Saturday, July 3, 2021

Why Fauci moved "herd immunity" goalposts

Why Did Fauci Move the Herd Immunity Goal Posts? | Medpage Today - Vinay Prasad MD, MPH:

December 29, 2020 - "As a former National Institutes of Health fellow, I have a profound reverence for Anthony Fauci, MD, the director of the National Institute of Allergy and Infectious Diseases.... At the same time, ... statements by Fauci raise a thorny and important question for scientists, doctors, and public health experts: Is it acceptable to distort the truth to get people to do what you want them to do?...

"Fauci told the New York Times that new science had changed his thinking on the herd immunity threshold.... Specifically, the fraction of people who would need immunity to SARS-CoV-2 (either through vaccination or recovery from prior infection) to extinguish the spread of the virus was initially estimated to be 60% to 70%. In recent weeks, Fauci had raised the percentage: from 70% to 75%, and then to  ... 80%, and 85%. Allow me to quote verbatim from the article, titled 'How Much Herd Immunity Is Enough?':

"When polls said only about half of all Americans would take a vaccine, I was saying herd immunity would take 70 to 75 percent," Fauci said. "Then, when newer surveys said 60 percent or more would take it, I thought, 'I can nudge this up a bit,' so I went to 80, 85."

"Of course, the herd immunity threshold is just an estimate, and the precise figure is contingent on population mixing and a host of other assumptions.... But, the two undeniable admissions in the Times article are 1) Fauci is, to some degree, basing his statements on what he thinks the public will accept, and to what degree his rhetoric might help vaccination efforts, and 2) this is the absolutely stunning part, he is admitting this openly to a reporter for the New York Times!

"This is not the first instance when Fauci made a public statement while considering, in part, what he believed people would do with the information. The first instance concerns masks and occurred during an interview on 60 Minutes in March.... Fauci would later clarify that his words were chosen to prevent a run on masks -- so that healthcare workers would get first priority -- but some have used this interview to question his veracity.

"Irrespective of your feelings in these specific cases, the core tension in both examples is whether we want scientific advisors and public health experts to report just the facts, as they see them, or do we want them to make the additional calculation of what the public would do with those facts, and use that to shape their comments, aiming to maximize the greater good? I believe that in 2020, scientists and public health experts can only report the complete, unvarnished truth, as they believe it to be. We cannot and must not attempt to distort our ideas in an effort to generate responses we think might occur. I hold this position for four reasons.

1. The information gap no longer exists. Experts are not inherently smarter, more analytical, or logical than members of the lay public. Perhaps in the past, they preferentially had access to certain types of insider information. In the modern world, due to the internet, this information gap no longer exists ... because too many in the public can directly interrogate the source material.... If an expert seeks to distort their view of the science to further a behavioral change amongst the public, the risk of detection is high -- at least by some in the public. As such, it runs the risk of immediate backlash and the ensuing loss of credibility.

2. It is not an easy game to play. Human beings are masterfully complex, and not easily predictable.... Fauci's messaging in March may have been intended to prevent a run on masks, but it also may, to some degree, have contributed to masks becoming one of the most polarized issues of 2020, and, in many quarters, fostered a deep suspicion and distrust of Fauci.... Admitting openly that you are selectively presenting your view of the herd immunity threshold based on your reading of what the public is ready to hear, and the way in which that percentage might affect vaccine uptake is a bold and unprecedented statement.... 

3. Loss of trust is incalculable. Once it is revealed that any individual has presented information selectively to get the listener to change their behavior -- that person will forever be viewed through that lens.... The moment the public believes that you might be withholding, selectively presenting, or distorting information to get them to behave a certain way, they will immediately put your comments through a translator. He might be saying this because it's what he believes, but what if he is saying it to change my behavior.... The moment you enter this state in a relationship, there is no path back, it is over. Trust is irrevocably broken. A new spokesperson is needed.

4. Distortion steals power from the people and gives it to scientists. In a prior column, I argued that 'Follow the Science' is an incoherent message. That's because science can tell you what might happen in varying scenarios, but science cannot tell you what to value. Science is necessary for sound policy, but it is not sufficient.... This means that scientists must not distort their view of a situation to get you to do the right thing... A scientist must always and only and indefatigably tell you the scientific truth, as best they see and understand it, but we all -- every last one of us who votes and participates in society -- we alone get to decide what the policy should be.

"As I stated at the outset, I have profound respect for Fauci for his career of service, and like many, I am a fan of his clear public speaking. Yet, these two events force us to ask whether fact manipulation is acceptable. I believe it cannot be. The public will not trust us, and should not trust us."

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