Science vs. bureaucracy

A New York Times online article today echoes many of the same thoughts that I wrote about in my Missed Opportunities & Misinformation blog post. The Pulitzer Prize winning author, David Leonhardt, was commenting on the terrible job the FDA does explaining to the American public why the vaccines needed boosters, and who would benefit. He comments on a discouraging trend by our national leaders: "Again and again, government officials have chosen to follow pre-existing bureaucratic procedures even when doing so has led to widespread public confusion and counterproductive behavior." He goes on to say:

Officials often defend this approach by saying they merely “follow the science,” but that’s not quite accurate. When there is a conflict between scientific evidence and bureaucratic protocols, science often takes a back seat.

Consider:

At the start of the pandemic, health officials around the country were desperate to conduct Covid-19 tests, but the C.D.C. sometimes kept those officials from developing their own tests — even as the C.D.C.’s own initial test was a failure.Around the same time, federal officials discouraged the public from wearing masks, saying there was not enough evidence to support them — despite masks’ longtime effectiveness in Asia and inside hospitals.For much of this year, the F.D.A. refused to grant full authorization to any Covid vaccine — even as its top leaders were saying the shots were safe and effective and urging Americans to get vaccinated.The F.D.A. has been slow to approve rapid Covid tests, which helps explain why Britain, France and Germany are awash in the tests — but your local drugstore may not have any.

The repeated slowness of U.S. officials stems from a worthy goal. They want to consider the scientific evidence carefully before making decisions. They want to avoid confusing the public or, even worse, promoting less than optimal medical treatments. 

Yet in their insistence on following procedures that were not written with a global pandemic in mind, officials have often ended up doing precisely what they sought to avoid. They have perplexed the public and encouraged medically dubious behavior.

Compare our American experience with that of a small European country, Portugal, which soundly defeated the pandemic and reopened their country. Portugal is among the world’s leaders in vaccinations, with 98 percent of those eligible for vaccines now fully vaccinated. In January 2021 however, much as in the US, Portugal's health system was collapsing under the crush of COVID-19 cases. Then in February the political leadership turned to a retired Admiral, Gouveia e Melo, with a background working on complicated logistical challenges in the military. He was a popular choice, a seafarer in the country where Magellan was born, and widely known to be apolitical. He assembled a medical and military logistics team outside of government influence and took on solving the distribution of testing and vaccination like a campaign. His legacy is a country with open stores, cafes and sports venues, with few COVID cases. Read about the Portuguese solution here. The contrast to our country is striking.

My  plea to FDA, CDC and NIH: I'm trying to get the message across and help my patients get through this pandemic. You aren't making it any easier.