Tag Archives: health policy

WAPO Undermines Public Health Confidence – Again

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I understand that the Washington Post and other so-called mainstream media think they have some obligation to report both (or many) sides to news matters of public interest. A lot is happening all the time so there is the difficult problem of triage – what do you choose to report and how much coverage do you give the chosen subjects?

In the latest problematic example, I am mystified as to the thinking behind the choice to devote 1,930 words to an item with the click-bait headline, “Biden team tries to get ahead of the virus — and maybe the science — with decision on booster shots.” https://wapo.st/2UChWHg The byline for this piece shows four names, all senior writers for WAPO with some degree of specialization in health policy.

To make the point of why this type of “journalism,” if that’s what it is, is so concerning, I am going to analyze the piece in some detail. Bear with me if you can.

The opening lines state the subject matter and point of view of the article:

President Biden vowed to “follow the science” in fighting the coronavirus pandemic, but some scientists say his decision to recommend widespread coronavirus vaccine booster shots relies on incomplete data and will put pressure on regulators yet to approve the plan.

You understand right off that the message is that the President has not lived up to his word, that “some scientists” think he’s made a major public health mistake in the fight against COVID-19 and is mixing politics with health science to get inappropriate approval from government health experts.

To support that thesis, WAPO quotes Vincent Racaniello, a professor of microbiology and immunology at Columbia University that the data thus far do not support the need for a COVID booster shot. I checked out Prof. Racanciello. He is a major figure in virus science. He sided with Dr. Fauci in his fight with Moron Sen. Rand Paul about whether Chinese researchers were doing “gain of function” research with bats that led to COVID-19. He is not, therefore, one of those random “doctors” who are dredged up by right-wing media to contradict whatever the CDC and other important health authorities have said.

Prof. Racaniello has tweeted his position on the sustaining power of COVID vaccines thus:

Science tells us that most Americans do not need a COVID-19 vaccine booster 1. With time, vaccine-induced antibodies wane but the same happens with all vaccines and infections. 2. It is not correct to conclude that COVID vaccine efficiency is waning. What is going down is protection against infection. Most human vaccines do not prevent infection. Results of studies have shown that despite waning antibody levels, most fully vaccinated people are protected against severe disease, hospitalization, and death. What we need to do is get everyone fully vaccinated!

The delta variant is NOT in itself causing cases to surge in the US. That is being driven by unvaccinated people, failure to mask, and a return to physical interactions. ANY SARS-CoV-2 variant would behave in the same way.

Those messages were met with considerable hostility by many Twitterfolk – this is a sensitive subject in which nuances of language can have huge emotional effects.

Returning then to WAPO, the article noted that,

While Biden acknowledged the plan was “pending approval” from the Food and Drug Administration and experts who advise the Centers for Disease Control and Prevention, the president mostly portrayed it as a done deal, saying that tens of millions of booster shots would become available the week of Sept. 20.

Thus, while the President expressly acknowledged that health policymakers’ approval was needed, WAPO’s writers assert that the President is dissembling. But then the article notes that he was not dissembling:

The president’s top science and medical advisers — including senior CDC and FDA officials — concluded last weekend that widespread booster shots were necessary, drawing on an array of data from the United States and Israel that suggested immunity from a two-dose regimen of coronavirus vaccine declined over time and that greater protection might be needed against the highly contagious delta variant.

Based on the rest of the article and on many other sources, the “dispute,” if there is one, is about whether to announce the booster program ahead of the surging infection numbers or wait until “more data” is available. Biden’s approach is supported by multiple health experts, including

  • Francis Collins, director of the National Institutes for Health, and
  • Claire Hannan, executive director of the Association of Immunization Managers

But, WAPO goes on, “a number of outside experts faulted Biden’s timing and said the White House was acting prematurely based on the latest vaccination data.”

For instance, the administration focused on multiple research studies showing that vaccine effectiveness against mild to moderate illness wanes over time, while boosters ramp up antibodies tenfold or more. Most, although not all, of the recent data shows the vaccines continue to provide robust protection against severe disease….

Many prominent figures in the scientific and medical communities said that’s the key measure of vaccine success. The vaccines’ main purpose is not to prevent infection, so much as to keep people from getting severely ill or dying, they note, and recent concerns about breakthrough coronavirus infections have been overblown….

