I’ve now read Yascha’s piece on this, Nate Silver’s and Zayep’s. And the comments below.
I think there are reasonable ethical arguments why essential workers and healthcare workers should be prioritized and given vaccine earlier. I definitely think the Stanford residents have a point for example- they are taking on risk, have very little …
I’ve now read Yascha’s piece on this, Nate Silver’s and Zayep’s. And the comments below.
I think there are reasonable ethical arguments why essential workers and healthcare workers should be prioritized and given vaccine earlier. I definitely think the Stanford residents have a point for example- they are taking on risk, have very little agency (much less than nurses for example), and make much less money/compensation (than nurses and attending physicians)—- but they do skew much younger than these other cohorts. Essential workers are similar. It’s like having a VA system-“to care for him who shall have borne the battle.”
What disturbs me is this conflation of “equity” among groups defined by skin color and historic grievances, and ethics. It seems reasonable enough to say we have an obligation to “reward the worker fior their toil,” but if motives here are “reparations through vaccination” than that has all of the ethical issues of reparations and has no place here.
All of this shows the dangers of what I hope will soon be called “late wokeness.” Intersectionality, critical theory, and the like are useful frameworks for examining how historic power imbalances among groups have influenced a situation; however, it’s not robust enough to be the only or the defining framework for any analysis. They are one side of a triangle and used alone it’s a becoming dagger into the heart of our civilization.
If our aim isn’t for a colorblind society, for a truly multicultural society, then what are we aiming for? If we no longer dream for a day when people are judged not by the color of their skin but the content of their characters, we have to replace it with something, and replacing it with “no wait let’s use the color of skin as a surrogate for who has been victimized the most” seems to me to only lead right back to hate, division, inequity, and despair. Despair most assuredly as in a world where the loudest victim wins, everyone will feel a pull to become a “victim” and for every interaction to escalate into a fight.
There really are no good reasons to prioritise essential workers, especially when the category is defined so broadly as to include more than 25% of Americans in it. Older adults are massively more likely to die than younger essential workers. Thus beyond frontline health workers, it is obvious that older adults should have priority. The CDC agrees because their estimates show that giving the vaccine to essential workers first will cause many more deaths. They just don't care because they are infected by a very different virus.
Also, if preventing hospitalization is the name of the game, then giving the vaccine to the people most likely to require hospitalization also makes the most sense. Healthy young people, with vanishingly rare exceptions, shrug this thing off.
That is a true statement, but in a system where hospitals are over capacity, higher hospitialization rate has caused more deaths. Not only from Covid, but from other illness that goes untreated due to covid precaution at hospitals.
I know in Oregon “essential workers” included teachers, lawyers etc who were not working at the time and would not work for several months after the vaccine came out (and some basically went back at about the same time as everyone else). It looked a little bit to me that essential work was synonymous with Democrat donor.
That said, I do agree that some level of essential worker rule might have been wise. Dr. Nurse EMT, others who might interact and spread the disease.
Also, as I recall ( please someone point
Out of if I am wrong… I’m not one those COVID historians so I may misremember). But at the time I thought the vaccine was more about reducing spread of the disease not the severity. Again, as I recall, the severity argument arose after it became apparent that the vaccine was not as effective as advertised at reducing spread.
If this is true it would make the argument for vaccinating people like to spread the disease more effective.
Long story short…at least in Oregon the idea of essential work let was kind of a farce because so many essential workers were not working (making the entire essential argument kind of odd).
92% of all deaths from COVID in the US have been among people 55+, and 86% of Black and Hispanic deaths fro COVID in the US have been among people 55+ . . . there is no reasonable ethical argument for prioritizing essential workers under 55
I’m not saying that the other arguments are good or correct, but they exist.
For example... assuming you are social distancing, avoiding crowds, etc... your chance of getting the virus is low. A 68 yo mask-denying Stop the Steal rally attendee had a choice about the risks they took that caused them to get the virus... the 48 yo working the checkout counter at Publix had much less of a choice.
