Thread by @jonlevyBU

1. I’ve been thinking a lot about the rationales given for various recent COVID policy decisions. Too often leaders use vague invocations of “The Tools” or “The Science” to avoid explaining hard decisions, and this ignores the values implicit in those decisions. 🧵

2. First, I *think* we can all agree that there are some good COVID prevention strategies and some bad ones.

Good: Keeping people with COVID from wandering around nursing homes

Bad: Permanent societal lockdown

3. But most policies sit in the middle - measures that reduce transmission or risk to some extent, with an associated tradeoff.

This is no different from most policies in any setting. There aren’t that many free lunches or single measures that will fix everything.

4. Here’s one example where “The Tools” were invoked for a COVID policy decision - having vaccines and treatments available as the rationale for a policy change. This was from the recent removal of testing requirements for international flights, but it could apply elsewhere.

5. Why is this a problem? Because if the mere existence of “The Tools” justify removing one protective policy, they can be the rationale for removing any protective policy. Some might argue that’s a good thing, but let’s unpack this a little bit.

6. First, it is farcical if taken to an extreme. Most people would not want someone with COVID sneezing on their immunocompromised grandma, even if we have “The Tools”. So there are clearly some exposure reduction steps we would take even in a world with vaccines and treatments.

7. Second, not everyone has vaccine protection. Some have chosen not to get vaccinated, some can’t be vaccinated, others are immunocompromised. Having vaccines as the rationale leaves these groups out, or more precisely, says that their risk increase doesn’t matter.

8. Now in an extreme case, if risk increased for one person while there were huge benefits for millions, most people would say that was a reasonable tradeoff. And if risk increased for millions to provide small gains to a few, most people would say that is a bad idea.

9. So using as the basis the existence of vaccines and treatments has an implicit balancing of risks and benefits across people. And using the same rationale for every policy and at varying levels of case incidence ignores the fact that this balance isn’t always the same.

10. For a given policy, reasonable people may disagree about the balance. But I think we can all agree that it exists, and that there are values implicit in each decision. This is not strictly about “The Tools”. It is a judgment balancing risks and benefits across people.

11. We also can’t ignore the fact that it isn’t random who has “The Tools”. There are inequities by income, race, ethnicity, and education in vaccination/booster rates, health status, health care access, etc. So who benefits isn’t the same as who is harmed.

12. Now, I’m not naive. I know policy decisions are made for a number of reasons, and a reasoned analysis of benefits and costs is not always one of them. So what do I want to see happen?

13. Just level with people. We have all experienced enough of the pandemic to know that there are many hard choices to make. Develop policies with on-ramps and off-ramps, and explain clearly why we are making changes when we make changes.

14. Acknowledge that any policy change will benefit some people and hurt others. Try to take compensatory steps to minimize the harms, and try to make sure it isn’t the same people harmed every time.

15. Just please don’t pretend that these decisions are only about “The Science”, or that vague statements about “The Tools” will suffice in all situations. Acknowledge the complexities and lead with values, and people may be more likely to respect the policy choices you make.