The arrival of effective vaccines against the covid-19 virus is a miraculous achievement that needs to be universally welcomed and embraced. Like other licensed drugs, they will come with a package insert describing downside risks, however small, that are inevitable with any active pharmaceutical. Anyone too sensible to pore over the inserts’ fine print will be familiar with their gist from the ubiquitous television commercials for today’s prescription medicines.
The founder of the drug company for which I once worked was remembered for the aphorism “Show me a drug with no side effects, and I’ll show you a drug with no effects.” But we develop these products because the harm they prevent is vastly greater than the costs they impose. We should use them, but carefully, not indiscriminately, or in cases where the risks of not using them are too great.
Maybe we need package inserts for nonmedical prescriptions, too. Had the most common, and often vitally necessary, societal treatment for the pandemic we are enduring come with a Food and Drug Administration label, it would have read something like this:
“Lockdown® is approved for the temporary relief of overcrowded hospital emergency rooms. Common side effects include postponement of annual physicals, screenings and other important preventive care; delayed treatment of diseases such as heart disease, asthma and diabetes; severe stress; increased risk of depression and suicide; and overuse of alcohol, opioids and other dangerous substances.
“Do not take Lockdown® if you are troubled by income inequality, educational inequality or unequal treatment of like individuals under law. Other complications reported are severe learning loss in children, increased domestic violence, the extinction of small businesses and the obliteration of life savings.” An FDA reviewer would have required much, much more, but you get the picture.
The vaccines now becoming available are miracles not only in the speed with which they arrived — please, let’s adopt permanently the streamlined, anti-bureaucratic waivers that enabled such speed — but also in their apparent efficacy, with some reported protective rates above 90 percent. We need an equally efficacious program to deliver them swiftly to entire populations, and to persuade everyone to take advantage of them.
We will do so in the certain knowledge that, very rarely, vaccinated individuals will suffer serious, possibly fatal, injury. The measles vaccine has led to anaphylaxis in a tiny percentage of children. The swine flu vaccine induced Guillain-Barre syndrome in 1 of every 100,000 individuals, leading to 53 deaths. Very small numbers of fatalities have been caused by vaccines for yellow fever, smallpox and rotavirus.
The nation has been well served in 2020 by its scientists and epidemiologists. Their expertise and, therefore, their advice have been focused on the minimization of viral spread; no one asked them for guidance about damage to educational attainment, economic prosperity or even other health consequences. Factoring in those questions was someone else’s job: governors, mayors, school boards.
Harry S. Truman, among others, felt that experts should be “on tap, not on top.” Positions of broad responsibility are at their very core about the duty to weigh and balance competing interests, to make and not duck often-excruciating trade-offs. Abdicating that duty in the pandemic, or delegating it to advocates for the most important — but not the only — criterion in a complex decision, may well have ultimately caused more harm than good. A “Lockdown” label would have included a black-box warning about the dangers of overdose, along with a reminder, “Use only as directed.”
“If it saves a single life . . .” That oft-heard statement is at once so natural, so human, so admirably empathetic . . . and so vacuous. If applied to the wondrous new vaccines, it could be taken to mean we should not inoculate anyone, because inevitably someone, somewhere, will be harmed or even perish from them.
We must excuse members of the lay public whose compassionate impulses led them to such careless thinking. But people steeped in the realm of medical science, statistics and assessments of relative risk should not have been blind or indifferent to the enormous side effects of the lockdown policies. Or, if they were, then those with ultimate authority should have taken those effects fully into account, and many did not.
In the pandemic’s early months, a maximalist approach was understandable, and excusable. As time went on and the costs, future as well as present, became more and more clear, caution became dereliction.
God willing, we will soon have vaccinated an entire population against the infection that has brought so much heartache and ruin to the world. As we do so, we will be making a reasoned, wise judgment with an open acceptance of the risks involved. If only we thought that way all the time.