The Stupidity of the Johnson & Johnson Pause

Update: Although not definitive, this study would seem to supply some evidence for my claim.

The pause on J&J shots because of an astronomically low risk rate is, I think, remarkably stupid. The chances of getting hit by lightning or winning the lottery are higher than the chance of a blood clot. Medicine always carries risks. The risks are typically much higher than 6 in one million. Although the American public might overrate such risks (they actually think the next ticket is the one that wins them the lottery), the “scientists” at the CDC should know better. Apparently, the people at the CDC are not much smarter than the American public; in fact, given that the American public at least has some common sense, they’re dumber. Yet, despite all evidence to the contrary, they are claiming science is on their side! Supposedly they did it to make people “feel better” about the vaccine when/if it reenters the market. I haven’t talked to one person who “feels better” about the shot because of it. I’ve talked to and seen many message boards/tweets of people who feel much worse about it now. Admittedly, my informal conversations and browsing of the web is also not science; but it is common sense. And their “science”, which contradicts most people’s common sense, has essentially taken J&J off the market. This whole “strategy” is too clever by half. And at a time when we desperately need vaccines going into arms.

This “expert’s” response to Nate Silver’s criticism says so much about an inherent problem of the “experts” illuminated by this episode. Rather than consulting common sense, she consults the supposed “science” which suggests people feel “more confident” about vaccines if you institute these sorts of pauses. Although it’s true that science has an important place in our politics, this kind of “science” is precisely what makes people not trust it. There are so few episodes of the distribution of a vaccine at record speed to a record amount of people that there’s no way science could have any reliable prediction as to what will happen to public psychology. Science depends partially on verifiable results through many repeated tests. We have none of that in this case. Thus, they’re making decisions based on what they predict will be the case with mass psychology. Although there’s some science in that, anyone who would say that they could be fully confident in those predictions is lying.

Isn’t it just as likely that the people, who tend to dramatically overrate risk, will be confirmed in their overrating by this pause? Further, based on this tenuous prediction in combination with an astronomically low risk rate, the CDC has halted the administering of millions of vaccines that will definitely save lives. The number of people who will die of Covid because of this pause in distribution is much higher than six. That we know with full certainty. Simple common sense reveals the stupidity of this decision. “Science,” despite what they might claim, doesn’t have the tools or the evidence, in this case, to refute simple common sense.

15 thoughts on “The Stupidity of the Johnson & Johnson Pause

  1. I would recommend that readers google and look up Anthony Fauci’s recent responses to this pause. What struck me, and I hope would strike others, is how sober, prudential, and common-sensical Fauci is compared to the overheated rhetoric on behalf of so-called common sense in Ben’s post. Fauci makes several points: 1) relatively short pauses like this are much more common in past vaccine development and in public health emergencies than one would know from the recent news; 2) the problem with respect to these particular blood clots is that the usual treatment for blood clots could be fatal. Doctors and health providers need to be quickly trained how to diagnose and respond to these events; 3) while the instances are rare, there is some uncertainty how rare in particular sub-groups of the population. For those sub-groups the incidence might be high enough to be a legitimate worry. The clinical trials were not large enough to provide this data; 4) lots of evidence indicates to Fauci and his team that vaccine confidence is enhanced if the public is reassured that governmental authorities take vaccine safety very seriously. The arguments of Ezra Klein, Nate Silver, and Ben here are all plausible. They may even be the right call under present circumstances. But they are not the knock-down case that their authors assume. More humility would be nice to see and also in the public interest.

    1. I guess we’ll see how long the pause actually is. By the end of it, we should determine how many people die of Covid during the pause who might have lived if the vaccine had been available in comparison to how many people would have died of the blood clot. And second, how well the public responds to this pause. Are they more or less likely to get the J&J vaccine now? If science is the standard, then answering those questions would certainly contribute to our understanding.
      I’m also not sure why rhetoric questioning this decision isn’t “in the public interest.” Part of what it means to live in a constitutional democracy is having the ability and even the responsibility to question governmental decisions that strike us as poorly made. And I’m sorry but I just don’t think this is a decision that requires more humility. This is an obviously bad decision that’s going to cause significantly more Covid deaths than six deaths from blood clots. That’s a terrible calculation. They can study more the problem as they deliver the vaccine more; stopping to study the minor problem doesn’t make sense in the midst of a pandemic that’s killing people. I refuse to be humble about that judgment. It’s my responsibility to call out bad decisions like this in strong terms. I was willing to use strong terms to call out terrible decisions made by the Trump administration. I don’t see why I shouldn’t do the same now.

    1. What I think the controversy over the J&J vaccine usefully demonstrates is the paramount importance of prudence in these matters. I do not know the issues well enough to know what was prudent here. But it is a reminder that these decisions require several different types of expertise–public health and public opinion, to name two–and that prudent political leaders must synthesize those. That’s especially true in fog-of-war situations in which expert opinions are likely to conflict with each other, both within and across spheres of expertise. Slogans (none of which I am attributing to Ben or the ensuing conversation) like “follow the science” or “open up now” make better bumper stickers than “be prudent.” But prudence is what the moment demands. Neither scientists nor economists nor any other kind of expert can pilot the plane alone. There are too many conflicting values to resolve.

