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How to say 'I'm sorry' and really mean it First rule: The apology isn't about you. A good apology isn’t a statement from one person to another; it’s a dialogue between both parties. Invites the question: is he really in charge? — Senator John Cornyn (@JohnCornyn) April 12, 2021 Cornyn complained that Biden’s tweets are “unimaginably conventional,” describing a president who uses his social media accounts for minimal basic communication of national matters, not self-aggrandazing, retweets of those who praise him, false statements, or attacks on others.

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A note before I begin: This is not a recommendation not to be vaccinated against Coronavirus. It’s an encouragement to decide for yourself and your family when to be vaccinated and which vaccine to choose based on the most accurate information available. That said, let’s proceed.

'Done right, vaccines end pandemics. Done wrong, pandemics end vaccines.'
—Andy Slavitt here

People in the United States, along with people in all of the rest of the world, are eager for a vaccine that provides immunity to the Covid-19 virus. Drug manufacturers, with a market of tens of billions of injections to sell into, are eager to roll one off the production line. Both groups are highly incentivized to get a vaccine into distribution quickly.

Hundreds of Billions in Potential Revenue

Let's look at the revenue side first. Here, for example, is what the three leading vaccine candidates are projected to cost in the UK according to a recent Sky News piece:

In two years the earth is projected to hold 8 billion people, and most leading vaccine candidates require at least two doses. Let's be conservative: If Moderna, say, sold its Covid vaccine to 1 billion people at ₤28 (about $37) per dose, the revenue stream from those sales would turn into real money fast — $74 billion in revenue at retail prices in less than two years.

And that's for capturing less than a sixth of the global market. A vaccine manufacturer that captures a third of that market would swim in wealth till the climate crisis took us all.

For comparison, consider Moderna's recent revenue profile. For the last few years, Moderna income has run between $60 and $200 million per year. Revenue for just the last quarter, however, jumped to $158 million. Moderna is clearly set for a windfall.

Needless to say, something like $100 billion or more in revenue would more than cover the cost of Covid vaccine development, so why the high retail prices? One can only guess.

How Effective Is 'Effective'?

About effectiveness, much is claimed. From the same Sky News article:

The UK has become the first country in the world to approve the Pfizer/BioNTech COVID-19 vaccine for use.

The government says the jab [vaccine], which has been given the green light by independent health regulator MHRA, will be rolled out across the UK from early next week.

Studies have shown the jab is 95% effective and works in all age groups. [emphasis added]

Moderna claims similar effectiveness — 94% — for its own vaccine candidate. But what does effectiveness mean?

To a lay person, a phrase like '95% effective' means one of two things: either that she or he, upon exposure to the virus, is protected 95% of the time, or that 95% of the people who take the vaccine are protected 100% of the time.

And this is where the mutual eagerness of the two highly motivated groups — the public; the profiteers — intersect. The public wants to hear '95% effectiveness' and think it knows what those words means. The drug companies want the same thing as the public; it wants the public to think it knows what those words mean.

But in the world of drug advertising, the word 'effective' does not mean what you think it means. The other way to look at effectiveness is this: Based on the numbers released from phase 3 trials, the Pfizer vaccine is 95% effective, but 1% of the time. In the same way, the Moderna vaccine is 94% effective, but 2% of the time.

Relative Effectiveness

To sort this out, let's look at real numbers, thanks to Twitter friend David Windt.

For the Moderna product, the phase 3 trial contained 30,000 individuals divided between those given the vaccine and those given a placebo. Let's assume that individuals in each group were allowed to roam freely 'in the wild' — that is, told to live their regular lives among the general population, including going out infrequently, staying masked, and practicing social distance — as opposed being proactively and aggressively exposed to the virus by the researchers, which would be highly immoral, to say the least.

In the Moderna vaccinated group, 11 people out of 15,000 got the virus (by Moderna's definition of what 'got the virus means') for an overall infection rate of 0.07%. (There's disagreement about whether the drug company's 'got the virus' measurements are well chosen; see the Forbes article 'Covid-19 Vaccine Protocols Reveal That Trials Are Designed To Succeed.' But we'll ignore that point for now.)

In the Moderna placebo group, 185 people of 15,000 got the virus, for an overall infection rate of 1.23%.

Do you see where this is headed? If you divide 0.07% by 1.23%, you get a 5.7% infection rate — or inversely, a 94% protection rate, which is what's claimed. But that's a percentage of a percentage, a ratio of a ratio, something called the 'relative rate' in the medical profession. What this really means is that, of the 1.23% of people who would have gotten the virus in the vaccinated group, 94% of them didn't.

