Last summer I wrote an essay about what science can and cannot do and the role it can play in public policy decisions including those pertaining to the COVID-19 pandemic. I concluded that science explains relationships between cause and effect: no more and no less. No normative conclusions about individual or collective decisions follow directly from science. Instead, costs, benefits, and other values properly enter both individual and collective decisions.
I have written twice since then about gradual recognition of this argument among medical professionals as well as journalists. I am writing again to recommend a recent column in the Washington Post by Leana S. Wen, a medical doctor as well as former health commissioner for the city of Baltimore. The title itself is striking in its clarity: “Public health is not only about science. It’s about values.”
The column describes the CDC and FDA scientific advisory committee discussions about the appropriate recommendation for COVID-19 booster shots. The data were not in question. “The coronavirus vaccines, though they still do well to protect against hospitalization and death, have waning immunity against symptomatic disease, especially in older and more vulnerable individuals. A third dose, given at least six months after the initial series, increases antibody response and reduces the likelihood of breakthrough infections.”
What was in dispute was the goal of vaccination: reduction of disease severity or prevention of symptomatic infection. Many medical professionals argue that only the former is the appropriate goal: “If you really use infection as an outcome, you probably need a booster every six months, which is unrealistic and unattainable,” said Dr. Peter Chin-Hong, an infectious disease expert at the University of California, San Francisco. “I don’t care about symptomatic disease — I care about severe disease.”
Dr. Wen responded as follows: “This is not a scientific question as much as one of personal values. Should academics and bureaucrats really be the sole arbiters in making such sweeping societal policy as to deny boosters to people who want to better protect themselves? Similarly, scientists shouldn’t be the only people to weigh in on whether the United States should be prioritizing boosters to our own citizens vs. vaccinating people in other countries. Who should decide, then? I believe it should be the American people.”
I could not have said it any better myself.