Donald Trump has figured out the One Weird Trick to winning the 2020 election: a working vaccine, announced just in time for the election and teased throughout the campaign. Having failed to control the pandemic, institute an adequate testing regime, provide enough economic support to keep people home, or save the lives of vulnerable Americans in places like nursing homes, he believes he has hit upon the infinite health cheat code, allowing him to shake off all those catastrophic errors and live to fight another day—or if you prefer, another presidential term.
There is a slight wrinkle. There is only a very, very small chance that a vaccine will actually be ready—that is, proven to be safe and effective—before November. At the moment, this doesn’t seem to trouble the president. Trump is pushing ahead, teasing the possibility that a vaccine will be available before “a very special date,” like it’s the Christmas episode of a TV show. We are thus left to wait and see what happens if the evidence of a safe and effective vaccine does not come at the end of October as promised—if the chief scientists and advisers in his administration are faced with the impossible task of convincing the president that he cannot do the insane, dangerous, and entirely selfish thing that he wants to do, which would be to pressure the Food and Drug Administration to issue an emergency use authorization, or EUA, for an unproven vaccine. The threat is apparently so great that a group of nine pharmaceutical companies developing vaccine candidates have issued a statement promising not to submit their drugs for approval until after Phase III trials have concluded.
It’s not every day that there’s cause to laud Big Pharma for being comparatively humane and responsible, but it’s just one more way in which everything gets warped and distorted in the funhouse mirror of Trumpian politics. There are, however, some particular dangers at seeing the prospect of a vaccine so reflected: If Trump says a vaccine will be ready by November, his supporters will likely absorb that as gospel. At the same time, his opponents might reflexively lose faith in any positive news that might come regarding a vaccine, unable to believe that it actually works—even if it does. This is a terrible and dangerous dynamic, one we’ve already seen play out during this pandemic both with Trump’s hydroxychloroquine craze and, to a lesser extent, with plasma treatments.
News of legitimate scientific advancements gets swirled together with Trump’s pseudoscientific pronouncements, leaving a polarized public no further path forward. Each new bit of snake oil promoted from the president’s pulpit becomes not just a miracle cure giving flimsy hope to scared patients, but a piece of revelation that people of certain political stripes must accept—another thing for red-faced guys holding fish in their Twitter avatars to yell at people about online. As soon as Trump became wedded to the prospect of having a vaccine available by Election Day, it became impossible to imagine how he would row back those promises if the vaccine doesn’t pan out by that convenient date. And the more the media criticizes his pronouncements as dangerous, the more important it will become for Trump to prove that he’s right.
Perhaps predictably, Trump is pushing the notion that Joe Biden has revealed himself as the anti-vaxxer in the race for criticizing the push to get a vaccine out before the election. Insisting that a vaccine should not be pushed on the public without first taking all the necessary steps to ensure its safety and efficacy is now the anti-science position, according to Republicans. On Labor Day, Trump attacked Biden’s “reckless anti-vaccine rhetoric,” which he claimed “undermines science.” House GOP Whip Kevin McCarthy tweeted a truly horrible Funny Internet Video, complete with references to eight-year-old memes, a semi-ironic deployment of the eagle-and-flag imagery, and what sounds like an H. Jon Benjamin impersonator, to explain how a vaccine could be made fast—and why Biden is wrong to say “no miracle is coming.” There is, however, a world of difference between saying that a vaccine can be produced much more quickly than usual and insisting that it could be safely approved before the election. One is a hopeful possibility; the other is a political Hail Mary.
There is a great risk that the vaccine will turn out to be ineffective, whether or not it’s approved before the election, and it would be a disaster for public health if Americans falsely believed themselves to be immune to the disease. The fact that vaccine candidates have reached Phase III human trials has little bearing on whether success is imminent; only 62 percent of drugs that get to Phase III testing make it to the next stage of approval. (That’s why you do the trials.) Even if the Covid-19 pandemic was taking place in a more sane political era, the advent and distribution of a vaccine would be a fraught moment for the country.
We need only look to a slightly saner era for evidence. As Rick Perlstein reminded us recently, there is precedent for dangerous political interference in the vaccine process: In 1976, President Gerald Ford pushed for a massive inoculation campaign against swine flu with a vaccine that turned out to cause a rare and dangerous syndrome in a small number of patients. The vaccine was pulled that December. Contrary to the wild beliefs of anti-vaxxers, the currently existing vaccines we all get as children and adults are very safe—precisely because they go through such rigorous testing and years of research. They are safe because of all the steps that Trump wants to skip.
The correct interpretation of the data produced from rigorous trials, and the policy decisions that will follow in its wake, depends on neutral governmental arbiters having influence during the process. One would hope that the president would defer to these arbiters and not make unilateral decisions based on his gut feelings; this is what Joe Biden means when he says he would “listen to scientists” regarding a vaccine. This is not to say that science is always clear-cut, correct, or untainted by human prejudices and assumptions; but in this case, it is really very important that we have chief scientists who we can trust to tell us whether the vaccine is safe and publicly break with any politician who might want to ignore the facts.
