Yascha Mounk: The CDC came scarily close to adopting a plan that would have killed thousands of Americans.
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.
Did the scientific analysis of the benefits of immunizing different groups incorporate the risk of infection, as well as the risk of death or serious illness if infected? The frontline essential workers group, while less likely to become seriously ill or die if infected, seem more likely per capita to become infected; and are likely more important as sources of subsequent transmission than the elderly (which is why nursing home residents -- closely packed and unable to isolate -- were in the first tier). You analysis seems to be limited only to risk of illness if COVID is acquired, but not to include primary risk of acquisition and subsequent transmission risk. We don't know if, or to what degree, the vaccines prevent transmission; so that's hard to assess right now, though the data is on the way.
I agree with a number of the criticisms offered respecting Yascha's article but I think it's worth pausing for a moment to recognize the thanks we all owe him as founder of Persuasion. The comments made in their totality comprise precisely the kind of civilized debate that Persuasion aims at. I could not be more grateful to him.
Interesting, this mirrors the World War II debate about whether scarce penicillin supplies should be used to treat troops wounded “on the battlefield or in the bordello.” After discussion it was decided to prioritise soldiers with venereal disease, who after a short course of antibiotics, could return to the battlefield, over the wounded, who required prolonged treatment. A decision based on military utility proved correct allowing allied forces to be reenforced at a key period of the war.
We are now in an analogous situation, a vitally important medical available in limited quantities. If we use the same logic, prioritizing maintaining and reenforcing our front line, it makes sense to allocate them to the people vital to maintaining society, medical personal, emergency services, military and transportation etc. Secondly would be those most vulnerable, the elderly, people with chronic medical conditions / disabilities and Aboriginal people, lastly young to middle aged people in good health in non-vital occupations (which includes me).
When you throw away your moral yardstick, there is nothing left to help you determine wrong from right. It is tragic, but hardly surprising that society as a whole has lost the ability to determine what is the morally better path. We are now in the third generation of moral relativism. 'What's right is what seems right at the moment based on how I feel'. They make bad decisions for political rather than moral reasons, while we object that they have lost the concept of right and wrong. The problem is that we are operating from different starting points. We don't have the same assumptions. Unable to agree on a common ground for debate, the two sides degenerate into insults and hatred. Unless and until we agree on a common moral framework, the problem will persist, and continue to worsen.
This is what happens when you kick God out of the public forum. A moral standard has to come from outside; otherwise morality becomes the prerogative of the powerful, and no-one can argue because there is no ground for critiquing decisions. We are nearly there - the point where expediency suffices for overruling moral objection. It won't be long before society collapses altogether into intractable factions seeking to conquer each other.
I could weep.
I completely agree with your analysis. I also think that we actually need to start saying (<=invisible italics) not just that such decisions are wrong, but that they are unethical and immoral. Admittedly, you strongly imply this. I just think saying it would be more persuasive, largely because that would help give others permission to say that. This is all about social pressure.
Thank you for the article and putting public pressure on the CDC to objectively seek to minimize deaths.
While I've likely lost more trust in the institutions - media, academic, and corporate - than you, this represents a watershed moment for me.
Alternative institutions ought to be invested in, including Persuasion. Our intellectual culture is in a dangerous, weak place.
Persuasion is a community and, to me, Yascha's article and the comments that followed are its first real 'test' (one that I hope provides an opportunity - which I'll explain below). IMHO, this comes from the fact that this article relates literally to 'life and death' decisions in a piece that Yascha writes in a very direct, urgent and (given the comments that followed) controversial manner. I'll save my full thoughts on the substance for a separate comment, but I want to highlight that although arguments were made (some better than others) this is the first time I have really seen hyperbole, name calling and ad hominem attacks make their way directly into our discussions. This is not to shame anyone, but, in conjunction with the EoY survey that Persuasion just sent out, my hope is that we collectively take this opportunity to 'up level' the conversation and improve not just our rhetorical skills but move toward a better understanding of the "other" which will hopefully mitigate the polarization we are all enmeshed in at the moment.