It may be that WAPO and the White House may be talking about two different things. As a matter of national emergency planning, the President is concerned about waiting until the resurgent virus (Delta Variant and possibly others) is even more widespread before beginning to boost resistance. The “dissenters” are making technical points about what the data shows right now about the continued strength of the vaccine.

“The metric that matters is the protection against severe disease, hospitalization and death among people vaccinated,” said David Rubin, director of PolicyLab at Children’s Hospital of Philadelphia. He said the booster decision was premature and potentially misleading. “It tends to portray that we’ve lost confidence in the ability of this vaccine to prevent severe infection. And I don’t think that’s the case,” he said.

Given that case counts are surging in multiple states, vaccinations are lagging, and health resources are being overrun yet again in multiple states, why is this “conflict” being written about as if the President were being dishonest or has, like his predecessor, attempted to politicize national health policy?

WAPO cites efforts by Dr. Fauci and others to reassure health policy staff but then “some experts said the White House was backtracking on its pledge to allow regulators to shape coronavirus policy,” citing Biden/Harris’s criticism of Trump for “publicly pressuring regulators to approve the first coronavirus vaccines.”

Does WAPO really believe that disagreement over whether it’s timely to talk about a booster program is the same as Trump’s declaration that the virus is “their new hoax” or whether hydroxychloroquine is a real treatment for COVID?

WAPO keeps doing the dance, first stating why the White House wants to get ahead of the virus, then citing more people who think it should wait for more data and trying to equate the push for a booster program to the “pressure the Trump administration exerted on scientific agencies, like a threat to fire then-FDA Commissioner Stephen Hahn if he didn’t move quickly to approve the Pfizer-BioNTech coronavirus vaccine.”

I can just imagine the reaction if a booster program becomes critical – “why didn’t the White House plan ahead and get on top of this instead of waiting until the catastrophe was obvious?”

WAPO continues both-sidesing this for many paragraphs, almost as if the authors were told they had to produce a certain volume of words. Granted, both sides are covered, but is this just a question of two honest differences of opinion when the political machinations of the prior administration are repeatedly injected into the discussion? Is WAPO really unaware of the differences between the Trump administration’s denial of the existence of a pandemic, and all that followed, versus the Biden administration’s effort to plan ahead and prepare for worst-case scenarios which are already present in places like Florida, Tennessee, Texas and Louisiana?

I have argued before that the main-stream press needs to be more cognizant of the effects of the words they use and how those words can be misused by people whose goal is not to protect the public but to score political points. WAPO seems intent upon feeding the misinformation media rather than focusing on critical issues of what is truth and what is not.

Some Lessons Learned from the Pandemic

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In listening to another press briefing by New York’s Governor Andrew Cuomo, I have noticed that he has consistently emphasized that much of what is being experienced, and governments’ responses, has never been faced in modern times. His related point is that if we want to avoid repeating the results of the past few months, we must learn from these experiences and change the way we do things going forward. We should not, he argues, just seek to restore everything from the past but build a new and better future based on the lessons learned during the pandemic. The possibilities are probably limitless but a few of them leap out at me.

Reliance on Foreign Supply

One big one is that as a society, we have come to rely on foreign sources, often but not solely from China, for many critical supplies, including medical supplies that are essential to addressing pandemic-driven illness. Cuomo correctly notes that the United States was ill-prepared to face an emergency of this nature, even though health experts have been predicting for years that a serious pandemic was virtually certain to occur.

How did we come to this situation? At the root of it, I suggest, is the “consumer mentality” of our evolved culture. Recognizing how broadly I am generalizing, it seems true that Americans generally lust for more and more “stuff” and the cheaper the price, the better. To accommodate this demand, our “free market” system of commerce turns to markets where labor and other factors permit the mass production of almost everything we lust for at prices below what they could be produced for domestically, remarkably even after the cost of transportation is accounted for. If you examine the origin labels on most of what you buy, you will see that most of it comes from China, South Korea, Vietnam and other countries in the Far East that are as far from here as you can physically get (except possibly for Australia).