But Moderna isn't testing 30,000 people who are infected with the virus, or even 15,000 people. Only 185 people 'got the virus' (by their definition) in the placebo group. That population was reduced to 11 people with vaccination. These are very small numbers. As stated above, the Moderna vaccine is 94% effective — but only 1.23% of the time.

(For another way to see that using a percentage of a percentage, or a ratio of a ratio, is confusing, consider an advertisement that claims a company's new product is 'twice as effective' as its old one. If the old product was effective only 2% of the time, and you knew this, would you buy the new one?)

Infection rates in those clinical trials seem low, by the way, which could be just an accident of statistics, or something off in their way of measuring who is counted as infected. From the start of the pandemic until now, the overall disease rate for Maricopa County, a high-infection zone, is 5034 per 100,000 people, or 5%. At the lower end, the overall disease rate for Multnomah County, a less-infected but still urban county, is 2363 per 100,000 people, or 2.4%.

Both rates are higher than the infection rates of the Moderna and Pfizer placebo groups. As stated, Moderna's placebo group experienced a 1.23% infection rate, and Pfizer's placebo group was infected just 0.75% of the time. Does this indicate a difference in how “infection” is determined, or just something else about these studies? Hard to tell at this point.

None of this is to imply dishonesty on the part of the drug companies. Measuring 'effectiveness' using the relative rate of infection is common in that world. It's just more meaningful when the overall infection rate of a pathogen is, say, 70% or higher, instead of 5% or less.

Absolute Effectiveness

For comparison, let's look at the absolute numbers from the Moderna test. In the unprotected population, 1.23% of the people who could have been exposed to the virus, got it. In the vaccinated population exposed to the same conditions, a little less than 0.07% got the virus. Subtracting the two, the absolute gain in protection was 1.16% — that is, taking the vaccine bought you a little over 1% in absolute protection.

The numbers for the Pfizer vaccine are similar. According to Windt, 'the infection rate was reduced slightly, from 0.75% to 0.04% - that's '95% efficacy' [but] these results do NOT mean that 95% of those vaccinated are protected.' In absolute terms, taking the Pfizer vaccine reduced the risk of getting the virus by just 0.71%.

Do you trust any of these drug manufacturers and their massively under-tested vaccines enough that you would take whatever risk is associated with their product to gain that amount of protection? I know good doctors who won't, and others who will.

Testing and Public Trust

I want to point to two articles about testing and public trust. First from MIT in November, consider this caution about public trust:

Covid-19 vaccines shouldn’t get emergency-use authorization

Public trust in vaccines is already in decline. The FDA should proceed with caution.

...The pace of covid-19 vaccine research has been astonishing: there are more than 200 vaccine candidates in some stage of development, including several that are already in phase 3 clinical trials, mere months after covid-19 became a global public health emergency. In order for the FDA to approve a vaccine, however, not only do these clinical trials need to be completed—a process that typically involves following tens of thousands of participants for at least six months—but the agency also needs to inspect production facilities, review detailed manufacturing plans and data about the product’s stability, and pore over reams of trial data. This review can easily take a year or more.

Excessive haste could have fatal consequences, since public confidence and wide vaccination are the only ways any vaccine, even the best ones, can work: 'Public health experts caution that vaccines don’t protect people; only vaccinations do. A vaccine that hasn’t gained enough public trust will therefore have a limited ability to control the pandemic even if it’s highly effective.' [emphasis mine]

This Forbes article from September, titled “Covid-19 Vaccine Protocols Reveal That Trials Are Designed To Succeed,” argues that the vaccine trials it examined measure efficacy by testing for the wrong things — the absence or presence of symptoms, especially mild ones:

One of the more immediate questions a trial needs to answer is whether a vaccine prevents infection. If someone takes this vaccine, are they far less likely to become infected with the virus? These trials all clearly focus on eliminating symptoms of Covid-19, and not infections themselves. Asymptomatic infection is listed as a secondary objective in these trials when they should be of critical importance.

It appears that all the pharmaceutical companies assume that the vaccine will never prevent infection. Their criteria for approval is the difference in symptoms between an infected control group and an infected vaccine group. They do not measure the difference between infection and noninfection as a primary motivation. [emphasis added]

Is this true of the latest trials? Last September is forever in Covid years. I’ll look at this side of the issue in a follow-up piece, but my early research says that the Forbes point is still valid. If this turns out to be the flaw Forbes thinks it is, public trust could be even more greatly eroded as these vaccines fail to deliver what we’re led to expect of them.

To Vaccinate or Not To Vaccinate?

