Biden pledged to ‘follow the science.’ But experts say he’s sometimes fallen short

WASHINGTON — It’s a mantra that President Biden has repeated since the early days of the 2020 campaign: If elected, he’d always “follow the science.”

As president, though, Biden has sometimes struggled to follow through on his science-first pledges. Over the winter, the White House press secretary publicly undercut the director of the Centers for Disease Control and Prevention after she suggested teachers didn’t necessarily need to be vaccinated for schools to be reopened safely. Then came the administration’s sudden U-turn on mask guidance in May, which was criticized for effectively assuming that unvaccinated Americans would still wear face coverings.

Most recently, and perhaps most striking, was the administration’s endorsement of “booster” vaccine doses, which numerous scientists say was based on scant evidence and undercuts the authority of scientific agencies.

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Given that Biden campaigned against a president who often downplayed Covid-19 and derided government scientists, many health experts hoped his election would mark the dawn of a more science-focused pandemic response. While the new president has made good on most of his scientific pledges, though, some of his apparent scientific stumbles have led some health experts to question whether he’s been true to his vow to follow the science — and whether politics have played a role in many of his administration’s most critical Covid-19 decisions.

“Normally, what you do is lay out the data first, and then say how the data supports the decision,” said Jesse Goodman, who served as the Food and Drug Administration’s chief scientist for four years during the Obama administration. When the White House made its announcement on booster shots, he argued, it did essentially the opposite.

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“This was a serious mistake in how it was handled,” Goodman said.

But Biden administration officials, including Anthony Fauci, the president’s chief medical adviser, pushed back strongly against the notion that the president’s Covid-19 response has been anything but data-driven.

“Remember, [Biden’s] not there at every single Zoom call, at every single decision,” Fauci told STAT in an interview. “But he set the standard, and he made it clear that he wants everyone in this administration, including the medical team, to make sure that science drives the guidelines. That science drives the decisions. That science drives the policy. He has been unequivocal.”

The Biden administration’s recent decision to give U.S. residents access to a third “booster” vaccine dose, in particular, has set off a firestorm. Epidemiologists have questioned whether there’s enough data to support their use.

While the White House has cited Israeli data in arguing that vaccines’ protectiveness wanes over time, even Rochelle Walensky, the director of the Centers for Disease Control and Prevention, acknowledged at a recent press briefing that for people who’ve received just two doses, “protection against severe disease and hospitalization is currently holding up pretty well.”

Still, the White House moved forward with its plan to make Americans eligible for a third dose of either Pfizer or Moderna’s vaccines eight months after the date of their second injection. Many global health officials derided the move as greedy: In most countries, vaccine access remains scarce. Providing U.S. residents a third shot, a top World Health Organization official said, is akin to “handing out extra life jackets to people who already have life jackets … while we’re leaving other people to drown.”

Many American scientists were distressed, too, that the administration’s decision appeared to undercut the authority of the CDC and FDA. To them, offering a third dose before the FDA’s approval, or before a CDC advisory panel’s recommendation, smacked of political interference with government science agencies — a phenomenon that Biden railed against in 2020 as he campaigned against President Trump.

At one point during the campaign, Trump’s team even attempted to mock Biden by claiming he “wants to listen to Tony Fauci.” Biden’s team responded with a one-word tweet: “Yes.

Since the announcement about the third dose, two senior FDA officials tasked with regulating vaccines have announced their retirements, though it’s unclear whether their departures were intended as a protest. At a meeting of a federal advisory committee on vaccines this week, one scientist on the panel said the White House’s policy “opened the door to a lot of confusion.”

Saskia Popescu, an epidemiology professor at the University of Arizona, said it wouldn’t be easy for any new administration to get the science just right.

“There have been some significant failures, but I appreciate that their goal is to use science to guide policy,” she said. “We do need some policy changes, but data is coming in at such a record pace. We’re constantly learning and evolving, so I empathize: It’s hard to guide policy with this changing science.”

Whether or not Biden has succeeded at marrying policy with data, he has signaled that science will reign supreme. He appointed Eric Lander, the prominent genomics researcher, as the first-ever cabinet-level science adviser. His White House quickly reinstated regular press briefings on Covid-19, orchestrated largely by three top health officials: Fauci, Walensky, and Vivek Murthy, the surgeon general.

