How do you judge a vaccine program?

Excess Mortality is not the only measure that matters

How should you judge the success of the COVID vaccination program? A recent JAMA IM paper claims Republicans did worse post-vax— b/c of higher excess mortality. But is this the sole metric of success? I don’t think so.

A good vaccination program does the following

1. Results in receipt of the vaccine among people who benefit

2. Minimizes receipt of the vaccine among those who do not benefit (in absence of herd immunity considerations)

3. Voluntary choice is better than coercion

4. Informed consent is better than uninformed persuasion (values freedom)

5. If herd immunity is at play— i.e. if the vax halts transmission— researchers demonstrate the threshold necessary and prioritizes #3

6. Researchers do not delay FDA EUA of the vaccine merely to sabotage an ongoing election

7. Regulators monitors safety concerns carefully, and rapidly respond to changes.

Let me run through these 7 points

1. Give the vax to those who benefit.

This isn’t controversial. If a vax benefits an 85 year old woman in a nursing home who hadn’t had COVID prior, then a good program would increase the percent of such people who get it.

Interestingly, the US did worse than the UK here. B/c the US prioritized a 27 year resident at Stanford over an 77 year old professor of economics at Stanford.

2. Minimizes receipt of the vaccine among those who do not benefit (in absence of herd immunity considerations)

COVID 19 shots don’t stop transmission. Ergo, there is no herd immunity consideration. And giving a booster to a 20 year old man who had COVID after 2 shots is net harmful. A good vaccine program would not have done this. Mandating a booster to this young man is negligent. Ideally, universities would be litigated for having done this (both civil and criminal penalties). Ultimately, vaccines cannot be shielded from litigation, and the company and universities should be sued.

Side bar: Why excess mortality is not the right consideration

Already you can see why excess mortality is not the right benchmark. It gives all the weight to maximizing #1, with no consideration of #2. You could force all Americans to get 25 COVID shots or put them in prison. You would increase 85 year olds who got the shot, but blow the hearts out on many young men. Excess mortality would capture the former, but the latter might take years to fully declare the long term damage (in the fraction of young men).

3. Voluntary Choice is better than coercion

Given that COVID shots don’t help other people, then coercion is always unethical. Use of mandates or threat of losing one’s job are inappropriate and should count against programs. Freedom matters. It also preserves trust in public health for a long term reputational game.

4. Informed consent is better than uninformed persuasion

Giving people the facts, especially absolute risk reduction by age, is needed. Telling an 18 year old man who had COVID to get a booster— with zero idea if it is a net benefit is not appropriate. Most vaccine campaigns engaged in uninformative persuasion sadly, which infantilizes the public and breeds distrust in public health.

5. If herd immunity is at play— i.e. if the vax halts transmission— researchers demonstrate the threshold necessary and prioritizes #3

Herd immunity was not in play with COVID19 shots, but the FDA failed the American people by not requiring manufacturers to randomly swab household contacts of a sample of individuals in the RCT to learn about transmission. Herd immunity thresholds offered by Fauci and others were fabricated.

6. Researchers do not delay FDA EUA of the vaccine merely to sabotage an ongoing election

As I detail in this paper, the initial EUA was delayed for no medically valid reason. This should be held against the US effort.

7.Regulators monitors safety concerns carefully, and rapidly respond to changes.

This had to have been dishonest when it was said, and is emblematic of the USA ignoring every safety signal. VITT should have led to revocation of J&J early. And myocarditis should have led to omitting dose 2 in young men. The USA did not take safety seriously.

Conclusion

These 7 metrics are more comprehensive than excess mortality, and should be the basis to judge vaccine programs. By these metrics, because of the the heavy handed use of mandates and the negligent FDA regulation, the USA does not do well. Which political party’s members had higher excess mortality is a partisan talking point but does not advance the discussion of vaccine programs meaningfully.