As I said before, this is an not an encouragement reject the vaccines. It's an encouragement to decide about them wisely by considering a number of factors — your need to feel 'safe,' your need to end this constant quarantine, and society's need to inoculate nearly everyone, versus your trust in the approval process, your personal level of caution, and the benefit of taking a relatively untested product to reduce your Covid risk by maybe 2% in absolute terms.

There are Covid hot-spots after all, areas of the country and the world where infections are soaring, and even low infection rates come at a heavy price. Covid has changed for the worse both the way we live and our economy. And people do die from it.

Maybe the first vaccines out of the gate, perhaps these three, will be everything a mother could want for her family and nation. But even if these products are are very very good, they have to be trusted to be effective.

If that trust is given blindly, and then betrayed, the consequences will be severe.

(This piece has been updated on December 9 with information on clinical trial design.)

Everyone knows Robert Frost’s “The Road Not Taken”—and almost everyone gets it wrong.

From The Road Not Taken: Finding America in the Poem Everyone Loves and Almost Everyone Gets Wrong, a new book by David Orr.

A young man hiking through a forest is abruptly confronted with a fork in the path. He pauses, his hands in his pockets, and looks back and forth between his options. As he hesitates, images from possible futures flicker past: the young man wading into the ocean, hitchhiking, riding a bus, kissing a beautiful woman, working, laughing, eating, running, weeping. The series resolves at last into a view of a different young man, with his thumb out on the side of a road. As a car slows to pick him up, we realize the driver is the original man from the crossroads, only now he’s accompanied by a lovely woman and a child. The man smiles slightly, as if confident in the life he’s chosen and happy to lend that confidence to a fellow traveler. As the car pulls away and the screen is lit with gold—for it’s a commercial we’ve been watching—the emblem of the Ford Motor Company briefly appears.

The advertisement I’ve just described ran in New Zealand in 2008. And it is, in most respects, a normal piece of smartly assembled and quietly manipulative product promotion. But there is one very unusual aspect to this commercial. Here is what is read by a voice-over artist, in the distinctive vowels of New Zealand, as the young man ponders his choice:

Two roads diverged in a yellow wood,
And sorry I could not travel both
And be one traveler, long I stood
And looked down one as far as I could
To where it bent in the undergrowth;

Then took the other, as just as fair,
And having perhaps the better claim,
Because it was grassy and wanted wear;
Though as for that the passing there
Had worn them really about the same,

And both that morning equally lay
In leaves no step had trodden black.
Oh, I kept the first for another day!
Yet knowing how way leads on to way,
I doubted if I should ever come back.

I shall be telling this with a sigh
Somewhere ages and ages hence:
Two roads diverged in a wood, and I—
I took the one less traveled by,
And that has made all the difference.

It is, of course, “The Road Not Taken” by Robert Frost. In the commercial, this fact is never announced; the audience is expected to recognize the poem unaided. For any mass audience to recognize any poem is (to put it mildly) unusual. For an audience of car buyers in New Zealand to recognize a hundred-year-old poem from a country eight thousand miles away is something else entirely.

But this isn’t just any poem. It’s “The Road Not Taken,” and it plays a unique role not simply in American literature, but in American culture —and in world culture as well. Its signature phrases have become so ubiquitous, so much a part of everything from coffee mugs to refrigerator magnets to graduation speeches, that it’s almost possible to forget the poem is actually a poem. In addition to the Ford commercial, “The Road Not Taken” has been used in advertisements for Mentos, Nicorette, the multibillion-dollar insurance company AIG, and the job-search Web site Monster.com, which deployed the poem during Super Bowl XXXIV to great success. Its lines have been borrowed by musical performers including (among many others) Bruce Hornsby, Melissa Etheridge, George Strait, and Talib Kweli, and it’s provided episode titles for more than a dozen television series, including Taxi, The Twilight Zone, and Battlestar Galactica, as well as lending its name to at least one video game, Spry Fox’s Road Not Taken (“a rogue-like puzzle game about surviving life’s surprises”). As one might expect, the influence of “The Road Not Taken” is even greater on journalists and authors. Over the past thirty-five years alone, language from Frost’s poem has appeared in nearly two thousand news stories worldwide, which yields a rate of more than once a week. In addition, “The Road Not Taken” appears as a title, subtitle, or chapter heading in more than four hundred books by authors other than Robert Frost, on subjects ranging from political theory to the impending zombie apocalypse. At least one of these was a massive international best seller: M. Scott Peck’s self-help book The Road Less Traveled: A New Psychology of Love, Traditional Values and Spiritual Growth, which was originally published in 1978 and has sold more than seven million copies in the United States and Canada.