I agree that none of that should matter but this sort of moral desert argument has long had a place in our resource allocation schemes in this country, so clearly plenty see this as a reasonable argument (work requirements for welfare, the VA system, healthcare quality metrics and tobacco penalities, safe driver discounts).
There’s also a whole argument about “quality adjusted life years” which is a big concept in global medicine and surgery and argues for using scarce resources to treat conditions related to trauma and that affect pediatric populations.
This is a nice post from the BMJ blog outlining all of the other considerations that may be relevant:
I do agree that QALY (quality adjusted life years) would be a great way to allocate vaccines, but we would have needed to start that analytical work months ago in order to implement it now. As for the argument that the elderly could socially distance, my concerns are that (i) many of the the most vulnerable adults 55+ (e.g., middle and lower income 55+ people of color in multi-generational households) can't isolate; and (ii) public health policies based on people perfectly following guidance often fail . . . back in the 80s and 90s we were told HIV could be stopped in the gay community if everyone would "just" use condoms or abstain from sex . . . that didn't work. And right now, we're seeing that even our political and public health leaders are struggling to follow their own social distancing guidelines.
It isn't a moral desert decision, but a moral desert within which one could make a decision based on science, or a decision based on racism. The latter was chosen and the corresponding (and confounding to the stated goal) outcome was manifested.
Not even close to most, but certainly enough to provoke the question.
What if it turned out that Western Civilization wasn't a tyrannical malign racist sexist patriarchy, but instead a relatively benign liberal humanistic civilization?
I do not see how residents have less agency than nurses. What choices do nurses have if they are told to work without adequate PPE or if covid positive by asymptomatic? They can quit - is that their agency? Nurses are the most front line of front line workers and they are being abused by hospital administrations and put into untenable situations sometimes without adequate training. Unlike residents nurses spend their whole shifts very close to their patients. I would say that the fact that they may make a bit more money than residents (who will ultimately make much more than the nurses do) is not an excuse to vaccinate residents before nurses.
I’ve now read Yascha’s piece on this, Nate Silver’s and Zayep’s. And the comments below.
I think there are reasonable ethical arguments why essential workers and healthcare workers should be prioritized and given vaccine earlier. I definitely think the Stanford residents have a point for example- they are taking on risk, have very little agency (much less than nurses for example), and make much less money/compensation (than nurses and attending physicians)—- but they do skew much younger than these other cohorts. Essential workers are similar. It’s like having a VA system-“to care for him who shall have borne the battle.”
What disturbs me is this conflation of “equity” among groups defined by skin color and historic grievances, and ethics. It seems reasonable enough to say we have an obligation to “reward the worker fior their toil,” but if motives here are “reparations through vaccination” than that has all of the ethical issues of reparations and has no place here.
All of this shows the dangers of what I hope will soon be called “late wokeness.” Intersectionality, critical theory, and the like are useful frameworks for examining how historic power imbalances among groups have influenced a situation; however, it’s not robust enough to be the only or the defining framework for any analysis. They are one side of a triangle and used alone it’s a becoming dagger into the heart of our civilization.
If our aim isn’t for a colorblind society, for a truly multicultural society, then what are we aiming for? If we no longer dream for a day when people are judged not by the color of their skin but the content of their characters, we have to replace it with something, and replacing it with “no wait let’s use the color of skin as a surrogate for who has been victimized the most” seems to me to only lead right back to hate, division, inequity, and despair. Despair most assuredly as in a world where the loudest victim wins, everyone will feel a pull to become a “victim” and for every interaction to escalate into a fight.
There really are no good reasons to prioritise essential workers, especially when the category is defined so broadly as to include more than 25% of Americans in it. Older adults are massively more likely to die than younger essential workers. Thus beyond frontline health workers, it is obvious that older adults should have priority. The CDC agrees because their estimates show that giving the vaccine to essential workers first will cause many more deaths. They just don't care because they are infected by a very different virus.
Also, if preventing hospitalization is the name of the game, then giving the vaccine to the people most likely to require hospitalization also makes the most sense. Healthy young people, with vanishingly rare exceptions, shrug this thing off.
