US is getting a crash course in scientific uncertainty
By Apoorva Mandavilli
When the coronavirus surfaced last year, no one was prepared for it to invade every aspect of daily life for so long, so insidiously. The pandemic has forced Americans to wrestle with life-or-death choices every day of the past 18 months — and there is no end in sight.
Scientific understanding of the virus changes by the hour, it seems. The virus spreads only by close contact or on contaminated surfaces, and then turns out to be airborne. The virus mutates slowly, but then emerges in a series of dangerous new forms. Americans do not need to wear masks. Wait, they do.
At no point in this ordeal has the ground beneath our feet seemed so uncertain. Just last week, federal health officials said they would begin offering booster shots to all Americans in the coming months. Days earlier, those officials had assured the public that the vaccines were holding strong against the delta variant of the virus, and that boosters would not be necessary.
On Aug. 23, the Food and Drug Administration formally approved the Pfizer-BioNTech vaccine, which had already been given to scores of millions of Americans. Some holdouts found it suspicious that the vaccine was not formally approved yet somehow widely dispensed. For them, “emergency authorization” has never seemed quite enough.
Americans are living with science as it unfolds in real time. The process has always been fluid, unpredictable. But rarely has it moved at this speed, leaving citizens to confront research findings as soon as they land at the front door, a stream of deliveries that no one ordered and no one wants.
Is a visit to my ailing parent too dangerous? Do the benefits of in-person schooling outweigh the possibility of physical harm to my child? Will our family gathering turn into a superspreader event?
Living with a capricious enemy has been unsettling even for researchers, public health officials and journalists who are used to the mutable nature of science. They, too, have frequently agonized over the best way to keep themselves and their loved ones safe.
But to frustrated Americans unfamiliar with the circuitous and often contentious path to scientific discovery, public health officials have seemed at times to be moving the goal posts and flip-flopping, or misleading, even lying to, the country.
Most of the time, scientists are “edging forward in a very incremental way,” said Richard Sever, assistant director of Cold Spring Harbor Laboratory Press and a founder of two popular websites, bioRxiv and medRxiv, where scientists post new research.
“There are blind alleys that people go down, and a lot of the time, you kind of don’t know what you don’t know.”
Biology and medicine are particularly demanding fields. Ideas are evaluated for years, sometimes decades, before they are accepted.
Researchers first frame the hypothesis and then design experiments to test it. Data from hundreds of studies, often by competing teams, are analyzed before the community of experts comes to a conclusion.
In the interim, scientists present the findings to their peers, often at niche conferences that are off-limits to journalists and the general public, and hone their ideas based on the feedback they receive. It is not unusual to see attendees at these meetings point out — sometimes harshly — every flaw in a study’s methods or conclusions, sending the author back to the lab for more experiments.
Fifteen years elapsed from the description of the first cases of HIV to the identification of two proteins the virus needs to infect cells, a finding crucial to research for a cure. Even after a study has reached a satisfying conclusion, it must be submitted for rigorous review at a scientific journal, which can add another year or more before the results become public.
Measured on that scale, scientists have familiarized themselves with the coronavirus at lightning speed, partly by accelerating changes to this process that were already underway.
Treatment results, epidemiological models, virological discoveries — research into all aspects of the pandemic turns up online almost as quickly as authors can finish their manuscripts. “Preprint” studies are dissected online, particularly on Twitter, or in emails between experts.
What researchers have not done is explain, in ways that the average person can understand, that this is how science has always worked.
The public disagreements and debates played out in public, instead of at obscure conferences, give the false impression that science is arbitrary or that scientists are making things up as they go along.
“What a nonscientist or the layperson doesn’t realize is that there is a huge bolus of information and consensus that the two people who are arguing will agree upon,” Sever said.
Is it really so surprising, then, that Americans feel bewildered and bamboozled, even enraged, by rapidly changing rules that have profound implications for their lives?
Federal agencies have an unenviable task: Creating guidelines needed to live with an unfamiliar, rapidly spreading virus. But health officials have not acknowledged clearly or often enough that their recommendations may — and very probably would — change as the virus, and their knowledge of it, evolved.
“Since the beginning of this pandemic, it’s been a piss-poor job, to say it in the nicest way,” said Dr. Syra Madad, an infectious disease epidemiologist at the Belfer Center for Science and International Affairs at Harvard University.
Leaders in the United States and Britain have promised too much too soon, and have had to backtrack. Health officials have failed to frame changing advice as necessary when scientists learn more about the virus.
And the officials have not really defined the pandemic’s end — for example, that the virus will finally loosen its stranglehold once the infections drop below a certain mark.
Without a clearly delineated goal, it can seem as if officials are asking people to give up their freedoms indefinitely.
One jarring backtrack was the mask guidance by the Centers for Disease Control and Prevention. The agency said in May that vaccinated people could drop their masks, advice that helped set the stage for a national reopening. Officials did not emphasize, or at least not enough, that the masks could be needed again. Now, with a new surge in infections, they are.
“It can be really difficult for public perception and public understanding when these big organizations seem to reverse course in a way that is really not clear,” said Ellie Murray, a science communicator and public health expert at Boston University.
Both information and disinformation about COVID-19 surface online, especially on social media, much more now than in previous public health crises. This represents a powerful opportunity to fill in the knowledge gaps for many Americans.
But health officials have not taken full advantage. The CDC’s Twitter feed is a robotic stream of announcements. Agency experts need not just to deliver messages, but also to answer questions about how the evolving facts apply to American lives.
And health officials need to be more nimble, so that bad actors do not define the narrative while real advice is delayed by a traditionally cumbersome bureaucracy.
“They’re not moving at the speed that this pandemic is moving,” Murray said. “That obviously creates a perception in the public that you can’t just rely on those more official sources of news.”
The road ahead will be difficult. The virus has more surprises in store, and the myths that have already become entrenched will be hard to erase. But it is not too much to hope that the lessons learned in this pandemic will help experts explain future disease outbreaks, as well as other urgent problems, like climate change, in which individual actions contribute to the whole.
The first step toward educating the public and winning their trust is to make plans, and then communicate them honestly — flaws, uncertainty and all.