Faced with these challenges from “foreign competition,” many American companies have closed their U.S. facilities and “shipped production overseas.” These decisions are supported, and sometimes even promoted, by the U.S. tax code, with the result that domestic jobs in hundreds of industries have been decimated and entire communities and even whole cities have been laid to waste. Youngstown, Ohio is one I am familiar with but there are many others all over the country.

These outcomes have not changed the demand for ever cheaper goods and have permitted companies like Amazon to dominate the supply chain for an astounding array of goods and services. If we are to believe the “reviews” on Amazon and elsewhere, much of what is produced in China and delivered in the U.S. is of low quality, but it’s “cheap” and it sells. What doesn’t sell is down-streamed through a largely invisible chain of distribution and re-distribution that sees a lot of this “stuff” for sale in so-called “dollar stores” and even second-hand shops.

If the only products we were considering were consumer electronics and such, the American lust for more and cheaper stuff would be somewhat less concerning, unless you ask someone who lives in a community devastated by the “foreign competition” that sucked local jobs dry and left the workers with nothing productive or remunerative to do.

Now comes the pandemic and we discover to our deep sorrow that we don’t have enough medical supplies to provide care of the swelling numbers of patients, many more of whom are going to die without it. Getting more supplies is now a global issue, as competition for scarce supplies erupts among countries and, we now learn, even between the states and our own federal government. The result is higher prices for everyone and still there is often a shortage requiring ordinary citizens to, for example, sew masks to try to protect healthcare workers on the front lines of patient care. If you’ve tried to buy your own masks from a foreign supplier, you may have learned, as I did, that much of the foreign supply is poorly made and often useless. And, of course, mask prices are now through the roof because government health policies are rigorously promoting/requiring mask use.

Another issue is that the federal government has allowed more than 100 coronavirus tests into the marketplace without full review. Many of these tests are sub-standard or worse. https://wapo.st/3c7V4TC

The lesson is clear, although the solutions are complicated and will, as with all major changes, take time. The United States should never again allow itself to be dependent on any foreign country for critical medical supplies. There will, of course, be a price to be paid for achieving this. Some things likely will cost more to produce here than in the “labor mills” of China. Americans will not willingly submit to the mass-production practices, and attendant low wages and poor working conditions, that dominate Chinese and other Far East manufacturing processes. So be it. Related to this is the question of foreign ownership of American companies, a readily available backdoor to foreign control of American business. We have to learn and change or face these problems all over again.

Tying Access to Health Insurance to Employment

Most Americans of working age buy health insurance provided/purchased through their employer. Putting aside ongoing issues of price/quality and coverage of options, not to mention extraordinary complexity of what is and is not covered, the real problem with this system is that when you lose your job, you lose your insurance as well. In normal circumstances, you have the option of paying for interim coverage through the COBRA program but there is no employer contribution, so the premiums are extremely high. There is also a time limit. COBRA can be a life-saver but it is economically challenging to put it mildly and highly disruptive.

The root problem is the connection between employment and insurance. There is no reason I know that this connection is immutable. Other systems exist in developed countries and seem to produce adequate or even superior protection for insureds. I am not an expert in all this, but it seems clear from the public dialogue about this that many people are invested in the current system, including the insurance companies. Many people are also opposed to greater direct government involvement on the grounds that it is “socialism.” The result is that the public discussion has partisan and irrational components that prevent a rational consideration of alternatives.

Of course, there is the issue of Obamacare that was intended to, among other things, give people the option of obtaining healthcare independent of an employer. In the gig economy that’s vital because so many people are independent contractors. When everyone’s health is tied together, as it is in a pandemic, we should be very concerned about people without health insurance and sick leave, but the Trump administration is working very hard to destroy Obamacare without proposing a replacement. Trump has, of course, denied that he is trying to end Obamacare and in particular has denied that he wants to eliminate insurance coverage of pre-existing conditions. Trump is lying about that. The Department of Justice is actively pressing litigation that would do precisely what Trump says he is not trying to do.

It is, however, clear that viable alternatives to the present system, whether it is Obamacare or something else, do exist and should be evaluated in a calmer, more rational way. I don’t know how to get there, but our society as a whole is paying a dear price for its failure to address this issue. The pandemic that has, as of this writing, led to nearly 40 million unemployed persons, has pushed evaluation of this issue to the top of the list of “must do” tasks as the United States tries to figure out what its future will be.