Visual story-telling: do you know or do you think?

One of the most important data questions of all time is: do you know? or do you think?

And one of the easiest traps to fall into is: I think, therefore I know.

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Visual story-telling can be great but it can also mislead. Deception sometimes happens when readers are nudged to "fill in the blanks" with stuff they think they know, but they don't.

A Twitter reader asked me to look at the map in this Los Angeles Times (paywall) opinion column.

The column promptly announces its premise:

Years of widening economic inequality, compounded by the pandemic and political storm and stress, have given Americans the impression that the country is on the wrong track. Now there’s empirical data to show just how far the country has run off the rails: Life expectancies have been falling.

The writer creates the expectation that he will reveal evidence in the form of data to show that life expectancies have been driven down by economic inequality, pandemic, and politics. Does he succeed?

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The map portrays average life expectancy (at birth) for some mysterious, presumably very recent, year for every county in the United States. From the color legend, we learn that the bottom-to-top range is about 20 years. There is a clear spatial pattern, with the worst results in the south (excepting south Florida).

The choice of colors is telling. Red and blue on a U.S. map has heavy baggage, as they signify the two main political parties in the country. Given that the author believes politics to be a key driver of health outcomes, the usage of red and blue here is deliberate. Throughout the article, the columnist connects the lower life expectancies in southern states to its politics.

For example, he said "these geographical disparities aren't artifacts of pure geography or demographics; they're the consequences of policy decisions at the state level... Of the 20 states with the worst life expectancies, eight are among the 12 that have not implemented Medicaid expansion under the Affordable Care Act..."

Casual readers may fall into a trap here. There is nothing on the map itself that draws the connection between politics and life expectancies; the idea is evoked purely through the red-blue color scheme. So, as readers, we are filling in the blanks with our own politics.

What could have been done instead? Let's look at the life expectancy map side by side with the map of the U.S. 2020 Presidential election.

Because of how close recent elections have been, we may think the political map has a nice balance of red and blue but it isn't. The Democrats' votes are heavily concentrated in densely-populated cities so most of the Presidential election map is red. When placed next to each other, it's obvious that politics don't explain the variance in life expectancy well. The Midwest is deep red and yet they have above average life expectancies. I have circled out various regions that contradict the claim that Republican politics drove life expectancies down.

It's not sufficient to point to the South, in which Republican votes and life expectancy are indeed inversely correlated. A good theory has to explain most of the country.

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The columnist also suggests that poverty is the cause of low life expectancy. That too cannot be gleaned from the published map. Again, readers are nudged to use their wild imagination to fill in the blank.

Data come to the rescue. Here is a side-by-side comparison of the map of life expectancies and the map of median incomes.

A similar conundrum. While the story feels right in the South, it fails to explain the northwest, Florida, and various other parts of the country. Take a look again at the circled areas. Lower income brackets are also sometimes associated with high life expectancies.

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The author supplies a third cause of lower life expectancies: Covid-19 response. Because Covid-19 was the "most obvious and convenient" explanation for the loss of life expectancy during the pandemic, this theory suggests that the red areas on the life expectancy map should correspond to the regions most ravaged by Covid-19.

Let's see the data.

The map on the right shows the number of confirmed cases until June 2021. As before, the correlation holds somewhat in the South but there are notable exceptions, e.g. the Midwest. We also have states with low Covid-19 cases but below-average life expectancy.

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What caused the decline of life expectancy in the U.S. - which began before the pandemic, and has continued beyond - is highly complex, beyond what a single map or a pair of maps or a few pairs of maps could convey. Showing a red-blue map presents a trap for readers to fall into, in which they start thinking, without knowing.

 

Trying too hard

Today, I return to the life expectancy graphic that Antonio submitted. In a previous post, I looked at the bumps chart. The centerpiece of that graphic is the following complicated bar chart.

Let's start with the dual axes. On the left, age, and on the right, year of birth. I actually like this type of dual axes. The two axes present two versions of the same scale so the dual axes exist without distortion. It just allows the reader to pick which scale they want to use.

It baffles me that the range of each bar runs from 2.5 years to 7.5 years or 7.5 years to 2.5 years, with 5 or 10 years situated in the middle of each bar.

