Strength of the Counter-Argument to Public Advocacy

On Dec 10th 2020, Zeynep Tufekci made a public argument for a trial of the single dosage of the Pfizer and Moderna mRNA vaccines on her mailing list, Insight. When I first read the argument and it’s basis on the apparent safety and efficacy of just the single dose of the Pfizer/BioNTech vaccine, as described in the official peer-reviewed paper, I agreed with Tufekci. Her argument is a solid one and poses the central question: Is vaccinating 95% of 50% of available doses better than 60-80% of the total available doses? The answer is equally simple: No one knows yet. Some inferences can be drawn from the data of the 1300 people who didn’t get the second dose in the original N = 40,000 clinical trial. But this subset of 1300 people is not as random as the original well-designed trial. Another clinical trial, the advocacy for it in as many public forums as possible and subsequent funding / trial design seems like the prudent way to go forward, as Tufekci describes in her post.

On Dec 30th 2020, Tufekci posted philosophy professor,Matthew Noah Smith’s counter to her original argument on Insight. I read that post today and found it to be particularly weak. This post goes on to explain why I felt that, and the peculiarities in Smith’s post.

The post intrigued me because I was looking forward to a rousing philosophical debate on the greater implications of whether public advocacy was really flawed in high-stakes situation. Unfortunately, the post doesn’t go much beyond this particular case.

For context, the number of available doses hovers around 50 million for the US right now. This question is already being faced by several other countries (Indeed, the UK has decided to go ahead with the single dosage regimen).

As can be seen, the incidence of Covid-19 drops off dramatically about 10 days after the first dose (look at the chart on the top left). However, the trial is designed to measure the efficacy of two doses: a prime and a booster. Eyeballing (we don’t have the underlying data), the first shot seems to have 65-80% efficacy in the full group—but we don’t know for how long that lasts.

One might argue accurately that countries scarcely have the time to accommodate philosophical arguments, that the best thing to do right now is the thing that will reduce short-term and long-term adverse outcomes. I will table that for the time-being.

Putting that aside, here are some things that I couldn’t reconcile within Smith’s argument, that ultimately lead me to believe that Smith’s argument is weak.

The cautious optimism/overt pessimism fork in attitudes

Here are some quotes from Smith’s article:

It is more difficult to weaponize technical language used in academic journals and grant applications than it is to weaponize exasperated charges of epistemic irresponsibility made in places like Twitter. For this reason alone, we should restrict calls for single-dose trials to venues where experts engage other experts.

Bad actors with power have regularly harmed marginalized communities in the name of science. This same pattern of oppression could be reproduced when it comes to vaccine distribution. … The rhetoric around a single-dose trial could be twisted by people as a pretext for denying second doses [to] the marginalized. (sic)

This plays into the pernicious pandemic wartime imaginary we’ve all been invited to take up. Doctors and nurses are “heroes” who have been at the “front lines,” and hospitals are “war zones.” Once we couple this with the firm conviction among conservatives that the police are a beleaguered identity group, an easy strategic choice in response to vaccine distribution woes will be to deny poor communities and communities of color both doses of the vaccine until all those “battling” the virus receive two doses.

I find that the fork in Smith’s argument’s attitudes towards similar groups of people remains unresolved: Smith is very optimistic that the conservative media will not find an article or letter in the Journal of the American Medical Association (JAMA) or find it hard to exploit; while being extremely pessimistic about the outcomes of public advocacy: namely, a coordinated and racist effort to ensure that police officers and other “front-line” workers will be given a 2-dose vaccine regimen, at the cost of the poor, homeless, and other vulnerable demographics; all of whom also have the least access to healthcare.

This dichotomy is hard to reconcile. The conservative media and the government bureaucrats and lackeys that Smith is splitting up in his article are both on the same side of the political spectrum, and ostensibly very close to each other in terms of both social and economic policies. Why would one group be particularly restrained about legitimizing single-dose regimens using a JAMA letter, whereas the other group would use a public version of the same content, to actively prevent particular people from being vaccinated? One must argue either that they are all con-artists who want to find the slightest shred of scientific doubt, and use it to exclude people or that they are restrained, well-intention-ed actors, whose moral threshold for converting scientific doubt into a strategy, lies somewhere between a New York Times article and a JAMA letter. Smith seems to be arguing for the former, but this quote is an outlier and doesn’t make it too far.

All they need is quasi-scientific cover for unequal spatial distribution of a two-dose vaccine distribution.

