I found this op-ed by Robert M. Kaplan and Dominick L. Frosch in the Wall Street Journal interesting and informative. In it the author question the approach being used to promote getting inoculated against SARS-CoV-2:
The current communication strategy—built on listening to advice from trusted leaders—is paternalistic and outdated. Public-health authorities, politicians, sports heroes and celebrities are taking to the airwaves to tout the vaccines. Protecting people from doubt is central to the strategy. That entails suppressing questions rather than answering them. Any hint about vaccine imperfections could make people apprehensive and must be avoided. Anyone who rejects the vaccine is stigmatized as foolish and irresponsible.
A better approach to persuasion is to assume you’re speaking to mature, self-interested decision makers, offer transparent and comprehensive information about the risks and benefits of the vaccine, and engage patients in the decision-making process. Many medical treatments require consideration of the balance between harms and benefits. Over the past 40 years the practice of medicine has evolved to embrace a process known as shared medical decision-making, in which physicians provide patients with the best scientific information about benefits and risks, and patients make decisions in collaboration with their doctors, which balance their personal preferences with imperfect science and uncertain risks. The same decision isn’t right for everyone.
While I agree in general terms that honesty is the best policy and that treating people like adults is generally a better practice, I’m not convinced that we can inoculate enough of the population using that approach to accomplish the presumed objective. Is it possible to adjust the approach to the individual rather than “one size fits all”? A substantial proportion of the population we want to get inoculated will be below average intelligence. Not only does the appetite for risk vary from person to person but the actual risks vary from person to person.
My siblings and I routinely experience rare side effects when we take medications. We just assume that we’re built differently from most people. That won’t stop me from getting inoculated if it’s offered to me, if only to reduce the likelihood of my wife’s contracting the disease.
I found this analysis interesting:
Isn’t avoiding Covid-19 worth these minor discomforts and small risks? That question isn’t so simple either. Articles about the vaccines imply that it raises your likelihood of avoiding infection from zero to 95%. That’s not factually correct. The Pfizer trial observed eight Covid-19 cases among 18,198 people who received the vaccine within two months of completing their second shot, an infection rate of 0.04%. Of the 18,325 volunteers who got the placebo 162, or 0.88%, got Covid. Less than 1% of each group became infected, but among those who got sick, 95% were in the placebo group.
For sure, the vaccines are highly efficacious. But some vaccinated people will still get infected. The 0.04% rate from the study would translate to 80,000 Covid cases among 200 million people vaccinated. In practice, wide immunity in the population would mean fewer actual infections, but it’s important to prepare the public for the likelihood that a few vaccinated people will still get sick.
I find it gratifying that presumably well-informed and knowledgeable individuals are making observations very much along the lines that I have.
I generally with the guy. Have been open and honest with our staff and brought in people with more expertise to answer questions none of us knew about for sure. The problem here, which I think you allude to, is that it is a complex issue and some people will have trouble understanding it. Some because they dont have the mental acuity and others because they dont want to understand. Too many people have already gotten their information from unreliable sources and it wont be possible to shake those beliefs. You arent going to change the minds of people who believe we are implanting 5G chips when we vaccinate.
Steve
I think the third paragraph quoted here is misleading, we don’t know how many people in either test group were exposed to the virus, so its not accurate to suggest some level of equivalence btw/ the vaccinated and those given placebos.
What we can know is the relative risk btw/ those two groups after a set point in time. Out of 170 infected, 8 had been vaccinated and 162 had not. If we extend that relationship out over a longer period of time, we would expect an increased separation:
16:324
32:648
64:1296
128:2592
256:5,184
512:10,368
A line graph would be better; the numbers makes it look to precise, but the behavioral scientists seem to be out of their lane when they are talking about how vaccines work and are evaluated, as opposed to how doctors and patients interact with each other. My main question would be how frequent will it be that a doctor will be available for a consultation when the vaccinations occur and whether they are likely to know much more than is on the FDA guidance sheet?
PD- Depends upon where you get your vaccination but at most places I would not expect to have a physician immediately available. Unless they have a special interest they wont know a lot more about the vaccine than is on the guidance sheet, depending upon their specialty. Rather, they will probably know a lot more about vaccines in general or viral illnesses and maybe Covid but not specifics about the vaccine. In some ways there is not a lot to know since the test populations were not that large.
Steve
@steve, I don’t know if you saw the e-mail Tyler Cowen posted at MR a a week or so ago: Physician complaining about government reimbursements for vaccinations with time breakdowns indicating the government was not going to pay for all of the services reasonably expected. I’m not alarmed by that; I think that’s how government frequently works to save money by passing costs onto expected long-term beneficiaries. But one should not expect top shelf physician time and attention in that context.
And from my doctor of justice background, I think disclosures of uncertainties and unknowns are completely useless, particularly when weighed against the uncertainties and unknowns of the risks of infection. The feds just need to produce lists with as much precision as possible of pre-existing conditions that at least warrant delay in vaccination at this time. The better the detail, the better physicians on the ground can assist in application.
PD- I read that letter. Sounded like the kind of problems you would see with a small practice. We are not losing money, actually making a little bit (not much).
Interesting comment on what is basically informed consent. I have always found that a bit irritating. I do my best to explain stuff all that time and when I am not being a smart ass am a pretty good communicator. However, I know that only a small percentage of people really understand what I am telling them.
The list pretty much exists, but it does have a lot of guesswork. There also needs to be a lot of individual adjustment. The official recommendation was to hold off if you are pregnant but the OB people are recommending that my pregnant people go ahead. We engage in the highest risk procedures so they thought the risk of infection was worse. Who really knows?
Steve