RUTHFULLY YOURS

For the health sciences, these are the best of times and the worst of times. The best have been dramatic achievements emerging from American and European labs. The worst have been lab practices in China and the secrecy surrounding them.

The powerful tools developed by Western scientists were consistently used to save lives, most dramatically with the development of vaccines that have succeeded in suppressing the pandemic in those places where their use has been widespread. The same tools, in the hands of Chinese virologists, were used to experiment with deadly pathogens. We don’t know if they were trying to develop biowarfare agents or tools to combat future pandemics, and we don’t know crucial information about the origins and early spread of the virus because Beijing is hiding it.

We do know the deadly toll. According to Johns Hopkins statistics, there have been 177 million known cases of COVID-19 worldwide and 3.8 million deaths. Beyond that is the devastating impact on mental health, schooling and economic activity worldwide.

A third group of scientists, public health specialists in the U.S., falls between the best and worst. Tasked with immense responsibility and under intense time pressure, they achieved mixed results, at best, in their primary task: protecting Americans’ health and safety.

As we emerge from our bunkers, people naturally want to assign responsibility for the high costs they incurred. Were all those costs necessary? Could we have done better? Who deserves blame—or praise? Some have piled that blame on “science,” when they really mean mistakes by public health officials. Those same officials, hoping to escape responsibility, have depicted themselves as the very embodiment of modern science and technical proficiency.

Both the attacks and defense of science are confused because they conflate different aspects of scientific work during the pandemic. A better approach is to distinguish three distinct strands of bioscience and public health over the past year and a half. Each deserves a different grade.

• Western lab science gets an A+.
• S. public health scientists and bureaucrats get a C, at most.
• China’s scientists and their political bosses get an F, but only because there isn’t a lower grade.

It is a fundamental mistake to lump together these different dimensions of modern science and then praise or damn them as a package. That’s true for Americans, eager to find scapegoats for the heavy costs they have borne. That’s equally true for public health specialists who want to insulate themselves from blame. It is sheer hubris for Dr. Anthony Fauci, the government’s lead scientist for infectious diseases, to claim that criticizing him is a mindless attack on science. It isn’t. Some criticism is properly directed at him for his uneven performance and, beyond that, at all public health officials. Since Dr. Fauci is the public face of that vast bureaucratic network, he gets both the praise and criticism.

The way to untangle this confusion is to look separately at each major element of scientific performance during the pandemic. We need to understand what went right and what went wrong so we can cope more effectively with future pandemics. Let’s begin with the best.

The Triumph of 400 Years of Western Science

Western lab scientists used the latest genetic discoveries and techniques to produce miracle vaccines in record time. Pfizer and Moderna relied on a novel approach, messenger RNA, to produce their vaccines. Although scientists had been working with messenger RNA for some time, no one had yet used it to produce a vaccine that had been tested on humans. Pfizer and Moderna did—and they did so within months, not the 5 to 10 years traditionally needed to produce conventional vaccines.

That rapid success is an enormous achievement. The good news actually goes beyond the current vaccines in two ways. First, the vaccines in use today can be modified easily for future variants of COVID. Second, these techniques hold great promise for vaccines targeting other viral illnesses, a long-run benefit that could be huge.

Another major lab triumph is the development of reliable, rapid testing to determine whether individuals are currently infected with COVID or have recovered from it. Those tests, like the vaccines, were developed with unprecedented speed.

The tests, vaccines and ability to mass produce both are spectacular achievements. They are the latest fruits of four centuries of Western scientific and economic progress, including ever more precise instrumentation, sophisticated manufacturing, and efficient, low-cost distribution that is capable of swiftly transporting delicate, low-temperature medicines to end users.

The vaccines and tests we use today are products of what is sometimes called the Fourth Industrial Revolution, based mainly on connective computing and biotechnology. The central agents are adaptive corporations seeking profits in competitive markets. The new vaccines and diagnostic tests are products of those organizational forms and political-economic structures, unique to the modern West.

Sir Francis Bacon in 1617

Modern science itself is one of those deep structures. Today’s biosciences build on traditions of scientific experimentation (begun by Francis Bacon around 1600), explicit hypothesis testing and mathematical expression. Modern biology began with formidable scholars in the 19th century, particularly Louis Pasteur, Gregor Mendel and Charles Darwin. A separate strand, initially focused on chemistry, began in modern research universities, which were created in mid-19th century Germany and soon spread to the rest of Europe and the United States. Almost immediately, they began making contributions in the biological and physical sciences.

What universities were doing as pure research, large corporations (themselves a modern invention) were doing for profit. General Electric created the first commercial research laboratory, led by Thomas Edison, Willis Whitney and Charles Steinmetz. Soon, corporate research facilities—including, most famously, Bell Labs—were ubiquitous. Their common goal was to produce a stream of innovative products and processes for profit. COVID vaccines and testing equipment flowed from these private research-and-development facilities, sometimes aided by government grants (which are critical to basic science at universities).

