It's simple, it's fair, and it saves the most lives
Matt, you really gotta start writing takes I disagree with! Feeling a bit deprived of the smug satisfaction of thinking someone else wrong on the internet.
Seriously though, I think if we're in a situation where people feel a bit aggrieved and jealous of those ahead of them on the vaccine line, and feel the pressure of others also clamoring to take it, that's probably a good thing all things considered. Sort of a toilet-paper-in-March effect, though this time for something a bit more important that wiping butts.
My wife is a frontline health care worker. She and many of her co-workers were fortunate enough to receive the vaccine yesterday. I’m actually going to push back on one of the initial premises of Matt’s post and say that it does not make sense to prioritize young, healthy health care workers over the elderly, at least as a blanket proposition. Partially for the reasons outlined above, but also for a few others.
1. Outside of nursing homes, I’ve seen no evidence that health care facilities are a major source of spread. They wear N95 masks and gloves religiously. Because of these precautions, there has been no identified work-related spread of COVID among the physicians in her department for the last eight months. And they won’t relax any of those protocols because there are too many unknowns around whether the virus can be spread through individuals who have received the vaccine. So working will still be inconvenient and unpleasant in that regard.
2. Some of these individuals receiving the vaccine have had COVID. *Recently*. It was unpleasant, but they all described it as a mild fever that lasted less than a week. And now it’s fairly certain that they have at least 6 months of immunity. We don’t have evidence that asymptomatic spread will be different in vaccinated populations vs post-COVID individuals. So how does it serve anyone to give them a vaccine two months after they recovered from COVID?
I’m glad my wife and her friends were vaccinated. (None reported any reactions from the vaccine, by the way!) But those vaccines did not save any lives, and I doubt they even prevented any infections. I would sign on to prioritizing health care workers who work on COVID floors and haven’t been infected yet, or maybe even high-risk health care workers writ large. But I personally believe this vaccine is wasted on recently-infected healthy thirty-year-olds, at least until there’s sufficient availability. Give it to the elderly, who are dying by the thousands every day.
I really don’t think this was about shoring up our health care infrastructure. This was about rewarding health care workers. I hope they really liked their gift, because someone paid for it with their life.
This article was good, and yet, the fact it has to be written is infuriating.
Hasn't the CDC already done enough to tarnish its reputation? They have completely lost the right (and maybe that was inevitable). This seems like a good way for everyone else to tune out the CDC. Meanwhile, conservatives will put a target on their back so big that I presume zombie Scott Pruitt will be running it in 4 years (wow, almost forgot about him!).
If this scheme comes to fruition, there will be an otherworld level of line-jumping for wealthy, elderly people. These people will be overwhelmingly white, and we already know that. There will be a ton of think pieces on the long-term structural issues that created this moment.
The structural issue is HERE, right HERE, we just need to do the thing that would not have raised an eyebrow in any other country. The issue may be long-term, but it's the long-term softening of our collective brains that causes us to take the most perilous road to any sensible solution.
Thinking about our institutions in broad, egalitarian, empirically minded terms may lead to the success of those institutions. The MAGA fools have been so successful in part because they seize on these weak moments and describe them as what they are: a failure. They do no better, but because they exist in the realm of commentary & never solutions, they channel emotion, and it has to go somewhere.
To what some others have said here: I don't mind carve outs for a couple high-contact occupations. But the "all essential workers" benchmark is insanity.
I'm not sure I agree that "saving the most lives" should be the goal, as opposed to saving the most QALYs. If your 95 year old grandmother who likely had 1-2 years left dies of/with Covid, that's sad. If a 35 year old grocery store worker gets Covid and is one of the long-haul patients who suffers permanent lung scarring and brain damage from oxygen deprivation -- not killing her, but making her life much worse, and making her less able to provide for her two young kids for their entire childhoods -- that is a _catastrophe_, even though she isn't dead.
Simplicity has benefits because it's easy for people to understand why decisions are made, and increase by in. From this standpoint: Matt's case is rock solid. From a "saving lives" standpoint, this is also an easy sell. The elderly are far more at risk than anyone else, this has been obvious since the early days of the pandemic.
I understand there's a broad segment of the progressive population which values racial ethics over all else. In this case that argument is basically an argument that the lives of POC should be valued more than the lives of white people. This is not a particularly ethical argument in my mind.
I heartily approve (of course I turn 70 in March; what's not to like?)
I'm glad you pointed out that we still don't know if vaccinated individuals can spread the disease. Whether or not that is so could argue for a different set of priorities for distribution of the vaccine -- and for safeguards, e.g. what vaccinated persons in health care settings and other high contact positions should be doing to protect others. So that ought to be an urgent
research goal at this moment, the results of which should determine priorities after the initial distribution.
I predict that if we actually pursue a simple strategy of vaccinating the elderly, you are going to see a lot of whinging in the NYT about how vaccine distribution was racially inequitable. So Branswell's argument for prioritizing POC makes sense from a public relations POV even if it makes no sense as medical ethics.
Maybe this goes without saying, but one group that should be at the front of the vaccine line are people who participated in the vaccine trials and got the placebo.
Typically cogent. I would add a footnote: I believe there's a long-standing pandemic contingency plan proposing that there should be small cadres of "pre-first-in-liners," including high government officials and the workers directly involved in producing the vaccine. I think this second category is obviously reasonable. Regarding the first category, I once read a compelling account of famine relief, that explained that during a famine you need first to give food to the military personnel distributing the food. The point being that a system promoting ethical justice doesn't work out so well unless you can ensure that the system will actually work.
“Society collapsing, no social trust , politicians doing nothing...” - somehow this feels true while the country somehow cranked out *two* vaccines in 9 months. We don’t at all celebrate that, and we should!
The most wonky ethical system incorporates a "net years of lives extended" calculation which does strongly favor older people. However, incorporating health status and other comorbidities into the equation creates some moral hazard problems. For example, if being a smoker moved you to the front of the line, there would be a lot of outrage.
Using just age as a proxy for risk simplifies the process but it will still create outrage and cries of unfairness.
Thanks for continuing to shine the light of reason on this dynamic of "symbolic racial issues over the concrete needs of non-white people." The world of virtue signaling and centering is a tricky needle to thread.
Why is this controversial? Obviously we should give it to the elderly and then go on down from there.
Your dek clearly reflects your objectives: you want simplicity (I'd say visible simplicity, I.e. transparency) first, then equity second, then life-saving value third.
That's because you are focused on the vaccine's distribution as a *political* event, and are primarily focused on its political effects: will it create more social cohesion and trust or erode it; will it lead to more corruption; will it bolster the status of scientific expertise or undermine it; and so on.
That, I conclude, is because you think that the state of America's *political* health is even worse than its sufferings under the pandemic.
I don't disagree with this, but it suggests two things.
First, that you might advise a different distribution plan for a well-functioning, high-trust, low-corruption society in which science is already well-regarded. Maybe Singapore or S Korea -- if they want to get fancy with their system of distribution, you would not object.
Second, that your complaint is not that the medical ethicists failed to consult specialists in ethics, but that they failed to consult specialists in political theory.
You may be right about the political diagnosis of the country, and right about which system of distribution will harm the US the least. But your arguments are mostly political ones. That makes me think that in your view, political considerations should override the judgement of medical ethicists. But it does not follow that the medical ethicists did their job badly.
Does anyone have a link to a smart person making a good argument in support of a more racially-centered vaccine prioritization protocol? The only people I see talking about this are people making arguments against it.