[Editor’s note: Today we present a guest post from Eric Kramer, an economist and lawyer whose interests include classical liberalism and libertarian approaches to political economy and who blogs at angrybearblog.com. Welcome!]
Martin Kulldorff and Jayanta Bhattacharya, two of the authors of the Great Barrington Declaration, have a piece up at the Brownstone Institute (and Newsweek) that claims Anthony Fauci, the Director of NIAID “got major epidemiology and public health questions wrong”.
Dr. Fauci’s policy positions and public statements can and should be examined and criticized as part of an effort to learn from our experience with the present epidemic. Unfortunately, the Kulldorff and Bhattacharya piece is mostly libertarian misdirection and bluster, and it presents little reasoned discussion of the merits of Fauci’s decision making during the pandemic. Here I review some of their charges and their supporting arguments and treatment of evidence.
False claim #1: Natural immunity undercuts the case for vaccine mandates
Kulldorff and Bhattacharya claim that by “pushing vaccine mandates, Dr. Fauci ignores naturally acquired immunity among the COVID-recovered”.
The bare fact that virus-based immunity exists (because remember – the immune response is naturally generated by your immune system whether it comes from a virus or a vaccine) does not show that vaccine mandates are unjustified. At most, natural immunity might justify an exemption from vaccine mandates for those who have recovered from COVID-19. However, there are plausible arguments against such exemptions. Notably, if vaccines increase immunity for those who have recovered from COVID-19, then vaccination may be justified on standard utilitarian grounds even if, as Kulldorff and Bhattacharya claim, “natural immunity is stronger and longer lasting than vaccine-induced immunity”. This comparison is completely irrelevant if the question is whether those with natural immunity should get vaccinated; the correct comparison is between natural immunity and natural immunity plus vaccination. This is not a difficult point to grasp. In addition, we need to consider that it is easier to design and implement a universal mandate than a mandate with an exemption for those with natural immunity.
I am not saying that these considerations are necessarily decisive. There are reasons to support an exemption for those with natural immunity. But it is just nonsense to suggest that Fauci has committed an obvious, absurd error like denying the existence of natural immunity. Kulldorff has made this incoherent claim about vaccine mandates and natural immunity before.
False claim #2: Vaccine mandates for health care workers harms patients
It gets worse. Kulldorff and Bhattacharya go on to make this claim:
Under Fauci’s mandates, hospitals are firing heroic nurses who recovered from COVID they contracted while caring for patients. With their superior immunity, they can safely care for the oldest and frailest patients with even lower transmission risk than the vaccinated.
If you follow the link about firing heroic nurses, you will end up at the Foundation for Economic Education, a libertarian organization. There you will learn about a nurse named Jennifer Bridges who was one of 150 employees fired from Houston Methodist hospital for not complying with the hospital’s vaccine mandate. There is no indication in this article that she has natural immunity. In fact, if you click through to the source that FEE cites, you discover this:
The Houston Methodist employees who filed the lawsuit likened their situation to medical experiments performed on unwilling victims in Nazi concentration camps during World War II. U.S. District Judge Lynn Hughes called that comparison “reprehensible” and said claims made in the lawsuit that the vaccines are experimental and dangerous are false.
Now that’s heroism. In fact, Bridges claims to have recovered from Covid-19 in 2020 and that she has natural immunity, but she does not cite this as her reason for rejecting the vaccine. Instead, she “believes the vaccines are a sinister political weapon being wielded by elites to dismantle global democracy”.
Furthermore:
Bridges said Tuesday was also her first day at her new job at a company that sends nurses into people’s homes.
So this unvaccinated health care worker is going into the homes of people who presumably have serious medical problems. Perhaps she has natural immunity. One imagines her patients would be safer if she were vaccinated as well, but as we have seen Kulldorff and Bhattacharya fail to consider this possibility (instead they focus on the irrelevant claim that natural immunity is stronger than vaccine-induced immunity, rather than on the relevant issue, whether vaccination provides added immunity to people who have recovered from COVID-19).
False claim #3: Vaccine mandates are severely damaging labor markets and hospitals
Finally, note that Bridges is still working as a nurse, which casts doubt on the unsubstantiated claim by Kulldorff and Bhattacharya that the mandate is “causing tremendous disruption to labor markets and hampering the operation of many hospitals”. Since Bridges is currently employed as a nurse in Texas, the fact that she is not employed at Houston Methodist does not show that the overall supply of nurses in Texas has decreased at all.
So far, news reports do not suggest that vaccine mandates are causing major problems in labor markets. It seems that most employees in most workplaces end up choosing to get vaccinated. (I suspect that many of those who end up quitting and dropping out of the labor market are close to retirement anyway, so any reduction in the size of the workforce will be temporary as well as small.) This hardly proves that mandates are not justified, and they may cause real difficulties for some employers. But it is telling that opponents of mandates are resorting to hysterical and unfounded claims about labor market disruption to bolster their case. The main cause of staffing difficulties at hospitals appears to be the COVID-19 epidemic itself and vaccine mandates are a plausible response to this problem.
False claim #4: Fauci’s position on school closures was indefensible
Kulldorff and Bhattacharya argue that “Dr. Fauci’s advocacy for school closures may be the single biggest mistake of his career.”