The name of the game is to prevent death, not hospitalization.
That is a true statement, but in a system where hospitals are over capacity, higher hospitialization rate has caused more deaths. Not only from Covid, but from other illness that goes untreated due to covid precaution at hospitals.
I know in Oregon “essential workers” included teachers, lawyers etc who were not working at the time and would not work for several months after the vaccine came out (and some basically went back at about the same time as everyone else). It looked a little bit to me that essential work was synonymous with Democrat donor.
That said, I do agree that some level of essential worker rule might have been wise. Dr. Nurse EMT, others who might interact and spread the disease.
Also, as I recall ( please someone point
Out of if I am wrong… I’m not one those COVID historians so I may misremember). But at the time I thought the vaccine was more about reducing spread of the disease not the severity. Again, as I recall, the severity argument arose after it became apparent that the vaccine was not as effective as advertised at reducing spread.
If this is true it would make the argument for vaccinating people like to spread the disease more effective.
Long story short…at least in Oregon the idea of essential work let was kind of a farce because so many essential workers were not working (making the entire essential argument kind of odd).
92% of all deaths from COVID in the US have been among people 55+, and 86% of Black and Hispanic deaths fro COVID in the US have been among people 55+ . . . there is no reasonable ethical argument for prioritizing essential workers under 55
I’m not saying that the other arguments are good or correct, but they exist.
For example... assuming you are social distancing, avoiding crowds, etc... your chance of getting the virus is low. A 68 yo mask-denying Stop the Steal rally attendee had a choice about the risks they took that caused them to get the virus... the 48 yo working the checkout counter at Publix had much less of a choice.
I agree that none of that should matter but this sort of moral desert argument has long had a place in our resource allocation schemes in this country, so clearly plenty see this as a reasonable argument (work requirements for welfare, the VA system, healthcare quality metrics and tobacco penalities, safe driver discounts).
There’s also a whole argument about “quality adjusted life years” which is a big concept in global medicine and surgery and argues for using scarce resources to treat conditions related to trauma and that affect pediatric populations.
This is a nice post from the BMJ blog outlining all of the other considerations that may be relevant:
https://blogs.bmj.com/medical-ethics/2020/11/11/vaccine-distribution-ethics-monotheism-or-polytheism/
I do agree that QALY (quality adjusted life years) would be a great way to allocate vaccines, but we would have needed to start that analytical work months ago in order to implement it now. As for the argument that the elderly could socially distance, my concerns are that (i) many of the the most vulnerable adults 55+ (e.g., middle and lower income 55+ people of color in multi-generational households) can't isolate; and (ii) public health policies based on people perfectly following guidance often fail . . . back in the 80s and 90s we were told HIV could be stopped in the gay community if everyone would "just" use condoms or abstain from sex . . . that didn't work. And right now, we're seeing that even our political and public health leaders are struggling to follow their own social distancing guidelines.
Well that plus the observation that the US, by charter, rejects the QALY allocation.
It isn't a moral desert decision, but a moral desert within which one could make a decision based on science, or a decision based on racism. The latter was chosen and the corresponding (and confounding to the stated goal) outcome was manifested.
In my darker moments, I think that most people don't want race to disappear. They don't know what else to base their identities on.
Not even close to most, but certainly enough to provoke the question.
What if it turned out that Western Civilization wasn't a tyrannical malign racist sexist patriarchy, but instead a relatively benign liberal humanistic civilization?
"Was" being the operative word.
I do not see how residents have less agency than nurses. What choices do nurses have if they are told to work without adequate PPE or if covid positive by asymptomatic? They can quit - is that their agency? Nurses are the most front line of front line workers and they are being abused by hospital administrations and put into untenable situations sometimes without adequate training. Unlike residents nurses spend their whole shifts very close to their patients. I would say that the fact that they may make a bit more money than residents (who will ultimately make much more than the nurses do) is not an excuse to vaccinate residents before nurses.
Having the ability to quit is the definition of agency.
Yes. That they can quit is their agency.