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JCVI endorses Status Quo Bias

The UK's Joint Committee on Vaccination and Immunisation recently recommended against vaccinating children under 16 against Covid, despite granting that "the benefits from vaccination are marginally greater than the potential known harms." (Of course, aggregated over a subpopulation of millions, even "marginal" improvements in risk profile can result in several saved lives and scores or hundreds fewer hospitalizations.  And, as Deepti Gurdasani makes clear in this thread,* all the evidence should lead us to expect the "unknown" risks from Covid to outweigh those from the vaccine, so taking uncertainty into account should lead us to regard vaccination as all the more important.)So what's behind the JCVI's verdict?  They are at least admirably transparent:In providing its advice, JCVI also recognises that in relation to childhood immunisation programmes, the UK public places a higher relative value on safety compared to benefits.It's important to be clear on what this really means. Note that this is not invoking any kind of philosophically defensible harm/benefit asymmetry.  (Many people think it's more important to reduce suffering than to promote happiness, but that's not what this is about.)  Vaccines aren't to make you happy. The "benefits" they provide are specifically safety benefits, i.e. against other health risks.  So what the JCVI is really saying is that they place higher value on protecting people from potential harms from [More]

The Ethics of "Off-Label" Vaccinations for Kids

The WSJ reports that some parents hope to get their kids (under 12) vaccinated against Covid, as "the FDA’s approval generally means vaccines are eligible for off-label use, meaning beyond approved populations."  However, "the FDA and Centers for Disease Control and Prevention have emphasized that the safest thing for this group of children is to wait for more data to be analyzed."I'm curious whether it's really true that waiting is "safest", or whether these advisories ignore status quo risk. I don't have the empirical knowledge to answer what really would be safest here, but questions worth asking include:(1) How many kids in this age group are expected to (i) suffer serious ill-effects, or (ii) die from Covid during this "wait"?(2) Given our background knowledge of similar vaccines, including the results of clinical trials for this vaccine on adolescents, what proportion of kids would you expect to (i) suffer serious ill-effects, or (ii) die if administered a "best guess" fractional dose of this vaccine?It would be pretty extraordinary if the vaccine posed a greater risk of death than Covid.  But if it doesn't, that would surely go some way towards undermining the assumption that waiting is necessarily "safer": it increases your child's risk of death!  Perhaps the risk of non-lethal but still serious vaccine side-effects could be great enough to outweigh the (typically mild) risks from Covid for this age group?  Maybe... The comparative risk [More]

Pandemic Paralysis

I'm continually appalled by how easily people move from "the consequences of doing X are uncertain" to "X must be banned!", even when there would seem every reason to expect that X actually has high expected value and ought to be encouraged, if anything.The latest example is X = J&J booster shots for the immunocompromised (or, indeed, everyone):The weasel words there ‘isn’t enough data to determine’ indicate a typical failure to think in Bayesian terms and use all the information available and a typical failure to think in terms of patient welfare and expected cost and benefits.Notice also the illiberal default. Instead of saying ‘we don’t have data on the J&J vaccine and the immunocompromised so we are not at this time recommending or not recommending boosters but leaving this decision in the hands of patients and their physicians’ they say ‘we don’t have data and so we are forbidding patients and their physicians from making a decision using their own judgment.’It's an ongoing problem in our pandemic response that prudent precautionary measures like this get blocked, without any positive medical justification, because the Powers That Be don't follow decision theory and instead insist that we all must sit passively on the tracks, ignoring the oncoming train, while they order routine safety checks on the service ladder.Apologies for sounding like a broken record on this, but this problem of pandemic paralysis is (i) really serious, and (ii) insufficiently [More]

'Risky Research' Redux

I'm looking forward to participating in 1DaySooner's Zoom panel discussion on 'What is the Upper Limit of Risk in Clinical Trials?' next week (May 4th, @6pm ET) -- you can register here if you're interested in attending.My basic view is that there is no absolute upper limit: given informed consent, the risk just needs to be proportionate, i.e. outweighed by the social value of the information gained from the research.Indeed, this strikes me as entirely straightforward.  There are two key values that public policy should be guided by: beneficence (promoting the overall good) and autonomy (respecting individuals' choices about their own lives).  Conflicts between the two values can be morally tricky.  But if both of these values point in the same direction, as they do in the case of valuable research involving willing volunteers, then it really should be a no-brainer.  There's just no good reason to engage in anti-beneficent paternalism.  So: let's please stop doing that!I think that's the simplest case for "risky research".  In my paper with Peter Singer, we additionally proposed a principle of risk parity according to which, "if it is permissible to expose some members of society (e.g. health workers or the economically vulnerable) to a certain level of ex ante risk in order to minimize overall harm from the virus, then it is permissible to expose fully informed volunteers to a comparable level of risk in the context of promising research [More]

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