At around the same time I was writing Monday’s post complaining about messaging around vaccine trials for younger kids, there was an argument picking up around the issue of FDA approval for the vaccines we already have. The vaccines now on offer in the US— Pfizer, Moderna, and Johnson&Johnson— are available under “Emergency Use Authorization,” not through the full approval process of the Food and Drug Administration. This may limit the ability of various public authorities to compel vaccination (or it may not; the answer is unclear because lawyers), which has led some people to argue that the FDA should just issue full approval now, shortcutting the usual process which would grind on for a few more months at least. You can read a pretty representative version of this argument from Matt Yglesias, if you want all the details.
There is, of course, a contingent of people arguing the opposite— that the FDA needs to go through its full process; I’ll use Kevin Drum’s version of this as the illustration, as he’s relatively calm and not gratuitously insulting about it. I don’t find this especially compelling, because as I said on Twitter, it’s a weird bit of needle-threading:
The best version of the “trust the process” argument I can come up with is what I shorthand in that thread as “Rules Are Rules:” that having established the procedures in advance, we have to follow them through, not change them on the fly. Which is hard to argue against, but then on some level serves as an argument that we do need to re-think these procedures. Even if we can’t speed up the approval of these vaccines, we should find a way to allow more flexibility in future emergencies, either by streamlining the FDA process or giving more authority to public officials to mandate use of vaccines that are only available on emergency-use status.
But, of course, while that’s the strongest of the arguments, it’s not particularly sexy, so most of the public debate centers around something that’s more suited to shouting. That is, the “trust in institutions” argument that the FDA needs to go through the full, slow process so that the public will trust that the final approval really has checked all the boxes, and is really, truly, safe and reliable.
The problem with this, as I said in that thread is that it’s self-defeating in two ways. First, if you’re saying that we need to go through the process because there’s a genuine possibility that there might be some rare effect that didn’t show up in the fast-tracked emergency use process, that’s not entirely consistent with arguing that everybody needs to get the emergency-use-approved vaccine right now. If there’s a genuine reason to think that there might be issues that will only emerge once Science has ground its exceedingly slow and fine way through all the formal trials, then that’s a genuine reason for people to be hesitant about taking the vaccine.
The second version of this argument is that if the FDA were to short-cut the full approval process, then anti-vaccine activists would seize on that to argue that it’s all a scam, the whole process is political, and some shadowy They are trying to implant microchips in people because something something the Book of Revelations. The problem with this, of course, is that they’re already doing that with regard to vaccines in use now. And I don’t mean just the emergency-use-authorized Covid vaccines, I mean things like the measles vaccines that have been around for decades and tested and re-tested countless times. Waiting out the formal process isn’t going to stop crazy people from believing crazy shit.
What really wraps this all up in a lovely bow, though, is a response I got to Monday’s post, which argued that it’s actually a good thing that people writing about vaccine trials for kids don’t talk about the very valid reasons why those need separate and lengthy testing, because that would, you guessed it, give ammunition to the anti-vaccine crowd. We both need to go through a slow approval process because there’s a genuine risk that some issue might come up, but also we shouldn’t talk forthrightly about that risk, because crazy people will use it to justify their craziness.
I hate to keep banging on about this (though it’s hard not to, given that I have a too-young-to-be-vaccinated son and keep reading stories like this), but I think this really illustrates one of the central issues of the disastrous messaging problems of the public health community during this pandemic. That is, the authorities keep warping what they say around concerns about what crazy people might do with the truth.
Almost all of the disasters of the pandemic fall in this category (most of the rest go under “Donald Trump is a sociopath”). There was a “go about your business normally” phase back in February of 2020, because they wanted to avoid panic. There was the “You shouldn’t wear masks” phase, a message pushed because they were afraid people would snatch up supplies needed for medical personnel. There was the “closing public parks” phase and the accompanying shaming of people doing stuff outdoors, on the theory that permitting even exceedingly low-risk outdoor activity might set a bad example (picnicking leads to touching, touching leads to sex, and then there are no mysteries left…). We got months of “Even if you’re vaccinated, you shouldn’t do anything” because that might encourage unvaccinated people to do stuff. And on and on and on. We’ve had endless examples of bad messaging, at every turn justified with “Well, but if we say the actual thing, then Bad People will use it to justify Bad Things…”
They’d take away my license to blog if I didn’t have a grand and simple solution to this, so here it is: Worry less about crazy people. We keep getting into trouble because of stupidly complicated bank-shot messaging that’s meant to head off some imagined misinterpretation of the actual facts. Essentially none of which actually works, mostly because it’s stupidly obvious. People figure out pretty quickly when the authorities are attempting to manipulate them, and that is way more corrosive to trust in institutions than anything that kooks and cranks might do.
Worry less about crazy people. You can’t predict what they’re going to believe— they’re crazy, remember?— and you damn sure can’t control it. Strategizing around what you think lunatics might do is a fool’s errand. Most people are not, in fact, crazy, so just be honest and straightforward. Tell people what you know and what you don’t, as forthrightly as you can manage, and the non-crazy people will, for the most part, do the right thing. It might take a little while to get there, because the bad precedent that public health officials will slant their messaging has been set, but it’s the better and more sustainable (maybe the only sustainable) policy in the end.
(Update: Literally while I was typing this, Yglesias did a follow-up post on the FDA approval argument that’s worth reading.)
All right, that’s a bit of a rant to close the week, but I feel better for having typed it out. If for some reason you would like to receive occasional cathartic outbursts like this via email, here’s a button:
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When they really take away your license to blog, it’ll be because you were too reasonable.
This is right. Focus on the well-intentioned majority. I remember some health official digging in on masks - "regular people aren't trained in taking them off and might get infected by the dirty outside of the mask". I wondered, if the outside of masks are treacherous, what about my shirt?