Trust and the COVID-19 Vaccine

 

In the last three weeks, the U. S. Food and Drug Administration has approved two vaccines for use against COVID-19.  Both the Pfizer-BioNTech and Moderna vaccines were developed in less than a year, a stunning technical achievement that relied on cutting-edge science and engineering.  Now the big question is, how many people will be willing to take it? 

 

The only vaccine rollout of comparable importance in my lifetime was the advent of polio vaccines in the late 1950s.  I was not old enough to be reading the newspaper regularly when I ate the sugar cube the Sabin vaccine came on, being about eight years of age, but I understood by the way my parents acted that it was a big deal. 

 

Polio was a terrifying disease for two reasons:  it tended to strike children and teenagers, and it usually crippled rather than killed you, putting many of its victims in clumsy braces, wheelchairs, or a medieval-looking contraption called an iron lung.  So it's not surprising that polio vaccines received near-universal acceptance in the far-off days when your doctor's word was tantamount to the word of God and the only people who objected to vaccines were Christian Scientists and other minority groups.

 

Things are different now in a lot of ways.  Public trust in expertise of all kinds has seen a decline in recent years.  There is now a substantial anti-vaccine movement motivated by a variety of factors, but sharing a common belief that the harm vaccines do may well outweigh the good, and assurances to the contrary by scientists or the medical profession should not be trusted.  Surveys asking people whether they will be willing to take a COVID-19 vaccine turn up substantial numbers of people who don't want it, although recent trends have been in the more-willing direction.  For example, a Kaiser Foundation survey conducted between Nov. 30 and Dec. 8 and reported in U. S. News says that 41% of Americans say they will definitely get it and 30% will "probably" get it.  The number of people who say they definitely won't get a vaccination is 15%, and 12% say probably not. 

 

The poll broke down respondents by rural versus urban, Republican versus Democrat, and African-American versus everything else.  Those in rural areas, Republicans, and African-Americans are less willing than other groups to get vaccinated for COVID-19.  Why is this?

 

One factor cited for the reluctance of African-Americans to receive the vaccine is the bad track record of medical experimentation on Black Americans exemplified by the infamous Tuskegee syphilis study conducted between 1932 and 1972, which followed the course of the untreated disease in African-American men by lying to them that they were receiving free medical treatment, when in fact they were not being helped at all, just observed as the disease progressed to its fatal conclusion.  This study is a poster child for unethical experimentation on human subjects, and it's not surprising that after betraying trust in this manner, the U. S. Public Health Service and the Centers for Disease Control find that Blacks are less than enthusiastic than other ethnic groups about government-supported vaccine programs. 

 

But that doesn't explain why 27% of the U. S. population still doesn't want a COVID-19 vaccination. 

 

Part of the reason may simply be that younger people don't think catching COVID-19 will hurt them that much, whereas the vaccine makers are admitting up front that the second of the two necessary injections makes many people mildly ill for a day or two.  Absent a job requirement to receive the vaccine (and I'm not aware of any organizations which have yet implemented such a requirement), that is a judgment call that is up to the individual. 

 

The novel factor in this whole situation is the way that a vaccine that can keep you from contracting a widespread potentially fatal disease has become a political football, with Republicans showing more reluctance to take it than Democrats.  The simplistic answer to this question, namely that followers of Donald Trump are a bunch of ignorant morons who he can lead around by their noses, won't do.  At least before the November election, Trump was boasting about how fast Operation Warp Speed was going to produce and distribute the vaccine.  So why aren't Republicans all on board with it? 

 

A better answer may be that trust in governmental institutions in general, rather than in individual politicians, has undergone severe erosion in the last decade or two, and perhaps more so among Republicans than among Democrats.  The Gallup poll organization publishes annual samplings of how ethical various professions and members of institutions are perceived to be.  The poll asks, "Please tell me how you would rate the honesty and ethical standards of people in these different fields—very high, high, average, low, or very low?"  Their findings are instructive.

 

Members of Congress, for example, don't do very well in these polls.  In the latest poll conducted earlier this month, Congresspeople rated only 1% very high, 7% high, 29% average, 39% low, and 24% very low.  Contrast this to the public perception of, say, engineers (in 2019):  17% very high, 49% high, 31% average, 2% low, and 1% very low (1% had no opinion).  This is better than engineers were doing in the 1970s, for example, when only 10% of respondents rated them very high. 

