Kid Vaccines and Communications Breakdowns
A failure to get out of the professional mindset.
Regular readers will know that we’ve got two kids, who I refer to by pseudonyms, because Internet (irregular readers are learning that now, I guess…). SteelyKid is 12, heading into eighth grade in the fall, and is fully vaccinated against Coid-19, having gotten both Pfizer shots back before the end of the school year. The Pip is 9, heading into fifth grade, and is not yet eligible for any Covid vaccines.
This gap between them is significantly limiting what we can do in terms of vacation-type activities, so I’m always on the lookout for stories about vaccine development for younger kids, which seem weirdly lacking in the media. We hear lots about adults who’ve been eligible for months but refuse to get the shots for a variety of not-very-good reasons, and next to nothing about when we’ll be able to protect my kid who will absolutely be getting it as soon as it’s legal to do so. (He’s very anti-needle as a general matter, but recognizes the need for it…)
So, when an article on this topic turned up in my social-media feeds, I jumped on it. It’s a piece in The Conversation with the title “Kids aren’t just littler adults – here’s why they need their own clinical trials for a COVID-19 vaccine,” written by Judy Martin, a pediatric medical researcher in Pittsburgh, and was disappointing to me in two major ways. First is that, buried somewhere down toward the end of the piece is the news that they’re only just now enrolling children under 12 in vaccine trials, which makes the chances of getting the Pip vaccinated in this calendar year seem pretty slim. The second and more important failure is sort of illustrative of the general failures of the public health community, in that it’s not actually addressing the question that I care most about.
This is not to say that the piece is badly written or anything like that; it’s perfectly good at what it is, which is to say an explainer of how the existing clinical trial system works, and why children are handled separately. It’s got a good summary of how clinical trials work, and the biological factors that mean drugs and vaccines that are safe and effective for adults won’t necessarily work for younger children.
But “what it is” is also kind of the problem, here. That is, this is a nice explainer of how clinical trials work under ordinary circumstances that doesn’t even touch the fact that these are not ordinary circumstances. To put it another way, it describes why developing a vaccine for, say, chicken pox takes time, but doesn’t engage with or even acknowledge the gravity of the current moment. The question parents like me have isn’t “Why do we do these laborious clinical trials of safety and efficacy as a general matter?” it’s “Why are we sticking to slow business-as-usual procedures in the middle of a global pandemic?” I get the point of the phased trials just fine, thanks, I want to know why there doesn’t seem to be any additional urgency in the process right now, given what’s been going on for the last year and a half.
(I’m not talking about doing human challenge trials in six-year olds, here, just things like wondering why it is that we’re only just now enrolling kids in trials, as opposed to starting in parallel with earlier studies. It seems borderline crazy that we’re nearly three months past approval for 12-year-olds but only just starting to collect data for younger kids. Given how contentious and important the topic of opening schools has been, you’d think this might’ve been bumped up the queue a bit.)
To a large extent, this is another example of the problem I talked about in the very first substantive post here, about how most of our disagreements aren’t breakdowns in “critical thinking,” but reflect differences in priorities. The author of the piece probably thinks the question has been adequately answered, because to someone operating within the mindset of a medical researcher, the mere fact that there might be differences in safety or efficacy is sufficient justification for moving slowly. People who go into that line of work tend to have near-zero tolerances for risk as a general matter— as I’ve joked before, these are folks who were using paper towels to open bathroom doors for years before there was a pandemic to justify it.
Now, it may well be that there are reasons why even the current crisis situation isn’t sufficient to justify cutting corners on the traditional clinical trial procedure. That’s a question that needs to be directly engaged and explicitly addressed, though. Just saying “Well, we have procedures for these things for a reason” without acknowledging that other people might quite reasonably feel that present circumstances might justify speedier action comes off as patronizing.
And, to be clear, this specific piece is actually pretty good at minimizing the patronizing. It’s calm and thorough and explains pretty clearly how the system works. There’s a lot of stuff out there on the larger Internet that’s much worse, up to and including “arguments” of the form “STAY IN YOUR LANE, PEON, THE EXPERTS WILL HANDLE THIS!” All of these come back to the same root problem, though, namely people in the public health sector not getting beyond their own professional mindset, and understanding the different priorities and concerns of others.
There’s a very direct parallel to earlier discussions about vaccine development in adults, but this same issue is at the heart of basically every communications debacle of the pandemic to date: the hygiene theater of hand sanitizer and surface scrubbing, freaking out about outdoor activities, many of the dumb arguments about masking, the weird procedural delays in approving vaccines for use, the disastrous messaging around rare side effects, etc. These all reflect the mindset of people for whom “pathologically risk-averse” is a professional qualification, and a failure to engage with people who think differently in a way that allows effective communication.
In every one of those cases, there were calm and thorough pieces explaining that, no, you should find the sudden suspension of a particular vaccine reassuring, because it means that system’s working as designed. Mostly because the people writing those pieces are themselves reassured by the normal operation of systems they find congenial, and not thinking about how people who aren’t in the public health sector react. And, of course, the calm and thorough pieces were accompanied by a lot of “STAY IN YOUR LANE!” yelling at people who do communications for a living, when they said “You know, I’m not sure that’s really how public opinion works…”
So I found this particular piece about kid vaccine trials maybe more frustrating than it should’ve been, because it feels very much of a piece with all the other mis-steps of the past year and a half. As with the other cases, I’m not sure they’re actually enacting bad policy— I’d personally like to see a bit more urgency here, but am willing to believe there might be reasons not to— but the communications around all this stuff has been and remains an absolute disaster. We really need a bit more effort to directly engage with the concerns of people who aren’t in the public-health-expert mindset in a way that’s not patronizing or dismissive.
In the meantime, we’ll be more or less sitting tight until The Pip can get his shots, sticking to outdoor events and smaller crowds. Though if anyone out there can hustle this along, that would be very much appreciated…
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I am reading Melville's "Moby Dick," having read several times before, and I just got done with a short story in the novel involving a character names Steelykilt. The name is close to that of the girl featured here.