Not throwing away our shot

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Science  16 Oct 2020:
Vol. 370, Issue 6514, pp. 266
DOI: 10.1126/science.abf2306

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Over the past few weeks, prominent scientific publications have condemned President Donald Trump's record on science. This is unprecedented. Although my predecessors at Science have always held elected U.S. officials accountable (but could not make a formal political endorsement because of the nonprofit status of the American Association for the Advancement of Science, the publisher of Science), many of these publications are now clearly denouncing the U.S. president, administration, and federal agency leaders as the nation approaches a highly consequential presidential election. To paraphrase lyrics by Lin-Manuel Miranda in “Hamilton” about another set of political essays, why do we write like we're running out of time? Because recent events show that the voice of the scientific community can lead to positive change.

I have been supportive and then critical of Stephen Hahn, commissioner of the U.S. Food and Drug Administration (FDA). When he granted the emergency use authorization (EUA) for hydroxychloroquine to treat coronavirus disease 2019 (COVID-19), much of the biomedical community lost trust in him, but I maintained that if he stuck to the science on the COVID-19 vaccine, the nation should support him. When he botched the announcement of the EUA for convalescent plasma to treat the disease, I lost confidence in him again and wrote that society was on its own to tackle COVID-19 without help from the FDA. At the same time, Eric Topol, editor-in-chief of Medscape and a prominent scientist and public health advocate, called for Hahn to resign.

Topol got Hahn's attention. After Topol's editorial appeared, the commissioner reached out to him, which, as Topol told me, started a series of conversations about their differences. Hahn confirmed to Topol that he had been instructed by the White House to extoll the benefits of convalescent plasma beyond his scientific judgment. Subsequently, the FDA proposed to the White House a more stringent protocol for approving a COVID-19 vaccine. In the case of the two leading vaccine candidates (Moderna and Pfizer), a 2-month delay would be required for half of the volunteers that received a second shot, which must be delivered 3 to 4 weeks after the first immunization. This meant that an EUA for a vaccine would not be approved before the election. Trump attacked Hahn and criticized this logical move for patient safety as being politically motivated. Surprisingly, a few days later, the White House agreed to the FDA guidelines. Hahn had stood up for science and stood up to Trump. In an interview with Topol, Hahn pledged to stand up for sound scientific judgement.

The pressure put on Hahn by the scientific community played a big role in stiffening his spine. Topol told me that Hahn said he was “profoundly dejected” after the convalescent plasma debacle and realized that the subsequent vaccine drama posed an “existential crisis”—either he would be fired by Trump or permanently lose his standing in the scientific community. Ultimately, he decided that doing what was right for the success of the COVID-19 vaccine trials and the safety of the public—while also repairing his reputation in medical science—was more important than keeping his job at the FDA. We can hope that it's too much trouble for Trump to fire him this close to the election. I'm now back to supporting Hahn knowing that scientists will decide whether to approve the COVID-19 vaccines and provided he continues to support science.

With his apparent recovery from COVID-19 due perhaps in part to receiving an experimental monoclonal antibody cocktail from Regeneron, Trump's attention has turned to touting this treatment as a “cure” and promising its availability to all Americans. An antibody-based treatment does deserve more scientific attention, but a therapeutic is not a cure. If an EUA for this treatment is announced, the scientific community needs Hahn to resist Trump's pressure to exaggerate and declare the pandemic over. These antibodies are helpful but currently in very limited supply and not something that will “get everybody out of the hospitals,” as Trump said recently. The scientific community must keep the pressure on Hahn to state the science clearly.

Readers who don't think Science and its publishing peers should write about politics often tell us to “stick to science.” We are sticking to science, but more importantly, we're sticking up for science.

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