Reading the rest of the chart is like unentangling some balled up wires. The author has created a statistical model that attributes cause of death to male life expectancy in such a way that you can take the difference in life expectancy between two time points, and do a kind of waterfall analysis in which each cause of death either adds to or subtracts from the prior life expectancy, with the sum of these additions and substractions leading to the end-of-period life expectancy.

The model is complicated enough, and the chart doesn't make it any easier.

The bars are rooted at the zero value. The horizontal axis plots addition or substraction to life expectancy, thus zero represents no change during the period. Zero does not mean the cause of death (e.g. cancer) does not contribute to life expectancy; it just means the contribution remains the same.

The changes to life expectancy are shown in units of months. I'd prefer to see units of years because life expectancy is almost always given in years. Using years turn 2.5 months into 0.2 years which is a fraction, but it allows me to see the impact on the reported life expectancy without having to do a month-to-year conversion.

The chart highlights seven causes of death with seven different colors, plus gray for others.

What really does a number on readers is the shading, which adds another layer on top of the hues. Each color comes in one of two shading, referencing two periods of time. The unshaded bar segments concern changes between 2010 and "2019" while the shaded segments concern changes between "2019" and 2020. The two periods are chosen to highlight the impact of COVID-19 (the red-orange color), which did not exist before "2019".

Let's zoom in on one of the rows of data - the 72.5 to 77.5 age group.

COVID-19 (red-orange) has a negative impact on life expectancy and that's the easy one to see. That's because COVID-19's contribution as a cause of death is exactly zero prior to "2019". Thus, the change in life expectancy is a change from zero. This is not how we can interpret any of the other colors.

Next, we look at cancer (blue). Since this bar segment sits on the right side of zero, cancer has contributed positively to change in life expectancy between 2010 and 2020. Practically, that means proportionally fewer people have died from cancer. Since the lengths of these bar segments correspond to the relative value, not absolute value, of life expectancy, longer bars do not necessarily indicate more numerous deaths.

Now the blue segment is actually divided into two parts, the shaded and not shaded. The not-shaded part is for the period "2019" to 2020 in the first year of the COVID-19 pandemic. The shaded part is for the period 2010 to "2019". It is a much wider span but it also contains 9 years of changes versus "1 year" so it's hard to tell if the single-year change is significantly different from the average single-year change of the past 9 years. (I'm using these quotes because I don't know whether they split the year 2019 in the middle since COVID-19 didn't show up till the end of that year.)

Next, we look at the yellow-brown color correponding to CVD. The key feature is that this block is split into two parts, one positive, one negative. Prior to "2019", CVD has been contributing positively to life expectancy changes while after "2019", it has contributed negatively. This observation raises some questions: why would CVD behave differently with the arrival of the pandemic? Are there data problems?

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A small multiples design - splitting the period into two charts - may help here. To make those two charts comparable, I'd suggest annualizing the data so that the 9-year numbers represent the average annual values instead of the cumulative values.

 

 

Two uses of bumps charts

Long-time reader Antonio R. submitted the following chart, which illustrates analysis from a preprint on the effect of Covid-19 on life expectancy in the U.S. (link)

For this post, I want to discuss the bumps chart on the lower right corner. Bumps charts are great at showing change over time. In this case, the authors are comparing two periods "2010-2019" and "2019-2020". By glancing at the chart, one quickly divides the causes of death into three groups: (a) COVID-19 and CVD, which experienced a big decline (b) respiratory, accidents, others ("rest"), and despair, which experienced increases, and (c) cancer and infectious, which remained the same.

And yet, something doesn't seem right.

What isn't clear is the measured quantity. The chart title says "months gained or lost" but it takes a moment to realize the plotted data are not number of months but ranks of the effects of the causes of deaths on life expectancy.

Observe that the distance between each cause of death is the same. Look at the first rising line (respiratory): the actual values went from 0.8 months down to 0.2.

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While the canonical bumps chart plots ranks, the same chart form can be used to show numeric data. I prefer to use the same term for both charts. In recent years, the bumps chart showing numeric data has been called "slopegraph".

Here is a side-by-side comparison of the two charts:

The one on the left is the same as the original. The one on the right plots the number of months increased or decreased.