So what stands between us and the prospect of Trump ordering up tens of millions of vials of useless or dangerous vaccines for political purposes? We have career bureaucrats at the FDA who assure The Washington Post that they both “take this responsibility very seriously and … understand what’s at stake” and grasp the importance of the FDA’s office of vaccines remaining a neutral and trusted institution in the eyes of the public. “Without a clear blessing from this office, I don’t think Americans would be willing to be vaccinated,” says one former administration official. It nevertheless feels naïve at best to imagine that the vast majority of Republicans would trust the FDA over their Dear Leader. Frankly, it seems more likely that a good chunk of them would let Trump personally inject their grandchildren with Trump-branded bleach than side with the FDA on the need for scientific rigor.
Moncef Slaoui, the chief scientific adviser to Operation Warp Speed—the Health and Human Services Department’s vaccine initiative—and FDA Commissioner Scott Hahn have made repeated public reaffirmations that approval for a vaccine would be entirely dependent on whether it worked and similar assurances that they are free from political interference from the president. Slaoui told Science that “there has been absolutely no interference,” and that he would resign if there were; “there will be no EUA filed if it’s not right,” he claimed. In comments that were seized on by the Trump campaign as evidence that the president is correct to claim a vaccine will arrive by November, Resistance hero Dr. Anthony Fauci told CNN last week that he “would not hesitate for a moment to take the vaccine.” What the Trump campaign left off was the caveat that Fauci would take that vaccine only if it’s “safe and effective.” Luckily for us, Fauci is “pretty sure it’s going to be the case that a vaccine would not be approved for the American public unless it was indeed both safe and effective.” Well, as long as you’re pretty sure!
In a similarly depressing vein, Fauci—who recently awoke from a surgical procedure to discover that a slew of Centers for Disease Control and Prevention Covid-19 testing guidelines had been changed while he was under anesthetic—recently told The Washington Post that if an EUA was granted for a vaccine before it was clear whether it was safe and effective, he would be “disappointed.” This does not instill much confidence. Wouldn’t it be a bit beyond disappointment if the president pushed his FDA to approve a vaccine that might not work or, worse, was dangerous? Wouldn’t that be more like “a massive disaster?”
There is already plenty of reason to distrust this administration, from Trump to his underlings, when it comes to sticking to science. As Science noted in its interview with Slaoui, the EUAs for hydroxychloroquine and convalescent plasma were not supported by science; the EUA for hydroxychloroquine was revoked after just a few months, after it became clear that the risks outweighed the known benefits. The editor in chief of Medscape recently wrote a scathing open letter calling on FDA Commissioner Stephen Hahn to resign for being “subservient to President Trump’s whims, unprecedented promotion of unproven therapies, outrageous lies, and political motivations,” and specifically criticized Hahn for massively overstating the established benefits of plasma treatments. Hahn apologized for this, which reportedly angered HHS Secretary Alex Azar—not because Hahn made the mistake, but because he admitted it.
All of the routine declarations that there is no political interference and that a vaccine will only be approved if the science supports it is belied by the president constantly suggesting that a vaccine will be widely available before the election. This is the political interference. It primes his supporters to expect a vaccine and the media to cover it as a possibility. It is a classic Trumpian use of the bully pulpit for selfish ends. It doesn’t need to be one of Trump’s signature demands for loyalty; the damage is already being done.
This is yet another example of one of the more amusing dynamics of the Trump era: the visible straining by his officials, probably involving countless hours of statement-crafting and planning, to maintain the lie that the president does not really support the bad idea someone leaked to reporters, or that he has no intention to do the terrifying, awful thing he was rumored to be contemplating—which is then completely undermined the next time he goes on Twitter or gets in front of a TV camera, at which point he promptly admits that he is absolutely going to do the awful thing, and he’s going to do it beautifully.
Thus far, it seems no different with the vaccine. Trump might as well be standing next to Anthony Fauci wearing a “World’s Number One Vaccine Science Interferer” while Fauci insists that no one will interfere with the scientific process. It’s tiresome for these people to pretend otherwise. It’s especially insulting to be this far into Trump’s tenure, surrounded by endless examples of error, incompetence, and low standards, and have anyone pretend that they’ll diverge from this form because of the intensity of this crisis, as if this were the catalyst we’ve all been waiting for to transform this greedy, needy homunculus into something “presidential.”
In a recent interview with The Atlantic, Yale health policy professor Howard Forman said that if the government had committed, early on, “even one-tenth of the amount of money that they have committed to a vaccine to a cheap testing initiative … we would have already saved tens of thousands of lives and certainly would have saved tens of thousands more going forward.” Other countries have controlled the virus far better than we have. If Trump had simply done his job months ago, we might not be worrying about this nearly so much; a vaccine would still be important, but we wouldn’t be losing 1,000 people every day that we didn’t have one, and it wouldn’t feel like the only way life might be normal again. Perhaps the really scary thing is not whether Trump approves a vaccine before it’s ready: It’s whether he gets another four years to keep failing at everything else, too.
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