Should Scientists Openly Debate Vaccine Policies?

Or does that only confuse the American public and embolden anti-vaccine activists.

Scientists constantly question the validity of scientific studies. It’s what they do. If you’re a scientist presenting at a national meeting, you benefit from discussions about the robustness, reproducibility, and internal consistency of your findings. Are your data strong enough to support your conclusions? Scientists welcome this scrutiny. It’s how their research improves.

This important back-and-forth doesn’t work well in the public arena. Openly questioning the strength of scientific studies behind public health recommendations is neither encouraged nor welcomed. Here’s a specific example:

In June 2022, the FDA Vaccine Advisory Committee met to discuss the omicron variant, which had entered the United States in late 2021. Omicron was immune evasive. This meant that people who had been previously vaccinated or naturally infected could still develop mild illness, some severe disease. In response, the FDA, in concert with pharmaceutical companies, reasoned that a bivalent vaccine was the answer. Instead of giving a full dose of the SARS-CoV-2 ancestral strain—which had been the only vaccine used since late 2020—let’s give a half dose of the ancestral strain and a half dose of an omicron variant. As it turned out, this wasn’t a good idea. Studies by researchers at Columbia and Harvard later showed that those who had received the bivalent vaccine in 2022 didn’t develop neutralizing antibody responses against omicron greater than that induced by the ancestral strain only. Also, clinical studies done in the United States, the United Kingdom, and France showed that the bivalent vaccine wasn’t better than the monovalent vaccine at preventing symptoms. It wasn’t worse. Boosters still boosted. But it wasn’t better.

Despite these data, some prominent health officials continued to claim that the bivalent vaccine wasn’t only better than what we had, it was much better. Dramatically better. In response, several scientists offered that this wasn’t the case. Publicly. And they were hammered for it. Many health officials, clinicians, and advocates believed that by countering a public health message—even one that wasn’t clearly supported by the science—these scientists had made it look like we didn’t know what we were doing. And that we were only encouraging anti-vaccine activists. Fortunately, the experience with the bivalent vaccine was a lesson quickly learned. No longer do we tether Covid vaccines to the ancestral strain, as we did in 2022.

In a better world, we wouldn’t worry about publicly debating the strength or weaknesses of scientific studies that lead to health policies. Indeed, the public would enjoy the debate—happy to be part of the scientific process of learning as we go. We would all welcome the transparency of the decision-making process, further engendering trust in the people and institutions responsible for those decisions. In this new world, the divisive, mean-spirited rants against the FDA, CDC, scientists, clinicians, and health officials would melt away, only to be replaced by a shared appreciation for how we are all in this together—all just trying to do what is right. In this better world, anti-vaccine activists would thank the academic and public health community for spending millions of dollars showing that vaccines don’t cause autism or diabetes or hyperactivity disorder or sudden infant death syndrome. Robert F. Kennedy Jr. would publicly apologize for his false and misleading claims about Covid vaccines, asking for forgiveness from those whom he had put in harm’s way. And Donald Trump would take to the airwaves to regale the American public with calming couplets from his favorite British romantic poets.

The point being, we don’t live in that world. In this world, any deviation from hardline support of public policy, no matter how thinly backed by the science, is viewed as a betrayal. In the words of Ken Kesey, “you’re either on the bus or you’re off the bus.”

Scientific debate is the cornerstone of crafting studies that are better. We should be able to have these debates in public. We should be able to trust that those involved in public health are trying to get it right even when they might not get it right the first time. But because we are so distrustful, so divided, so quick to see conspiracies, we often stifle a public debate that would be valuable for all to hear.