The choice of chart form paints very different pictures. There are four blue lines on the left, indicating a relative increase in life expectancy - these causes of death contributed more to life expectancy between the two periods. Three of the four are red lines on the right chart. Cancer was shown as a flat line on the left - because it was the highest ranked item in both periods. The right chart shows that the numeric value for cancer suffered one of the largest drops.

The left chart exaggerates small numeric changes while it condenses large numeric changes.

 

 

Another reminder that aggregate trends hide information

The last time I looked at the U.S. employment situation, it was during the pandemic. The data revealed the deep flaws of the so-called "not in labor force" classification. This classification is used to dehumanize unemployed people who are declared "not in labor force," in which case they are neither employed nor unemployed -- just not counted at all in the official unemployment (or employment) statistics.

The reason given for such a designation was that some people just have no interest in working, or even looking for a job. Now they are not merely discouraged - as there is a category of those people. In theory, these people haven't been looking for a job for so long that they are no longer visible to the bean counters at the Bureau of Labor Statistics.

What happened when the pandemic precipitated a shutdown in many major cities across America? The number of "not in labor force" shot up instantly, literally within a few weeks. That makes a mockery of the reason for such a designation. See this post for more.

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The data we saw last time was up to April, 2020. That's more than two years old.

So I have updated the charts to show what has happened in the last couple of years.

Here is the overall picture.

In this new version, I centered the chart at the 1990 data. The chart features two key drivers of the headline unemployment rate - the proportion of people designated "invisible", and the proportion of those who are considered "employed" who are "part-time" workers.

The last two recessions have caused structural changes to the labor market. From 1990 to late 2000s, which included the dot-com bust, these two metrics circulated within a small area of the chart. The Great Recession of late 2000s led to a huge jump in the proportion called "invisible". It also pushed the proportion of part-timers to all0time highs. The proportion of part-timers has fallen although it is hard to interpret from this chart alone - because if the newly invisible were previously part-time employed, then the same cause can be responsible for either trend.

Readers of Numbersense (link) might be reminded of a trick used by school deans to pump up their US News rankings. Some schools accept lots of transfer students. This subpopulation is invisible to the US News statisticians since they do not factor into the rankings. The recent scandal at Columbia University also involves reclassifying students (see this post).

Zooming in on the last two years. It appears that the pandemic-related unemployment situation has reversed.

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Let's split the data by gender.

American men have been stuck in a negative spiral since the 1990s. With each recession, a higher proportion of men are designated BLS invisibles.

In the grid system set up in this scatter plot, the top right corner is the worse of all worlds - the work force has shrunken and there are more part-timers among those counted as employed. The U.S. men are not exiting this quadrant any time soon.

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What about the women?

If we compare 1990 with 2022, the story is not bad. The female work force is gradually reaching the same scale as in 1990 while the proportion of part-time workers have declined.

However, celebrating the above is to ignore the tremendous gains American women made in the 1990s and 2000s. In 1990, only 58% of women are considered part of the work force - the other 42% are not working but they are not counted as unemployed. By 2000, the female work force has expanded to include about 60% with similar proportions counted as part-time employed as in 1990. That's great news.

The Great Recession of the late 2000s changed that picture. Just like men, many women became invisible to BLS. The invisible proportion reached 44% in 2015 and have not returned to anywhere near the 2000 level. Fewer women are counted as part-time employed; as I said above, it's hard to tell whether this is because the women exiting the work force previously worked part-time.

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The color of the dots in all charts are determined by the headline unemployment number. Blue represents low unemployment. During the 1990-2022 period, there are three moments in which unemployment is reported as 4 percent or lower. These charts are intended to show that an aggregate statistic hides a lot of information. The three times at which unemployment rate reached historic lows represent three very different situations, if one were to consider the sizes of the work force and the number of part-time workers.

 

P.S. [8-15-2022] Some more background about the visualization can be found in prior posts on the blog: here is the introduction, and here's one that breaks it down by race. Chapter 6 of Numbersense (link) gets into the details of how unemployment rate is computed, and the implications of the choices BLS made.

P.S. [8-16-2022] Corrected the axis title on the charts (see comment below). Also, added source of data label.

