COVID: Your opinion counts
Grant Schofield PhD, Professor of Public Health AUT
On robust debate
Everyone has an opinion on COVID and the public policy that goes with it. We all think differently and all of our opinions matter. Some have opinions counted more than others because they have experience or specific expertise in the area. Some are simply saying a lot and doing so often.
I’m a Professor of Public Health, so I feel I have at least some understanding of the issues we face now. I feel that I have some duty to voice these opinions. These of course are my opinions only, not those of my employer. With all opinions they are just that, and I hope that as new information comes to hand, or I simply learn more, that I will be able to keep changing my mind.
In fact, that’s the exact way science is supposed to operate. We take a thesis (an idea about the world), we consider evidence for the antithesis (a different, but plausible view of the world), and we collect new data. On the basis of what we find we usually form a new thesis as we may partially or completely change our view. This new synthesis progresses knowledge and is the scientific method. It necessarily requires an admission of having incorrect knowledge, and moving towards more true views of the world.
This means that scientists like me, and other scientists will often have opposing views. That’s normal and healthy in science, including public health. It’s often people from different fields who offer a new view which is closer to the truth. There is evidence over the course of the last centuries of science that experts who move the field substantially at one point have difficulty moving it again later in their careers.
The very human trait of cognitive dissonance makes it hard for an individual to change their mind. The long history of research started in the 1950s by psychologist Leon Festinger begets us to understand our thinking traps which make us frail as individuals and as a society. The longer and deeper you are in a specialist field the harder this becomes. The same humanity afflicts our politicians and this dissonance is coined the “Vision of the Anointed” by Thomas Soowell. Sowell claims that the normal response of a politician to failure in policy is to never admit it wasn’t fit for purpose and we need to synthesise a new view and action, but rather that it is and always was a great idea, and just needs to be implemented harder and longer.
I think we’ve seen ample evidence of cognitive dissonance in the scientific community over the course of the COVID pandemic, now a COVID endemic. We’ve seen ample evidence of the vision of the anointed from our politicians.
To be clear, I’m not criticising our scientists and politicians. This is just plain normal human psychology. We should expect this. But we should not accept this.
How do we deal with the fragility of `our own ego whether it be political or scientific?
We must, for the sake of our society, be open for debate. This is a robust debate with different ideas and even ideals. This needs to occur openly and without prejudice.
The media plays a key role in this. Academics, like me, are key in this as we enjoy the freedom and pressure of specific laws of academic freedom under the Tertiary Education Act which allow us to fulfill a specific (in my case contractually explicit) role as the “critic and conscience of society”. This means we can legitimately bring up ideas counter to the mainstream narrative, so long as we stay within our areas of expertise.
I call upon all academics across a range of disciplines to contribute robustly to the current COVID policy debate. You don’t need to be an infectious disease epidemiologist or a microbiologist to make your contribution.
In fact, the overreliance on input from these two disciplines while excluding psychologists, sociologists, economists, educators, historians, theologians, philosophers and many more seems to be a gaping hole in how we approach this COVID challenge.
Your view necessarily contributes to the whole. The media bias, and the academic snobbery around this are a national disgrace. But you can do something about this.
Yes there are downsides. Some thinkers will put forward some pretty crazy ideas which in the end make no sense. A benefit could be that “misinformation” can’t become a label which is dished out to anything not government policy.
For the academics themselves, there will be a level of discomfort in presenting views in a robust argumentative way in public. But that goes with the territory. If you want the privilege of being included in the critic and conscience of society, then it goes both ways and you can expect robust counter debate. That’s healthy and necessary for society to fulfill its promise of the best of a democracy.
Myself, I finally got the guts up to engage again in COVID mandates in December. One post saw nearly a million combined views of FB and Linkedin. There were a variety of responses to a controversial issue. It is also worth noting that besides a very few, I was treated fairly and for the most part debate didn’t revolve around ad hominem attacks.
To this, I agree with Hendy and Wiles. The colour of your hair or your weight has no place in robust debate about these important issues. That’s different from criticizing hypocrisy, or widespread disagreement about your view on an issue from other scientists and the general public. These are open slather. We all have an opinion and we are in, or at least should be, part of the same functioning society.
It’s obvious to us all that no one person has the expertise to contribute to the policy and science across all of the endemic. A reliance on single or even a few experts is a problem. In my opinion this has resulted in a myopic view of public health policy around COVID.
It’s now clear that there is very little consideration of the wider harms and benefits of our policy interventions. It’s clear that the investment in preventing a COVID sickness or death is way out of proportion to what we are willing to invest in other foreseeable health harms like cancer, heart disease, strole, and mental health to name a few biggies.
