Who is accountable: political leaders or the scientists who advise them?

Regarding Anthony Fauci, Former White House COVID Czar Ashish Jha says:

Politicians are to blame for bad decisions; scientists just advise them.

Is this true?

Theoretically, this is how it is supposed to work. A scientist can tell you there is a 30% chance there will be a hurricane, but a politician has to decide whether to close the beach. In this case, the politician is judged for the wisdom of the closure, but the scientist can still be judged on the accuracy of the prediction. If a scientists is found to consistently inflate the chance a hurricane will strike our town— the scientist could face scorn.

Yet, this is ideal. A scientists gives probabilities and trade offs and policy makers decide. But that isn’t close to what we have today, and that certainly doesn’t capture the role of Anthony Fauci.

Today, we have activist scientists.

Remember the 2025 debate about the hep B vaccine. Should it remain universal at day 0, or should it consider the mother’s hep B status (and actual risk) and maybe be delayed a month or two? That was the question.

I didn’t hear anyone say: If the mother tests negative with an ultra-sensitive assay, the kid’s risk of contracting hepatitis in wks 0-8 is 0.00000000000001%, so a policy of allowing people to delay a month or two would introduce only two risks: the infinitesimal risk of contracting the virus in the delay period and the larger risk of loss of follow up (which we still estimate to be 0.003%), and the trade-off would be a demonstration of less dogmatism in vaccine schedules (a new national priority in a nation which has erred the other way) and alignment with some European nations. So there is a trade off for policy makers to consi…. No, no one said that. The medical establishment view was: shut up and keep getting that shot minutes after you are born. They even made new vaccine schedules by different medical societies, rather than articulate the trade off.

Actually, it was worse. Doctors pretended we don’t have ultra-sensitive assays. They seemed to argue we had to use bad tests. Worse, they refused to admit some women and families are truly low risk— you don’t need to be a rocket scientist to find them. Second, they also refused to admit we know very little about the potential side effects of universal dose 1 at day 0 vs a delay. I could go on and on, but the discussion was 0% scientific.

One final note: there was actually one doctor smart enough to make these points at the time. Who else…

Is there an argument to be made for turning down the outrage on the hepatitis B vaccine decision?

That’s just how medicine is these days. Congress people want to be tik-tok stars. And scientific advisors want to be politicians: with the insipid slogans and fliers, rather than real consideration of the nuances.

Fauci was the king of activists.

Fauci didn’t say: if you open schools, community transmission will increase by 1 in 10,000 cases per week, but 100 kids will gain on average a week of schooling, which translates into 0.0004% net increase in longevity. He said close schools. (And his diary admits to doing this on phone calls with politicians. Publicly he famously criticized DeSantis for reopening).

He didn’t say: if we forced masking, we might slow community spread by 0- 0.00002% percent. He said: wear a cloth mask, even if you are two years old. Sorry, I meant no mask. Did I say no mask, I meant double mask! It would have been comedy had it not been so real.

He made specific policy determinations on television, in private calls with politicians, and bulldozed anyone who disagreed. Not once, did I hear him describe trade-offs. Instead, he already decided the “correct” course of action.

Then he turned out to be incorrect on all the points. Government coercive lockdowns did not save lives (and probably barely impacted behavior) over voluntary choices. Not seeing dying relatives in nursing homes was a human rights violation. Masks did nothing. School closure was net harmful, etc, etc.

His diary makes me worried he actually doesn’t see the world as trade-offs. I doubt he knows any of the parameters I mentioned above. I think the diary reveals that far from being a scientific “mastermind” his grasp of the evolving science of epidemiologic and economic trade-offs is quite limited.

So: who is to blame? Politicians or their science advisors. That depends on whether the advisors did their job, or instead if they usurped a larger role.

In many ways, Fauci was meant for Shakespeare. Even his name is perfect: Anthony Fauci. An ambitious man, struck with his own vanity, pushing others to do and do more outrageous acts to please the gods, and then gradually, the illusion vanishes,

“Th’ abuse of greatness is when it disjoins remorse from power.”

could be a line in the play.