Think twice before you spiral

After Nathan at FlowingData sang praises of the following chart, a debate ensued on Twitter as others dislike it.

The chart was printed in an opinion column in the New York Times (link).

I have found few uses for spiral charts, and this example has not changed my mind.

The canonical time-series chart is like this:

 

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The area chart takes no effort to understand. We can see when the peaks occurred. We notice that the current surge is already double the last peak seen a year ago.

It's instructive to trace how one gets from the simple area chart to the spiral chart.

Step 1 is to center the area on the zero baseline, instead of having the zero baseline as the baseline. While this technique frequently makes for a more pleasant visual (because of our preference for symmetry), it actually makes it harder to see the trend over time. Effectively, any change is split in half, which is why the envelope of the area is less sharp.

In Step 2, I massively compress the vertical scale. That's because when you plot a spiral, you are forced to fit each cycle of data into a much shorter range. Such compression causes the year on year doubling of cases to appear less dramatic. (Actually, the aspect ratio is devastated because while the vertical scale is hugely compressed, the horizontal scale is dramatically stretched out due to the curled up design)

Step 3 may elude your attention. If you simply curl up the compressed, centered area chart, you don't get the spiral chart. The key is to ask about the radius of the spiral. As best I can tell, the radius has no meaning; it is gradually increased so that each year of data has its own "orbit". What would the change in radius translate to on our non-circular chart? It should mean that the center of the area is gradually lifted away from the zero line. On the right chart, I mimic this effect (I only measured the change in radius every 3 months so the change is more angular than displayed in the spiral chart.) The problem I have with this Step is that it serves no purpose, while it complicates cognition,

In Step 4, just curl up the object into a ball based on aligning months of the year.

This is the point when I realized I missed a Step 2B. I carefully aligned the scales of both charts so that the 150K cases shown in the legend on the right have the same vertical representation as on the left. This exposes a severe horizontal rescaling. The length of the horizontal axis on the left chart is many times smaller than the circumference of the spiral! That's why earlier, I said one of the biggest feature of this spiral chart is that it imposes a dubious aspect ratio, that is extremely wide and extremely short.

As usual, think twice before you spiral.

 

 

Illustrating coronavirus waves with moving images

The New York Times put out a master class in visualizing space and time data recently, in a visualization of five waves of Covid-19 that have torched the U.S. thus far (link).

The project displays one dataset using three designs, which provides an opportunity to compare and contrast them.

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The first design - above the headline - is an animated choropleth map. This is a straightforward presentation of space and time data. The level of cases in each county is indicated by color, dividing the country into 12 levels (plus unknown). Time is run forward. The time legend plays double duty as a line chart that shows the change in the weekly rate of reported cases over the course of the pandemic. A small piece of interactivity binds the legend with the map.

(To see a screen recording of the animation, click on the image above.)

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The second design comprises six panels, snapshots that capture crucial "turning points" during the Covid-19 pandemic. The color of each county now encodes an average case rate (I hope they didn't just average the daily rates). 

The line-chart legend is gone -  it's not hard to see Winter > Fall 2020 > Summer/Fall 2021 >... so I don't think it's a big loss.

The small-multiples setup is particularly effective at facilitating comparisons: across time, and across space. It presents a story in pictures.

They may have left off 2020 following "Winter" because December to February spans both years but "Winter 2020" may do more benefit than harm here.

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The third design is a series of short films, which stands mid-way between the single animated map and the six snapshots. Each movie covers a separate window of time.

This design does a better job telling the story within each time window while it obstructs comparisons across time windows.

The informative legend is back. This time, it's showing the static time window for each map.

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The three designs come from the same dataset. I think of them as one long movie, six snapshots, and five short films.

The one long movie is a like a data dump. It shows every number in the dataset, which is the weekly case rate for each county for a given week. All the data are streamed into a single map. It's a show piece.

As an instrument to help readers understand the patterns in the dataset, the movie falls short. Too much is going on, making it hard to focus and pick out key trends. When your eyes are everywhere, they are nowhere.

The six snapshots represent the other extreme. The graph does not move, as the time axis is reduced to six discrete time points. But this display describes the change points, and tells a story. The long movie, by contrast, invites readers to find a story.

