Cost Benefit Analysis of J&J Vaccine Pause

From this Medium article I’m forced to quote because I spend too much time criticizing John Gruber and Daring Fireball:

Now, you might look at this story [the two-week vaccine pause] and assume that, as they say, “The system worked.” But it’d be more accurate to say that the system worked as it’s designed to work, and not as we might want it to work. While the initial decision to pause the vaccine was praised by many as evidence of the seriousness with which regulators were taking safety, that doesn’t mean the decision to extend the pause for almost two weeks represented a sensible balancing of costs and benefits. Instead, as medical ethicists Govind Persad and William Parker put it in The Washington Post last weekend, “slowing down vaccinations was a deadly mistake.” It was also, in some sense, a predictable one.

Consider this guesstimate / analysis:

Now, in the grand scheme of things, the costs of this delay were not great. There may be some impact on people’s attitudes toward the J&J vaccine, but it’s not clear how large that impact will be, and there seems to have been no impact on people’s willingness to take the Pfizer and Moderna vaccines. But saying that the costs were not great is not the same as saying they were not important. At Friday’s meeting, the CDC’s Sara Oliver said that over the next 6 months, the J&J vaccine would be expected to result in 800–3500 fewer ICU admissions, and 600–1400 fewer deaths, while causing 26–45 cases of clotting. If you extrapolate from those numbers, they suggest that if the pause had ended 10 days earlier, somewhere between 33 and 75 lives would have been saved, at the cost of 1–2 cases of clotting.

Now that may be a overestimate. But the point is the same: the pause cost many more lives than it saved. That may have been a reasonable price to pay in order for regulators to be more sure that the vaccine was safe. But it’s important to recognize that a price was paid — and it wasn’t paid by the people who made the decision to pause the vaccine.

When the numbers are in the range of +-100 lives when all is said and done, who would fault those at the time who followed the rules and played it by the book? In a pandemic which has claimed lives on the magnitude of 500k, how can we look at 100 (possible) deaths and say “yeah they fucked up”?

I don’t think we can.

Instead, we can think that in a public health crisis that the rules were followed and the best guidance we had at the time was applied and a decent outcome was reached.

In the next pandemic – maybe we’ve learned something and the behavior will be different. That’s ok! We can learn and grow. But if the vaccine pause ends up being the most rational choice which could have been made, let the armchair critics eat crow.

Giving the author, James Surowiecki, his due:

Surowiecki’s writing has appeared in a wide range of publications, including The New York Times, the Wall Street Journal, The Motley Fool, Foreign Affairs, Artforum, Wired, MIT Technology Review, and Slate.

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