So let’s be part of a functioning society.
To the public. Let’s engage robustly on this debate with your eyes wide open. But do this in a constructive and fair way. Going along with a set of rules you feel confers more harm than good is being complicit in that system. The least you can do is have your say. But can we do this without the personal attacks and concentrating on the data, our ideals and putting forward our aspirations?
I wrote to the Vice Chancellor of my university at Christmas. I was concerned about the clause in my contract which states that I should avoid bringing the university into disrepute. I was concerned about my further engagement in public COVID debate given the way others challenging the narrative have been attacked and ridiculed. I was clear that I meant to engage in more debate, and that I would try to remain within the area that I felt I could comment on.
I wasn’t asking for his protection, nor his endorsement of any position. I was simply wishing to be clear of my and his expectations of my role.
I was buoyed by his reply which encouraged me to contribute to the debate in this capacity, and that as a Professor of Public Health at the university he felt academic debate on these issues was not something the university wished to interfere with, and so long as it is “my lane” it is encouraged, indeed necessary.
Of course, I will also have opinions as a member of the public. I am a parent, a husband, a son, a brother, a volunteer in surf lifesaving, a recreational athlete, a sports team coach, and a partial business owner. All of these give me some right to have my say on important topics in society.
You are many of these and more too.
I’m going to write plenty in the next little while. I’d just try to be clear where I think I have the appropriate public health expertise to have my say, and when I’m like you a member of a democracy with an opinion. I hope both have value beyond the cathartic benefit of writing itself.
On Vaccine benefit v harm
Let’s get going with the tricky issue (again) oif vaccines.
I feel I understand that public health interventions must substantively prove they provide high benefit and low harm. This must take not just a narrow view but a very wide view of consequences both intended and unintended.
My view on COVID vaccines is that they almost certainly will have the benefits of reducing hospitalisations and death from Delta and earlier variants of COVID. These benefits are likely to be more profound in high risk groups such as the elderly and those with metabolic comorbidities. I expect that’s about half of us.
The effectiveness in vaccine preventable hospitalisations and death is likely to wane after a period of months. Booster shots confer this benefit again but how long these last is currently unknown.
If vaccination reduces spread then this effect is likely to be quite small and also reduced further by vaccine wanning.
For this reason we should consider this treatment, especially if the risk of severe outcomes or death are high. For Delta and earlier variants death and serious illness have been high in some sub-groups of the population, compared to similar illnesses. For other groups it is the same or much less.
I’m not sure about Omicron exactly yet, but it appears the risk profile is absolutely lower. It’s also not clear how effective current vaccines are in reducing mortality and serious illness. I think they will be effective above non-vaccination but the magnitude of that effect is unclear. They do appear ineffective in reducing spread.
Before we go any further we need to understand the possibility of harm. Harms are usual in medical treatments. In some places medical misadventure accounts for ¼ of all deaths.
The first place to examine harm is in the individual as a direct result of the vaccine. To do this you either need a clinical trial big enough and long enough, and without the need to exclude initial harms from the trial protocol to detect often small but sometimes serious adverse events.
The current set of trials around the different vaccines show little evidence of harms to worry about. There are some plausible reasons for this. One is that these events are very very rare and not worth worrying about. It may be that they are serious and worth worrying about, but we either missed them by exclusion of those who had an adverse reaction and they were dropped out of the trial, or we didn’t have a trial cohort either big enough (statistical power) or diverse enough (sub-group risk, also statistical power) to notice these important events. There is also the possibility that we didn’t follow up long enough to detect adverse events.
All is not lost though. In the case of a deadly virus and emergency treatments it’s possible to consider approving a treatment provisionally and carefully monitoring adverse events. To do this you would need mandatory reporting of all medical events to a common database. You could then understand if these rose above the background in the vaccinated group, and/or compared to the unvaccinated group. The latter is preferable in this case because there may be global extra harms because of lockdowns etc like mental health issues or reduced access to medical treatment for everyone. you want to account for.
This wouldn’t be as good as a decent long term trial, but with some statistical adjustments there are ways of understanding harms with some confidence.
Without mandatory reporting of all events, there is no robust way of understanding adverse events.
My view is that in the absence of long term trials, questions over the Pfizer trial protocols revealed in the BMJ, and the lack of robust mandatory medical event reporting for vaxxed and non-vaxxed we have little robust knowledge of adverse events.
This is even more likely to be an issue in the adolescent and children’s trials for vaccines. These have been smaller and for even shorter durations. These are key groups to consider as their risk of serious illness and death from COVID are very low. So understanding both efficacy and adverse events would require large trials. This hasn’t been the case.