Without motion, the small-multiples format allows us to pick out specific counties or regions and compare the case rates across time. This task is close to impossible in the long movie, as it requires freezing the movie, and jumping back and forth.

The five short films may be the best of both worlds. It retains the motion. If the time windows are chosen wisely, each short film contains a few simple patterns that can easily be discerned. For example, the third film shows how the winter wave emerged from the midwest and then walloped the whole country, spreading southward and toward the coasts.

(If the above gif doesn't play, click it.)

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If there is double or triple the time allocated to this project, I'd want to explore spatial clustering. I'd like to dampen the spatial noise (neighboring counties that have slightly different experiences). There is also temporal noise (fluctuations from week to week for the same county) - which can be smoothed away. I think with these statistical techniques, the "wave" feature of the pandemic may be more visible.

 

 

Visually displaying multipliers

As I'm preparing a blog about another real-world study of Covid-19 vaccines, I came across the following chart (the chart title is mine).

As background, this is the trend in Covid-19 cases in the U.K. in the last couple of months, courtesy of OurWorldinData.org.

The React-1 Study sends swab kits to randomly selected people in England in order to assess the prevalence of Covid-19. Every month, there is a new round of returned swabs that are tested for Covid-19. This measurement method captures asymptomatic cases although it probably missed severe and hospitalized cases. Despite having some shortcomings, this is a far better way to measure cases than the hotch-potch assembling of variable-quality data submitted by different jurisdictions that has become the dominant source of our data.

Rounds 12 and 13 captured an inflection point in the pandemic in England. The period marked the beginning of the end of the belief that widespread vaccination will end the pandemic.

The chart I excerpted up top broke the data down by age groups. The column heights represent the estimated prevalence of Covid-19 during each round - also, described precisely in the paper as "swab positivity." Based on the study's design, one may generalize the prevalence to the population at large. About 1.5% of those aged 13-24 in England are estimated to have Covid-19 around the time of Round 13 (roughly early July).

The researchers came to the following conclusion:

We show that the third wave of infections in England was being driven primarily by the Delta variant in younger, unvaccinated people. This focus of infection offers considerable scope for interventions to reduce transmission among younger people, with knock-on benefits across the entire population... In our data, the highest prevalence of infection was among 12 to 24 year olds, raising the prospect that vaccinating more of this group by extending the UK programme to those aged 12 to 17 years could substantially reduce transmission potential in the autumn when levels of social mixing increase

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Raise your hand if the graphics software you prefer dictates at least one default behavior you can't stand. I'm sure most hands are up in the air. No matter how much you love the software, there is always something the developer likes that you don't.

The first thing I did with today's chart is to get rid of all such default details.

For me, the bottom chart is cleaner and more inviting.

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The researchers wanted readers to think in terms of Round 3 numbers as multiples of Round 2 numbers. In the text, they use statements such as:

weighted prevalence in round 13 was nine-fold higher in 13-17 year olds at 1.56% (1.25%, 1.95%) compared with 0.16% (0.08%, 0.31%) in round 12

It's not easy to perceive a nine-fold jump from the paired column chart, even though this chart form is better than several others. I added some subtle divisions inside each orange column in order to facilitate this task:

I have recommended this before. I'm co-opting pictograms in constructing the column chart.

An alternative is to plot everything on an index scale although one would have to drop the prevalence numbers.

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The chart requires an additional piece of context to interpret properly. I added each age group's share of the population below the chart - just to illustrate this point, not to recommend it as a best practice.

The researchers concluded that their data supported vaccinating 13-17 year olds because that group experienced the highest multiplier from Round 12 to Round 13. Notice that the 13-17 year old age group represents only 6 percent of England's population, and is the least populous age group shown on the chart.

The neighboring 18-24 age group experienced a 4.5 times jump in prevalence in Round 13 so this age group is doing much better than 13-17 year olds, right? Not really.

While the same infection rate was found in both age groups during this period, the slightly older age group accounted for 50% more cases -- and that's due to the larger share of population.

A similar calculation shows that while the infection rate of people under 24 is about 3 times higher than that of those 25 and over, both age groups suffered over 175,000 infections during the Round 3 time period (the difference between groups was < 4,000).  So I don't agree that focusing on 13-17 year olds gives England the biggest bang for the buck: while they are the most likely to get infected, their cases account for only 14% of all infections. Almost half of the infections are in people 25 and over.