First observation, the comments section is great for folks to add an idea or two, but it is poor way to engage in actual conversation/dialogue. As of this post there are over 140+ comments in a hodge podge order that frankly hurts, not helps the discussion. We need a mechanism that enables real dialogue. Perhaps, when an article gets over ‘x’ number of comments we can invite a member of the community to write a rebuttal to the original work? Alternatively, we can automatically schedule a Zoom debate where members of the community can engage with each other in a structured dialogue. Or. . . perhaps there’s a better online tool than the comments section for structured online written interaction?
Second, could we either hire someone at Persuasion (or crowd source the Persuasion community) to “independently” critique arguments? For example, could we color code common imperfections in argumentation? Specifically, ad hominem attacks could be highlighted in green, common logical fallacies could be color coded, perhaps we could highlight bias as well. To effectively persuade we need to be able to identify and avoid these common traps.
Lastly (for me, but I ask that you all please add others), we need to be focused on trying to better understand “the other.” This is where the comments section on this piece seems to go especially awry. If you have a bent and rationale for why you think something is true – please let us know. To me it is always more powerful to understand “why” you believe a certain thing. This provides context and allows an opening for people to share their experiences around ‘why’ they have come to certain positions. A quick read revealed folks who have significant distrust in governmental institutions, others who have different value systems with regard to human life and still others are frustrated with the inequities of our world. The human condition is a fascinating thing and how we each come to our positions is critical to understanding different perspectives and ultimately finding common ground to the big problems like the one Yascha discussed in his piece.
I would suggest that we have something unique (and quite hopeful) here. Venues where careless assertions and rhetoric sate our more base urges are a dime a dozen but that is not Persuasion. Although this is probably not the best place to consolidate our thinking on this topic (another deficiency of the comments section), it would be great if we could add our thoughts via the EoY survey or otherwise facilitate improvements to ‘up level’ our community dialogue.
I feel like there's a few factors here that argue against just looking at case fatality rates:
1. More old people die, but more young people spread the disease. Frontline workers especially come in contact with lots of people. Biasing the distribution to these people (frontline workers in particular, but also just younger people.. people who are more likely to go to bars and restaurants) can improve the epidemiological curves.
2. Ethically, it seems very reasonable that if we're asking someone to do a job where they are especially exposed to people in a pandemic, then they should get priority access to a vaccine. Maybe they're young and less likely to die, but we're still asking them to take on a much greater risk for the rest of society to function, that should come with some kind of reward.
3. A 90 year old may be ~10x more likely to die from Covid than a 40 year old. However, if you give the vaccine to the latter, you're likely saving 10x more *years* of life. So if you're optimizing for "number of additional years of life" you can provide, biasing too heavily towards the elderly may not be optimal. Prioritizing this stuff is never easy, but surely we need to take into account the fact the fact that the *increased risk* of death from covid is approximately the same for all ages (about 10%)?
Proof that the Rational Resistance can have a real effect. Great job Yascha and others for drawing public attention to this issue.
Dooling and her ilk would have faced a death sentence at the Nuremberg Trials for this sort of planning. Now she doesn't even risk her pension. Our Society is broken.
While I sympathize completely, with your concern about the role that "social justice" plays in the rationale offered by the CDC, I understand that there is another way of looking at the calculus that may provide better justification for the CDC's focus on vaccinating essential workers.
You're right that defining that category is difficult. But the most persuasive reasoning I've seen to vaccinate "essential workers" whoever they are, is that they are the ones who are mostly likely to get and then pass on the virus among the larger population.
The difference is whether you focus on deaths averted or infections averted. As someone a couple of years over 65, and with a father who's 92, I am very aware of the ethical value of saving the lives of the elderly -- and particularly the frail elderly.
But I can't also help thinking about the staggeringly high infection rates right now. I live in California, where the rates have climbed to levels we never dreamed of as we all did our best to keep them down, and succeeded for months. Now our infection rates are among the highest in the nation, having gone from the single-digits per 100,000 up to 107 per 100,000.
My father will be vaccinated soon, but I can't help thinking about how many other lives would be saved if the grocery workers or teachers or Uber drivers were vaccinated. I have no idea how many people they come into contact with every day, but the sheer numbers, and the exponential number of others the people they come into contact with would come into subsequent contact with, seems like a number worth reckoning with. The increase in deaths among that group would need to be balanced against the more immediate deaths among the elderly.
