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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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