The preliminary results of the mRNA vaccine randomized controlled trials (RCTs) by Pfizer and Moderna were celebrated as spectacularly successful and so governments and the media assumed that the solution had been found. A procession of leaders assured the public that the vaccines were so effective that once injected, you would not become infected or pass infection on to others.
Government programs need to be rigorously evaluated, particularly when they affect public health and individual rights. The objectives should be clear, whereas in this case they were vague and constantly shifting. And the outcomes data should be straightforward, whereas in this case they depend on complex and variable statistical processing of small samples.
In response to this hypothetical scenario, governments panicked, ignored their own pandemic preparedness plans and adopted high-risk strategies that imposed restrictions on individual liberty never seen before. These countermeasures caused major harms and collateral damage, including loss of lives from delayed medical care and the medium-term aftereffects of increased unemployment and increased extreme poverty (for example the World Bank found that ‘the pandemic led to 97 million more people being in [extreme] poverty in 2020’).
Policy in public health should be only made on the basis of the evidence available. The evidence available indicates that the strategy of universal vaccination of the whole population exposed some groups to unnecessary risk, and that a differentiated risk-based strategy would have led to better outcomes. Some countries are now belatedly moving in this direction at least for boosters.
Both universities and governments imposed extreme policies, extending to the micro-management of everyday life during lockdowns and gross violations of human rights, including the right to bodily autonomy. These extreme policies were not supported by hard evidence of effectiveness either at the time or since.
There has been a general feeling that in a public health emergency, anything goes. But on the contrary, in a public health emergency, when so much is at stake, the utmost care needs to be taken to find the right path, and not to fall into error, leading to unintended consequences. This involves exploring different paths rather than mandating one path and preventing any possibility of reconsideration.
Governments got it all wrong. They should have chosen the mitigation strategy all along, leaving the management of pathogens to actual medical professionals who deal with individuals and their problems rather than push a central plan hatched by computer scientists, political leaders, and their advisors..
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