More from Sure by Alex Tabarrok March 3, 2021 at 7:29 am in Current Affairs Medicine The excellent Sure in the comments. I would draw attention to “I believe in evidence based medicine, not eminence based medicine” from last time and “methodolotry” from today. And to think this website is free. One of the most frustrating things about this pandemic is how much people are unwilling to make a decision in light of previous experience and basic scientific literacy. Most vaccines provide some significant protection after their first dose: MMR, Varicella, influenza, meningococcus (both), and HPV are all dosed with either no follow on jab or with significant delays before the second jab in the official CDC schedules. And even the ones that we do run close together can show decent effect after the first shot. And we should expect better vaccine response with more modern technology. We provide only the epitopes most likely to have the greatest effect and do not need the immune system to do as much trial and error during its clonal expansion and affinity maturation. And regardless, we can tell pretty easily if things bind immediately or if we need some sort of class switching (and with a bit more work if we are getting good T-cell responses). So we should have had exceptionally strong priors that these vaccines would work and given the data from phase II, we should have had very strong priors that FDF would be viable in a situation of scarce supply and exponential growth (or decay). And let us recall the big boogeymen of failed vaccines past: using a completely different process over 60 years ago Cutter Labs failed to inactivate polio and just injected it straight into kids (i.e. a failure mode not physically possible with current technology), some weird autoimmune interactions in the 1970s gave us 1/100,000 rates of GBS (i.e. not even a rounding error in the Covid death toll), ADE in dengue vaccines in the Philippines (maybe, the official lookback could not definitely tell if a couple of dozen kids died from ADE induced by the vaccine or if that was just dengue being its normal malevolent self), and a small increase in bowel obstruction with rotavirus (1/12,000, only seen in one variant and not observed in other rotavirus vaccines). We could have had all of them in the Covid vaccines and they would still be an order of magnitude safer than the status quo. And they would still be an order of magnitude safer than the status quo for the under 50 crowd. Yes, I get it, there is some tail risk that somewhere out there might be something new we have never seen before. I cannot tell you that I have absolutely zero uncertainty that something completely new will rear its ugly head here; but that same uncertainty exists for the status quo. Will lockdowns lead to delayed mental health issues? I don’t know, but the indicators I see right now are not pretty. Does shafting childrens’ educations for more and more months have lifelong impacts on things like suicide risk, IVDU, CAD, and the rest? Cannot say for certain, but I see no reason why it doesn’t unless you have an extremely dim view of education’s ability to impact on life outcomes. Delayed cancer screenings, deferred elective surgeries … the uncertainty in the NPIs easily dwarfs that of the vaccines. We should have been saying, back in July, that results are remarkedly promising. All the data suggests that these vaccines will work and we might even open up a large “open label trial” concurrent to a phase III crossover trial and release the data in real time. Titer levels from the vaccines should have been trumpeted from the beginning with historical context. And this BS about % effectiveness should have been lead off with, at every point, that all of these vaccines are vastly more effective at preventing hospitalization and death. And I get it. If some bureaucrat stands up and says time to be risk tolerant they risk their job, their social standing, and all the rest. But this is what it means to be a physician. You wrote some BS on your medical school application that you need to be a tiny bit true so you do the hard thing and save lives. But instead everyone cowers down and holds to mere methodolotry because following the science is too hard to do for real.