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Special Feature
Interview With McGill’s Jay Kaufman About The COVID Pandemic And His
Experience As An Op-Ed Author For The NY Times
We contacted Jay
Kaufman, the McGill University professor of epidemiology and past
president of the Society for Epidemiologic Research, who authored the
Times essay to obtain a fuller understanding of his perspective. He
agreed to be interviewed and the candid exchange is published below.
Epi Monitor:
We are well into the pandemic now. The fourth wave I believe. Was
there a specific event or reason that triggered your writing of the
essay at this time? Have you written other pieces about the pandemic?
Kaufman:
I have co-authored a number of scientific papers on SARS-CoV-2 and
COVID-19 over the last 18 months, as well as some newspaper editorials
and blog posts on the pandemic, but this NYT essay was the most
socio-political in focus.
Plenary Speech
The backstory is not
so dramatic, really. I served as President of SER from July 2020 to
July 2021, probably the worst year ever to be president of
anything. At the annual meeting in June, the departing president
always gives a plenary speech. I gave a broad talk on lessons learned
from the pandemic which included many methodological observations, but
I also chose to discuss the politicization of the pandemic because as
a social epidemiologist this seemed a dominating issue for me in
understanding our responses, as a scientific community, and how these
responses contributed or did not contribute to public health policy.
Value of Remarks
That science is a
social process, carried out by people enmeshed in ideologies and
institutions is a rather hum-drum observation in fields like sociology
and history. Indeed there are departments of “science and technology
studies” and a whole professional society (“4S – Society for Social
Study of Science”) that describe and dissect these relationships in
baroque detail. Compared to that scholarship, my remarks were quite
amateurish, but I thought them relevant and timely for a meeting of
professional epidemiologists.
Big Picture
SER meetings can dwell
excessively on nerdy statistical or methodological arguments, so I
wanted to give some attention to the big-picture topic of our social
milieu and the way that it organizes our efforts and their societal
impacts. Interestingly, Marc Lipsitch gave an overview of the
COVID-19 pandemic for his invited plenary at the meeting, and he also
discussed political polarization as a special challenge for
contemporary health scientists.
Times Inquiry
The speech was
pre-recorded and then broadcast during the meeting in June, and some
energetic SER groupies dutifully Tweeted around screen shots of the
talk. Soon enough a NYT editor who had stumbled across a Tweet
contacted Sue Bevan at SER headquarters and asked for access to
the recording of the talk.
This was provided, and
a few weeks later they contacted me and asked me to contribute the
text of the speech to be turned into an op-ed. So I sent the text,
edited down to remove the methods observations and focusing only on
the issues of political polarization and social context.
Revisions, Revisions
I did not realize what
a grueling process lay ahead. The “ship of Theseus” story in
philosophy asks if after every plank in the ship is replaced, whether
it can still be called the same ship. After weeks of revisions with
one editor after another, I am pretty sure
that every single word in my essay was replaced at least once.
They haggled over everything, including the translation of the Virchow
quotes from German.
But somehow the basic
theme did survive, and so that is the whole story of how it got into
the NYT.
Twitter
I am in general not a
fan of Twitter, and I do not personally have an account. But I am
grateful to the SER communications committee, which orchestrates
enthusiastic Tweeting of all our SER activities, including my talk. I
simply had the good fortune that one of these Tweets fell into the
right hands.
EpiMonitor:
It’s not easy to get an op-ed published in the NYTimes. I know I have
tried and failed a couple of times as they get multiple submissions.
Do you have any information about why yours was selected? I believe
the title is provocative.
Kaufman:
My role in getting this published was a relatively passive one, so I
regret that I don’t have any specific advice. I don’t think I could
try to make that happen if I wanted to. I also have to admit that
they did not use my proposed title. Indeed, the article ran under
several different headlines, each progressively more provocative, and
none of them were written by me or even checked for my approval. I
also did not see the artwork until the article was published.
EpiMonitor:
You
mentioned to me that you do not think there is anything so profound or
original or astonishing in your commentary. I disagree by the way and
wish I had written something so clear and helpful in understanding the
significance of the pandemic.
Perhaps it is not news
that social factors have been very impactful during this pandemic.
Granted that, do you believe that political dysfunction is perhaps the
most impactful social factor in this US pandemic situation and in our
response to it? If so, it seems to make the pandemic more tragic
because so much more of it was preventable.
Kaufman:
Yes, a
point I tried to make is that there has been huge social and
geographic variation in the force of the pandemic, in responses to it,
and in the relative success or failure of those responses. We talk
about parameters like R (reproduction number), IFR (infection fatality
rate) and CFR (case fatality rate) as though these are
characteristics of the bug, but in fact they result from complex
interactions of biology, behavior and context.
None of these
quantities are stable over time, and the individual and collective
behavioral responses are highly patterned by politics, ideologies,
media and history. In this sense, yes, much of the loss of life and
the disruption to economies was in some sense preventable, although
hindsight is 20-20 and it would be preposterous to suggest that we
could all have agreed in March 2020 on the optimal course of action.
