After months of waiting, the F.D.A. has granted full approval to the Pfizer vaccine.
A vial of Pfizer’s Covid-19 vaccine.Saul Martinez for The New York Times
‘Above all, try something’
The F.D.A.’s full approval of Pfizer’s Covid-19 vaccine is already making a difference. Within hours of the announcement yesterday, the Pentagon and several large companies and universities announced new vaccine mandates. President Biden, speaking at the White House yesterday afternoon, urged other organizations to follow: “Require your employees to get vaccinated or face strict requirements,” he said.
But the much-celebrated impact of the F.D.A.’s decision has a flip side: The monthslong wait to reach this point has had large costs.
It has delayed the hundreds of thousands of vaccinations that will now occur within the military and elsewhere. The lack of full approval has meant that some Americans who are skeptical of vaccination — but not firmly opposed to it — still have not gotten a shot, fueling the spread of the Delta variant and causing many unnecessary deaths. (These maps show that vaccination rates for people over age 65 are much lower in the U.S. than in Britain.)
Over the past week, about 1,000 Americans per day have died of Covid; vaccination would probably have saved more than 95 percent of them.
By The New York Times | Source: Centers for Disease Control and Prevention
Why, then, has the F.D.A. been so slow to act?
The short answer is bureaucratic caution. The F.D.A.’s leaders wanted to hew as closely as possible to their normal process for granting full approval to a vaccine. They bestowed “emergency authorization” on the Covid vaccines from Pfizer, Moderna and Johnson & Johnson months ago, so that Americans could begin receiving shots. In the meantime, the F.D.A. spent months reviewing trial results before granting full approval to any Covid vaccine.
F.D.A. officials have defended this approach by pointing out — fairly — that a careful approval process can increase people’s confidence in a vaccine. But officials have also claimed that they had little choice but to follow the cautious path that they did. And that part of their defense is inconsistent with the facts.
‘Met our standards’
There are two basic ways to see that the F.D.A. did have a choice and could have acted more quickly than it did. The first is that the agency has acknowledged that it moved more quickly in this case than it normally does. A typical vaccine approval process takes between eight and 12 months; Pfizer’s Covid vaccine received full approval three and a half months after the company filed its application.
There is nothing magical about three and a half months, however. Once the F.D.A. had already departed from its usual process, it could have done so more aggressively than it did. Multiple medical experts have been urging so for months. No White House official, member of Congress or federal judge was threatening to stand in the way of an expedited process.
After all, the F.D.A. leaders made clear that they had made up their minds long ago about the substantive part of the decision to grant full approval. They publicly endorsed the vaccines, urging Americans to get shots. Dr. Janet Woodcock, the acting commissioner, said three months ago that the vaccines “have met our high standards for quality, safety and effectiveness.” Early last month, Dr. Peter Marks, who oversees the approval process, wrote, “If we truly want our lives to return to normal, the fastest way to do so is simple — get vaccinated right now.”
The wait for full approval, then, was more about process than science.
The F.D.R. approach
The second key point is that American history is rich with examples of government officials doing what the F.D.A. decided not to do in this case: overhaul their process in a time of crisis.
Franklin D. Roosevelt repeatedly broke with tradition — and endured confrontation with the courts — to fight the Great Depression. His administration, working closely with business, also threw out the normal bureaucratic procedures to build World War II ships, planes, tanks, bombs and other matériel with stunning speed. In this century, the Federal Reserve under Ben Bernanke took creative risks that helped keep the financial crisis of 2007-9 from becoming another Great Depression. (The title of Bernanke’s memoir is telling: “The Courage to Act.”)
In each of the instances, officials avoided taking steps that clearly violated the law. Yet they recognized that the law often includes gray areas and gives government agencies leeway to choose one of several approaches. During normal times, taking the cautious route and following procedural precedent tends to make sense. It minimizes chaos and mistakes.
But a national emergency can change the equation. In an emergency — like a depression, a war or a pandemic — government leaders will sometimes decide that the abstract benefits of bureaucratic continuity are smaller than the concrete benefits of preventing a depression, winning a war or saving lives. These leaders refuse to be bound by precedent.
In 1932, Roosevelt described his approach as: “Above all, try something.” In 2021, the F.D.A. took a different approach.