It is certainly plausible to argue that some school closures in the United States were unjustified; possibly many were. However, if you follow the link Kulldorff and Bhattacharya supply, what you will find is a Substack post that shows Fauci approved of school closures for the first three months of the pandemic as a mitigation measure and because the risk to children from COVID-19 was unclear. You can argue that this was not the best possible advice given the information available at the time, but it was far from insane. At that point Fauci started to argue that closures should be used when transmission is high, that it was important to open schools, and that we would be better off closing bars to slow transmission and to keep schools open.
You can argue that Fauci’s advice was vague, or that schools should be kept open even when prevalence is high. But to suggest that Fauci was an unequivocal advocate of school closures is wrong, based on the anti-Fauci post that Kulldorff and Bhattacharya cite. And it is important to remember that schooling is largely a state and local issue, and it is far from clear that Fauci, a federal health official, bears much responsibility for school closures.
False claim #5: Fauci oversold masks and undersold ventilation
Kulldorff and Bhattacharya suggest that Fauci overstated the case for masks and understated the case for improved ventilation in schools:
The gold standard of medical research is randomized trials, and there have now been two on COVID masks for adults. For children, there is no solid scientific evidence that masks work. A Danish study found no statistically significant difference between masking and not masking when it came to coronavirus infection. In a study in Bangladesh, the 95 percent confidence interval showed that masks reduced transmission between 0 percent and 18 percent. Hence, masks are either of zero or limited benefit. There are many more critical pandemic measures that Dr. Fauci could have emphasized, such as better ventilation in schools and hiring nursing home staff with natural immunity.
There are two issues here: 1) the effectiveness of masking, and 2) whether Fauci put too much emphasis on masking relative to other possible pandemic responses, notably improved school ventilation, in his public communication.
On the effectiveness of masking, there is no justification for focusing only on the two studies Kulldorff and Bhattacharya cite, even though they are RCTs, rather than evaluating the available evidence in a holistic and open-minded way. RCTs have limitations, especially when it comes to evaluating a practice like masking. The Danish paper was a study of whether masks help protect wearers, but the main public health benefit of masks is that it helps protect other people. The Danish study simply did not measure that. The Bangladesh study also appears to have methodological problems. This does not mean it has no probative value, but given their clear limitations there is no justification for relying solely on these RCTs and ignoring other forms of evidence on the value of masking.
Did Fauci put too much emphasis on masking in his public communications? Should he have put more emphasis on improving ventilation in schools?
Kulldorff and Bhattacharya support their claim that Fauci should have emphasized improved ventilation by pointing to a popular article that extols the cognitive benefits of improved ventilation in schools, not the COVID-19 prevention benefits. Moreover, the main study cited in the article is not an RCT, it reaches a result that appears to be implausible, and it has been subject to serious criticism. Other studies mentioned in the article Kulldorff and Bhattacharya link to seem even more implausible – one reports a doubling of cognitive test scores in advanced green buildings. Sure.
I am entirely open to the idea that the federal government should have done more to help schools reopen safely, including by improving ventilation. But Kulldorff and Bhattacharya seem to evaluate evidence according to whether it helps them reach their desired conclusion, not by carefully considering how probative it is, and how much weight to assign to different studies and forms of evidence. Flawed RCTs that cast doubt on the value of masks are fine; a seriously flawed observational study that purports to show large cognitive benefits of ventilation is accepted uncritically as evidence for the value of ventilation against COVID-19.
Let us assume, for the sake of argument, that the federal government should have done more to help schools reopen safely, and that Fauci spent more time advocating for masking than for improved ventilation in schools. (Kulldorff and Bhattacharya present no evidence for this, but it seems plausible and perhaps it is true.)
This would not show that Fauci was wrong to support masking. In his media appearances, it seems reasonable for Fauci to emphasize things that all Americans can do to slow the spread of COVID-19. Perhaps Fauci advocated for improved school ventilation behind the scenes, in conversations with legislators or executive branch policymakers. This could have been a sensible approach.
Finally, Kulldorff and Bhattacharya simply assume, without argument, that schools would have reopened sooner if Fauci had spent more time talking about school ventilation in public. This is far from obviously true. If Fauci had publicly and repeatedly stressed the importance of improved ventilation, that might have led some schools to stay closed if they lacked the resources to improve their ventilation, even if they should have opened without new ventilation systems. We can argue about all this, but Kulldorff and Bhattacharya have not even made a coherent argument for the claim that Fauci seriously and clearly erred by focusing too much on masks and too little on ventilation, much less provided relevant evidence supporting this conclusion.
Conclusion: Kulldorff and Bhattacharya are using ideas to further a libertarian agenda, not to get at truth or find common ground
As I said earlier, it is perfectly reasonable to evaluate and criticize major policy decisions and public statements by public officials. Unfortunately, Kulldorff and Bhattacharya seem more interested in reaching libertarian conclusions than in learning lessons for the future or finding areas of common ground with people who do not share their libertarian values. They make arguments that are patently incoherent. They misrepresent evidence. They share links that do not support their argument.
Unfortunately, this has been common throughout the pandemic on the libertarian right. The Brownstone Institute, where Kulldorff and Bhattacharya are both senior scholars, publishes essays that gaslight readers, twist evidence, and encourage vaccine hesitancy and distrust of public officials. Some essays it publishes are incoherent or unhinged. Kulldorff and Bhattacharya claim that their ideas enjoy wide support among academics, but that many are unwilling to admit this publicly to avoid stigma or retribution. I have no basis for evaluating this claim, but I suspect even academics who have some sympathy for their policy ideas would be hesitant to be associated with their tendentious arguments and ideologically-driven agenda.