Like everyone else, I would not relish having to balance those two estimates against one another. But that more dynamic way of looking at the calculation -- deaths averted vs. infections averted -- seems like a better approach the CDC might have taken, rather than its more politically motivated one. Of course, it's unfair to criticize those in government for making decisions based on political factors and their necessarily reduced scope of vision. But that is, I think, a more realistic way of analyzing their process.
It's hard to watch this slow-motion train wreck of our institutions. I still assume we'll stop well short of Maoism or Soviet style institutional capture, because we this is all coming from social pressure, activism. As much as they try, they'll never actually destroy our press freedoms, and eventually wiser voices will prevail... right? With Trump fading away, I see 2021 as the year everyone finally recognizes how morally corrupt this new social justice ideology is.
I read the comment made by Mamma Miya, mentioning some reasons why essential workers should be prioritized (like spreading the virus), which I agree with.
But Mamma Miya and many others are missing the whole point of this article is that based on the presentation provided by CDC (page 31) puts the racial reasons to prioritize essential workers even tho it is mentioned that more people are estimated to die because of that, is insane. This is not the right direction that America is going.... We should learn from history that such extreme actions make American people to not to believe in their government anymore. Hope you understand Mamma Miya
The obvious omission from your essay is that preventing DEATH isn't the ONLY goal of public health policy. Minimizing the number of people who get infected is also crucial (they may be silent carriers and super spreaders, long term health effects, short term pressure on the health care system, overall suffering, economic impact, etc.).
In other words, prioritization should look at people who are at highest risk of dying (the elderly) AND people who are at highest risk of being exposed (frontline workers).
It seems to me that many journalists have fetishised the former, while ignoring the latter. An 85-year-old retired writer man, sitting at home with his 85-year-old retired writer wife, getting groceries delivered every other week and avoiding people in lockdown may face a high risk of dying of COVID-19 if they get it, but they face a very low risk of actually getting the virus (on account of their lack of social contact, by virtue of their work). A 50-year old operator in a meat packing plant, however, is much more likely to actually get the virus in the first place.
I have been astonished that these famous writers and journalists have all failed to address this point. It is such an obvious omission (Fox News style omission) that I cannot take the outcry seriously.
I know there is a lot of money to be made these days from ascribing problems to the "woke" and to the campus snowflakes, but I expected a little more responsible and honest work from you (if not from Andrew Sullivan - also known as "David Duke with a PhD").
Utterly irresponsible "journalism". The woke may be cuckoo-clock crazy, but the anti-woke are even scarier because they run around claiming to be high-minded folks in defense of liberal democracy. But they are just backward-justifying their opinion, too.
I'm genuinely appalled.
The CDC actually DID adopt a plan that will end up killing more people of color. As Yascha Mount points out later in the article, the CDC is STILL not prioritizing seniors between the ages of 64 and 75 (even ones with comorbidities) -- and this includes people of color who are dying in the largest numbers.
This is what happens when you call 87 million non-medical workers "essential", and then prioritize people between the ages of 65 and 75 below one third of them and equal to two thirds of them, as the CDC has done. Since there are only 209 million adults in the country, you have essentially thrown these vulnerable seniors -- INCLUDING SENIORS OF COLOR -- in with the general population.
This results in articles like the following from yesterday's lawsitesblog.com with the headline: "CDC Says Lawyers and Judges A Priority for Coronavirus Vaccine". The CDC committee's priority list is a product of professional/managerial class interest using a dishonest rationale of "social equity" as cover.
If the committee had honestly been interested in "social justice", they could have prioritized seniors in the hardest hit zip codes. The data is there; it would be easy to do. They could even lower the definition of "senior" to 50 in those zip codes. And then they could go on to the remainder of the seniors, in descending order of age.
As Yascha Mount frankly put it, this is "one of the most shocking moral misjudgments by a public body" he has ever seen. Other countries have adopted a rational and humane priority list, vaccinating people in order of risk of death by covid-19 right behind front line medical workers.