Do Less Harm

In the middle of a global emergency, an “abundance of caution” may be deadly.

Early this morning, I awoke to news that the CDC and FDA are recommending a pause on all vaccinations using the Johnson & Johnson COVID-19 vaccine. This is very bad news, though not because of a problem with the vaccine itself. The issue at hand, “severe blood clots”, seems to be vanishingly rare. There have thus far been 6 reported cases out of 6.8 million doses administered, making this literally a one in a million issue.

The much bigger problem is the act of immediately and publicly pausing the vaccine’s rollout. This seems certain to lead to vastly more negative outcomes than the issue being investigated. Until the CDC and FDA complete their reviews, many fewer people will be vaccinated, which will result in many more people contracting COVID. When more people contract COVID, more people die.

Worse than the short-term delay in vaccination may be the long-term reduction in confidence this pause will lead to. No matter how quickly the government gives an all-clear, some amount of damage will already have been done. Vaccine hesitancy seems certain to increase both in America and abroad. It may take a long time to overcome that.

The result of this decision is sure to be a lower number of people vaccinated, over a longer period of time. We know that will cause more COVID deaths. By contrast, just one death is currently associated with this vaccine. It’s unpleasant to measure one set of deaths against another, but that’s precisely what must be done in a public health crisis. If we were able to vaccinate all of the US with the J&J vaccine, we would currently expect to see about 330 issues with blood clots. Meanwhile, more than 560,000 Americans have lost their lives to COVID already, with 330 more being killed by COVID every few hours.

Human beings are horrifically bad at understanding large numbers and terrible at assessing broad risks. Public health officials ought to take that reality into consideration before making a move like this. I fear that they have not, and as a result, many more will suffer.

The ultimate goal when it comes to public health must be the highest number of positive outcomes. Even if we accept that there may be an extremely rare issue with the J&J vaccine, the cost of not administering it would appear to be many orders of magnitude higher. It seems terribly ill-advised to throw a wrench into things so completely “out of an abundance of caution”. In the middle of a global emergency, an abundance of caution could well be far more deadly.