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OPINION: Is one shot for all better none for some?

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In my four years in Congress, the phrase I’ve heard most regularly abused is “Follow the science.”

Politicians, bureaucrats and reporters in Washington—many of whom, based on their comments, seem to have last attended science class in eighth grade—have a penchant for developing policies and then lecturing the opposition on the “science” that follows their agenda. Like my granddad used to say, “figures lie and liars figure.” Covid-19 policy is no exception.

In medical school, my classmates and I were taught to apply the science practically to the messy world around us, not merely follow theories as if we practiced medicine in a vacuum. Once we got out of the classroom, many of us quickly found that not every patient’s clinical course was exactly what the textbooks said. The medical school graduates who quickly became the best physicians were those who listened to their patients, called on their experience, and, yes, applied the science only as made sense in particular circumstances.

Nothing is harder for a physician to manage than a virus. Human papillomavirus, for example, often causes cervical precancer and cancer. Our obstetrics and gynecology residency program studied HPV as far back as my internship in 1987.

From 1997 to 2003, by combining pap smears with HPV strain identification, doctors could employ technology that identified which patients were truly at risk for cancer, versus those who should merely be observed. But finding the correct application took roughly a decade, and as doctors struggled to use the data to distinguish who was at high and low risk, I observed the condition was often overtreated.

It took real-world trial and error to tailor the right approach. Along with the approval of the HPV vaccine in 2006, medical researchers over the past decade have consistently shown enough scientific data for physicians to know with confidence which patients should be monitored and which need cervical procedures or hysterectomies.

This eliminated millions of unnecessary surgeries, preserved fertility, and decreased extreme premature delivery in some instances. I can say as a physician that what we’ve seen developed over the past year regarding diagnosis and treatment and vaccines for Covid is truly a miracle. But the medical community is still developing its understanding of treatments and risk factors.

Similarly, viral infections during pregnancy are completely unpredictable. Even understanding risk factors, you never know how an individual patient’s physiology will react. How well patients fight off a virus depends on their natural immunity, which depends on all sorts of

largely unknowable criteria. Whether it’s hepatitis, chickenpox, West Nile or the common flu, my professor once told me, “If you’ve seen one case of a particular virus in pregnancy, you’ve only seen one case.” His point? Apply the science as best you can, but each case has its own complexities. Developing better treatments takes a long time and real-world data from treating patients.

It’s impossible to follow the science of most any virus with great certainty, especially a novel virus. The medical community knew from day one that the science on Covid would be predictably unpredictable and constantly changing. When government scientists—let alone politicians and journalists—present a hasty, incomplete hypothesis as indisputable fact, they’re acting contrary to science—and often driving a preconceived agenda.

Science is a systematic enterprise that organizes knowledge into predictions about the universe. It is not a gospel of indisputable, never-changing truth. Just as cancer treatments have changed over time, doctors will discover countless false hypotheses that were put forward as fact by government agencies and healthcare experts from all fields surrounding Covid-19. Science is never settled.

Take the notorious subject of mask mandates. The overly certain “science” of bureaucrats first told Americans not to wear masks. Then we had to wear them indoors. Then this was extended to include outdoor mask wearing. Now, a good American needs to don two, maybe three masks even if you’ve had the virus or the vaccine to “follow the science”—unless you are seated at a restaurant, or with a small group that also is vaccinated. Then you’re safe.

There is little scientific logic behind these shifts. But out of an abundance of caution, please keep wearing your masks in public.

Now let’s talk about applying science. Real-world evidence suggests that the effectiveness of one shot of the Pfizer or Moderna vaccine ranges between 72% to 92.6% after two weeks. Further evidence suggests the second shot could be given 12 weeks later instead of three or four weeks and be equally effective.

After every senior citizen and high-risk individual gets their two shots, applied science would suggest we could save tens of thousands of lives if we give one shot to as many people as possible and came back for a second dose as more vaccines are available. This is assuming that robust real-world evidence finds a second shot even necessary, which it’s possible won’t be borne out by the evidence.

Consider this: If you had 200 Pfizer vaccines and 200 family members, and it was up to you, how would you allocate them? The current emergency-use authorization tells you to give 100 people two shots. Assuming it will be 95% effective, only 100 people would be vaccinated, and 95 would be protected.

Alternatively, you could give 200 people one shot, assuming 75% effectiveness, 150 people at a minimum would be protected. This approach has the potential to address the relative limitations in supply and the hiccups we are seeing ramping up in mass vaccination sites right now. Each day that applied science is delayed, more people than otherwise will die from Covid-19, and the opening of businesses and schools will be unnecessarily delayed.