 

Working hard at clarity

As I am preparing another blog post about the pandemic, I came across the following data graphic, recently produced by the CDC for a vaccine advisory board meeting:

This is not an example of effective visual communications.

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For one thing, readers are directed to scour the footnotes to figure out what's going on. If we ignore those for the moment, we see clusters of bubbles that have remained pretty stable from December 2020 to August 2021. The data concern some measure of Americans' intent to take the COVID-19 vaccine. That much we know.

There may have been a bit of an upward trend between January and May, although if you were shown the clusters for December, February and April, you'd think the trend's been pretty flat. 

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But those colors? What could they represent? You'd surely have to fish this one out of the footnotes. Specifically, this obtuse sentence: "Surveys with multiple time points are shown with the same color bubble for each time point." I had to read it several times. I think it simply means "Color represents the pollster." 

Then it adds: "Surveys with only one time point are shown in gray." which simply means "All pollsters who have only one entry in the dataset are grouped together and shown in gray."

Another problem with this chart is over-plotting. Look at the July cluster. It's impossible to tell how many polls were conducted in July because the circles pile on top of one another. 

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The appearance of the flat trend is a result of two unfortunate decisions made by the designer. If I retained the chart form, I'd have produced something that looks like this:

The first design choice is to expand the vertical axis to range from 0% to 100%. This effectively squeezes all the bubbles into a small range.

The second design choice is to enlarge the bubbles causing copious amount of overlapping. 

In particular, this decision blows up the Pew poll (big pink bubble) that contained 10 times the sample size of most of the other polls. The Pew outcome actually came in at 70% but the top of the pink bubble extends to over 80%. Because of this, the outlier poll of December 2020 - which surprisingly printed the highest number of all polls in the entire time window - no longer looks special. 

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Now, let's see what else we can do to enhance this chart. 

I don't like how bubble size is used to encode the sample size. It creates a weird sensation for anyone who's familiar with sampling errors, and confidence regions. The Pew poll with 10 times the sample size is the most reliable poll of them all. Reliability means the error bars around the Pew poll outcome is the smallest of them all. I tend to think of the area around a point estimate as showing the sampling error so the Pew poll would be a dot, showing the high precision of that estimate. 

But that won't work because larger bubbles catch more of the reader's attention. So, in the following version, all dots have the same size. I encode reliability in the opacity of the color. The darker dots are polls that are more reliable, that have larger sample sizes.

Two of the pollsters have more frequent polling than others. In this next version, I highlighted those two, which reveals the trend better.

 

 

 

Simple charts are the hardest to do right

The CDC website has a variety of data graphics about many topics, one of which is U.S. vaccinations. I was looking for information about Covid-19 data broken down by age groups, and that's when I landed on these charts (link).

The left panel shows people with at least one dose, and the right panel shows those who are "fully vaccinated." This simple chart takes an unreasonable amount of time to comprehend.

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The analyst introduces three metrics, all of which are described as "percentages". Upon reflection, they are proportions of the people in specific age ranges.

Readers are thus invited to compare these proportions. It's not clear, however, which comparisons are intended. The first item listed in the legend states "Percent among Persons who completed all recommended doses in last 14 days". For most readers, including me, this introduces an unexpected concept. The 14 days here do not refer to the (in)famous 14-day case-counting window but literally the most recent two weeks relative to when the chart was produced.

It would have been clearer if the concept of Proportions were introduced in the chart title or axis title, while the color legend explains the concept of the base population. From the lighter shade to the darker shade (of red and blue) to the gray color, the base population shifts from "Among Those Who Completed/Initiated Vaccinations Within Last 14 Days" to "Among Those Who Completed/Initiated Vaccinations Any Time" to "Among the U.S. Population (regardless of vaccination status)".

Also, a reverse order helps our comprehension. Each subsequent category is a subset of the one above. First, the whole population, then those who are fully vaccinated, and finally those who recently completed vaccinations.

The next hurdle concerns the Q corner of our Trifecta Checkup. The design leaves few hints as to what question(s) its creator intended to address. The age distribution of the U.S. population is useless unless it is compared to something.

