I value criticism and my collaborations are based on the ability to openly criticize other’s ideas as a means of finding the “right” answer.
Dear Dr. Baral,
My first and most recent article here at SBM were very different, but they both quoted you extensively. I was reminded of this symmetry of when I saw two comments you made on social media this week, both of which were very reasonable.
In the first comment you wrote:
At the beginning of covid, I was worried that academics personally attacking other academics with whom they didn’t agree would undermine the respect for academia and ultimately the power of evidence in driving policy.
You were right to be worried about personal attacks that undermine the respect for academia and ultimately the power of evidence in driving policy.
I expressed similar sentiments in my most recent article, Did I Lie About My Conference Invitation? How Bad Faith Engagement Functions As A Distraction and Silencing Technique. In that article, I showed that some doctors substituted straw man arguments, tone-trolling, and shill accusations/juvenile insults for civil debate of my ideas. I sincerely apologize for times when I did not engage in good faith. There were occasions when I should have elevated the discourse, but did not. I’ll do my best not to let that happen again. However, my core argument was that bad faith engagement serves to both silence potential critics and distract from more substantive discussion of facts, data, and science. We both agree this is where the focus should be. So let’s leave pettiness behind and get to it.
In the second comment you wrote:
I value criticism and my collaborations are based on the ability to openly criticize other’s ideas as a means of finding the “right” answer.
I couldn’t agree more. We should be able to receive good faith criticism and openly criticize other’s ideas. That’s what I did with my first article here, Should COVID-19 Vaccines Be Administered to Children Under an Emergency Use Authorization?, which discussed your article Covid Vaccines for Children Should Not Get Emergency Use Authorization. Both of our articles were published in May 2021, and I strongly encourage readers to pause and read them. Given that we both value criticism and the ability to openly criticize other’s ideas, I think now would be a good time to look back and see how our respective articles have fared.
Covid Vaccines for Children Should Not Get Emergency Use Authorization
I’ve defended your article. I am on record as having said you wrote it in good faith, though I strongly disagreed with it. My response was written in good faith. I was blunt, but there were no personal attacks, and I’ve only ever discussed your ideas. Here’s how my article began:
An article entitled “Covid Vaccines for Children Should Not Get Emergency Use Authorization” was recently published in The BMJ by Drs. Wesley Pegden, Vinay Prasad, and Stefan Baral. The central thesis of the argument is that “severe outcomes or death associated with COVID-19 infection is very low for children, undermining the appropriateness of an emergency use authorization for child COVID-19 vaccines”. They express a concern that under an Emergency Use Authorization (EUA), “the risk of rare adverse events remains and, if the benefit achieved by an intervention is insufficient, any serious, yet rare, adverse effects can prove to be the lasting legacy of a regulatory decision”. The article contained several crucial omissions that I believe undermine their conclusion.
That opening paragraph established a pattern for my writing. I linked to your article, and though your position was obvious from the title alone, I directly quoted your key ideas fully and fairly. I’ve never purposefully misrepresented anyone’s ideas in any way. If you feel I’ve done that, please let me know exactly where so I can fix it and apologize, though I’m pleased that you haven’t yet identified anywhere where you feel I’ve done this. Straw-man arguments are bad faith engagement.
Having fairly presented your ideas, I then explained why I disagreed with them. Specifically, I identified your article’s many “crucial omissions”. Your article contained a just single link, about the 1976 swine flu debacle. However, it didn’t contain a single statistic about how COVID had impacted children to that point, nor did it mention that a successful pediatric vaccine RCT had been reported via a company press release. (The paper, showing the vaccine was 100% effective for adolescents, was published in the NEJM a few weeks later.)
Your article also didn’t explain the difference between an EUA and full vaccine approval or why that added regulatory designation would be so valuable. The difference turns out just to be waiting longer. That’s it. Given that vaccine side-effects almost always emerge shortly after the vaccine itself, that waiting period did not seem to be of any value, and it wouldn’t have identified the rare, usually mild vaccine-side effects that did emerge.
My article was a lengthy piece- an unfortunate pattern- that tried to fill in these gaps. I felt that any discussion of vaccinating children should include some basic facts. I argued that while COVID had obviously been worse for adults, that did not mean it had been entirely benign for children. Just under 500 children died during the pandemic’s first year, and many thousands more had been hospitalized. COVID’s harms to children were comparable to many other vaccine-preventable diseases, though unlike those diseases, COVID did its damage with strict mitigation measures in place. As I acknowledged, your article said that “emergency use authorizations should be considered for children at genuinely high risk of serious complications,” however according to the most recent data, half of hospitalized children have no underlying conditions, and 18% of these were admitted to the ICU. COVID is not serious for most children thankfully, but it can be really bad for some of them.
