First, an admission: this is not really a column about the origin of SARS-CoV-2. Others have written great ones, and I am not terribly interested in the question. Why? Right now, the two most widely discussed possibilities are the virus underwent zoonotic transmission (from some animal to a person), possibly at a wet market, and the other is that it escaped from the Wuhan Institute of Virology due to poor safety protocols in a biosafety level (BSL) 3 or 4 laboratory.
If it escaped due to a wet market, I would strongly suggest we clean up wet markets and improve safety in BSL laboratories because a future virus could come from either. And, if it was a lab leak, I would strongly suggest we clean up wet markets and improve safety in BSL 3 and 4 ... you get the idea. Both vulnerabilities must be fixed, no matter which was the culprit in this case, because either could be the culprit next time.
I want to talk about the real lesson of "lab leak," which in my mind is the way in which the idea moved from a taboo subject -- a conspiracy theory -- to a perfectly acceptable topic of discussion. In fact, last week, Facebook removed its ban on posts discussing the laboratory escape of the virus as a possibility. How could this happen? What was misinformation yesterday is something that needs investigating today? Other writers have discussed how prominent social media accounts took extreme positions that dissuaded the media from fairly considering the possibility of a lab leak, and on the heels of an election, turned the lab-leak idea into a political issue.
"Lab leak" isn't the only topic that has undergone massive swings in opinion. In early March 2020, for example, experts advised against mask wearing. A few weeks later the pendulum swung the other way, and the U.S. and CDC went beyond World Health Organization (WHO) guidance and recommended cloth masks to kids as young as 2 years old (WHO said 5 and up). With time, we may still see more shifts on this topic, as at least two cluster randomized trials are ongoing. In January of this year, I wrote two columns arguing that 14 days after the second dose of vaccination, people can ditch the mask or hug a loved one. There was fierce pushback on Twitter. A few months later, CDC guidance fell in line with my perspective.
Recently, a Tweet from an anonymous cardiologist was flagged as misleading for arguing that mRNA vaccines may have a stronger link to myocarditis than asymptomatic SARS-CoV-2. The jury is still out, but since that warning, based on early Israeli data, the CDC has announced an investigation into the link between mRNA vaccines and myocarditis. Finally, I continue to believe the pendulum on school closures is going to swing so far the other way it will make your head spin -- prolonged closure will someday be seen as a crime against kids with negligible impact on viral spread.
I chose these examples not because I want to rehash whether one side is right (though for several I have my pick), but to make the broader point that stifling debate, shrinking the acceptable bounds of dialogue, and banning discussion has got to be wrong when we see over and over again how quickly debates can move. Yesterday's misinformation is today's popular view.
Times Have Changed
When I was in college, 20 years ago, life was different. We did not have phones capable of audio or video recording and social media did not exist. I remember staying up till dawn with kids in my dorm and having vigorous discussions about politics, science, and the good life. I went to college at Michigan State University. We had Republican kids, Democrat kids, and kids who weren't interested in politics (most of us); we had kids whose parents were executives at General Motors, and kids whose parents worked on the plant floor. The debates were on hot topics -- topics that these days would lead to Twitter pile-ons and folks calling someone's employer. Yet, that never happened back then.
People who disagreed politically still met on Saturday to tailgate together and sing the fight song. We argued, but didn't believe anyone was morally superior -- in fact, we all recognized how small and insignificant we were in the world. When we spoke, we never felt like we would offend. You could make a crass joke, and folks might groan, but they wouldn't disavow you. You could hold views that others would disagree with, but they only hated you if you drank the last beer. For me, the child of immigrants, that is what America meant -- a place where people from different backgrounds could talk about different things. Debates could be serious, but they were seldom personal.
In 2021, we are swirling in a craze. Entire swaths of the human condition are taboo topics that you dare not talk about. Jokes can enter your mind, and you have to pinch yourself lest you say it. You have to study people silently for days to see if they might be the type of person who likes to hear jokes. With some people, you never take a chance. You go to a dinner party, and never know if someone will capture a 15-second video of you to post online, claiming that you are a bad person for your views on a technical and complex regulatory issue, such as whether the emergency use authorization was warranted for 12- to 15-year-olds. The America I knew seems to be on life support.
Limiting Debate Is Dangerous
If we learn anything from the shift on the lab-leak theory, it is that curtailing free expression and limiting reasonable debate is a mistake. That's especially true when information is dynamic, and you are making unprecedented decisions. In human history, we have never asked so many people to deprive themselves of social interaction for so long. We have never closed schools for so many kids and for so long. Naturally, these policies will spark disagreements, even fierce ones. Restricting the bounds of what's appropriate -- particularly with the brute force of platforms like Facebook -- is a fool's errand. Pseudo-consensus is cheap and easy in a world of social media.
Fostering Liberalism in Science
One persistent mistake we make is confusing democracy and liberty. Liberty is the right to govern your own life, your own mind, to make a future as you see fit, with whomever you wish to. Democracy is the will of the majority. Although we live in a place where we have both, the two are not linked. Some autocracies have been astonishingly liberal, and democracies can succumb to tyranny of the majority, and become profoundly illiberal. The idea that we could not discuss the lab-leak hypothesis for over a year represents a failure of scientific liberalism, and possibly the tension between the majority and liberalism. Many scientists on social media may have viewed the lab leak as a hypothesis that would help their political opponent, and pushed to curtail its consideration. Such a gambit was dangerously shortsighted.
Liberalism in science -- the ability to hold and discuss a broad range of views -- is a newborn bird. We hold it in our hands. It matters even more than the right answer. Lab leak is just a salient reminder of how vulnerable that bird is -- and that's the real lesson we need to learn.
Vinay Prasad, MD, MPH, is a hematologist-oncologist and associate professor of medicine at the University of California San Francisco, and author of Malignant: How Bad Policy and Bad Evidence Harm People With Cancer.