Certainly there is now acknowledged evidence that the individual benefits for adolescents, especially males are outweighed by the individual harms.
I observed the holes in this system as a parent recently. One of my sons, aged 19, got his second shot in December. This was mandated by his employer, so there was a coercion element. That aside, he ended up hospitalised after becoming extremely unwell in the pharmacy where he received the treatment. He was taken by ambulance and hospitalised. Thankfully he appears to be OK now. Bizarrely this was not recorded as an adverse event. He was misdiagnosed with dehydration. How this became a diagnosis is beyond me. Parents aren’t allowed in the hospital to observe treatment because fo COVID risks which is in of itself distressing to be in a carpark or on the phone. He later received a text saying this was a minor reaction and for his booster he might consider lying down!
Understandably he will refuse the booster. If his university makes the booster mandatory as they have for the double vaccine he will be excluded from his study.
Another important epidemiological factor is who actually ends up in the real world being affected seriously by COVID? Are they vaxxed or unvaxxed? Do they get seriously ill or die?
To answer this we need to know about the COVID related hospitalisations and deaths with more granularity.
I think it’s critical to understand whether someone is hospitalised or dies with COVID or because of COVID. To me, this is a critical statistic. We have a situation in NZ guided by the WHO definition where this is hard to understand. I assume because we had someone who died of a gunshot and tested positive for COVID postmortem that this death was not caused by COVID. I assume a few other deaths including one child who only tested COVID positive postmortem were not caused by COVID. Yet the truth is that assumption could be wrong. The same criteria would also need to be applied to vaccine harms.
Any statistics around this endemic require this level of analysis. Anything outside of that is meaningless. This will become important as we get many thousands of Omicron cases everyday. People die everyday from other causes, so when a high proportion of the population are infected we can expect to see some underlying death regardless how deadly omicron is.
The media has a particular obligation to get these statistics right, and not doing so is a failure in duty, and in my opinion, fails to meet the basics of our broadcasting standards in New Zealand.
Other wider harms are plausible not so much from the vaccine adverse events itself, but because of the mandates around that vaccine. Let’s think about that now.
On vaccine mandates and passports
I’m not on first principles against mandating things. We have a legal framework which we utilise all the time to avoid predictable harms and ensure the safety and well being of citizens.
We don’t want people driving or operating potentially dangerous machinery when they are drunk or drugged. We have eyesight requirements for various things. We have a whole swag of policy and legislative things going on to reduce tobacco consumption.
There are many more, and new ones will appear in the future. I think most of us are OK with that.
The important thing is that these are grounded in a practical reality that intervening in this way will create substantial and lasting benefit and this benefit will well outweigh the harm they cause.
For this reason I support the government encouraging people to get a COVID vaccine. At least for adults, and especially at risk adults the reductions in serious illness and death have been shown. This is at least for the original trials which were with different variants. The effect seems robust for the delta variant. The Omicron variant outcomes and how these track into the future is still unclear in my opinion.
As a disclosure, I got the double Pfizer vaccination. I have yet to make a decision about booster vaccines for myself. I expect that will depend on the mandate for this and the emerging new data and new variants. At my date of vaccination I was unaware of the waning effects. I am mandated by my employer to be vaccinated.
Further, I encouraged my higher risk parents and in laws to get vaccinated, and supported them with a booster treatment recently. I have no idea where this will lead as multiple boosters a few times a year seems unsustainable and there is currently no long term evidence.
What happens after everyone gets COVID is also not clear. It’s endemic and my assumption is not if but when you will be infected. Wil natural immunity help. I imagine it may.
Also, my 11 year old son currently remains unvaccinated. I feel there is a lack of data for benefit v harm to convince me this is a good idea right now. I may change my mind. He isn’t mandated directly or indirectly through sporting exclusion or other cultural or education activities like school camps or other activities just yet. These shouldn’t be factors to consider but sadly for many parents they are. My view is that the harm v benefit for our children and adolescents should be considered at that level not for protection of other parties like older people. At least that’s my assessment with the current data.
On mandates, In my opinion they are and will most likely cause more harm than good. This is my view at the time of writing with Omicron coming and the current data we have. It’s interesting to observe significant policy shifts right now in other countries with the UK abandoning almost all restrictions including masks, lockdowns, and vaccine mandates.
They are moving on.
