Decision to pause Johnson & Johnson vaccine causes public confidence in vaccine to sink

From YouGov:

Comparing the results from those who took the survey before the announcement with those who took the survey afterward shows the huge impact the CDC’s decision has had on the perceived safety of the Johnson & Johnson vaccine.

Among those who started the survey before the announcement about the Johnson & Johnson vaccine pause, about half (52%) considered the shot “very safe” or “somewhat safe” – twice the number who believed it “very unsafe” or “somewhat unsafe.” After the announcement was made, these figures had converged – just 37% called the vaccine safe, and 39% feeling it unsafe.

A month from now, assuming the blood clot investigation turns up no major problems, the numbers will have reverted to the mean and we’ll be back with folks getting all three vaccines.

It’s unfortunate that there was a pause, but that doesn’t mean it should not have happened. Considering we obtained these vaccines in record time, we can deal with some minor issues.

Money Stuff – They’ll Go Far in Banking

From April 15:

Second, though, these are like … pre-selected package vacations? (Litquidity has the memo; it says “Click on the link of available trips to pick the package that speaks to you.”) Ew, no. The classy move here is to say “take yourself a nice vacation and put it on the corporate credit card.” And then everyone takes whatever vacation they want, and they are much happier than they are with the firm-selected package deals. Ideally you don’t even specify a price limit and assume your bankers can figure it out. Some people will subtly compete to spend as little as possible of the firm’s money, and other people will subtly compete to spend as much as possible of the firm’s money without getting fired, and realistically the winners of both of those competitions are going to go far in banking.

Find Matt Levine at Bloomberg.

Options on the J&J Vaccine Pause

Looking back at what I wrote yesterday, I had been mulling the various options:

  • Say nothing, do nothing. Don’t announce the investigation into the blood clots, don’t pause the vaccine.
  • Say something, do nothing. Announce you’re investigating, but don’t pause the vaccine.
  • Say nothing, do something. Don’t publicly announce it, but quietly tell states not to use the vaccine while you investigate.
  • Say something, do something. This is what is currently happening.

Clearly the third option wouldn’t work. It would eventually be reported, at which point it seems obvious that you were trying to hide ‘something’ and mistrust of not just the vaccine, but the entire apparatus and the government overall goes through the roof.

Between the first two options, the latter is better than the former. If you just ignore that there could maybe be a link between the vaccine and these clots, it would make the world question what else you’ve been ignoring or overlooking. Once the question of if these vaccines could lead to clots, even in rare cases, it warrants some sort of investigative action.

Saying something seems like the right move. But should any action be taken regarding the vaccine on the meantime? This has the most gray area, and I think coming down on the side of “do something” makes the most sense for the argument given yesterday – you want primary care physicians and other front-line workers to take notice. Pausing the vaccine did just that.

The argument for “say something, do nothing” is that by doing something you’ll make everyone take notice, not just the PCP’s and front-line workers. The uneducated masses will interpret the pause as a negative, and will become suspicious of the vaccine and perhaps all vaccines, thus reducing the overall population who vaccinate. There’s a decent argument the other way, though. If you say something and do nothing and claim “we’re investigating this vaccine which might cause blood clots but hey keep using it it’s fine these clots are super rare,” does that lead to less panic, or more? Folks who are suspicious of the government and large social programs (such as this mass vaccination drive) are going to latch on to that (really any) negative news announcement and claim that because you continued administering the vaccine despite announcing it was (maybe, somewhat) unsafe, that therefore you’re just lying to everyone about the vaccine overall. Tucker Carlson and other nut bags on TV could certainly broadcast that message widely.

In the meantime, by not placing a pause on the vaccine distribution, you’ve not effectively warned the PCP’s and front-line workers. You may sow distrust or discord with them, too! Those folks could look at your hesitance to place even a brief pause on the J&J vaccine as a sign you’re bending to political pressure over the pure science.