 

Now engineers don't have to run for public office by raising millions of dollars of campaign funds, and if they did, their public perception might be different.  Interestingly, of all the major professions, nurses come out even better than engineers:  41% of the public in December 2020 thought nurses' ethics and honesty were very high and 48% thought they were high.  So maybe public-service ads featuring nurses encouraging you to get a COVID-19 vaccine would be more effective than government pronouncements.

 

As you probably know, the vaccines will not begin to affect the overall spread and persistence of COVID-19 until a substantial fraction of the public receives effective vaccines.  Estimates of the substantial fraction vary, but it's somewhere around half.  And one thing that is still unknown is whether the vaccines only prevent people from suffering adverse symptoms of COVID-19 (it's pretty clear that they do that), or whether they prevent people from spreading it as well.  There simply hasn't been enough time to determine their effectiveness at reducing infectiousness.

 

Well, my sister (a nurse, whom I trust) received the first of her pair of COVID-19 vaccine injections last week, and assuming it's eventually available to people in my category (engineer, college teacher, over 65), I plan to get it too.  But I can understand that people may have reasons to refuse, and so far, this is a free enough country where you can do that.

 

Sources:  The U. S. News report on the Kaiser poll about willingness to take a COVID-19 vaccine appeared at https://www.usnews.com/news/health-news/articles/2020-12-15/americans-willingness-to-get-coronavirus-vaccine-increases-poll-finds.  The Gallup organization has posted historical and up-to-date responses to its honesty-and-ethics polls at https://news.gallup.com/poll/1654/honesty-ethics-professions.aspx.  I also consulted the Wikipedia article on "Tuskegee Syphilis Study."

The COVID-19 Vaccine: When, Where, and Who?

 

Most experts agree that the only thing which will put the current COVID-19 pandemic to rest is some kind of vaccine.  One firm—Pfizer/BioNtech—has progressed to what is called a Phase 3 trial, which involved about 43,000 people who took it with apparently no serious side effects.  There is still a long way to go even with the most advanced projects, because achieving "herd immunity"—enough immune people to discourage the virus from spreading—may require on the order of several billion doses.  And many of the prospective vaccines require two injections spaced weeks apart, which further complicates matters.

 

Engineers are familiar with tradeoffs that are usually imposed by economic restrictions.  When I was a young engineer just out of college, I was teamed with an older and more experienced engineer, and one day we were talking about various possible ways to tackle a certain problem in a new design we were working on.  I described three or four different ways to tackle it that I thought were pretty clever, but he seemed unimpressed.  Finally, I asked him why he wasn't more excited about these innovative ideas I was proposing.

 

"Heck, I can build one of anything!  The real challenge is making thousands of them work at a price we can afford."  The harsh realities of the marketplace had educated him to look not just for technically sweet ideas, but for ideas—new, old, or otherwise—that would do the best job for the least money.  That taught me that having clever ideas—or one dose of a highly effective vaccine—is only a small step toward solving a real-world engineering or technical problem.

 

Making a billion high-quality vaccine doses in a short time is a challenge that hasn't been discussed much so far.  But supposing that vast production problem is overcome, and reliable vaccine doses begin to enter the pipeline, who is going to get them first? 

 

An interesting study cited by a recent BBC article says that the first doses should go to different groups, depending on how effective the vaccine is.  No vaccine is 100% effective, and this is especially true of virus vaccines.  The annual flu-virus vaccine that millions of people get is rarely more than 60% or so effective, depending on the particular year and the mix of viruses that show up after the vaccine is developed. 

 

There are different ways to measure the effectiveness of vaccines.  One way is to measure how many people who are vaccinated and then exposed to the virus develop symptoms.  Another way is to measure how likely a vaccinated and exposed person is to spread the disease to others, whether or not they manifest symptoms.  The study's authors point out that if you developed a vaccine that was only 30% effective in preventing symptoms, it would fall below the U. S. Food and Drug Administration's 50% threshold and wouldn't even be approved.  But if it happened to be 70% effective at stopping people from spreading the virus, it would actually do more good than a different vaccine that prevented symptoms with 100% effectiveness but allowed the virus to spread.

