Deciding to get or not get a COVID shot, whether primary dose or booster, should obviously mean assessing the pros and cons: risks, benefits, costs, hassles, and uncertainties.
We ought to be able to count on pharma companies, public health agencies, and technical experts to facilitate this assessment by telling us what they know and what they believe (distinguishing the two!). But they obviously have competing goals.
For pharma, profitability is a competing goal. For agencies and experts, more importantly, getting us to do “the right thing” is a competing goal – and often preempts the goal of fully informing us.
I’ve written about this before (for example, here and here). And you and I have discussed it at length 
. Agencies and experts figure out what they think we should do, and then tend to cherry-pick what they tell us in an effort to maximize the odds that we’ll do it. Rather than tell us “the whole truth,” they tend to tell us what they think will best motivate us to protect our health. In the case of vaccination, that too often means overstating benefits and understating risks, costs, hassles, and uncertainties.
In the short term, this bias saves lives. In the long term, it undermines trust. I spent much of my career vainly trying to convince my public health clients that their altruistic dishonesty (“noble lies”) would ultimately come home to roost. I was wrong until COVID.
Ethics aside, I think altruistic dishonesty is unwise. I believe a dispassionate, fully transparent communication posture would convince most people to say yes to most recommended vaccine doses – nurturing both informed, autonomous decision-making and trust in officials’ and experts’ recommendations. Even if altruistic dishonesty made public health sense before COVID (which I doubt), it surely no longer makes sense.
I would love to see a neutral, thoughtful investigation of the ways in which COVID vaccination has been oversold.
But there are many reasons to doubt that Florida will conduct a neutral, thoughtful investigation. I read the DeSantis petition 
asking the Florida Supreme Court to convene a grand jury investigation. It’s not a good start:
- It virtually ignores viral mutations, treating claims that were true until they weren’t as if they were false from the outset.
- It ignores uncertainty, treating overconfident but plausible claims that turned out false as if they were intentional lies.
- It plays games with definitional ambiguities, treating words like “protect” as if they meant total protection, which isn’t what they usually mean these days (especially in puffery).
- It ignores differences of opinion, treating debatable opinions and even mainstream opinions with which some outliers disagree as if they were certifiably false.
- It is necessarily limited to possible violations of Florida law, which will require a focus on pharma villainy whereas the real problem is altruistic dishonesty, officials and experts who prioritize health over truth.
Any investigation of COVID pro-vax dishonesty would probably give some aid and comfort to antivax activists and their adherents. As a result, the world seems to be divided between vaccination supporters who decline to address that dishonesty and vaccination opponents who overstate it. What’s desperately needed is an investigation of pro-vax dishonesty that is itself pro-vax. We need an investigation that aims to reduce mistrust by sadly acknowledging how COVID vaccines have been oversold, not one that aims to increase mistrust by triumphantly showcasing and exaggerating how COVID vaccines have been oversold.
It looks to me like Florida is likely to give us the wrong sort of investigation.
I agree that boosters are “undersold” in the sense that too few people, especially too few seniors, are “buying” them – that is, choosing to get boosted. But I doubt that’s chiefly because public health officials and experts aren’t making the pro-vax case strongly and clearly enough. I think it’s more because they have sacrificed trust by the ways they oversold vaccine effectiveness earlier in the pandemic (partly but only partly because VE was genuinely higher earlier in the pandemic).
I wonder how many more people might choose to get boosted if the messaging was something along these lines:
We’re so sorry we overstated the effectiveness of COVID vaccines earlier in the pandemic. Now a lot of people aren’t getting the COVID boosters that could help them avoid serious illness because they understandably have learned not to trust us. So here are some candid truths – about what we got wrong earlier; about who really really really should get a booster now; and about who isn’t so much at risk and can probably afford to decide to take a chance….
Also re myocarditis etc.:
I’m not qualified to offer a professional opinion on which vaccination decisions are no-brainers and which are debatable. I get that myocarditis and related cardiac risks are the clearest downside of the mRNA COVID vaccines, especially for adolescent and young adult males. It’s beyond my expertise to assess for whom they’re a big enough downside to choose a non-mRNA vaccine instead, or even to forgo a recommended booster altogether.
The same goes for related questions:
- When is an allergic condition sufficient reason to get a different shot or no shot?
- When is a bad side effect from a prior shot sufficient reason to get a different shot or no shot?
- Etc.
And of course the more fundamental question I posed in my hypothetical: Who really really really should get a booster now, and who isn’t so much at risk and can probably afford to decide to take a chance?
The answers to these questions are way outside my wheelhouse. What’s very much in my wheelhouse is this: Public health professionals have devoted far too little public attention to providing answers.
To some extent this was because they didn’t actually want prospective vaccinees thinking about maybe not getting any recommended dose – the altruistic dishonesty I’ve already discussed. Why answer a question you’d rather people weren’t asking in the first place?
But I suspect the main reason for this neglect was (and is) the desire of public health professionals to “keep it simple.” Simple explanations of technical information really do play better than complicated ones. But I think officials and experts have “misoversimplified.” In their effort to avoid getting lost in the complexities of vaccine decision-making, they have given the impression that they were trying to avoid acknowledging the downsides of vaccination – trying to keep prospective vaccinees from making their own fully informed decisions.
Copyright © 2022 by Peter M. Sandman