The medicine and equipment could be mass produced only because mass manufacturing had been perfected over the past two centuries. These unprecedented achievements in production and distribution, the source of the West’s vast wealth, didn’t just happen. They were induced by the pursuit of private profit in competitive markets. For the past 150 years, that pursuit has included the swift commercial adoption of scientific discoveries.

The research that culminated in COVID vaccines was possible only because of earlier, more fundamental scientific discoveries, notably Francis Crick and James Watson’s unraveling the double-helix structure of DNA, which they did in the early 1950s. Since then, medicine has moved toward treatments based less on hit-or-miss experimentation and more on a fundamental understanding of cellular mechanisms, genetic structure and epigenetic expression. The diagnosis and treatment of COVID-19 would not have been possible without this cumulative understanding and established protocols for evaluating new treatments.

It was confidence in these scientific methods that led to a risky but brilliant bet by the Trump administration. The president decided to mass produce COVID vaccines before they had passed the final tests for effectiveness. That had never been done before. The risk was that billions of dollars would be wasted if the vaccines failed the final test.

That bet hit the jackpot. Actually, the Trump administration made two successful bets. The first was a no-brainer. Pump a lot of federal research money into COVID vaccine research and do it without the time-consuming procedures normally used to vet research grants. The public health experts who authorized those funds deserve credit for doing it quickly. They also deserve credit for cutting red tape to allow scientists to move quickly to test their vaccines on human subjects, first for safety, then for effectiveness.

Once the vaccines showed promise, they needed funding for immediate testing on a much wider scale. Trump provided $472 million for Moderna to begin those final, Phase 3 trials. Pfizer did not seek U.S. funding for research or testing, though it did receive major contracts later to manufacture the vaccine. Pfizer’s partner, BioNTech, received funding from the German government for the RNA technology it developed.

The second bet, to begin manufacturing the vaccines before final approval, was far riskier. It was ultimately President Trump’s call to move forward with production before Phase 3 trials were complete. That decision, made in August 2020, saved thousands of American lives and many more worldwide.

While the decision was Trump’s, it was feasible only because (1) the U.S. is an immensely wealthy country so it could afford the bet; (2) its pharmaceutical giants were capable of producing this complex new drug in large quantities; and (3) lab scientists were confident their work would pass the final trials and yield a safe and effective vaccine. Everyone feared delay would cost lives. Of course, they would wait to inoculate the public until the Food and Drug Administration (FDA) issued its approval.

America’s wealth helped in another way. The Trump administration quickly decided that all tests and vaccinations would be free.

After the FDA granted its approval, the next challenge was getting vaccines out quickly to hospitals, pharmacies and state distribution centers and, from them, into people’s arms. There were initial glitches, which the media trumpeted as failures of Trump’s Operation Warp Speed. A typical example is The Washington Post’s headline on Dec. 31, 2020: “Trump administration falls far short of vaccination goals.”

The problem was not shipping the vaccine, even though that was a very complex task. The problem was getting shots into arms. That was difficult not only because the scale of the rollout was so large, but because they couldn’t be administered the easiest way: first-come, first-served. Instead, the first doses needed to go to essential workers, such as medical professionals, as well as people at high risk of morbidity, such as diabetics and the elderly. Setting these priorities had not been done before by healthcare officials at the federal or local levels or by hospitals, which were allocated dosages and told to determine their own priorities.

All of them fumbled, at least at first, leading to public confusion and frustration. Trump’s Operation Warp Speed bears some of that responsibility, as do public and private healthcare managers. Local officials had a large role to play here because the Trump administration consistently stressed decentralized responsibility for patient care and any restrictions on public activity. Washington provided data, advice and backup resources, such as ventilators, when hospitals ran short.

Fortunately, the problems administering shots were temporary. After that slow start, the process ramped up quickly. By mid-January, about 1 million shots per day were being given, and the numbers continued to rise. By May 2021, the shots were readily available to everyone. They were even available to 12- to 15-year-olds, after testing for that population had been completed. In the U.S. as a whole, the constraint shifted from supply shortages, which had disappeared, to the reluctance of some groups to get vaccinated.

Vaccination center in Seattle on Jan. 21, 2021. Image Credit: Grant Hindley/AFP

Although the early problems with vaccine distribution were temporary, they were intensely frustrating. By then, the public knew that vaccinations were by far the best protection and that any delays put them at risk. Since supplies were initially limited, individuals tied up phone lines and websites, trying to schedule appointments. Irritating as those initial problems were, they were far less important than the earlier decision, largely ignored by the media, to produce the vaccines en masse before final FDA approval. That unprecedented decision was a complete success.