Given the pervasiveness of Frost’s lines, it should come as no surprise that the popularity of “The Road Not Taken” appears to exceed that of every other major twentieth-century American poem, including those often considered more central to the modern (and modernist) era. Admittedly, the popularity of poetry is difficult to judge. Poems that are attractive to educators may not be popular with readers, so the appearance of a given poem in anthologies and on syllabi doesn’t necessarily reveal much. And book sales indicate more about the popularity of a particular poet than of any individual poem. But there are at least two reasons to think that “The Road Not Taken” is the most widely read and recalled American poem of the past century (and perhaps the adjective “American” could be discarded). The first is the Favorite Poem Project, which was devised by former poet laureate Robert Pinsky. Pinsky used his public role to ask Americans to submit their favorite poem in various forms; the clear favorite among more than eighteen thousand entries was “The Road Not Taken.”

The second, more persuasive reason comes from Google. Until it was discontinued in late 2012, a tool called Google Insights for Search allowed anyone to see how frequently certain expressions were being searched by users worldwide over time and to compare expressions to one another. Google normalized the data to account for regional differences in population, converted it to a scale of one to one hundred, and displayed the results so that the relative differences in search volume would be obvious. Here is the result that Google provided when “The Road Not Taken” and “Frost” were compared with several of the best-known modern poems and their authors, all of which are often taught alongside Frost’s work in college courses on American poetry of the first half of the twentieth century:

SEARCH TERMS | SCALED WORLDWIDE SEARCH VOLUME

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According to Google, then, “The Road Not Taken” was, as of mid-2012, at least four times as searched as the central text of the modernist era—The Waste Land—and at least twenty-four times as searched as the most anthologized poem by Ezra Pound. By comparison, this is even greater than the margin by which the term “college football ” beats “archery” and “water polo.” Given Frost’s typically prickly relationships with almost all of his peers (he once described Ezra Pound as trying to become original by “imitating somebody that hasn’t been imitated recently”), one can only imagine the pleasure this news would have brought him.

But as everyone knows, poetry itself isn’t especially widely read, so perhaps being the most popular poem is like being the most widely requested salad at a steak house. How did “The Road Not Taken” fare against slightly tougher competition? Better than you might think:

SEARCH TERMS | SCALED WORLDWIDE SEARCH VOLUME

The results here are even more impressive when you consider that “The Road Not Taken” is routinely misidentified as “The Road Less Traveled,” thereby reducing the search volume under the poem’s actual title. (For instance, a search for “Frost’s poem the road less traveled” produces more than two hundred thousand results, none of which would have been counted above.) Frost once claimed his goal as a poet was “to lodge a few poems where they will be hard to get rid of ”; with “The Road Not Taken,” he appears to have lodged his lines in granite. On a word-for-word basis, it may be the most popular piece of literature ever written by an American.

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And almost everyone gets it wrong. This is the most remarkable thing about “The Road Not Taken”—not its immense popularity (which is remarkable enough), but the fact that it is popular for what seem to be the wrong reasons. It’s worth pausing here to underscore a truth so obvious that it is often taken for granted: Most widely celebrated artistic projects are known for being essentially what they purport to be. When we play “White Christmas” in December, we correctly assume that it’s a song about memory and longing centered around the image of snow falling at Christmas. When we read Joyce’s Ulysses, we correctly assume that it’s a complex story about a journey around Dublin as filtered through many voices and styles. A cultural offering may be simple or complex, cooked or raw, but its audience nearly always knows what kind of dish is being served.

Frost’s poem turns this expectation on its head. Most readers consider “The Road Not Taken” to be a paean to triumphant self-assertion (“I took the one less traveled by”), but the literal meaning of the poem’s own lines seems completely at odds with this interpretation. The poem’s speaker tells us he “shall be telling,” at some point in the future, of how he took the road less traveled by, yet he has already admitted that the two paths “equally lay / In leaves” and “the passing there / Had worn them really about the same.” So the road he will later call less traveled is actually the road equally traveled. The two roads are interchangeable.

According to this reading, then, the speaker will be claiming “ages and ages hence” that his decision made “all the difference” only because this is the kind of claim we make when we want to comfort or blame ourselves by assuming that our current position is the product of our own choices (as opposed to what was chosen for us or allotted to us by chance). The poem isn’t a salute to can-do individualism; it’s a commentary on the self-deception we practice when constructing the story of our own lives. “The Road Not Taken” may be, as the critic Frank Lentricchia memorably put it, “the best example in all of American poetry of a wolf in sheep’s clothing.” But we could go further: It may be the best example in all of American culture of a wolf in sheep’s clothing.

