The Johnson and Johnson vaccine against COVID-19 might not be as effective as the sought-after Pfizer and Moderna vaccines, but it has a major advantage: it only requires one dose, instead of two doses several weeks apart. Not only does it mean health authorities aren’t left deciding whether to delay the second dose so more people can get a first one, but people who are reluctant to get vaccinated - or are just really, really terrified of needles, might be more willing to get a single shot.
That was the hope, anyway. Now that the FDA is asking that use of the Johnson & Johnson vaccine be paused, because of blood clots in some recipients, vaccine-hesitant people may no longer trust it. Or even any other vaccine.
The U.S. Food and Drug Administration's decision to recommend a pause in distribution of the Johnson & Johnson COVID vaccine has been roundly — and rightly — condemned across the political spectrum. It's clear that the hypersensitive "abundance of caution" standard the FDA applied is inappropriate for a global pandemic. Less well recognized is that the same standard, applied during normal times, also has enormous costs for lives and health of Americans.
The FDA acted after blood clots were observed in less than one in a million people who have received the J&J vaccine in the U.S. By contrast, COVID has already killed 1,712 out of every million Americans. What's more, from the information the FDA released initially, it was not clear that any of the blood clots were fatal, though officials later said one woman had died. By its own admission, the agency does not know if there is a causal link between the vaccine and the clotting.
Sadly, this kind of deadly overweighting of costs relative to benefits is not uncommon at the FDA.
No decision rule is perfect, and oversight agencies (public and private) inevitably make mistakes. But analysis by researchers at the Massachusetts Institute of Technology suggests the FDA's basic approval standards are too cautious.
These standards persist in part because it is extremely easy to measure the lives lost by a drug's side effects, but it is nearly impossible to calculate the lives lost by a drug never having been introduced at all. Would it have mitigated the illness it was designed to treat? Would it have complemented or discouraged the development of later therapies?
To be fair, I don’t envy people in charge of regulating medications and vaccines, even at the best of times. During a global pandemic it’s even more stressful. And they do have a duty to inform people of possible side effects.
The FDA could have done that without pausing the use of this vaccine altogether. My hope is that the Johnson & Johnson vaccine will be given the go-ahead before too long - it might even be back into use by the time you get this newsletter - but the damage may already be done. Even here in Canada people are turning down the AstraZeneca vaccine, and I won’t be surprised if the same thing happens for this one.
As for me, I stand by what I wrote a few weeks ago: not only am I more than willing to get the AstraZeneca or Johnson & Johnson vaccine, I would actually prefer to get one of them. Even if Pfizer or Moderna can be considered “better,” there are many more people out there who need it much more than I do.
Quebec is actually letting people specify that they want AstraZeneca vaccine. If Nova Scotia does the same, I’m in.
Canadians are used to our government being much more competent than that of our neighbours to the south, so the Americans vaccinating their people much faster than us has us feeling like Frank Grimes (or “Grimey,” as he liked to be called) learning that Homer Simpson can afford lobster.
Jonathan Kay, writing for The Washington Post, explains what a blow this has been to Canadian smugness about ‘Merica:
Until the Barack Obama era (or, for us, the Stephen Harper era), Canadian attitudes toward the United States featured an even mix of material envy and moral smugness. Yes, Americans had more stuff than we did: wealth, higher rates of homeownership and bigger homes when they had them. But surely our single-payer health system, thicker social-safety net and pacifist foreign policy marked us as more enlightened and compassionate. During the later Cold War, the natural tension between these two sentiments effectively defined Canada’s national superego.
But that tension began dissipating 15 years ago when the U.S. financial system and housing market fell apart and Canada’s economy remained relatively unscathed. In the years following, median household income in the two countries headed toward parity. This was followed by the ascension of U.S. President Donald Trump, the embodiment of liberal Canadian stereotypes that present America as a land of perpetually agitated, low-information hotheads and bigots. Our envy evaporated. Now it was just untethered smugness.
[…]
Which is why it hit my Canadian pride especially hard when I learned that Florida Man’s home state, of all places, just dropped vaccine eligibility to 18 years old. Every adult in the state can sign up to get vaccinated. This is Spring Break Central we’re talking about — not, say, Vermont or Massachusetts, places that Canadians tend to regard as culturally kindred regions.
By way of comparison: I’m 52 and have no idea when I’ll be vaccinated (though I doubt it will be later than the end of May). As of this week, only 1.88 percent of Canadians have received both doses of the vaccine, less than a tenth of the corresponding figure in the United States. Within a month or two, the United States is going to have a vaccine surplus, in fact, and my country will be joining Mexico and other nations in the lineup for your leftovers.
For months, Canadian media have been blaming Prime Minister Justin Trudeau for failing to get more vaccine doses into our supply chain sooner. (Editorial cartoonists have shown him on the phone with Big Pharma, in various states of distress and indignity.) But the real problem is that, for all our Canadian smugness, our country hasn’t produced a single dose of vaccine, the one technology that will allow us to return to normal life. We’re entirely beholden to imports. And it’s not surprising that Pfizer, Moderna and Johnson & Johnson have collectively prioritized the needs of their American home market.
In the long run, the most important indicator of how nations deal with the pandemic will be the number of people who die. In per capita terms, Canada has done better than the United States. The covid-19 death toll in the United States has reached roughly 1 in every 580 Americans. In Canada, the death rate is 1 in 1,613.
But in the short run, Canadians are learning a lesson in humility. We’re being reminded that, despite America’s political meltdown, increasingly loony media culture, and precariously unequal social structure, the United States remains a scientific and economic powerhouse. Say what you want about the cruelties of U.S.-style capitalism, but when Americans want something, they tend to get a lot of it — and quickly. Canada, meanwhile, remains a relatively small country completely dependent on others, the United States especially, for the goods we need.
I can laugh all I want at Florida Man. The fact of the matter is that I’m locked down at home while he’s out having a blast.
Florida Man is celebrating America’s relative success with vaccination by shooting into hurricanes.
The good-ish news for any jealous Canadians is that the American FDA, through its muddled messaging and questionable decisions, might narrow our countries’ vaccination gap all on its own.
The Americans also have this asshole. (I mean Carlson, not Patterico. Patterico is fine.)
Thanks, Unilever!
Glad they know it was murder, for which specific intent to kill is required, too. Maybe they should be in the mind-reading business instead of delicious but overpriced ice cream and soap. (Kim Potter, the police officer who shot Wright after apparently mistaking her gun for a Taser, is being charged with second degree manslaughter, which seems much more appropriate. I’m gonna have so much fun explaining this to the outrage addicts on Twitter.)
Anyhoo, I am pleased to see that Ben and Jerry’s is bravely calling for police abolition from notoriously crime-prone Vermont, and that they will not uphold this system of white supremacy by pursuing criminal charges next time their stores are robbed.
Hook it to my veins
Explaining finer legal points to people on Twitter sounds like a great way to use the day. Almost as good as staying in bed with a migraine *-}