans.

[filghy2]

To be clear, I'm not saying that the recommendation is wrong; it may well be the right balance of different considerations at this time. I was getting at the more general issues around what "following the science" means and how much authority a democracy should cede to unelected experts. Like all three-word slogans, it raises as many issues as it resolves.

I've been thinking about this lately because Australian governments have ceded more authority to medical officials in this pandemic than almost any other country, and consequently we've had about the most restrictive regime of any democracy. This worked fairly well until recently, because we were able to eliminate community transmission so that most of the country had only limited periods of lockdown.

It's not working so well with the delta variant, with much of the country now in seemingly never-ending lockdowns that have limited the rise in cases but haven't been able to suppress the virus. The current plan is that restrictions will be eased once they reach the 70% vaccination target, which is expected around the end of October. However, some outside experts claim that even this is too risky, and restrictions may be reimposed if cases start to rise too rapidly. State governments are also taking different approaches, so interstate travel restrictions are likely to continue for longer.

This raises issues about democratic legitimacy and whether officials are making decisions that extend beyond their area of expertise. Medical advisors are experts is assessing the risks associated with the virus under different scenarios. It's not clear that this makes them experts in balancing these risks against the negative impacts of lockdowns and other restrictions. That is the de facto situation when governments say they must defer to medical advice.

It is true that this delegation of authority is being made by elected governments who can be defeated at the next election if voters are unhappy with the outcomes. However, the longer that extraordinary emergency powers are extended the more we seem take on some of the attributes of technocratic dictatorship.

[broncofan]

I understand all of your points and agree with them. Follow the science is a useless slogan when public policy decisions don't just depend on descriptions of what is but also what people value and want. Sometimes in regulation the description of what is leads very clearly to a response which is probably the only place where following the science is straight-forward. But at least part of the decisions elected officials make with respect to policy involve social sciences and are always normative anyway.

I also understand both the problems with legitimacy when it comes to experts who were not elected and people's unreasonable expectation that the policy preferences of experts are deferred to in all cases. This is particularly the case when there's so much pressure for them to be lock-step with scientists that they are accused of denying reality if they choose an alternative.

Just to offer an off-hand opinion I don't think lockdowns make a lot of sense at this point simply because we know it's very unlikely delta is going to disappear unless the world gets a lucky break (a less deadly variant people get more durable immunity to). Maybe they would make sense if hospitals were overrun. Wearing masks and getting vaccinated is probably going to be the way forward until things change, as they have many times.

[Stavros]

Damn those pesky experts...! If the people no longer trust science because they choose to believe Climate Change science is at least not proven, or total rubbish; if people no longer trust the Generals who say the invasion of Iraq is 'doable' (Dick Cheney's word) but don't plan for the aftermath, and get their 'invasion lite' wrong anyway; and if people no longer trust the bankers who lend and borrow more than they earn, why trust the scientists when it comes to Covid-19?

I think, in general terms, the logic of face masks and vaccinations as antidotes to Covid-19 is irresistible, and that only cranks and those with an extreme anti-Government agenda oppose the science. But as frustration grows at the length of time it is taking to 'get back to normal' then even rational people begin to query the extent which science is shaping policy.

I am a bit of a Priest on this, and take the faith as well as the medicine, but I cannot officiate on other people's behalf, and can only plea for more time and obedience. Or the hallowed ground of normal life will take even longer to return, though I am confident it will happen before the return of Jesus, and no, that's not the Mexican taxi-driver who never showed up to return me to my LA hotel all those years ago.

[filghy2]

Just to offer an off-hand opinion I don't think lockdowns make a lot of sense at this point simply because we know it's very unlikely delta is going to disappear unless the world gets a lucky break (a less deadly variant people get more durable immunity to). Maybe they would make sense if hospitals were overrun. Wearing masks and getting vaccinated is probably going to be the way forward until things change, as they have many times.

The best argument for lockdowns (combined with border controls) is that going early and hard could allow the virus to be eliminated until vaccines became widely disseminated. This way you could limit the death toll while also limiting the economic disruption over time. Australia was able to achieve this previously, but it's much harder with the more infectious delta strain, which must change the benefit-cost calculus. Compliance with restrictions also declines when people can't see an end in sight.

[filghy2]

But as frustration grows at the length of time it is taking to 'get back to normal' then even rational people begin to query the extent which science is shaping policy.

I am a bit of a Priest on this, and take the faith as well as the medicine, but I cannot officiate on other people's behalf, and can only plea for more time and obedience.

The issue is that the right approach is not just a question of science, but also involves consideration of economics, ethics and human psychology. Medical scientists will always focus on the question of how to limit the health impacts below a certain level, because that is what they are trained to do. But we also have to consider what must be sacrificed to achieve this outcome, as well as peoples' willingness to accept restrictions, given their effectiveness depends on a high degree of voluntary compliance.

I would make a distinction between policy decisions being informed by scientific advice and policy decisions being based purely on scientific advice. It is not anti-science to say that scientific advice sometimes needs to be balanced against other considerations. The right balance between freedom and risk is ultimately a social/political question rather than a technocratic question.

[blackchubby38]

Now the question becomes do I go ahead and just get the 3rd Pfizer shot or wait for the CDC and the FDA to make up its mind about mix and matching:


CDC 'starting to see mix-and-match data' for COVID-19 vaccines: Director

finance.yahoo.com/news/cdc-starting-to-see-mix-and-match-data-for-covid-19-vaccines-director-131034795.html

[sukumvit boy]

Now the question becomes do I go ahead and just get the 3rd Pfizer shot or wait for the CDC and the FDA to make up its mind about mix and matching:


CDC 'starting to see mix-and-match data' for COVID-19 vaccines: Director

finance.yahoo.com/news/cdc-starting-to-see-mix-and-match-data-for-covid-19-vaccines-director-131034795.html

Yes , get your Pfizer booster, I did.
Or , for the hands down best antibody response, catch Covid ,get your Moderna or Pfizer #1 and #2 ,than throw in a mixed booster. Oh ,and don't forget your flu shot!

[broncofan]

Sukumvit I am sure will be interested in this since he spoke of new antivirals at the beginning of the pandemic.

Merck developed a new antiviral drug called molnupiravir and the phase iii trials show significant reduction in hospitalization and death. In fact, the results of the study were so strong that the study was stopped on recommendations of regulators. I assume this means there were enough signs of efficacy that it would be considered unethical to continue giving the control group placebo.

The article also said that the pill is likely to work against new and old covid variants with similar effectiveness.

https://www.reuters.com/business/hea...dy-2021-10-01/