One apparently informative comparison is the age distribution of those fully vaccinated versus the age distribution of all Americans. This is revealed by comparing the lengths of the dark blue bar and the gray bar. But is this comparison informative? It's telling me that people aged 50 to 64 account for ~25% of those who are fully vaccinated, and ~20% of all Americans. Because proportions necessarily add to 100%, this implies that other age groups have been less vaccinated. Duh! Isn't that the result of an age-based vaccination prioritization? During the first week of the vaccination campaign, one might expect close to 100% of all vaccinations to be in the highest age group while it was 0% for the other age groups.

This is a chart in search of a question. The 25% vs 20% comparison does not assist readers in making a judgement. Does this mean the vaccination campaign is working as expected, worse than expected or better than expected? The problem is the wrong baseline. The designer of this chart implies that the expected proportions should conform to the overall age distribution - but that clearly stands in the way of CDC's initial prioritization of higher-risk age groups.

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In my version of the chart, I illustrate the proportion of people in each age group who have been fully vaccinated.

Among those fully vaccinated, some did it within the most recent two weeks:

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Elsewhere on the CDC site, one learns that on these charts, "fully vaccinated" means one shot of J&J or 2 shots of Pfizer or Moderna, without dealing with the 14-day window or other complications. Why do we think different definitions are used in different analyses? Story-first thinking, as I have explained here. When it comes to telling the story about vaccinations, the story is about the number of shots in arms. They want as big a number as possible, and abandon any criterion that decreases the count. When it comes to reporting on vaccine effectiveness, they want as small a number of cases as possible.

 

 

 

 

 

Check your presumptions while you're reading this chart about Israel's vaccination campaign

On July 30, Israel began administering third doses of mRNA vaccines to targeted groups of people. This decision was controversial since there is no science to support it. The policymakers do have educated guesses by experts based on best-available information. By science, I mean actual evidence. Since no one has previously been given three shots, there can be no data on which anyone can root such a decision. Nevertheless, the pandemic does not always give us time to collect relevant data, and so speculative analysis has found its calling.

Dvir Aran, at Technion, has been diligently tracking the situation in Israel on his Twitter. Ten days after July 30, he posted the following chart, which immediately led many commentators to bounce out of their seats crowning the third shot as a magic bullet. Notably, Dvir himself did not endorse such a claim. (See here to learn how other hasty conclusions by experts have fared.)

When you look at Dvir's chart, what do we see?

Possibly one of the following two things, depending on what concern you have in your head.

1) The red line sits far above the other two lines, showing that unvaccinated people are much more likely to get infected.

2) The blue line diverges from the green line almost immediately after the 3rd shots started getting into arms, showing that the 3rd shot is super effective.

If you take another moment to look, you might start asking questions, as many in Twitter world did. Dvir was startlingly efficient at answering these queries.

A) Does the green line represent people with 2 or 3 doses, or is it strictly 2 doses? Aron asked this question and got the answer (the former):

It's time to check our presumptions. When you read that chart, did you presume it's exactly 2 doses or did you presume it's 2 or 3 doses? Or did you immediately spot the ambiguity? As I said in this article, graphs attain efficiency at communication because the designer leverages unspoken rules - the chart conveys certain information without explicitly placing it on the chart. But this can backfire. In this case, I presumed the three lines to display three non-overlapping groups of people, and thus the green line indicates those with 2 doses but not 3. That presumption led me to misinterpret what's on the chart.

B) What is the denominator of the case rates? Is it literal - by that I mean, all unvaccinated people for the red line, and all people with 3 doses for the blue line? Or is the denominator the population of Israel, the same number for all three lines? Lukas asked this question, and got the answer (the former).

C) Since third shots are recommended for 60 year olds and over who were vaccinated at least 5 months ago, and most unvaccinated Israelis are below 60, this answer opens the possibility that the lines compare apples and oranges. Joe. S. asked about this, and received an answer (all lines display only 60 year olds and over.)

Jason P. asked, and learned that the 5-month-out criterion is immaterial since 90% of the vaccinated have already reached that time point.

