Thread by @ASlavitt

COVID Update September 2: Vaccine by November 1 come hell or high water.

Some misunderstand the purpose of vaccines. Commissioner @SteveFDA is one of them. Donald Trump is another.

That lack of understanding has the potential to cause COVID-19 to be hear for a long time.

The purpose of a vaccine is not to protect "me." It is to protect "we."

Done right, vaccines end pandemics. Done wrong, pandemics end vaccines.

Let's start with some simple math. If the goal is to stop the virus from spreading, it has to have a place to be spread from. And to. If 1 of those 2 people is vaccinated, the vaccine can't spread.

The 2 things the FDA needs to maximize are: 1) vaccine effectiveness and 2) vaccine trust.

We want those 2 numbers to be as high as possible. You can simply multiply them. Multiply 100% by 50%. It equals 50%.

Here's the trick...

It doesn't matter which way. If the trust in a vaccine is 80%, but effectiveness is 50%, we will add 40% to herd immunity.

If a vaccine is only 50% effective, but trusted by 80%, we get the same 40%.

So trust is just as important as effectiveness.

How effective is a first vaccine likely to be?

The FDA originally set a goal of 50%. A typical successful influenza vaccine would be at that level.

So trust is essential if we care about the "we."

So how a vaccine is introduced is just as important-- JUST as important-- as what a vaccine does.

A 50% effective vaccine that is 25% trusted would impact 12.5% of the population.

How quickly would we get rid of the virus with an untrusted vaccine? Well, we wouldn't. Vaccines are a pact between us all to protect one another.

'If I count on you & you count on me but neither of us takes the vaccine, we both lose.

What would cause us not to trust the vaccine @SteveFDA? This is a question you are obligated to take seriously.

You started out ok by allowing the FDA scientists to articulate the measure they would use to approve a vaccine. 50%. But you abandoned that.

So here's a list of ways to destroy trust if it helps you:
1. Breaking your promise on the 50% metric
2. Bowing to political pressure on hydroxy
3. Knowingly mis-stating the benefit of a treatment like convalescent plasma

These are things you've done already Steve.

Here are some others.

-Overruling FDA scientists
-Letting scientists get bullied by the president's tweets
-Having a scientist resign in protest
-Rushing an EUA without data
-Allowing any political factor, like an election, to interfere with decision making.

Here is how you would preserve trust in the vaccine.
-Get all the data from phase 3 as you said you would
-Share it publicly and transparently
-Do that when you get results.

When will that be?

That is going to be when 10s of thousands of people have had enough exposure to the virus and when those who got the vaccine can be compared against those who didn't.

If that happens at 6 o'clock tonight, great. If it takes 3 months or 6, that's when we will have an answer.

Before you ask 30 million healthy people to take something, you have to do that? Rushing a short time could cost us our ability to eradicate this in the foreseeable future.

I'm going to suggest how you handle it when Trump asks for the EUA to be issued.

I understand you have shown a weakness to please the president. Someone will try to convince you that for a small subset of the population its safe and since they are at risk, you should grant limited approval.

If you grant it & you shouldn't, your senior scientists have vowed to resign. If they do, game over. So tell the president that you will side with your scientists this time no matter what they say. Tell him that now. Tell us that.

Trump has the authority to overrule you as does Secretary Azar. Force them to do it. If they back down, you will have preserved enough trust. If they don't it will be one of many unprecedented steps, but the scientific community will rally with a constant message behind you.

My advice to Democrats is not to reflexively rebel against the vaccine even as poorly designed theater as it is. That is the trap Trump is setting. The more controversial, the worse or more limited the data, the better for him.

He wants to paint the Democrats as anti-vaccine just because he is for it. Don't do that. Embrace getting a vaccine to people as soon as possible. Show people that, unlike Trump, you will put people's lives first. Let scientific experts speak to the data.

A vaccine no one takes would take one of our best weapons against COVID off the field. It would hamper us. Trump doesn't care. Hahn must understand this.

At risk is not just COVID, but all the future things we need vaccines for.

Its high time someone showed some bravery. So many public figures starting with Jim Comey have wilted under relentless pressure from Trump. Its how we got here.

Steve, this is beyond the presidency, beyond a career. Its a historical mistake you can make. We need these weapons.

Let the vaccine undo the virus. Don't let the president and the virus undo vaccines. /end