As federal officials considered how the government should respond to an emerging pandemic in 2020, Francis Collins recalled last year, “we weren’t really considering the consequences” of extreme measures such as closing businesses , school closures and stay-at-home orders. . It was a surprising admission from Collins, who played a major role in these conversations as director of the National Institutes of Health (NIH).
Collins, whose July 2023 commented recently attracted online attention, admitted that “public health officials” made a “truly unfortunate” mistake in ignoring the devastating side effects of interventions they believed were necessary to reduce COVID-19 transmission. This error holds important lessons not only for future responses to communicable diseases, but also for a wide range of public policies that cause harm in the name of saving lives.
Collins, who led the NIH from 2009 to 2021, was speaking in Gettysburg, Pa., conference Sponsored by Braver angels, an organization that aims to “bridge the political divide” by encouraging civil debate between people with different ideologies and partisan allegiances. During session Along with Wilk Wilkinson, a Minnesota highway transportation director and podcast host who is a vocal critic of the policy response to COVID-19, Collins attempted to explain the perspective of the scientists who have shaped that response.
“If you’re a public health official,” he said, “you have a very narrow view of what the right decision is, and it’s something that will save a life. (No matter what What else is going on.”
This seemingly noble impulse, Collins noted, encouraged public health specialists to overlook the unintended but predictable costs of the policies they recommended. “You place infinite value in stopping the disease and saving a life,” he said. “You don’t put any value on whether this totally disrupts people’s lives, ruins the economy and keeps a lot of kids out of school in a way that they could never really get away with. to put back.”
The folly of attaching “infinite value” to a life saved by government regulation should be obvious. After all, economists and regulators regularly and rightly seek to balance the costs of new rules against the expected benefits, a calculation that involves estimating the “value of a statistical life“.
If this value were infinite, it would justify any policy promising to save lives, whatever the cost. A universal speed limit of 40 kilometers per hour (or, more ambitiously, a ban on automobiles) would, for example, reduce the number of road deaths, but at a cost that few of us would consider acceptable.
During the pandemic, the wisdom of weighing The contrast between costs and benefits has not only been forgotten, but explicitly repudiated. Andrew Cuomo, then governor of New York, insisted that the goal was to “save lives, period, whatever it takes,” because “we are not going to accept the assumption that human life is disposable.”
Although Collins describes this attitude as characteristic of “public health people”, there was dissidents even among experts falling into this category. In October 2020, for example, three epidemiologists – Martin Kulldorff of Harvard, Sunetra Gupta of Oxford and Jay Bhattacharya of Stanford – published the Great Barrington Declarationwhich recommends taking steps to protect those particularly vulnerable to COVID-19 while allowing “those at minimal risk of death to live their lives normally.”
At the Braver Angels conference, Collins described Kulldorff et al. as “very distinguished”. He was less respectful in October 2020 E-mail to White House COVID-19 advisor Anthony Fauci, saying “this proposal from the three fringe epidemiologists” demanded “a rapid and devastating public takedown of its premises.”
In his exchange with Wilkinson, Collins explained that he was “deeply troubled” by the Great Barrington Declaration, which he considered reckless. “I regret using terminology that I probably shouldn’t use,” he said.
Collins also regrets that he and his colleagues have not paid enough attention to the “collateral damage” caused by restrictions on social, economic and educational activities. “We probably needed to have this conversation in a more effective way,” he said. Better late than never.
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