China’s Failure—and the Price the World Paid

We still don’t know what we need to know about the Wuhan Institute of Virology and its responsibility for the pandemic. But what we do know is bad, and we are likely to know a lot more soon when U.S. intelligence reports are released. Congress is pressing for them, and some information has already leaked from the agencies.

We already know the Wuhan lab was working on “gain of function” research and had inadequate containment procedures, despite the high dangers of its work. The lab had suffered leaks previously. We need to know more, a lot more. The fact that so much is hidden is due entirely to Beijing’s stonewalling. America and its G7 partners are demanding answers. The Chinese Communist Party is unlikely to provide them.

If the pathogen escaped from the lab, it was undoubtedly an accident, not a deliberate bio-attack. It is likely, though not certain, the lab was researching bioweapons, which involved making natural viruses more lethal. We’re not certain because Beijing is hiding everything about the lab.

What we do know for sure is that China deceived the world about how the virus spread and chose, quite deliberately, to allow Chinese nationals to travel around the world after Beijing knew the virus spread from human to human. That decision was deadly. It killed millions, wrecked economies and destroyed countless families.

In early 2020, when countries began to recognize the contagious disease was spreading from China, they moved to restrict those international flights. The restrictions were immediately attacked as xenophobic, first by the Chinese and then by Western leftists, eager to designate everything as racism. Remember how anyone who called it the “Wuhan virus” was deemed a racist? Remember how universities, in their newly accustomed role as language police, prohibited even the use of “Wuhan” or “China” in connection with the illness?

Remember how The New York Times editorial board took a short break from rewriting American history and told us never to use those terms. The Los Angeles Times reported: “San Diego law professor under investigation over Chinese reference in coronavirus blog post.” Other universities prohibited the language as well. Of course, the World Health Organization, working closely with China, inveighed against those terms.

Whether the COVID-19 virus was man-made or naturally occurring is a separate issue from whether it escaped the Wuhan lab. A natural virus could have escaped and so could an enhanced one. The difference is that an enhanced one would be more contagious and lethal, and Beijing’s responsibility would be even greater.

We simply don’t know, at least not yet, what kind of virus began spreading near Wuhan, and we don’t know for sure if it was caused by a lab leak. We do know Wuhan scientists were working on gain-of-function research and doing so in conjunction with the Chinese military.

We may never know the origin story for certain. The reason is simple: Beijing is hiding everything to do with the Wuhan Virology Institute and anyone initially infected with COVID-19. The Chinese Communist Party refuses to share information, has destroyed as much crucial data as they can (the very opposite of Western scientific practice), has hidden or guarded anyone who might provide answers, and has consistently refused to allow outside scientists to investigate freely. They are clearly hiding something, but we don’t know exactly what.

There is circumstantial evidence of COVID-like infections in the Wuhan region some two-three months before they began spreading farther afield. We know China began restricting travel around the Wuhan Institute and then restricting travel from that region to the rest of China. They would impose those restrictions only if they believed or at least suspected the virus could spread from human to human. We also know China refused to tell the world about these internal restrictions so we could draw our own inferences. Beijing didn’t just stay silent. The CCP, Chinese scientists and the World Health Organization all denied human-to-human contagion was possible. Taiwanese scientists told us the truth early on.

Since China is refusing to allow open investigations by outside scientists, the most conclusive evidence is likely to come from study of the virus’s DNA structure and from Western intelligence intercepts. Does the DNA show any evidence of manipulation at the same genetic location where scientists have changed other viruses? Can we find evidence of identical viruses occurring in nature? Western intelligence agencies might be able to supplement that information if they have captured Chinese communications or gained access to whistleblowers or defectors with inside information.

While Beijing tries to keep us in the dark, we need to shift our default answer from “Who knows how this pandemic began and who is responsible?” to “Beijing should be deemed responsible for this damage unless they permit free and open inspection by independent scientists.”

The Mixed Record of Public Health Officials

The record for public health scientists is mixed. That’s true across the world. Mistakes are certainly understandable in the first months of the pandemic. The virus was new, and nobody understood exactly how it infected people, how it spread, who was most vulnerable (and who was not), and how to cope with it. We didn’t have good population data on infections, either. Now, over a year later, the lack of knowledge and sure-footed advice is much more troublesome.

Epidemiologists in the U.S. government imposed heavy costs on workers, businesses, schoolchildren, parents, universities, hospitals, nursing homes—on everyone. We need to remember that public health professionals faced unprecedented challenges. But we should also acknowledge that they didn’t always meet them, didn’t always tell us what they knew, and issued confident pronouncements without clear epidemiological evidence.

For over a year they were unable to provide clear-cut medical answers about which activities were safe and which were not. If it turns out that these same U.S. officials were funding gain-of-function research in China and hiding that information from Congress and the president, they face even bigger trouble. Much bigger.

