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Sensemaker: The greatest good?

Thursday 15 April 2021

What just happened


Long stories short

  • The UK government’s Equality and Human Rights Commission warned Covid passports could amount to unlawful discrimination. 
  • India reported more than 200,000 new Covid cases, pushing its total count to over 14 million cases.
  • The Minnesota police officer who appeared to mistake her gun for her Taser and killed Daunte Wright, a 20-year-old Black man, was charged with manslaughter.

The greatest good?

Allow me for a moment to turn to some philosophical principles, and to Jeremy Bentham – the philosopher whose criticisms of the law and of institutions helped to shape our modern state and, arguably, our vaccine roll-out. Bentham’s maxim was that we should produce “the greatest happiness for the greatest number”. 

Some 240 years later, the UK government’s vaccine roll-out still follows in the spirit of this so-called “utilitarian” maxim: increasing the gap between jabs one and two ensures that we have enough vaccine supply to give more people some protection – i.e. a single dose – rather than giving a smaller number two doses. 

But how to weigh this calculus when it comes to risk? This is where things have gone awry. 

  • On 14 April the roll-out of the Johnson & Johnson vaccine was paused in the US, South Africa, and European Union after reports of rare blood clotting – six cases in around 6.8 million doses in the US, according to the Food and Drug Administration. The company itself has paused distribution in response to this decision.
  • All six of these cases were in women between 18 and 48, with symptoms – including swelling, persistent headache, dizziness, seizures or vomiting – appearing six to 13 days after the jab. 
  • The US said the pause was “out of an abundance of caution”. The decision was fiercely criticised by frontline health workers who said the pause could further erode trust in vaccines – one said it was like “gasoline for vaccine hesitancy” – and would hit hard-to-reach people particularly hard. J&J is one of the few vaccines that can be kept at room temperature, and requires just one shot. 
  • Immediately after the announcement, large retailers and several US states stopped administering doses made by J&J.
  • The pause follows global confusion over the AstraZeneca blood clot risk, a vaccine which also uses something called “adenoviral vectors” to prompt an immune response. To be clear on the numbers: AstraZeneca’s blood clot risk was estimated at four in one million. J&J presented six clots in 6.8 million. The risk of death from those clots is even lower. Covid kills one in 1,000 infected in their 40s who develop symptoms. It kills older people at much higher rates.

It’s really the abundance of caution line that raised such fierce criticism. The risk/benefit calculus in this decision is hard to understand: how to justify the vanishingly small risk with the vast benefits of maintaining faith in vaccines, and in reaching the most vulnerable and under-served populations? 

Critics say that regulators in this case have been far too quick to abandon the utilitarian principle of maximising health. After all, thousands of women have pointed out that many other medicines have a far higher and accepted clot risk – the contraceptive pill, for example. 

In the case of the AstraZeneca clot risk, the UK government struck the risk/benefit balance pretty well – it made a decision to recommend a different jab in the most at-risk group, but keep using it in groups where the risk appeared low. They also let doctors know about the details of the clots, so they could watch out for them.

There’s a clear rationale there. I’m hopeful this will extend to the distribution of the J&J vaccine – the health of many depends on it.


New things technology, science, engineering

Open space
You’d imagine the software used in space exploration would be heavily armed and guarded. Well, not anymore. Nasa has announced that in 2023 its VIPER rover, which will travel the surface of the moon in search of water, will be running open-source software. This means Nasa will release the code under a special licence, allowing it to be used or modified or distributed by anyone, for any purpose. It’s a long way from the space race, and feels like a marked shift from the competitive and proprietary world of space travel we’ve known until now – the spirit of the hackathon meets the final frontier. 


Wealth investment, fairness, prosperity

Big lie
Bernard Madoff, who ran the largest and possibly most ruinous scam in history, died in a North Carolina prison. Madoff deposited client funds into a bank account and let them sit. When clients wanted to redeem their funds, he paid them out with new capital. A classic Ponzi scheme, which ran for decades and earned him tens of billions of dollars until the financial crisis hit and redemptions outstripped his ability to pay out. The Madoff story is one of greed, chicanery, and great personal loss. His victims were devastated. His sons, who reported him to the authorities, died – one by suicide, the other cancer. But it’s also a story of official failure: regulators investigated Madoff’s company at least eight times before its collapse and never filed charges. In the crisis, Madoff had summoned one of his sons to a meeting and told him: “It’s all just one big lie.”


Belonging identity, society, beliefs, countries

Human wrongs
Priti Patel, Britain’s home secretary, breached human rights rules when she failed to properly investigate deaths in immigration detention centres. The immigration court ruling relates to two Nigerian friends, Ahmed Lawal and Oscar Lucky Okwurime, who were in an immigration removal centre when Okwurime was found dead in his cell in 2019. Lawal had come forward as a witness, but the Home Office tried to deport him before he could provide evidence. The immigration court ruled that the attempt to deport Lawal was a failure to secure evidence for an inquest into Okwurime’s death. The inquest jury found Okwurime had died as a result of poor medical care. 


Our planet environment, natural resources, geopolitics

Glacial pace
An Alaskan glacier is on the move. The Muldrow Glacier, a 39-mile-long ice river, has been moving up to 90 feet a day over the past few months. The move is unusually fast and has excited glaciologists who are studying it with a mixture of satellite imaging, aerial photography, and global positioning systems. Mark Fahnestock, a glaciologist at the University of Alaska Fairbanks, thinks global warming, which causes less ice accumulation and more melting, is likely to be behind the glacier’s march. “There will be effects, especially in Alaska because the mass loss is so high,” Fahnestock said.


The 100-year life health, education, living, public poliCY

Shrooms
Magic mushrooms, which contain the hallucinogen psilocybin, are as good at reducing symptoms of depression as conventional treatment. The result comes from a small, early-stage study by Imperial College London’s Centre for Psychedelic Research. Researchers measured the mood and functioning of 59 participants, who were given either psilocybin or a common antidepressant, and found little difference between the two. It’s the first study of its kind and “not a quantum leap,” according to Oxford professor Guy Goodwin. “However, it offers tantalising clues that it may be.”

Thanks for reading, and do share this around.

Basia Cummings
@basialcummings

Photographs by Getty Images and NASA


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