D) We have even more presumptions. Like me, did you presume that the red line represents the "unvaccinated," meaning people who have not had any vaccine shots? If so, we may both be wrong about this. It has become the norm by vaccine researchers to lump "partially vaccinated" people with "unvaccinated", and call this combined group "unvaccinated". Here is an excerpt from a recent report from Public Health Ontario (link to PDF), which clearly states this unintuitive counting rule:

Notice that in this definition, someone who got infected within 14 days of the first shot is classified as an "unvaccinated" case and not a "partially vaccinated case".

In the following tweet, Dvir gave a hint of what he plotted:

In a previous analysis, he averaged the rates of people with 0 doses and 1 dose, which is equivalent to combining them and calling them unvaccinated. It's unclear to me what he did to the 1-dose subgroup in our featured chart - did it just vanish from the chart? (How people and cases are classified into these groups is a major factor in all vaccine effectiveness calculations - a topic I covered here. Unfortunately, most published reports do a poor job explaining what the analysts did).

E) Did you presume that all three lines are equally important? That's far from true. Since Israel is the world champion in vaccination, the bulk of the 60+ population form the green line. I asked Dvir and he responded that only 7.5%, or roughly 100K are unvaccinated.

That means 1.2 million people are part of the green line, 12 times higher. There are roughly 50 cases per day among unvaccinated, and 370 daily cases among those with 2 or 3 doses. In other words, vaccinated people account for almost 90% of all cases.

Yes, this is inevitable when over 90% of the age group have been vaccinated (but it is predictable on the first day someone blasted everywhere that real-world VE is proved by the fact that almost all new cases were in the unvaccinated.)

If your job is to minimize infections, you should be spending most of your time thinking about the 370 cases among vaccinated than the 50 cases among unvaccinated. If you halve the case rate, that would be a difference of 185 cases vs 25. In Israel, the vaccination campaign has already succeeded; it's time to look forward, which is exactly why they are re-focusing on the already vaccinated.

***

If what you worry about most is the effectiveness of the original two-dose regimen, Dvir's chart raises a puzzle. Ignore the blue line, and remember that the green line already includes everybody represented by the blue line.

In the following chart, I removed the blue line, and added reference lines in dashed purple that correspond to 25%, 50% and 75% vaccine effectiveness. The data plotted on this chart are unadjusted case rates. A 75% effective vaccine cuts case rate by three quarters.

This chart shows the 2-dose mRNA vaccine was nowhere near 90% effective. (As regular readers know, I don't endorse this simplistic calculation and have outlined the problems here, but this style of calculation keeps getting published and passed around. Those who use it to claim real-world studies confirm prior clinical trial outcomes can either (a) insist on using it and retract their earlier conclusions, or (b) admit that such a calculation was, and is, a bad take.)

Also observe how the vaccinated (green) line is moving away from the unvaccinated (red) line. The vaccine apparently is becoming more effective, which runs counter to the trend used by the Israeli government to justify third doses. This improvement also precedes the start of the third-shot campaign. When the analytical method is bad, it generates all sorts of spurious findings.

***

As Dvir said, it is premature to comment on the third doses based on 10 days of data. For one thing, the vaccine developers insist that their vaccines must be given 14 days to work. In a typical calculation, all of the cases in the blue line fall outside the case-counting window. The effective number of cases that would be attributed to the 3-dose group right now is zero, and the vaccine effectiveness using the standard methodology is 100%, even better than shown in the chart.

There is an alternative interpretation of this graph. Statisticians call this the selection effect. On July 30, the blue line split out of the green: some people were selected to receive the 3rd dose - this includes an official selection (the government makes certain subgroups eligible) as well as a self-selection (within the eligible subgroup, certain people decide to get the 3rd shot earlier.) If those who are less exposed to the virus, or more risk averse, get the shots first, then all that is happening may be that we have split off a high VE subgroup from the green line. Even if the third shot were useless, the selection effect itself could explain the gap.

Statistics is about grays. It's not either-or. It's usually some of each. If you feel like Groundhog Day, you're getting the picture. When they rolled out two doses, we lived through an optimistic period in which most experts rejoiced about 90-100% real-world effectiveness, and then as more people get vaccinated, the effect washed away. The selection effect gradually disappears when vaccination becomes widespread. Are we starting a new cycle of hope and despair? We'll find out soon enough.