 

That is why there is no single answer to the question, "Who should get the vaccine first?"  If it is most effective in preventing the virus from spreading, then the target population should be the ones who spread it the most.  Currently that appears to be older children and younger adults, say between 10 and 35.  Few people in that group die of the virus, but just because many of them have either mild symptoms or are asymptomatic, they spread it very easily. 

 

On the other hand, if the vaccine is good at preventing symptoms but not so good at stopping the spread, you probably want to target the population that is most vulnerable to the disease:  people in rest homes and over 65.  That will save the most lives in the short term, while giving us time to vaccinate the rest of the population to approach the goal of herd immunity.

 

Any way you slice it, we face a very long uphill battle in fighting this disease.  In some countries such as the U. S. and China, the expense of buying and distributing the vaccine is relatively trivial compared to other things the government is doing.  But in poorer countries, vaccinating the majority of the population with anything is a major challenge, and so we can expect the disease to hang around in pockets long after it has been controlled in more economically well-off places.  So the last thing to go may be travel restrictions concerning COVID-19, at least to some countries where it may not be controlled for several more years.

 

Within a given country, the distribution of the vaccine may be implemented mainly by the government, mainly by private enterprise, or more typically by a combination of the two.  As it is in the interests of every government to free its citizens from the threat of COVID-19, substantially free distribution would seem to be a no-brainer, although there are practical obstacles to that as well.  Certain minority populations have been disproportionally affected by COVID-19, and the U. S. National Academies of Science, Engineering, and Medicine has stated that there is a "moral imperative" to make sure that this imbalance is addressed in any proposed distribution scheme. 

 

And last but not least, there is the problem that not everybody is going to want to be vaccinated.  We are a long way from the 1950s, when Jonas Salk was universally praised as a god-like hero and millions of U. S. citizens gratefully took their children to receive polio vaccine injections without raising even a quibble concerning its safety.  Nowadays, the pronouncements of experts always inspire somebody on the Internet to say, "Sez who?" and the small but vocal opponents of any kind of vaccination have persuaded lots of people at least to hesitate before believing uncritically anything an expert says. 

 

Even with all these uncertainties, it does look like we we get a vaccine sometime, and eventually it will begin to slow down the spread of COVID-19.  As far as I'm concerned, it can't come too soon.

 

Sources:  The BBC published the article "COVID:  How close are we to a vaccine?" on Nov. 12, 2020 at https://www.bbc.com/news/health-51665497.  The New York Times published "Who should get a COVID-19 vaccine first?" at https://www.nytimes.com/2020/11/05/magazine/who-gets-covid-vaccine.html on Nov. 5, 2020. 

Ignoring the Experts: Autism and Vaccinations

By necessity, engineers are experts in their professional field compared to the public at large.  And as we've discussed many times before, expertise confers both privileges and responsibilities.  Most of the time, engineers and other experts who inform the general public about questions of interest find that the public at least listens to them, and usually takes what they say seriously.  But not always.  And when expert advice and information is ignored, we have to go beyond strict logic and rational thought and deal with a wider range of human behavior.

All that is to preface an issue that on the surface, seems to fly in the face of logic and even common sense:  the question of whether autism is caused by the routine measles-mumps-rubella (MMR) vaccine that, until recently, was a non-controversial part of every baby's medical care in industrialized countries. 

Then in 1998, one Dr. Andrew Wakefield published an article claiming that he'd found a link between the unexplained rise in incidence of autism and something about the MMR vaccine, possibly the tiny amount of mercury present in it used as a preservative. 

To parents of autistic children searching for a reason why their son or daughter has such a debilitating disease, Dr. Wakefield seemed like a godsend.  Here at last was something to blame.  At the time, his report made huge headlines and spawned parents' groups who took up the cause of delaying or abstaining altogether from MMR vaccines. 