Values and
Policymaking
Optimal courses of
action also necessarily rely on values and when values are not shared,
there cannot be a consensus. A great example of that dilemma at this
particular moment is the fierce debate over vaccination of children
younger than 12 years old. The ethics are cloudy because kids can
expect to have such a benign course of SARS-CoV-2 infection that most
of the benefit of vaccination would accrue to others, not to the
vaccinated child. This is not unprecedented, but it does become
controversial because of the inherent uncertainty around novel
technologies for a novel infection, the dearth of data because severe
disease for kids is rare and adverse vaccine events are rare, and the
instability of these calculations over time, because risk/benefits
calculations are function of background rates, and therefore also
affected by other behavioral responses like masking and adult
vaccination behavior.
We entrust this
complex policy decision to a political process like the US FDA, but
they are potentially influenced by commercial and political pressures
that don’t reflect our individual values and priorities. The result is
a lot of distrust, frustration and confusion, and makes me grateful
every day that I am not on any social media so that I am largely
unaware of all the screaming back and forth about this kind of thing.
EpiMonitor:
Developing remarkably effective and safe vaccines so rapidly was a big
scientific success I believe in this pandemic. What successes or
silver linings do you see in the pandemic experience so far?
Kaufman:
The mMRA technologies that you refer to are obviously the most
promising “silver lining” and Moderna is about to begin a trial
applying this technology against HIV infection, a bug that has eluded
a successful vaccine for 3 decades.
Testing
But I hope we also
learned important lessons about testing, where the US and Canada
lagged disastrously in 2020, and then demonstrated an inexplicable
reluctance to deploy inexpensive rapid antigen testing. Stuck in the
clinical mindset of diagnostic testing, we missed the opportunity to
deploy a public health model of testing, and this was a costly error.
Influenza
The absence of any
appreciable influenza in the winter of 2020-2021 was another pleasant
surprise, and showed the impact of masking and additional hygiene
measures on other infectious diseases.
As we all know in
academia, software for web-conferencing got a huge shot in the arm,
too, and will probably be with us forever (for better and for worse).
Publishing
The pandemic also
changed the face of academic publishing forever, with the sudden
prominence of pre-print repositories like medRxiv, and it
relocated the nexus of scientific debate from professional meetings to
the pugnacious rapid-fire of Twitter.
Lessons Learned
But I do hope the more
important lessons learned are not the technological fixes but rather
the logistical, organizational and political ones. We need a robust
public health infrastructure, we need high levels of social trust to
facilitate vaccination uptake and contract tracing, and we need
crucial public agencies like CDC and FDA to be run by long-term
professional civil servants rather than short-term political
appointees. It is not yet clear whether such lessons will be heeded
or not.
EpiMonitor:
Your
article ends with the example of Dr Virchow taking an activist
position vis-a-vis social change by going to the barricades in Berlin
to fight for the revolution. Given the importance of social factors in
disease, what is your view of the proper role of epidemiologists in
bringing about social change.
Kaufman:
The example of Virchow was meant to demonstrate that pandemics are
structured by social inequalities and injustices, and that these
ultimately require political solutions rather than technological
solutions.
Indeed, we came up
with an amazing technological advance with the mRNA vaccines, but
distrust and political factionalism kept that potential miracle from
achieving its full potential in the US.
Citizen Obligations
Virchow was an eminent
scientist, but also involved himself politically in a struggle for
social justice and equality. We are all citizens of our respective
countries who share that same obligation, to be engaged as citizens in
parallel with our work as scientists.
I think it hopeless to
aspire to be free of social influences, which would be incompatible
with a human existence that has always been inherently social.
Likewise, absolute objectivity is a mythical goal, although we can
certainly strive to improve our critical thinking.
Objectivity
A society that
facilitates continual challenges to our views is the healthiest one
for optimizing our rationality and objectivity, and therefore open
expression is a crucial tenet to uphold in the interests of scientific
rigor.
Objectivity as a goal
also falls short because policies depend as much on values as they do
on facts. It is therefore necessary for us to articulate our values,
debate them, and reach a democratic consensus, but science alone is
not a path to that end. Values do not emerge from a laboratory or a
regression model. We need to find them elsewhere.
EpiMonitor:
Have you
had much response to your essay and if so what has been the theme?
Kaufman:
The essay
was published online on a Friday, and I was not prepared for the
deluge into my inbox over the week-end that followed. These messages
were highly varied in tone and content, some supportive, some
disapproving. Many people scolded me for things I neglected and some
attached long documents outlining their own idiosyncratic theories or
models.
Preconceptions
I would say that the
comments skewed more positive than negative, but people found in the
text the particular messages that seemed to support their
preconceptions. Those with a progressive commitment to public health
lauded the focus on social determinants, and those with
anti-establishment suspicions thanked me for pointing out that the
institutions of science were corrupted and unreliable.
Some comments were
strangely off-topic, like the well-known economist who sent me
recommendations for what to watch on Netflix.
Hope
I am grateful to those
colleagues, my fellow epidemiologists, who took the time to express
their support, and I hope that as a field we can maintain a high level
of public engagement in the media, promoting public health and the
importance of investing in our collectives, because pandemic problems
cannot be solved by individuals thinking and acting only as
individuals. ■
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