      1. Exactly right, Greg. By their nature a number of decisions could all arguably be prudent. Assuming the one most prudent choice is actually a species of the kind of thinking for which prudence is an alternative mode. Ben’s preference on this matter might indeed be a prudent one. Lots of commentators agree with him. But Ben’s assumption that another defensible path is obviously stupid is not a prudent choice of words. And his failure to see and acknowledge the whole complicated picture is a failure of prudent thinking.

  2. Greg’s comment prompts another observation about prudence and the pandemic. It is a mistake to assume that the politicians are always the prudent ones and the scientists are not. I was led to this observation last night as the Governor of Michigan called for a surge in vaccines to her state given the extraordinary surge of hospitalizations, infections, and deaths there. The response from Biden’s CDC director, Rochelle Wilensky, was to surge PPE and even more importantly highly effective monoclonal antibody treatments, while keeping the schedule for vaccines at the status quo. She explained that vaccines are useless for those who are already infected — that there preventive effect takes weeks– and that the crisis is right now and requires treatments for right now.

  3. I’m sorry but no matter how much I try to screw up my vision, I can’t land on anything other than the rather dramatic imprudence of this decision. And I think it’s imprudence of which only a scientist is capable. By handing these decisions over to science, we subject ourselves to their peculiar vision of the world. In their scientific viewpoint, common sense has very little place. This led them to “follow the science” in a direction which actually doesn’t make much sense. Perhaps I’m wrong and perhaps this will increase faith in J&J. I hope so. We shall see; I’d be very surprised. Although I aim for moderation and the prudence that both follows from it and dictates it, there are times when prudence requires more dramatic rhetoric. That is, there are times when prudence calls for something other than moderation. I can appreciate that the CDC came to a decision. I can appreciate that a lot of factors went into their decision. But that appreciation doesn’t prevent me from calling them out for landing at a very imprudent decision. And as a citizen, non-scientist, it can be prudent to call them out strongly for this bad decision. I refuse to bow before their “science.” Moderation itself doesn’t require a middle-of-the-road opinion in every case. I dare not compare myself to Lincoln, but Lincoln was prudent and thus often moderate. But, as Charnwood says of him, he had a “deadly moderation” which dictated at times a more firm stance. Stephen Douglas aimed at moderation as he compromised with slavery’s interests. Lincoln understood that the situation required a more firm position.
    At the risk of “what-aboutism”, Perhaps the better way to get at this point is to imagine this having been done under the Trump administration. He’s anti-science we would exclaim. Six bad outcomes and he’s stopping an entire program! Doesn’t he understand how probability works? Sure Faucci is doing it but Trump must be forcing him to do it. People are dying from Covid and Trump is worried about six accidents.

  4. Don’t want to beat this issue to death. But what is so hard about seeing the prudential complexities? For examples: both the J & J and Astra Zeneca vaccines use similar platforms and have had very significant roll out problems. Astra Zeneca had poorly designed trials and data collection; J & J had 15 million doses ruined in their Baltimore production facility. Both are also correlated with the possible blood clot problem — and the truth is that the CDC does not actually know yet the extent of that problem, the best ways to contend with it and so forth. As JV Last says in the link I posted above — the remedy for this kind of problem is truthfulness and transparency. Within the US, the pause will not significantly affect the speed of vaccinating the US population. We are soon to have an oversupply of vaccinations even without J & J. (Worldwide is a very different story). To repeat what I said before, it might be more prudent not to pause as you and many others say. But a pause of one or two weeks cannot reasonably be called stupid. I mean really? It is stunningly arrogant to say with such certainty that one knows that Fauci and Wilensky are stupid. It is hard to imagine your Trump counter-factual since your own position is so much like Trump’s.

  5. Ill say a few more things and then Im letting it go: if this decision means people stop getting the j&j vaccine after this pause and that means we continue at a rate of 1,000 deaths/day then I don’t see how this would be anything other than a bad decision. And part of my point was that we defer too much to so-called scientific expertise when this really is more of a political question. So you’re right: I’m not willing to defer to Fauci. I recognize his expertise in many things. I don’t see why he would have special knowledge about mass psychology in response to the administration of a vaccine like we’ve never seen before. Science depends for its confidence on repeated experiments. He has an educated guess. But there’s no necessary reason why we can’t question his educated guess. And I think he made an educated guess that doesn’t square with common sense. Perhaps you’re right that my rhetoric was too inflammatory: Im cranky because I feel like a truck hit me after the second shot.

  6. I think it is important to ask you to read what I write more carefully. I never suggested that you shouldn’t disagree with Fauci or Wilensky. I rather said that you should not call them stupid.

  7. Would “unwise” be a better word? There are always many more reasons to say “no” than to apply wisdom and reach a reasoned judgment. I think what the CDC and FDA did in pausing the vaccine was unwise. While all the factors they considered were valid, the bigger picture, which was the further loss of faith in the safety of the J&J vaccine and even all vaccines approved under the Emergency Use Authorization, was lost in the fog of negatives that obscured wisdom. Scientists are supposed to be knowledgeable and so it is right for them to point out risks. Decision makers are supposed to be wise and therefore capable of selecting the best course taking all factors into account. When decision makers say they are basing a decision on science, they are abdicating their role as deciders and making themselves irrelevant.

    1. “Unwise” is a much better way to put it and much more moderate. And you’re exactly right that the decision makers abdicated their responsibilities by handing the decision over to scientists. I was being intentionally provocative precisely to point out that scientists, despite all of their claims to expertise, can be remarkably dumb when it comes to understanding things beyond their expertise. I thought being provocative would highlight that fact more than being moderate.

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