Remember, too, that their confident recommendations for complete lockdowns conveyed enormous political power to governors and mayors with almost no constraints. The public was tolerant of those restrictions, at least for a while, because the emergency was obvious and everyone wanted to stay safe. As the emergency ebbed, the public became more irritated by the restrictions and less tolerant of the fiat orders, all of which bypassed normal, deliberative legislative procedures.

In retrospect, it is unclear how many of these restrictions were essential and how many were not. Scientists, enamored with double-blind clinical trials, were extremely reluctant to rely on population data from the general public, so-called “natural experiments.” If they had done so, they might have focused much more intensively on protecting nursing home patients and been more relaxed about outdoor activities for young people. The biggest political success of the pandemic was Florida Gov. Ron DeSantis’ close attention to nursing home safety. The biggest loser is New York Gov. Andrew Cuomo, also because of nursing homes, compounded by the media’s now-embarrassing deification of him for giving good press conferences.

Public health officials also gave political cover to teachers unions, which didn’t want a return to in-person learning, despite mounting evidence that children (at least those under high school age) were perfectly safe. We now know that private schools, which mostly remained open, fared very well. Their students and families were safe. Meanwhile, public school students lost a year of education and socialization. It is perfectly reasonable to assign blame for those unnecessary costs, especially after the first months of confusion had passed.

Worse than the poorly grounded but overconfident recommendations were the occasional lies. The most obvious was telling the public not to buy masks early in the pandemic when public health officials actually believed they provided protection. The motive was benign. Medical professionals needed the masks, and they might not get them if the public scooped them all up, as Fauci later said explicitly. Once the doctors and nurses had masks, the recommendation changed. Now, the public was ordered to wear them. The reversal drained confidence in those recommendations, but worse was to come. It came when the public learned that the initial recommendation was not an innocent error but a deliberate lie. With that discovery, public trust in pronouncements by public health officials plummeted.

That mistrust is coming back to bite Fauci, the most prominent face of government science during this outbreak. His responsibility for the deceit about masks has eroded his standing as he tries to explain whether his division of the National Institutes of Health funded inappropriate research in Wuhan. His story on that keeps changing, and it does so against the harsh backdrop of his earlier deceit. The recent release of his emails compounds his troubles.

Fauci’s biggest problem now is his recent congressional testimony that he did not fund gain-of-function research in Wuhan. That denial turns out to be a little slippery. His unit gave money to a U.S. nonprofit, which then provided it to the Wuhan Institute of Virology. It is still unclear if Fauci knew about this pass-through and the research it funded. He will be forced to explain exactly what he knew, and so will the chief executive of that nonprofit.

Another problem for public health experts was the total screw-up in early testing. In spring 2020, when we needed lots of accurate COVID tests, the FDA moved with its usual lethargy. Finally, it granted emergency use authorization for a test developed by the Centers for Disease Control (CDC). Unfortunately, the CDC had problems manufacturing the initial tests. In spite of those problems, the CDC refused to let private companies use the more accurate tests they were developing. As NBC News explained in mid-March 2020, “The CDC took control of distributing and administering tests while the private sector and foreign-developed tests were kept out of the process during the crucial weeks between when the virus was first identified in December and when it started rapidly spreading among the American public.”

The Political Stakes

As the country looks back on this strange and terrible period, it will hold accountable public officials who performed poorly, and especially those who lied. As we do so, it is important to forgive the understandable errors, made in a hurry with incomplete information. Those are different from bureaucratic bungling and the failure to collect and analyze population data that could have guided better decisions. In any case, it is a mistake to damn or praise “science” as a whole. Some parts deserve that condemnation, others praise and still others forbearance. We need to split, not lump.

The pandemic is likely to produce three major effects on lab science, going forward. First, all labs working with dangerous pathogens will be subject to even more scrutiny for their safety protocols. Second, collaboration between Western scientists and their Chinese counterparts will be sharply curtailed. Western funding agencies won’t permit it, and Western scientists will shy away from the risks. This new, more adversarial environment might also curtail enrollment of Chinese students in Western universities.

Finally, knowing that China has been working on lethal biological agents (or likely is doing so), the U.S. defense establishment will necessarily undertake similar work, not to produce offensive biological weapons but to produce antidotes and vaccines. That work will involve close collaborations with major research institutions and pharmaceutical companies.

For China, the shocks from this global crisis are not over. Far from it. The verdict on its behavior is already bad, and it could get much worse. What we learn over the next few months about China’s culpability could reshape its relationship with the world, strategically and economically. The stakes are enormous.

The past year and a half has been a very bumpy ride. Although the worst days of the pandemic are behind us, the political aftershocks are not. This hard ride ain’t over.