195 Comments

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.

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I dunno. Wiping your butt is pretty important.

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Less so if you have Tushy, the bidet 4/5 podcasters recommend.

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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.

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You raise some powerful points, but for me a major part of the determinative calculus here is the *pace* of the rollout of mass inoculation, and the *size* of the frontline healthcare workforce. If the latter can be inoculated rapidly with very little delaying impact on the vaccination of old people, I think it might pass ethical muster (especially if the recently infected and presumed immune are exempted). I realize healthcare workers are skilled at protecting themselves, but (I'd imagine) the stress of being constantly, perpetually hyper-vigilant with respect to infection risk must take a toll.

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That's reasonable, but there still are quite a few health care workers to vaccinate, at least several million. And I'm just suggesting that vaccinating 10,000 82-year-olds is better than vaccinating 10,000 front line health care workers.

I can't speak for the people who actually go through it day in and day out. But I do think considerations like stress and job satisfaction are secondary to life and death. And only one is permanent!

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I’m in the exact same situation (wife got the vaccine yesterday) and I secretly agree with you. The funniest re-emphasis of your point is that she’s been reporting to me that a whole bunch of her colleagues have been catching the virus lately - because there are parties that the anesthesia and OBGYN residents are throwing, and of course they’re all going.

One thing you’re not considering, though, is that these health care workers - especially the borderline indentured servants like residents and nurses and technicians - *should* have been revolting in March/April. No one becomes, say, an oncologist expecting even the possibility of exposure to a deadly disease, and they certainly don’t expect to be one without a supply of masks etc. The US healthcare establishment got lucky that all of their employees didn’t figure out that they’d been thrust into a completely unfair situation until it was too late for them to really push back, but this time around I would worry about them simply saying “I’m not coming to work under these conditions”.

That probably isn’t a strong enough argument on its own, which is why at the end of the day I agree with you, but it’s at least one good reason for the other side.

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I almost added to my comment that a better way to throw them a bone would be to regulate working conditions for residents. But of course residents are a small subset of the population we're discussing.

I mean, to throw in another take that I'm not fully at liberty to express at the kitchen table, other essential workers were exposed to similar risks without the getting the status boost and generous compensation that doctors, PAs, and even nurses enjoy. The worst off people have been the nurse's assistants and aides cleaning health care facilities. They get all the risk, 30% the compensation, and much less of the cultural gratitude.

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My view here is basically that if you are going to ask people to do dangerous things to protect others, you need to take steps to mitigate those harms even if it's somewhat at cross purposes to the overall mission.

You can argue the net is a little wide, that's probably better than trying to narrowly target the most impacted health care workers, because you'll inevitably fail, not giving it to some who really need it while accidentally including some who don't.

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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.

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Well-put. Republicans are ghouls, but the Democrats and government generally just makes it so easy for them.

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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.

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I mean, you're right of course. But the age effects are SO strong that they mostly overwhelm this kind of thing. It'd be one thing if the IFR for a 35 year old were 0.1% and the IFR for a 60 year old were 0.2%. But it's not. The IFR for a 35 year old is 0.05% and the 60 year old is 0.5% -- and the 95 year old grandma is who knows, quite possibly 20%. Even adjusting for QALYS, you'll *mostly* approximate the same "the older you are, the higher priority you should be," and the differences are small enough that adding the complexity and potential for unfairness aren't worthwhile.

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***I mean, you're right of course. But the age effects are SO strong that they mostly overwhelm this kind of thing.***

Not only that, but "QALY" calculus gets overwhelmingly complicated, quickly, and we need a strategy now.

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I'm not sure we really _know_ what the comparative QALY loss is. Infection Fatality Rate is not useful for assessing that. Yes, only 0.05% of the healthy 35 year olds _die_. What % of the healthy 35 year olds experience serious long-term problems, though? Do we have that well-established even, yet? If one 35 year old who otherwise would've lived 60 healthy years gets, instead, _zero_ more _healthy_ years -- and is instead unhealthy and dealing with expensive problems for the rest of her life, and dies a decade or two earlier than she would've -- that is arguably _worse_ than one 85 year old dying who o/w would've lived in middling health to 90 or 95.

I think it is fair to argue, though, that getting this right is too hard a problem to solve in the next week or two, and anything we could cobble together would be subject to gaming by people with connections. So probably the age rule is in-practice better than anything we could actually come up with.

