For scale, pls keep in mind:

—About one in every 588 Americans have died of COVID (562K of 331 million ppl)

—About one in 10 Americans have been infected w COVID (31 million of 331 million)

—About 1 in a million who got J & J have had blood clots— just 6 ppl out of 6 million https://twitter.com/US_FDA/status/1381925613691412480

This sense of scale is difficult for media to convey, but VERY important to try do: The risk of COVID, the third largest killer of USians last risk, is FAR more than any risk from J&J. Unfortunately, headlines and framing may skew the potential risk from J&J.

Also difficult for us journalists to convey, but important: We are ALL essentially in a trial to see how (very) safe drugs are, in an emergency situation w a virus taking the lives of one in every 588 ppl in the wealthiest country. The risks are worth it & not bad. I'll explain.

Largely beginning with HIV/AIDS, how trials were conducted changed, with good reason: A virus that, in its height 15 years into that pandemic took abt 55K US lives in a year (just 10% of COVODI) was so deadly, it was not ethical to wait yrs to try the best science had w humans.

So, you test with a small group, then a larger group to make sure the meds are safe, under emergency use.

All of these vaccines were tested with tens of thousands of people.

All good.

But, say, if you test with 60,000 ppl, you know the limits of safety only go up to "free of problems in no more than 1 in 60K."

OK, this is FANTASTIC ALREADY. W a virus killing one in 588, knowing a vaccine hasn't harmed even one in a 60,000 IS ALREADY FANTASTIC!

So your safety floor is already so safe! A vaccine that will stop something killing one in 588 ppl and is not harming any of the 60,000 people is already an astounding success.

So as we get it, we are testing something quite wonderful: How high is that safety ceiling?

Now we are looking at, is one person out of 100K reacting aversely?

One in 500,000?

One in a million?

The more people who get it, eventually you may find that if they number gets high enough, someone may have an adverse reaction. This is expected.

Clearly, one in a million odds are a lot better to face than one in 588.

The other issue is that, as tens and then hundreds of millions of people get a vaccine, lots of USians are going to die.

Just, fortunately, not of COVID, the 3rd biggest killer in the US.

But when you get to tens and then hundreds of millions of shots administered, it could be easy for journalists to assign the kinds of deaths that WILL happen regardless among hundreds of millions to the vaccines that shouldn't be.

I will take J&J (or any vax) when offered (abt for 3 weeks from now). I'm sad the FDA is pausing bc of an irony: the "abundance of caution" of a 1 in a million possibility of death will sow doubt abt how the best adress a 1 in 588 certainty of death, which will cause more death.

(And BTW, my apologies abt using all US data here. COVID is a worldwide problem. But my knowledge of the data is strongest w the US, and it is the US FDA pausing, and the US deaths are still the highest, so I used US data in this thread to make my point to other USians.)

I keep thinking abt, how do we effectively & without shame counter the fear "They're going to put something in me that will kill me!" among ppl heistant of vaccines and recenter a sense of caution abt a virus that is one of the most lethal forces on the planet right now?

And I think back to the early, pre-med days of AIDS.

When tens of thousands of gay men & other ppl were dying every yr, if you'd told them one day, "Hey, there's a drug to stop all this death, it's free & you just have to get one or two shots & the govt will give it to you"...

...people would have been partying in the streets.

And if you'd told them that nearly every person with HIV would eventually die of AIDS but one out of a million might have an adverse reaction to the medicine, I'd hope facing certain death would soothed any anxiety.

We are facing death, mass death—a plague of a scale we haven't seen as a species for some time.

Please, let's keep proportionality of risks in mind.

One in a million odds of complications are SO MUCH better than a one in 588 chance of death one in 10 of infection.

@threadreaderapp unroll