Is It Safe? Scientific Consensus and Trust

Trusting experts appears to be less common than we thought.

This is a fairly long discussion about the delayed dose schedule being used in the UK for COVID-19 vaccines. The plan wasn’t to send out yet more COVID-19 vaccine material, but I’ve found some of the debate around this slightly bizarre. So here are some thoughts.

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Consensus and Trust

By declaring a single dose is sufficient in the short-term, with the vital second jab coming three months later, this Government is gambling with people’s lives.

Those in care homes – where residents who have had the first dose are dying before they get the second – are once again being thrown to the wolves.

Prime Minister Johnson and Health Secretary Matt Hancock made a political decision to get a first dose out to as many as possible and extend the date for a second from 21 days to 12 weeks.

Voice of Sunday People: Boris Johnson gambles with lives by ignoring vaccine science The Daily Mirror

It is clear, at least on social media, that whether a scientific consensus is acceptable depends on the political viewpoint and framing of those considering it. The story above clearly frames the policy on delayed dose vaccine strategy as political. It is not.

Many think of themselves as rationalists assessing evidence and situations without prejudice, but sadly we are human. Our intellects make it easy to construct a narrative to make the facts fit our viewpoint, rather than the viewpoint fit the facts. The more intelligent you are the easier it is build the arguments supporting your pre-existing opinion.

The COVID-19 pandemic is throwing up interesting cases where policies based on a scientific consensus, as expressed by government expert advisory committees, are treated differently dependent on partisan views of the government.

There have been many missteps since the start of the COVID-19, by both experts and politicians. These could be variously ascribed, amongst many reasons, as to having to deal with a novel pandemic (UK planning was based on influenza), incorrect assumptions about public acceptance of policies (such as lockdown), a rigid view of what evidence is acceptable (for masks), and political decisions about the balance of the economy and public health. This isn't just the UK either, WHO and other countries made similar mistakes.

So, imagine a situation in which an expert scientific advisory committee, a learned society of relevant scientists, and numerous public health experts have advised a certain course of action to the government. Then imagine the government decided to ignore it, and go with a viewpoint expressed on both the media and social media by other scientists and other public figures. For those who consider that populist attacks on expertise and science are undermining society, this might be seen as another example that this government ignores expert opinion and science.

Yet, when it comes to the delayed second dose vaccine strategy, the government appear to be being criticised for following expert opinion and science.

The delayed dose vaccine strategy being used by the UK government is a consensus scientific position. It was advised by the Joint Expert Committee on Vaccines and Immunisations (JCVI) and has the support of the Society of Immunologists. It even has the blessing of Independent SAGE.

‘A new variant of COVID-19 is out of control in Great Britain – it’s a finely balanced decision but delaying a second dose of vaccine is justifiable, but only as part of a comprehensive ambitious strategy to suppress infections’

That isn't to say there aren't concerns about this strategy (a lot of this is covered extremely well in this podcast episode at The Times, which has a lot of competing expert views presented). These risks are known unknowns around virus mutations and vaccine efficacy, but are considered low risk, and the trade off is important. Faster roll out of single dose to vulnerable groups enabled by delayed second doses of vaccine will save additional lives as a greater number of people would be protected more quickly, even more important given the current prevalence of COVID-19 in the population. However, it is decision that is 'finely balanced' as independent SAGE says.

The JCVI rarely gets second guessed, yet this decision is opposed by the BMA, the Doctors’ Association UK, and some influential social media personalities. The media reporting of this, and social media discussion, have led to many questioning the consensus on delayed second vaccinations. Any discussion about the success of the UK's vaccination campaign on social media is instantly followed by tweets alleging that people with a single vaccine are partially vaccinated, not vaccinated at all, and accusations of government spin - despite single doses being the key metric across the world. This is despite the NHS being fully transparent about the number of first versus second doses.

Contrast this with the approach to lockdown. Even though the government has imposed lockdown in the UK, it is perceived as intellectually opposed to such measures. This is attributed to libertarian tendencies and a privileging of economic concerns over COVID-19 containment. There is debate about whether government failed to impose lockdown as soon as advised, but in the Summer/Autumn/Winter period prior to the second wave lockdown it appears clear that things could have been handled better, with accusations of failing to listen to experts, and Team Hancock losing to Team Sunak. However, any scientific consensus around lockdown measures that the government implements gets support from people who disagree with the government because it is framed as opposing the government's in-built tendencies.

Lockdown sceptics are therefore pariahs for opposing what is considered a scientific consensus. Yet those criticising the JCVI’s delayed second dose vaccine policy are often the same people criticising lockdown skeptics. For some reason, the scientific consensus as expressed through the JCVI is not respected. The policy is attributed to 'the government', removing the JCVI as the source of the policy.

As noted, the JCVI decision is 'finely balanced'. Yet the policy will be under constant review as evidence is collated, and there do appear to be studies being undertaken to inform future decision making. The policy might change due to evidence, changes in the nature of the pandemic threat, or large scale vaccination of the most at risk groups. That's fine. A scientific consensus should change over time on the basis of additional evidence. However, I'm not sure it should change in the face of a campaign that appears to be based on a slavish sticking to a product licence (granted on narrow terms on clinical trial evidence, rather than the wider remit the JCVI have), and a need to kick every government decision on the basis that everything they do is by default wrong.

To be clear, to have a differing view of the evidence and the assessment of the risks is fine, and there are individuals making that case well (see the already noted podcast). It is the attempt to paint this as spinning vaccination figures by the government, calling it partial vaccination, or ignoring the fact the government policy is based on expert scientific advice, that is the problem. You cannot complain that the government don’t follow scientific advice on issue X, but then on issue Y complain when they do.

There's an alternative universe where the government disagreed with the JCVI, and insisted on the licensed dosing schedule for vaccines. No doubt they would then have been accused of ignoring scientific advice that might maximise vaccine roll-out to vulnerable groups, and then have been blamed for every additional death this policy caused.

There is no evidence that the JCVI have come under government pressure to give the right answer. It is not even clear why the government would have a independent position on this matter, apart from wanting to follow expert advice to maximise vaccine benefits and reduce deaths. If the accusation is that the government is trying to cover up mismanagement of the second wave by maximising roll out of the vaccine to save lives, I'm not sure trying to prevent them saving those lives by enacting this scientific advice is an entirely sound position to hold.

There comes a point at which we need to have some trust in systems in place, even when they have made mistakes, as is bound to happen when making decisions based on limited information in time restricted circumstances. You can't run an effective science or evidence based approach to policy in government when no trust exists. We have to trust organisations like NICE, the MHRA, SAGE, and JCVI. Even when they make mistakes. Back in 2002, Onora O'Neil wrote this in the Reith lectures.

'We live in an age of communication technologies. It should be easier than it used to be to check out strangers and institutions, to test credentials, to authenticate sources, and to place trust with discrimination. But unfortunately many of the new ways of communicating don't offer adequate, let alone easy, ways of doing so. The new information technologies are ideal for spreading reliable information, but they dislocate our ordinary ways of judging one another's claims and deciding where to place our trust.'

This was pre-social media, but if anything the situation has worsened. Something we should all agree with is that scientific advisory committees should be a default trusted source, and we should accept that 'childish fantasies that we can have total guarantees of others’ performance' are fantasies. Mistakes will be made, but without trust in institutions we merely end up with a competing morass of voices, and then politicians will have the excuse to pick the loudest, rather than the most expert, voice.

Stay safe.

Anthony

Don’t forget to report your suspected adverse effects from medicines and vaccines. In the UK, this means using the Yellow Card Scheme.