Trouble was, according to the vast majority of medical experts, Dr. Wakefield's paper was deeply flawed.  Of course, other labs and researchers got onto the bandwagon and started investigating the alleged link.  From what I have read and from a recent report in the Annals of Internal Medicine on a Danish study of over 600,000 children for eleven years, there is no statistical link between MMR vaccine and autism.  None.  It just doesn't happen, according to the best and most judicious scientific knowledge we have today.  And this is not new news.  In 2010, Wakefield was found by the British General Medical Council to be guilty of dishonesty in connection with his paper, which was retracted by Lancet, the journal that published it.  Wakefield is as discredited as a professional can get. 

But none of this seems to matter to a persistent group of people who keep sharing and encouraging the idea that vaccines cause autism.  In the latest attempt to stifle this misinformation, the president of the American Academy of Pediatrics, Dr. Kyle Yasuda, wrote letters to Google, Facebook, and Pinterest, asking them to do more about the vaccine misinformation that is spread through YouTube, Instagram, and Google's search engine. 

Dr. Yasuda cites the danger of increased measles outbreaks, such as the one that occurred in connection with Disneyland in the winter of 2014-2015.  Over a hundred cases were identified in this outbreak, and four out of five of the victims were either unvaccinated or could not show proof that they had been vaccinated for measles.  One out of five of the victims had to be hospitalized.

While in my long-ago youth, measles was just part of growing up, it wasn't a necessary rite of passage.  It can lead to complications involving many bodily systems and can even kill you.  A world without measles is unquestionably a better world than one with the disease.  And until Dr. Wakefield started meddling with his fraudulent paper, we were well on the way to eradicating measles much as smallpox has been eradicated—through systematic vaccinations and the hunting down of outbreaks with treatment, isolation, and more vaccinations.

But something has changed in the way U. S. society (and societies in many other Western countries) view experts and their opinions.  Maybe it started in the general 1960s rebellion against authority.  Granted, the 1950s were a little too conformist for many peoples' taste.  But most of what everybody knows is known by authority.  If we all had to learn our physics, chemistry, and mathematics from experience, most of us would never finish and we would be continually reinventing the wheel.  In case you hadn't noticed, one of the big differences between what G. K. Chesterton called "civilization versus savagery" is that civilization accumulates knowledge (and sometimes even wisdom), thus saving succeeding generations from the trouble and expense of figuring the world out all over again. 

With the advent of the Internet, this process became much easier.  Instead of shipping piles of paper around, we ship bits, which are much lighter.  So light, in fact, that any yahoo with a computer and Internet connection can set himself up as an authority and, once he finds the key phrases that trigger fears or anxieties enough to get his message to go viral, he can get more attention than those who have dedicated their lives to the pursuit of expertise and truly know what they are talking about. 

I am sure that some of the parents of autistic children are entirely sincere in their belief that autism is caused by vaccinations.  But sincerity of belief on the part of individuals makes absolutely no difference to objective truth, which is true for everybody all the time.  That's what objective truth means.  Part of the problem is that for many people in advanced countries, the worst thing that's happened to them is not that bad compared to routine life occurrences that were common fifty or a hundred years ago.  I am old enough to recall the fear that every summer brought when a few kids in town would come down with polio.  That was banished with the polio vaccine, at least in the U. S.  But people who grow up protected by things that ward off terrible diseases, sometimes do not appreciate what the protection is doing for them, and are liable to throw it away if persuaded that along with the great but invisible good it does, the protection (e. g. MMR vaccines) is even suspected of doing some harm—especially if it is mysterious harm such as having a baby born with autism.

Engineers tend to think that logic reigns supreme, and if you just explain a thing to someone and make them see the logic in it, they'll automatically agree with you.  The ongoing controversy about autism and vaccines shows that this assumption is a bad one.  And wise engineers should be prepared to deal with the emotionality and, yes, even irrationality, of the public whenever their activities get into controversial areas.

Sources:  An online version of the article "New study finds no autism, vaccine link" by Nicole Villalpando of the Austin American-Statesman appeared on Mar. 5, 2019 at https://www.austin360.com/entertainmentlife/20190305/doctors-urge-tech-companies-to-stop-misinformation-as-new-study-finds-no-autism-vaccine-link.  I also referred to the CDC summary of the California measles outbreak at https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6406a5.htm and the Wikipedia article on Dr. Andrew Wakefield.