Fauci may have quietly averted a 9/11 scale disaster – only experts can say

By Dave Wieneke | in , Big Ideas, Boston news, Healthcare, Irony | 26 Feb 2021 | 35 Comments

Hope is not a plan, neither is it science.

This post celebrates the informed voice of uncertainty. As we live during the worst public health crisis in a century, many of the facts we navigate by are uncertain. So, I offer this knowing the facts of this time are far from set.

Last week, Pulitzer-winning science writer. Laurie Garrett tweeted the news on breaking research that caught my eye and retweet.  It promised deeply-concerning research from Boston. (I sort of loved how the source of the research was my city, Boston. Not MGH, or BU’s Biosafety Level 4 lab for emerging infectious disease…Boston, and its implicit authority…yes, I digress.

2/
Taking just one dose of either vaccine? VERY bad idea. A 30-fold lower virus-fighting capacity with 1 dose.
The UK B.1.1.7 variant isn’t a vax problem.
BUT the P1 (Brazil), P2 (Japan) variants –20-fold decrease in vax efficacy.
The SoAfrican (B1351) — 100-fold decrease.
MORE

— Laurie Garrett (@Laurie_Garrett) February 19, 2021

Hard Stop.  For the last few months, there’s been a live debate about whether to provide both doses of two-dose vaccines to patients or to double population coverage by giving more people one dose, and catching up with second doses once vaccine production catches up.

Brittan in fact adopted this ‘more people get just the first dose’ approach. Dr. Fauci reached a different conclusion which guided U.S. policy.

Dr Fauci told CNN: “We know from the clinical trials that the optimal time is to give it on one day and for [the Moderna jab which is also approved in the US] wait 28 days and for Pfizer 21 days later.” He added that while you can “make the argument” for stretching out the doses, he would not be in favour of doing that.

Pfizer and BioNTech also warned that the two doses were crucial to achieving maximum protection against Covid, saying that they did not have evidence that the first dose alone would protect patients after three weeks.

So, on February 19th when Lauri tweeted this was a hot debate. Scientists and policymakers had opinions on the best course to take, and Dr. Fauci took a conservative approach, that America’s response would follow the protocol which research had confirmed was effective. According to Garrett, this new research suggested a 20-fold to 100-fold decrease in effectiveness, which sounded like a disastrous course of action to guess one’s way into.

But the findings of the research became more dire in Garrett’s third Tweet:

3/
What we are looking at is “vaccine resistance” — it’s akin to antibiotic resistance that can be so strong in some bacteria that they are 100% incurable infections.
In this study, the spectre of #COVID19 #vaccines being rendered useless looms — NOT assured, but ominous.

— Laurie Garrett (@Laurie_Garrett) February 19, 2021

Garrett’s third tweet is the killer, since the vaccine would be only a tiny fraction as effective, it could function as training wheels to teach the virus to achieve vaccine resistance.

If you accept this research as strong, and Garrett’s analysis as conclusive — it suggests that Fauci’s choice to hew to what research has proven may have saved tens or even hundreds of thousands of lives. This would be a magnitude of death many times higher than America’s 9/11 disaster – which suitably has an annual commemoration.

Taking these facts as given, one might imagine the need for a significantly larger commemoration over Fauci’s choice not to stretch beyond the assurance of research.  Conversely, Brittons might need to quickly need to reconsider their decision to administer literally half-measures to avert worsening the pandemic, and spawning a super-virus able to infect those already vaccinated.

Of course, nothing about a disaster is clear during it. The research that Garrett quotes is dense and scientific. Laurie is an esteemed science writer – but a larger community will have to review this work.  Others are not crisp in their acceptance of these findings or the strength of the research.

Anthony Fauci may have averted a cataclysmic public health misstep. This is a truth that only experts and perhaps historians can explain. I’m not an expert, and I’m aware that my source is an esteemed journalist. This is what the fog of war in a pandemic feels like. In the absence of a definitive expert – we look to a Dr. Fauci or Laurie Garrett to make sense of still uncertain knowledge, not knowing if it spells disaster, relief, or more uncertainty.

In a time where there may be no definitive expert, who do you trust? We mix our own epistemology, knowing that expertise in this context still remains a good faith attempt to progress in partial light.

Uninformed voices speak with certainty in their baseless opinions. Who asks the politician, the shock jock turned commentator, or the Pillow Guy why anyone should listen to their opinion? The act of giving them airtime, to present divergent but valueless insights beside experts obviates this question with false equivalency. Trump lies sometimes began with the words “many people are saying”. Herd mentality may be the road to disaster in a fast-changing and uncertain world.

So, Fauci’s cautious stance is a victory for the informed voice of uncertainty. The news cycle and slap fight cadence of social media creates an appetite for false certainty. Anthony Fauci day, for me, would celebrate both expertise and the modesty to wait and rely on proven knowledge over even an informed opinion. The Hippocratic oath of first doing no harm may have been a first principle that served us all well.