In addition to presenting these basic facts, I explained the difference between an EUA and full vaccine approval, I discussed the successful pediatric vaccine RCT, and I also wrote the following:
It is not inconceivable that a COVID-19 variant could significantly affect children and spread widely before we could widely vaccinate children. Precaution against the unknown works in both directions.
For these reasons, I concluded that the EUA for children was appropriate. Fortunately, FDA regulators felt the same way and the EUA was issued on the same day I published my article, May 10, 2021. As a result, millions of children were vaccinated before they were infected.
I think this was a good thing.
COVID-19 Vaccine Is Strongly Effective For Children And Adolescents During Delta And Omicron
A lot has changed since we wrote our articles in May 2021.
At the risk of sounding immodest, I think my article aged very well, and I’ve defended it’s core ideas dozens of times here at SBM, in my book, and in podcasts. I’ve continued to do my best to fully enumerate COVID’s impact on children, which greatly worsened after May 2021. Though not everyone worried about them, the variants I feared arrived, sadly. One typical headline from December 2021 said Pediatric Hospitalizations Up 395% In NYC Amid COVID-19 Surge.
These variants also closed down schools across the country, not just in areas governed by timid liberals (Florida, Arkansas, Idaho, Texas, Oklahoma, Kentucky , Alabama, Georgia, Wyoming, North Carolina, Ohio, South Carolina, North Dakota, Tennessee, Kansas, West Virginia, Missouri, Louisiana, Mississippi). Even when schools were “open”, that didn’t mean children were learning in them. One typical headline from January 2022 read COVID Hammers NYC School Attendance Among Students And Teachers. Of course, by merely reporting that this happened, I am not “defending”, it as has been alleged. I didn’t want the virus to impact education. I wanted healthy kids learning from healthy teachers, and I suspect this would have happened more often if children had been vaccinated.
We obviously know a lot more about the vaccine than we did in May 2021. There have been many dozens of studies on its safety and efficacy, and I’ve also done my best to present this data fully and fairly many times. The evidence is overwhelmingly clear that while the vaccine is not a panacea, it has protected a meaningful number of children from real harm.
The vaccine did not receive full FDA approval for adolescents until July 2022, and it is still only available to younger children under an EUA. I am confident that more children would have suffered and missed school had the vaccine been unavailable to children during this time.
However, I expect you will disagree with me about all this, and I really want to understand why.
I 100% stand by what we wrote
Several months after you wrote your article in the BMJ, you said “I 100% stand by what we wrote“. Yet, I have not seen you explain why in any detail, as I have with my original article. What do you think would have happened had their been no EUA for the pediatric vaccine, and why do you think this outcome would have been preferable to what actually happened?
My success rate in asking people, even those who claim to love debate and discussion, to defend their ideas is zero. In fact, people often get very angry at me for reminding them of their ideas. However, in the spirit of finding the “right” answer, I invite you to explore this hypothetical scenario and make the case that the EUA was a mistake. Although you later claimed that your article was “not about vaccinating young kids“, it’s inarguable that had regulators heeded your advice, the vaccine would have been unavailable to nearly all children when the Delta and Omicron variants arrived. It seems to me that your article, which was titled Covid Vaccines For Children Should Not Get Emergency Use Authorization, was very much about vaccinating children. As such, I hope you can make the case that the EUA hurt them, that too many of them were vaccinated, and that the pandemic would have unfolded better for children and their education if the vaccine was available to only a small subset of them when these worse variants emerged.
Like you, I value criticism, and I hope you will openly criticize my ideas as a means of finding the “right” answer. I’ve lamented the near total absence of good faith criticism of my ideas. Where is it? So in addition to making the affirmative case the the EUA was a mistake, I hope you’ll let me know exactly what I got wrong in my article. I hope that you’ll extensively quote from it- or anything I’ve written- to show exactly which of my ideas aged poorly. If you discover any factual errors, please let me know so I can correct them. Don’t worry about hurting my feelings. As long as you quote my ideas fully and accurately, while reporting the science and data fully and accurately, I won’t call you silly names or question your motivations.
Of course, you could also argue that looking back, the EUA was appropriate after all. That option is available to you, and no one should criticize you if you exercise it.
As I wrote, ignoring me is not bad faith engagement. However, since this is not the path you’ve chosen, I hope you’ll engage with my ideas in good faith. That’s what I’ve done.
I look forward to learning from you.
Jonathan