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As another epicycle, I'd also add that outside the nursing home setting, the 35 year old grocery store worker is _much_ more likely than an 85 year old who has secure private housing to pass the virus on -- to their kids, and to other workers -- so in theory you should be pricing that into your model as well. But again, this means more uncertainty and complication.

I feel quite certain that it would be better / more-just to vaccinate at least some essential workers ahead of elderly who have secure housing and can afford to have food and whatnot delivered to them. I just am not sure we have any way of clarifying _which_ essential workers, and who among the elderly counts as secure.

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I agree that we don't know for certain, but there's very little evidence that suggests that "severe cases that might lead to highly reduced quality of life" are distributed any differently from "severe cases that might lead to death," and lots of good prima facia reasons to believe that they aren't.

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I disagree strongly with your last clause. My impression is that the evidence suggests that the difference between the old and the young is more or less that what's rising exponentially with age is the likelihood that a severe case kills you, instead of just damaging you a lot but leaving you alive. The percentage of cases that are severe, and leave lasting evidence of damage to the heart, lungs, and cranial vasculature, is high even in the young -- possibly as high as 30%.

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Death rate increases more than linearly with age. In fact increases *exponentially* -- just eyeballing the graph, each increase of 20 years increases the death rate by a factor of 10.

LY's remaining decreases linearly with age.

Therefore we do know, by math, that if we treat the oldest first we will save exponentially more years of life than if we do something else.

It isn't close at all -- the increase LYs saved will be exponentially more if we go oldest to youngest than anything else, by more or less the distance from the strategy implemented to an "oldest to youngest" strategy to whatever exponential one calculates.

No "QA" -- in this calculation. I'm treating a LY for a 70 year old same as a LY for a 25 year old.

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But that's just the problem. The quality adjustment _matters_. If a 35 year old was going to have fifty years of health, and instead they will lose ten years, but also spend the other forty years significantly impaired, unable to maintain their career or care for their kids, that is _almost as bad_ as if they just fully lost the fifty years. And don't really have a solid estimate of what % of younger patients live, but have serious damage. Like, I've seen estimates anywhere from 2% to 30%. We probably won't really know for sure until we've had a decade of longitudinal followups.

I've come around to the view that we simply don't have good enough data or good enough administrative resources to solve this problem in a way that wouldn't instantly get gamed, and so age is the best we can do in the real world. But I think if you pretend it isn't a problem, you're not really serious about the ethics of healthcare.

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I thought QALYs were being used to discount the remaining years of life of old people, not to add a cost factor on the "young" side of the balance sheet.

Thinking this through...

Even so, due to the exponential increase in death rate, the cost term from impacted LY's on the "young" side of the ledger would have to be huge to make up for the exponential increase in death rate -- the severity and frequency would have to be high.

I think that if young people were basically getting crippled by this disease at a rate comparable to the old person IFR, we'd be hearing about it. I think this is unlikely especially as it's apparent that the disease generally is more severe in old people than young -- frequency of negative long term impacts is likely to follow same trends as the IFR.

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Suppose that a 75 year old would've lived to 85, gets a severe case, and drops dead.

Suppose a 35 year old would've lived to 85, gets a severe case, and then lives a significantly-worse life and dies at 75.

The cost at the tail end of life is identical, but then you _also_ have to account for the way everyone connected to that 35 year old has a worse life for the interening forty years. The 35 year old doesn't have to be "crippled" for long-term lung, heart, and mental problems to impose a _huge_ cost on society. Look at the enormous gains we see when we do stuff like just reduce the impact of air pollution on kids ( https://www.vox.com/2020/1/8/21051869/indoor-air-pollution-student-achievement ). Having one of your parents go from healthy and active, to suffering chronic asthma and brain fogs, will have significant knock-on effects.

And then add in the fact that the the young person is more likely to also transmit the disease -- old people outside the nursing home context generally have an easier time reducing social contacts.

If in fact it is true that the distribution of "severe cases" is identical among the old and young, but "severe cases" for the young are much less fatal in the short term, then the total social cost of infections among the young is _obviously_ much higher.