Despite some criticism, Biden’s approach has marked a night-and-day difference from Trump’s coronavirus response. While Trump constantly minimized the pandemic’s seriousness, dismissed advice from medical advisers, and pushed unproven drugs like hydroxychloroquine as Covid cure-alls, Biden has nearly always deferred to the expertise of his medical and scientific staff.

“Largely, we have competent scientists trying to make science-based decisions,” Goodman said. “People shouldn’t totally lose perspective: We’ve gone from essentially denialism to a sincere effort to deal with the pandemic.”

Still, several of the new administration’s perceived scientific slip-ups have frustrated experts. Until now, though, many kept their frustrations private, conceding that small mistakes are inevitable when responding to a fast-evolving pandemic.

The booster brouhaha, however, has reignited several dormant debates about the White House’s policy process.

Some date back to Biden’s first days as president — in particular, the February controversy over school reopening. The debate centered on one of the new president’s signature pledges: That all American schools would offer in-person learning within 100 days of his inauguration.

Vaccines, however, were still scarce. Many teachers’ unions, fearing their members’ exposure to students, demanded that instruction remain virtual until they could be vaccinated. Walensky soon weighed in, arguing that vaccinating teachers was not a prerequisite for in-person teaching. Almost immediately, though, the White House undercut her: Jen Psaki, the press secretary, said Walensky was speaking “in her personal capacity.”

To many scientists, it represented an inauspicious start for the new administration. After pledging for months to “listen to the doctors,” the White House had publicly undercut its own CDC director, and one of the nation’s top infectious diseases experts, during Biden’s first weeks in power.

“That struck me as very odd,” said Amesh Adalja, a doctor and researcher at the Johns Hopkins School of Public Health. “The whole reason she was hired to be CDC director is because of her personal experience and personal opinions on infectious disease. So that was the first red flag, to me.”

Some of the CDC’s stumbles, however, were self-inflicted. In April, as confusion still reigned over exactly how effective the vaccines were, Walensky declared unequivocally that “vaccinated people do not transmit the virus.” The claim generated immense pushback from scientists, who said it was too soon to say. The agency then backtracked of its own accord: A spokesperson soon clarified that Walensky “spoke broadly,” and the science remained unclear.

Then, in May, the CDC suddenly introduced new guidelines on masks: Vaccinated Americans no longer had to wear masks indoors. The move generated mixed reviews: While most experts acknowledged vaccinated people were unlikely to contract Covid-19 inside, others argued that Americans would shun masks regardless of their vaccination status, potentially sparking a new wave of cases.

Most recently, the White House has also taken flack for moving too quickly in the opposite direction.

Following a cluster of cases in Provincetown, Mass., that occurred almost entirely among people who were fully vaccinated, the administration recommended reimposing indoor mask guidelines in areas of “substantial” or “high” coronavirus transmission.

“I thought that was also puzzling,” Adalja said. “Dr. Walensky said they were taking the data from Provincetown. They said this was a very rare event. It wasn’t driving transmission, and all the infections were mild. So I thought: Did that necessarily need to force a guidance change? It’s clear today, and it was clear then, that vaccinated individuals are not driving cases.”

But in the interview with STAT, Fauci pushed back strongly on nearly every criticism that outside experts have leveled at the administration.

Walensky’s allegedly overbroad claim that vaccinated people can’t transmit Covid-19, he said, was a “classic example of following the science” — in other words, guidance that the agency updated once it gathered new information and circumstances changed.

And on boosters, in particular, he acknowledged it “might appear” that the White House preempted the FDA and the Advisory Committee on Immunization Practices, the CDC committee tasked with formulating vaccine guidance. Still, he rejected the notion that the administration’s booster shot guidelines undercut either agency.

Overall, Fauci said, Biden’s coronavirus response has been entirely driven by science and true to his pledge.

“When the target continues to evolve in a very, very dynamic way, you can follow the science very strictly and still look like you’re a little shaky about it, when you’re not,” Fauci said.

Source: STAT