Smith’s overt, almost militant, pessimism towards the prevention of the second dose for a particular group of people seems unnecessary and hard to justify: Even if it was just informal policy, any widespread attempt to deny second vaccine doses will quickly become a big story in the Liberal media. Moreover, states where the state legislatures are Democrat-controlled do exist (albeit, they are in the minority). Vaccine efficacy rates in these states will be much higher even when the same number of doses per-capita have been doled out; scientists and pundits will both be hard-pressed to find the reason and this (in)formal policy would be the primary suspect.

Are Technical articles harder to exploit for political gain?

While it is impossible to prevent cynical politicians from weaponizing science for short-term gain, simple precautions should be taken. One tactic is to avoid turning a scientific disagreement into acrimonious public disagreement. It is more difficult to weaponize technical language used in academic journals and grant applications than it is to weaponize exasperated charges of epistemic irresponsibility made in places like Twitter.

The second peculiarity in the argument is that Smith vehemently believes that it will be considerably harder to demonize the kernel of scientific doubt, inherent in everything, if that doubt is expressed in a JAMA letter, whereas it will be far easier to exploit if it was done through a post on Tufekci’s blog, a New York Times article, and a press conference at Harvard. Considering that the conservative media is made up of competent institutions which have researchers combing through public discourse to find chinks in the armor of the 2-dose vaccine regimen’s requirement, there is no doubt in my mind that they would find the JAMA letter. Given that base assumption, what makes a JAMA letter harder to exploit? The content would have been the same. Smith says the same thing, “All they need is quasi-scientific cover for unequal spatial distribution of a two-dose vaccine distribution.”, although this acceptance doesn’t affect his underlying argument.

Going one step further, I argue that the JAMA letter approach would be detrimental to Tufekci’s cause, as the journal article would have far fewer readers. It would not enter the organic news feeds that are consumed by people who don’t get their news from conservative media. They might even come across the article first through coverage of conservative media on other media outlets as a “Factcheck” or as “Media critic”, which substantially reduces the power of the advocacy.

The story that deserves to be publicized is not the one that the Conservative media took a JAMA letter and mis-categorized it. This would invariable be what goes into the feeds watched by Liberal news consumers. The coverage of the story will become the story, similar to CNN coverage of the Healthcare bill’s repeal.

In fact, in the quote at the beginning of this section, Smith seems to accept that it’s impossible to prevent cynicism, and that these would simply be measures that might work. Weighing the argument for a single dose trial (which could potentially double the number of vaccinated people) against the off-chance that cynical politicians and media outlets on the right will be sloppy and miss a JAMA letter, the former’s superiority, in terms of better, wider, positive outcomes, is clear to me.

Tufekci’s argument’s coverage will mislead non-medical observers

My final qualm with Smith’s argument is his belief that the stories covering the strategy that Tufekci took will be confusing or misleading, even if they don’t intend to be.

Even though the public message is that we should trial a single-dose vaccine, it is reasonable for someone unfamiliar with how medical research works to infer from a news story about the proposal that a single dose would be sufficient for vaccination. Furthermore, it is reasonable for someone who sees a story on TV about a study of single test efficacy to then describe it to acquaintances as a story about how only one dose of the vaccine is needed. After all, isn’t it rational for these non-experts to infer from respected professors aggressively advocating in public for a single-dose trial that a single dose would be sufficient? Why else would they be so vocal and so insistent on the urgency of a trial?

The intensity of emotions around these issues does not make trivial, often ersatz, scientific disagreement less likely to be perverted into a tool to discredit even the most widely accepted views.

What will happen if rhetoric supporting a single-dose trial is weaponized? It is difficult to determine. We have some evidence from both this pandemic and the anti-vax movement that non-trivial portions of the population might, on the basis of the weaponization of public advocacy for a single-dose trial, reject public health guidelines around vaccination.

This lies in direct contrast to something that he says just a few paragraphs before:

If a trial is warranted, then we ought to have some confidence that a single dose of either vaccine would be effective. But we also should have sufficiently low confidence that a single dose would be effective. This is exactly why a trial is necessary.

Smith seems to be saying that non-medical readers will somehow “miss the point”, even in good faith coverage of Tufekci’s strategy. I don’t think this is true or fair. The problem is not with the coverage, but with how most people consume the news: in short bites, as web page titles OR the first 2-3 minutes of a YouTube video describing the story. A consumer who reads Tufekci’s article, even just the first few paragraphs, will not come out believing that a single dose is better or efficient enough. To her credit, the article on Tufekci’s blog doesn’t even mention her argument in the title. It is a broader appeal for effective policy-making in the absence of sufficient data.