This week, emails released through a Freedom of Information Act request filed by the American Institute for Economic Research revealed what I see as worrisome communication between Francis Collins, Anthony Fauci, and others within the National Institutes of Health in the fall of 2020. At issue was the Great Barrington Declaration, an open letter written in October 2020 and eventually signed by thousands of scientists. It argues that Covid-19 policy should focus on protecting the elderly and vulnerable, and largely re-open society and school for others.
At the time, Americans would have benefited from a broad debate among scientists about the available policy options for controlling the Covid-19 pandemic, and perhaps a bit of compromise. The emails tell us why that isn’t what we got.
An email written by Collins, the director of the NIH, which was addressed to Fauci, the director of the National Institute of Allergy and Infectious Diseases, and several others read:
Collins appeared on television this week to confirm that the email was authentic, and that he stood by the message. At the time, he believed the Great Barrington Declaration idea of focused protection would result in more deaths than the alternative view of one-size-fits all restrictions. Collins also confirmed that he believed the three authors of the declaration were “fringe” scientists.
October 2020, when Collins wrote that email, was a time fraught with uncertainty. Positive results from Pfizer’s ongoing vaccine trial were still four weeks away. Many Americans were fatigued with ongoing restrictions, either imposed by governments or self-imposed. And two dueling documents — the Great Barrington Declaration and the John Snow Memorandum — were released and garnered thousands of signatures. The declaration argued for focused protection and permitting many people to return to normal life. The memorandum favored prolonged one-size-fits all restrictions.
At the time, I did not take sides, and urged public dialogue between scientists who held both views. We needed “a Covid policy response that engages with people who hold views and perspectives different than our own,” I wrote then.
What concerns me about the NIH director’s email and his interview on television is that he appeared unwilling to have this dialogue. Collins’s day job does not make him arbiter of scientific truth, the Pope for all scientists. On questions of unprecedented pandemic policy, he is surely entitled to his opinion — as we all are — but his is just one opinion of many.
When it comes to lockdowns or school closures, the answer to the question of whether the benefits exceed the harms and, if so, under what conditions, is far from certain, and scientists will continue to study this for decades. As a good scientist, Collins should have recognized the massive uncertainty around these policies.
Collins’s response to a memo signed by thousands of scientists should not have been to call for an immediate and devastating take down, but to use his pulpit as NIH director to hold a series of public discussions and dialogues. In a world where scientists were trapped in their own homes for months, a series of dialogues — even virtual ones — made available for the broader scientific community, policy makers, and the public would have benefited us all.
It is possible that through the heat of dialogue, weak premises of the argument for focused protection might have been revealed. But it is also possible that the idea might have attracted even more scientists to devise creative ways to achieve the goal, and who would have recognized the gargantuan trade-offs involved in pandemic policy to date.
It’s also possible that compromises might have been struck. One tenet of the Great Barrington Declaration was that schools should reopen immediately and broadly. In hindsight, it is now clear that reopening schools could have been done safely, as was done in many European nations in 2020 and in the U.S. in the fall of 2021, even before vaccines became available for children. A public forum between scientists might not have accepted all of the reasoning in the declaration, but might have reached a vital compromise, which would have benefitted millions of children, particularly poor or disadvantaged children — and their parents. Unfortunately, we failed them all.
A dialogue might also have led to better strategies for nursing home residents, the group most decimated by Covid-19. The U.S. did not — but could have — launched a large, registry-based randomized trial in this cohort, similar to the U.K.’s recovery trial. Such a trial might have helped vaccinate more of these at-risk individuals sooner and, with the first hint of vaccine efficacy in November 2020, all participants could have been crossed over to receive vaccines. Other intense strategies to aggressively test nursing home workers may have been proposed and received unanimous support.
Jeffrey Flier, the former dean of Harvard Medical School, and I called for dialogue and debate among scientists without demonization in April 2020. I’m disappointed to see a few months later that the NIH director, a man uniquely positioned to foster such a debate, had actively sought to thwart and discredit scientists with alternative ideas to the pandemic response. His ad-hominem comment that the authors were “fringe” was unnecessary and unhelpful. In the weeks that followed, more and more mud would be slung against the authors of the Great Barrington Declaration, as well as against scientists who held alternative policy views, and favored more and stronger restrictions. The vitriol ensured that the country would not have the dialogue it so desperately needed.
I must admit that I don’t know what would have happened had scientists been more willing to talk to each other. I believe that the world of social isolation — a world of seeing each other through the Post-it-sized Zoom squares — led to dehumanization and irrational hatred, which led to two entrenched policy poles with little room for compromise.
Had Collins, a man who has contributed greatly to science, chosen dialogue instead of contributing to animosity and combativeness, we might have been in a better place today.
Vinay Prasad is a hematologist-oncologist, associate professor of epidemiology and biostatistics at the University of California San Francisco, and author of “Malignant: How Bad Policy and Bad Evidence Harm People with Cancer” (Johns Hopkins University Press, April 2020).
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