If a conservative is a liberal who got mugged, what’s a liberal who got their Johnson & Johnson vaccine appointment canceled?
Two hours before my appointment for the J&J vaccine at my local New England Walmart, the store pharmacy called to say that my appointment was canceled. I’m hardly alone. The Food & Drug Administration and the Centers for Disease Control recommended pausing the use of J&J vaccines which have become the Instant Pot of innoculations since they are paragons of convenience, requiring only one dose. Almost 7 million Americans have gotten one of these just-once jabs. But after six cases of severe blood clots were identified in people (all women under 50) who received the J&J vaccine, leading to one death, public health officials formally urged a pause.
As a good liberal who appreciates the generally thankless work performed by government workers, my disappearing vaccine triggered a clash of emotions. I had selfish rage at having immunity delayed when it was tantalizingly close. I also had altruistic sympathy for the public health officials doing their best to balance risk amidst crises.
With bureaucratic decision-making comes second-guessing, and in the social media age, it is turbocharged. Twitter raged. FiveThirtyEight’s Nate Silver. “6 cases out of 7 million people. What a disaster,” Silver opined. “This is going to get people killed. And it’s going to create more vaccine hesitancy. These people don’t understand cost-benefit analysis. They keep making mistakes by orders of magnitude.”
The New York Times’ Ezra Klein piled on: “If you’re going to pause J&J, go to first doses first of Pfizer and Moderna. Or since the clots were all in women, use J&J for men and Pfizer/Moderna for women. Do something to show you are as fearful of [the variant] B117 as adverse vaccine events.”
Such critiques resonate with my selfish rage side, which must be driven by some latent libertarian DNA in my Y-chromosomes. Why should the government be able to stop me from getting my J&J? (Never mind the fact that the government made the vaccine possible in the first place.)
But if our impatience ruled the day, who knows what junk would have ended up in our veins? Whatever vaccine hesitancy might be instigated by the J&J pause must pale in comparison to the communication nightmare we would suffer if we didn’t have rigorous public health officials willing to resist public pressures and exercise caution.
As is often the case, the single data point generating outrage—only “6 cases out of 7 million people”—doesn’t tell the whole story. Former FDA Commissioner Scott Gottlieb (who now serves on the board of Pfizer) explained on CNBC Tuesday morning that public health officials are likely concerned “that they’re only seeing the severe [blood clot] cases, and they’re missing some of the more mild cases and by taking this action that’s going to elicit more reporting.” Remember, J&J vaccines weren’t available until six weeks ago, and the blood clots didn’t materialize until one to two weeks after the women received their shot. Scientists need more data to be able to determine if there is a connection between the vaccine and the clotting, and by calling attention to the issues, they will be getting more data.
A full suspension may not have been needed to identify more blood clot cases. But there was a related concern: how to treat these particular blood clot cases.
Dr. Peter Marks, director of the FDA’s Center for Biologics Evaluation and Research, told the press Tuesday that “if one administers the standard treatments, that we as doctors have learned to give for blood clots, one can actually cause tremendous harm, or the outcome can be fatal.” At the same briefing, the CDC’s deputy director Dr. Anne Schuchat said a pause in administering J&J vaccines was necessary, “so that there was time for the health care community to learn what they needed to learn about how to diagnose, treat and report.” If there is a connection between the J&J vaccine and the blood clots, then continued vaccination would not only create more clots, doctors would not have enough information to know how to save patients with clots from dying.
Still, the crude cost-benefit analyses loom. Will the number of people saved by learning how to treat vaccine-related blood clots be larger than the number of people who contract Covid-19 because they grew suspicious of all vaccines or had their vaccination delayed?
Vaccine distribution point man, Jeff Zients, reassured the White House press corps that there was now plenty of vaccines around, so there shouldn’t be too much inconvenience, especially since J&J only comprises about 5 percent of the shots given. Sure enough, later on Tuesday afternoon, I was able to schedule both doses of the Pfizer vaccine—one this week and one three weeks from now. Not bad!
However, the CDC considers one “fully vaccinated” two weeks after their final dose. So I will be fully vaccinated on May 21. I had received my J&J vaccine as initially scheduled, that day would have been April 27. How many people in a similar position as me will contract coronavirus between the time they would have been fully vaccinated via the one-shot J&J and the time they are now scheduled to receive their second dose of Pfizer or Moderna? I don’t know the answer, but I do know it’s not as simple as “follow the science.”
Government officials make choices where, no matter which course of action they take, some people die. And it can seem like the right course is to follow the logic of John Stuart Mill, or Spock in Star Trek II: The Wrath of Khan as he sacrifices himself: “The needs of the many outweigh the needs of the few.”
Yet there is room for Captain James T. Kirk’s reasoning in Star Trek III: The Search for Spock: “The needs of the one outweigh the needs of the many.” Kirk was speaking of the importance of friendship. But the Biden administration likely is also looking beyond the raw body count in considering an additional ethical factor: in each vaccine scenario, who would be directly responsible for the deaths?
If people died of blood clots because the federal government encouraged the use of a vaccine with a known clotting risk, then the federal government would have been directly responsible. But if I get Covid-19 before May 21, it will be because I will have engaged in some form of risky activity in defiance of other government instructions regarding social distancing, mask wearing or hand sanitizing.
Nevertheless, if anyone who had been scheduled for the J&J vaccine dies, then the Biden administration will get horsewhipped, as it would if more vaccinated people die from blood clots. There is no risk-free political path.
That is why simplistic analyses of Biden’s overall governing strategy fail to capture the complexities of…governing.
In January, Klein wrote in The New York Times: “Great presidencies — and new political eras — are born of crises … A successful mass immunization campaign will save lives, supercharge the economy and allow us to hug our families and see our friends again. Few presidents, outside the worst of wartime, have entered office with as much opportunity to better people’s lives immediately through competent governance. Biden’s team understands that.”
But in a column last week, before the J&J pause, Klein fretted, “Are people dying because our coronavirus response is far too conservative?” (in the cautious sense, not the ideological sense.) He went to question Biden’s capacity for boldness: “…he’s said, repeatedly, that he doesn’t want to get ahead of the science. Unfortunately, science can’t tell you what it does not yet know, and the virus spreads faster than our knowledge. It’s the job of politicians to weigh the information we have and the possible benefits of experimentation, against society’s broader goals.”
In the case of the blood clot issue, the FDA and the CDC concluded they needed to know more before they could encourage more J&J jabs. Klein, in his Twitter thread, weighed the information differently. But there is no definitive right or wrong answer, and some faction of people will be displeased—and some people will become sick and die—whichever course is taken.
This is why a strategy to “better people’s lives immediately through competent governance” is hardly a foolproof political strategy, because competence, while obviously desirable, does not prevent grappling with governmental Sophie’s Choices and does not immunize governments from criticism when inherently imperfect and unsatisfying decisions have to be made.
The Trumpian disdain for expertise has its obvious flaws, but the one advantage is it keeps people’s expectations low. When you run on competence, people want governmental perfection, which is utopian and unattainable, or mere excellence, which is also tough.
So I’m going to shelve my initial anger, mask up, and wait another month. I’ll remind myself liberal government can inspire and deliver, yet at times it will inevitably disappoint. Pols aren’t perfect. Neither is Fauci. Still, let me kvetch. To paraphrase “Hamilton,” I can’t believe they’re giving away my shot.