In all of this, the same issue recurs: What should regulators do when there’s an idea that might work to save a large number of lives and appears to be safe in early testing but there isn’t time to run large studies? “People say things like, ‘You shouldn’t cut corners,’” Tabarrok told me. “But that’s stupid. Of course you should cut corners when you need to get somewhere fast. Ambulances go through red lights!”
One problem is no one, on either side of this debate, really knows what will and won’t destroy public trust. Britain, which has been one of the most flexible in its approach to vaccines, has less vaccine hesitancy than Germany or the United States. But is that because of regulatory decisions, policy decisions, population characteristics, history, political leadership or some other factor? Scientists and politicians are jointly managing public psychology, and they’re just guessing. If a faster, looser F.D.A. would lose public trust, that’s a good reason not to have a faster, looser F.D.A. But that’s a possibility, not a fact.
“My view is this was all psychology which no one really understood, so I just said, ‘Go with the expected value. Do the thing that’ll save the most lives and stick with it,’” Tabarrok said. “That’s a better rule than trying to figure out ‘If I do this, what will someone else do?’”
One thing I came to believe, reporting this column, is that politicians have too often hidden behind regulators. For much of the pandemic, Trump had no plan at all, and so the decisions of governors and regulators were paramount. Biden is doing much more, but 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.
The good news is we know more now than we did a year ago. “We got really lucky,” Gregg Gonsalves, an epidemiologist at Yale, told me. “These were incredibly potent vaccines. If things were on the margins, we’d be a lot more uncomfortable right now about what we’re doing.” It’s an important point. Regulators have seen medicines fail, sometimes in lethal fashion. They would have to live with the consequences of a decision gone terribly wrong, in ways that their critics would not. But we did get lucky. And so there may be policies that looked risky six months ago, or fantastical a year ago, that we can, and should, consider now.
When I asked Tabarrok what his agenda was now, much of it was the same. “The variants come from the unvaccinated,” he said, so we need to finish vaccinating Americans and do everything in our power to accelerate vaccinations in the rest of the world. Everything he’s argued for in America applies globally: First doses first, run challenge studies to see if half-dosing or fractional dosing works, pump money into vaccine supply.
To Tabarrok, vaccines have shown themselves to be so valuable that it’s simply absurd that we wouldn’t do everything possible to be fully equipped for mass vaccination campaigns in the future. Florian Krammer, a microbiologist, has proposed developing and testing vaccines for all of the respiratory virus strains that are plausible drivers of future pandemics. Tabarrok backs that plan.
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