In a no-win situation like this, going with “the truth” or the answer which most closely adheres to your honest principals seems the wisest course of action. The die had already been cast once the vaccine had any credible link to blood clots.

U.S. Calls for Pause on Johnson & Johnson Vaccine After Blood Clotting Cases

From The New York Times:

Injections of Johnson & Johnson’s coronavirus vaccine came to a sudden halt across the country on Tuesday after federal health agencies called for a pause in the vaccine’s use as they examine a rare blood-clotting disorder that emerged in six recipients.

Which has led to some very bad hot takes:

One death after 7 million J&J vaccinations for these blood clots (which they don’t even know are attributable to the vaccine), versus over 50,000 dead per 7 million cases of COVID in Americans. That’s a ratio of 1 : 50,000. You can fairly argue those mortality numbers are skewed by the fact that COVID has already ripped through our nursing homes, killing a lot of our most vulnerable people, but still, the risk numbers aren’t even in the same ballpark. And mortality numbers don’t include the millions of Americans who suffered or are suffering from severe cases that require hospitalization.

This is criminal innumeracy.

No, it’s not.

And this:

Given a bit of time to process the information, this seems the be the right take. From @craig_a_spencer, a New York City ER doc:

The many hot takes on here that the complications from J&J are so rare we shouldn’t have paused it’s use are persuasive at face value. The pandemic IS still raging. We NEED shots in arms. And the risk is SO low! This is all true.

But that argument is missing something critical.

If my loved one was among the 6 with a complication AND the FDA/CDC/US govt knew there was a signal but didn’t act, I’d be furious.

I really appreciate the transparency here.

They could’ve easily argued this away…”this is the background rate of clots” etc. But they didn’t.

Will this mean it’ll be harder to convince many, especially younger women, to get the J&J vaccine if/when we start using it widely again? Yes.

…even if the risk is shown to be much lower than Covid, getting struck by lighting, or dying from a vending machine crushing you? Yes.

But the practical importance of this pause – and how it was messaged, with a focus on informing providers – was huge. And really responsible.

I was in the ER today. One of the first patients I saw after getting briefed on the J&J decision was a young woman in her 30s.

She got the J&J vaccine a week ago. She had symptoms that overlap with those we were told to look out for. Today’s announcement changed my differential diagnosis & impacted my clinical management.

That’s exactly what it was meant to do. It’s also how we’ll get the data we need.

Look, let’s stop pretending that people don’t know the difference between vaccines. Or that potential issues with one vaccine means they won’t get the others if they’re available to them.

Will today’s announcement impact vaccine hesitancy? Perhaps. Maybe a bit. At most.

But more importantly, it should drastically improve our faith in the public health institutions tasked with protecting us. With how they had been politicized & over-ruled by the previous admin, this is critical.

And that’s exactly why I think today’s decision was the right one.

Link to tweet thread.

This pandemic isn’t an episode of House, MD. The principle of “first, do no harm” doesn’t mean the CDC and other government (science-focused) agencies should make a game theory-informed calculation about whether announcing the J&J vaccine pause will cause folks to go unvaccinated. The point was to raise awareness among care providers and better inform them. The public masses have been misinterpreting the science and the messaging for a long while now. This latest round of it is just that – the latest round of it. And around we’ll continue to go.

Avoiding Technical Debt

From Chelsey Troy’s Blog:

Also worth noting is that, since open source contributors act as authors of their code bases, they are empowered to make decisions about rethinking or removing features. I talk about the value of this practice more in this piece (my take on the 10x developer trend), but in order to streamline or remove features, developers need permission from the product and the business. They often don’t have it. On open source projects, by contrast, the devs are usually in charge. They can say “I changed these two APIs so now they both use the same backend. No, I didn’t ask any of you. I promise, it works better now. You’re welcome!” Such a missive would go over poorly in most private companies.

Why, yes. Yes it would.

Emphasis mine.