In this it strongly resembles its creator. Frost is the only major literary figure in American history with two distinct audiences, one of which regularly assumes that the other has been deceived. The first audience is relatively small and consists of poetry devotees, most of whom inhabit the art form’s academic subculture. For these readers, Frost is a mainstay of syllabi and seminars, and a regular subject of scholarly articles (though he falls well short of inspiring the interest that Ezra Pound and Wallace Stevens enjoy). He’s considered bleak, dark, complex, and manipulative; a genuine poet’s poet, not a historical artifact like Longfellow or a folk balladeer like Carl Sandburg. While Frost isn’t the most esteemed of the early twentieth-century poets, very few dedicated poetry readers talk about him as if he wrote greeting card verse.

Then there is the other audience. This is the great mass of readers at all age levels who can conjure a few lines of “The Road Not Taken” and “Stopping by Woods on a Snowy Evening,” and possibly “Mending Wall ” or “Birches,” and who think of Frost as quintessentially American in the way that “amber waves of grain” are quintessentially American. To these readers (or so the first audience often assumes), he isn’t bleak or sardonic but rather a symbol of Yankee stoicism and countrified wisdom. This audience is large. Indeed, the search patterns of Google users indicate that, in terms of popularity, Frost’s true peers aren’t Pound or Stevens or Eliot, but rather figures like Pablo Picasso and Winston Churchill. Frost is not simply that rare bird, a popular poet; he is one of the best-known personages of the past hundred years in any cultural arena. In all of American history, the only writers who can match or surpass him are Mark Twain and Edgar Allan Poe, and the only poet in the history of English-language verse who commands more attention is William Shakespeare.

This level of recognition makes poetry readers uncomfortable. Poets, we assume, are not popular—at least after 1910 or so. If one becomes popular, then either he must be a second-tier talent catering to mass taste (as Sandburg is often thought to be) or there must be some kind of confusion or deception going on. The latter explanation is generally applied to Frost’s celebrity. As Robert Lowell once put it, “Robert Frost at midnight, the audience gone / to vapor, the great act laid on the shelf in mothballs.” The “great act” is for “the audience” of ordinary readers, but his true admirers know better. He is really a wolf, we say, and it is only the sheep who are fooled. It’s an explanation that Frost himself sometimes encouraged, much as he used to boast about the trickiness of “The Road Not Taken” in private correspondence. (“I’ll bet not half a dozen people can tell who was hit and where he was hit by my Road Not Taken,” he wrote to his friend Louis Untermeyer.) In this sense, the poem is emblematic. Just as millions of people know its language about the road “less traveled” without understanding what that language is actually saying, millions of people recognize its author without understanding what that author was actually doing.

But is this view of “The Road Not Taken” and its creator entirely accurate? Poems, after all, aren’t arguments—they are to be interpreted, not proven, and that process of interpretation admits a range of possibilities, some supported by diction, some by tone, some by quirks of form and structure. Certainly it’s wrong to say that “The Road Not Taken” is a straightforward and sentimental celebration of individualism: this interpretation is contradicted by the poem’s own lines. Yet it’s also not quite right to say that the poem is merely a knowing literary joke disguised as shopworn magazine verse that has somehow managed to fool millions of readers for a hundred years. A role too artfully assumed ceases to become a role and instead becomes a species of identity—an observation equally true of Robert Frost himself. One of Frost’s greatest advocates, the scholar Richard Poirier, has written with regard to Frost’s recognition among ordinary readers that “there is no point trying to explain the popularity away, as if it were a misconception prompted by a pose.” By the same token, there is no point in trying to explain away the general misreadings of “The Road Not Taken,” as if they were a mistake encouraged by a fraud. The poem both is and isn’t about individualism, and it both is and isn’t about rationalization. It isn’t a wolf in sheep’s clothing so much as a wolf that is somehow also a sheep, or a sheep that is also a wolf. It is a poem about the necessity of choosing that somehow, like its author, never makes a choice itself—that instead repeatedly returns us to the same enigmatic, leaf-shadowed crossroads.

From The Road Not Taken: Finding America in the Poem Everyone Loves and Almost Everyone Gets Wrong by David Orr. Reprinted by arrangement with The Penguin Press, an imprint of Penguin Publishing Group, a division of Penguin Random House LLC. Copyright © 2015 by David Orr.

David Orr is the poetry columnist for the New York Times Book Review. He is the winner of the Nona Balakian Prize from the National Book Critics Circle, and his writing has appeared in The New Yorker, Poetry, Slate, and The Yale Review.