I’ve written previously about the harm and benefit balance, especially considering losing health care workers and teachers. This has now extended to first responders including police, ambulance, Fire and Emergency. Surf lifesaving and Coastguard. These are already under resourced systems and most were short staffed and struggling before losing a percentage of their staff. Some of these groups have also recently mandated boosters.
Any of those who were terminated will suffer personal hardship and some will suffer serious psychological harm. This of course goes beyond the sectors above as there are other mandates beyond these.
There is also the matter of excluding a proportion of society from normal civil society. When you can’t go to shops, get a haircut, go to a movie, the gym, a sporting or cultural event and much else including cafes and pubs. My eldest son’s girlfriend, who lives with us, was recently denied medical treatment because she was unvaccinated. I find all of this divisive and contrary to the NZ Bill of Rights.
It might not be wrong if there was clear and compelling evidence of infection from the unvaxxed which conferred widespread very deadly outcomes. Even then this requires plenty of debate and actual scientific modelling to justify the change from the status quo.
That would be the “cautious” approach.
We have seen no such analysis which considers such harms and benefits. In fact, much of the modelling we have seen in its limited predictions has been myopic and wildly pessimistic in predictions of COVID and we seem to have learnt nothing from the frailty of the modeling, assumptions and the modellers’s egos.
The data simply hasn’t played out the way of supporting mandates. The emergence of Omicron makes it clear that for reductions in transmission there is very little protection, if any, from vaccination.
It’s even more farcical when you consider that many early vaxxed people are effectively unvaxxed now because of waning. Yet they enjoy freedoms. That Omicron is pretty much here and vaccinated people will pass COVID freely around society.
I find the lack of nuance and dualistic thinking around this issue disturbing.
My observation of humanity is that we like to separate things into good/bad, right/wrong – and in this case vaxxed/not vaxxed.
If only we could be more nuanced and understand that age and health status confer the biggest risk.
Such nuance would understand:
- That this risk is graded steeply
- That vaccination has some benefit but this wanes and it wanes differentially by age and health status.
- That policy interventions cause harm and benefit at the same time. That balancing these is a way that gets the best outcome is useful. It is up to the modelling and policy to clearly understand how harm and benefit both change before moving from the status quo. The same conservative approach should be applied to all medical treatments.
- That science gets things wrong and changing our view rapidly is the scientific process.
- That scientific and public dissent is normal and healthy.
- That metabolic health was, and still is, a major public health problem both in the COVID and wider context, and that this already overwhelms the health system as does poor mental health yet we are happy to watch this idly.
- That the health system has become even more overwhelmed and dysfunctional as a result of COVID restrictions and many many procedures, diagnoses, and other treatments have been missed.
My citizen views
Above is my professional protest against mandates. Below is my individual citizen protest against the futility of mandates. I give this not as a Professor of Public Health but as a member of society having my say.
My short speech is based on the idea that North Korea only exists because the people let it exist, and a thought experiment where tomorrow morning virtually everyone in North Korea wakes up and says that their totalitarian comminst state is pover, then it will be over….
Here’s my speech…
“I need to scan your vaccine passport”
Me “OK, I’m going to give a short speech as we are doing that”
There is what I assume to be a bemused look, but I can’t tell because they are wearing a mask. Generally no one says anything to me at this stage.
Me “You are engaging in an unsustainable strategy to reach an unattainable goal. I find that these mandates are divisive, agans the NZ Bill of Rights, and will cause more harm than good. My view is that I don’t want to be part of a society that coerces and then punishes people who choose not to receive a personal medical procedure. I understand that you are just doing your job by law.”
Responses fall into three equal categories,
- They agree with me
- They say nothing
- They fire back with some sort of personal attack. Often this includes a view that everyone wants this.
Interestingly to date I haven’t had anyone defend this explicitly on health grounds. No one has offered back a scientific opinion. I admit that this isn’t the ideal spot for such a debate.
I honestly don’t expect this to achieve anything by itself. My only views are that:
- I feel strongly that complying without protest is to be passively complicit in a system you find to do more harm than good.
- If everyone did this right now, or at least those who feel this way, then the democracy we live in would remain robust, and if enough people were vocal in this then the mandate would collapse. Perhaps this might result in a faster return to removing the workplace mandats..
Well done if you made it this far. These are only my views. You will have different ones and nuances to express and I hope you do.
My job, and everyone’s job is to engage in the democracy we live in. That is progress.
Please share, engage, do your own thing as you see fit on the public health issue of our lifetime.
A good addition to this is an piece by Peter Attia published after this was written – he has plenty of up to date numbers around Omicron, natural immunity, and transmission https://peterattiamd.com/why-im-for-covid-vaccines-but-against-vaccine-mandates/