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I'm glad you brought this up, I think people are getting a bit heated about _deaths_ when that's not the only criteria that the CDC is using, the ACIP slides from the 19/20th meeting take into account the potentially lifelong health effects of catching Covid which Matt seems to not mention. I realize this thread was opened on the 18th but we've about these health problems for months at this point. The CDC very well could make the wrong decision about how much value is gained by focusing on reducing infection rather then reducing deaths, but it's a valid decision to make and they're right to consider it. (afaik they won't actually make the decision until the meeting on the 20th)

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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.

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It sounds like their argument is even worse than that. If the numbers in this post are correct, it seems that vaccinating the elderly would still save more lives of minorities and POC, just as a smaller percent of total lives saved. Targeting essential workers would mean more POC die overall, and it's only equitable because proportionally more white people die as well.

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I heartily approve (of course I turn 70 in March; what's not to like?)

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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.

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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.

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Seriously, fuck those people. We're talking about letting more vulnerable people die so some people in a cult can feel good about themselves.

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Couldn’t have said it better myself

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Most people don't read the NYT

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For better or worse, the people who make decisions about who’s hired as chief medical ethicist do

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Honestly, that paragraph in the New York Times is one of the more shocking things I've read in awhile.

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I wasn't shocked they privately felt that way, but I was shocked they would say it plainly in an interview with the New York Times.

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Has anyone run the numbers on whether prioritizing the elderly first would actually save more people of color in total than prioritizing essential workers? I kind of suspect it would, which would be a further irony here if they go forward with the plan on those CDC slides. But it could also provide legit egalitarian grounds for opposing that plan.

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In other words, if what they're suggesting is taking two options:

A: Save 20,000 POC and 80,000 white people

B: Save 15,000 POC and 15,000 white people

and choosing option B, that should be considered worse even from the woke perspective.

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I think Matt gets at this in the article when he points out that, while its true that the elderly are not as highly represented in the over 65 cohort as they are in the essential worker category, the difference isn't start enough to countervail the fatality rate. Something like 1.5x as many in the essential worker grouping, but the fatality rate for elderly POCs is 10x that of younger ones, so even though they make up more people their likelihood of death/serious complications is so much lower that vaccinating more of them will have a considerably smaller impact on deaths. So the best way to save the most lives of POC is still to vaccinate based on age.

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The difference in Infection Fatality rate between the age of HCWs and the over-65s as a group is so stark that it simply _has_ to be the case that if what you care about is fatalities, the trade-off is as you describe. On the order of "a thousand vaccinations of elderly saves ten lives, and a thousand vaccinations of young saves 0.1 lives."

As I noted above, I think that fatality rate is _definitely not_ the only thing we should care about, but I'm persuaded that we don't have good enough data about the other stuff we care about, or trustworthy administrative infrastructure to use it, and so I'm down with the simpler age rule.

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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.

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It doesn't go without saying to me. Your logic is that this is some kind of thank you for your service concept? But they weren't supposed to do anything dangerous, they just got an injection of saline solution and lived their lives. The reward for the trial was a chance at the vaccine early. If the chance didn't work out for them, they knew it wasn't 100%.

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You raise a fair point. Your pushback got me to do some extra googling and apparently it's more complicated than I thought.

One issue is that researchers want to continue to collect trial data, so ideally trial participants should be treated exactly like the general population in terms of priority order.

Apparently, Pfizer will follow the CDC priority guidelines at first to continue gathering data, but eventually plans to switch all placebo participants over to the vaccine arm of the study.

https://www.statnews.com/2020/11/12/pfizer-says-placebo-patients-will-eventually-get-its-covid-19-vaccine-the-question-of-when-is-complicated/

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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.

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“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!

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We cranked out two vaccines in a matter of weeks and then took 9 months to get them through the regulatory process. The technology here is amazing, the societal aspect just sorta chugged along without fucking up too badly.

Really the takeaway from this year should bullish on technology and bearish on our society.

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It's great a couple of US-based firms have been able to accomplish this, but you'd expect a country with a fifth of global GDP to account for an oversized share of medical innovations. Also, China appears to have developed a successful vaccine, too, and they didn't lose one out of every 800 citizens (and counting) while doing so.

I'm ecstatic vaccines have arrived, mind you, but I really don't see much to celebrate in America's response to this pandemic.

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With the massive caveat that private companies did that, not the federal government.

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Even if we assume that the scientific findings of federally-funded research didn't make a difference, the federal government payed for the education of almost every scientist that the private companies hired.

