Scott Gottlieb warns CDC: If you're too cautious in your guidance for vaccinated people, the public will ignore you

Take the time to watch this clip, as it’s been received with acclaim today on Twitter as an unusually sober assessment of risk calculation by a respected medical expert (and former FDA chief). If you’ve watched a single interview with a doctor or scientist over the past year, you know what to expect: Almost universally they counsel maximum aversion to risk in the name of limiting transmission and containing the virus. In any given situation, if you’re wondering whether to take a particular precaution or chance it, the official advice is “Don’t chance it.”

Gottlieb’s reply: That’s silly in the case of vaccinated people. Of course they’re going to chance it and reward themselves for their decision to get immunized by enjoying certain activities again. If you tell them that the only activity they can conscientiously engage in is small social gatherings with other immunized people — which is what, it seems, the CDC is poised to do — then you’re begging them to ignore you. Vaccinated people are going to go out to eat and to the movies whether Anthony Fauci likes it or not. So the smart play is to grapple with that reality, condone the activity, but advise on ways to make it as safe as possible for the unvaccinated people around them.

What’s the point in issuing guidance if you know people will ignore it, after all?

Gottlieb’s worried about the “cat and mouse” game I described in this post yesterday, in which the CDC deliberately makes its guidance overly cautious in the belief that Americans will follow it somewhat less cautiously and Americans end up following it somewhat less cautiously because they know the CDC is being overly cautious. He’s ready to end that Catch-22 by being realistic about vaccinated people’s behavior. I’m not sure I’ve heard anything like this from someone of his stature in the past 12 months:

He gave that interview this morning in anticipation of the CDC’s guidance for vaccinated people being issued today. But there’s since been a twist. For reasons that are unclear, the guidance has been postponed:

After a series of meetings and calls with senior officials on the White House’s Covid-19 task force and the Department of Health and Human Services over the last two days, the CDC was told to “hold off on releasing” the recommendations, one of those sources said. The reason is still unclear but one senior administration official said the guidelines were still being finalized…

The CDC’s guidelines for vaccinated people, as described to POLITICO earlier this week, were supposed to say that those who had received a full course of vaccine could socialize with other vaccinated people in small groups in the home without masks. But the guidelines said that vaccinated individuals should continue to adhere to mask and social distancing guidance in public. The guidelines were also set to include various scenarios for immunized people to consider, including travel…

There is no evidence to suggest that the Biden White House is trying to suppress the CDC guidelines or override the judgement of CDC scientists.

It’s unthinkable that they’d rewrite the guidance at the last minute to make it more liberal and realistic, as Gottlieb is recommending. Could they be rewriting it to make it even more hyper-cautious than it was supposed to be originally? I.e. vaccinated people should only socialize with other vaccinated people in small groups if they’re all wearing masks?

Relatedly, as Jim Geraghty points out, why do we still not have CDC guidance for vaccinated people two and a half months after vaccinations began? That’s another reason why the public doesn’t pay the agency much heed, I think. As with school reopenings, they’re so slow-footed in issuing recommendations on how to make life more manageable during the pandemic that people feel they have no choice but to try to feel their own way forward rather than wait. A grandparent who got vaccinated in January and has spent the past six weeks playing with their grandchildren again won’t devote a moment’s thought to the CDC suddenly declaring in March that, ackshually, they shouldn’t be doing that since the grandkids aren’t immune yet.

Anyway, as I say, you should savor Gottlieb’s commentary because it’s such an extreme outlier. At the Times this morning, the headlines look like this:

That story goes on to say that there are now multiple data points showing that people who’ve been vaccinated transmit far less virus than the unvaccinated do, on the order of a 75 percent reduction in some studies. But because the risk isn’t zero and because those studies aren’t definitive, the prudent thing to do is for the vaccinated to continue to mask up. (“They should wear masks until we actually prove that vaccines prevent transmission,” said Fauci to the NYT.) That’s defensible because mask-wearing is such a small imposition and because the reality of the next several months is that many millions of vulnerable people who want the vaccine will be barred from getting it, but it’s also part of the trade-off that Gottlieb has in mind. Encourage the vaccinated to start living life again in public spaces, but impress upon them that a small concession amid that return to normalcy is to do what they can to protect those around them. They’re going to live life anyway. If you’re going to nudge them, nudge them to be good citizens about it.