I’m not trying to be too prescriptive. The Food and Drug Administration is tasked to ensure the safety, efficacy and security of all medical products. Congress should clarify how and when the FDA considers real-world evidence in emergency-use authorizations during pandemics—and make sure that practical realities are accounted for.

State and local officials and healthcare providers across the country need to do the scientific thing and apply theory to the world practically, not blindly follow it as if we exist in a vacuum.

Dr. Marshall, a Republican, is a U.S. senator from Kansas. He represented the First Congressional District, 2017-21, and was a practicing obstetrician and gynecologist in Great Bend, Kan.

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In Other News

REQUEST FOR EXPRESSIONS OF INTEREST

(CONSULTING SERVICES – INDIVIDUAL SELECTION)

 

OECS MSME Guarantee Facility Project

Loan No.: IDA-62670, IDA-62660, IDA-62640, IBRD-88830, IDA-62650

Assignment Title: Senior Operating Officer (SOO)

Reference No. KN-ECPCGC-207852-CS-INDV

 

The Governments of Antigua and Barbuda, Commonwealth of Dominica, Grenada, St. Lucia and St. Vincent and the Grenadines have received financing in the amount of US$10 million equivalent from the World Bank towards the cost of establishing a partial credit guarantee scheme, and they intend to apply part of the proceeds to payments for goods, and consulting services to be procured under this project. 

The consultant will serve as the “Senior Operating Officer (SOO)” for the ECPCGC and should possess extensive knowledge of MSME lending with some direct experience lending to Micro, small and medium-sized businesses, knowledge of the internal control processes necessary for a lending operation and the ability to design and implement risk mitigation procedures. The ideal candidate should possess an Undergraduate Degree from a reputable college or university, preferably in Business, Accounting, Banking or related field, with a minimum of 5 years’ experience in lending, inclusive of MSME lending. The initial employment period will be for two years on a contractual basis. Renewal of the contract will be subject to a performance evaluation at the end of the contractual period. The assignment is expected to begin on September 30th, 2021.  The consultant will report directly to the Chief Executive Officer of the ECPCGC.

The detailed Terms of Reference (TOR) for the assignment can be viewed by following the attached link below. 

 

https://bit.ly/3iVannm

 

The Eastern Caribbean Partial Credit Guarantee Corporation (ECPCGC) now invites eligible “Consultants” to indicate their interest in providing the Services. Interested Consultants should provide information demonstrating that they have:

  • An Undergraduate Degree from a reputable college or university, preferably in Business, Finance, Banking or related field; and
  • Minimum of 5 years’ experience in MSME lending. Applicants should also have:
  • The ability to design and implement risk management procedures 
  • Extensive knowledge of MSME lending with some direct experience lending to small and medium-sized businesses
  • Extensive knowledge of MSME banking operations
  • Knowledge of the internal controls necessary for a lending operation and the ability to design and implement risk management procedures
  • Experience developing and presenting information in public, including responding to questions in real-time
  • Experience lending to MSMEs located in the ECCU
  • Knowledge of marketing and communicating with the MSME sector
  • Ability to draft procedures to be used in a lending operation
  • Familiarity with the mechanics of a loan guarantee program
  • Exceptional written, oral, interpersonal, and presentation skills, and
  • Proficiency in the use of Microsoft Office suite.

The attention of interested Individual Consultants is drawn to Section III, Paragraphs 3.14, 3.16, and 3.17 of the World Bank’s Procurement Regulations for IPF Borrowers July 2016, [revised November 2017] (“Procurement Regulations”), setting forth the World Bank’s policy on conflict of interest. A Consultant will be selected in accordance with the Approved Selection Method for Individual Consultants set out in the clause 7.34 of the World Bank Procurement Regulations for IPF Borrowers. 

 

Further information can be obtained at the address below during office hours 0800 to 1700 hours:

Eastern Caribbean Partial Credit Guarantee Corporation

Brid Rock, Basseterre,

St. Kitts.

Expressions of interest must be delivered in a written form by e-mail by August 11th, 2021, to [email protected]. 

 

For further information, please contact:

Carmen Gomez-Trigg                                                            Bernard Thomas

Chief Executive Officer                                                          Chief Financial Officer

Tel: 868-620-8144                                                                  Tel: 869-765-2385

Email: [email protected]                                          [email protected]