(Almost any science PhD in the US, unless they win the rare private fellowship, has some part of their studies funded either as part of a federal research grant won by their PhD advisor, or else directly by the NSF.)

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That's both true and completely unconvincing to the point of it being irrelevant. What is more salient, the government funding the training of scientists that eventually, maybe, invent something that makes headlines, or that nearly every interaction with any level of government is awful and most news stories are about the government screwing up?

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I'm really curious how people come to such obviously false views. About 70% of federal spending goes to the military, social security, and medicare and medicaid. Those are *very* popular programs.

At the state level, most of the money goes on education. Public schools have a net positive favourability rating.

It's a long way from perfect but "almost every interaction is awful" is just detached from reality.

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People like the programs that take up the majority of the budget, there for people have a generally favorable view of the government? That makes no sense. For what it's worth, we have to go back to 2004 to get a Gallup poll where unfavorability toward the way the government is run is below 50%

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You wrote nearly every interaction with government is awful. That's not true. It's so obviously untrue I'm curious how you could come to seriously write such a thing. That's all.

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I don't think that's a caveat. The US has a complicated and messy industrial complex - sometimes it really is the government doing science, a lot of the time they're just making the money flow, and I'd generalize that as a task becomes more like engineering and less like science it's more likely to be contracted to the private sector if it's not already fully privatized.

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Right so the government largely getting out of the way to let drug companies do their thing is going to reassure the public the government is effective? Bit of a bankshot to me, but ok.

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I don't know what Henry's original intent in his comment was, but I did not read "the country" as "the Government" in his original comment - I read the country as some vague union of the public sector, the private sector, citizens, academia, in other words "hand wave all of us".

So no, I agree with you, I think if the Federal government punts to the states on public health issues while the President undermines messaging on Twitter, having some private sector vaccines, some paid for by grants, some not, doesn't restore faith in goverrnment.

But if you feel a sort of American malaise (e.g. look at our bad outcomes compared to similarly industrialized countries or something) then maybe being a home to vaccine development does counter that.

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and the caveat that "we" didn't do all that. One of the vaccines was made in Germany by a pair of Turks.

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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.

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I'm still waiting for the backlash when people find out the prison population is getting vaccinated first. Regardless of whether it's right or wrong, people are going to be upset.

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Zero doubt on that, considering this is the United States we're talking about.

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I just posted a hypothetical question about the net years of lives extended above.

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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.

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Why is this controversial? Obviously we should give it to the elderly and then go on down from there.

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Because well-meaning people are often smart enough to logic themselves into stupid conclusions.

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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.

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If I follow Matt's argument, the medical ethicists are recommending an approach that will lead to more deaths because they're not prioritizing the elderly. If that's true, then medical ethicists are bad at their jobs.

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Yeah, that's not his argument. He concedes that the policy of prioritizing the elderly may not lead to the best health outcomes. You might save more lives with a more complicated system dreamed up by clever ethicists. But he thinks it is politically better, and from a health standpoint it is good *enough* -- it may not save quite as many as a more complicated procedure would save, but it's roughly in the ball-park. And once its roughly in the same ball-park so far as lives go, then political considerations can justifiably over-ride minor improvements in life-saving. Here's where he says it:

"What this means is if you start with the oldest people and just work your way down, you can eliminate the majority of the mortality risk way before you’ve vaccinated half the population.

Compared to a completely idealized plan where you simultaneously consider age risk, occupational risk, and prior health diagnoses, this is a bit worse. But the age correlation alone really is very strong. "

So, it's "a bit worse" in lives saved than an idealized plan (i.e. one that would be less transparent, less equitable) but since the "age correlation is very strong," it's close enough on the life-saving front, and much preferable on the political front.

Am I misunderstanding the structure of his argument? Are you? Luckily, our host can weigh in to defend himself if he feels that he is being misunderstood.

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I think you might be mistaking the rhetorical point he's making when he says it may not be ideal. The ideal plan he's referring to isn't the plan the CDC is actually discussing, it's a hypothetical plan that isn't on the table right now.

Note the next sentence of your quote: "And the arguments for prioritizing essential workers don’t seem to me to hold a lot of water." That is the plan he is really comparing against, the "ideal plan" is more a rhetorical flourish. He is saying, essentially, "giving to the elderly first may not be 100% perfect in every way, but it's a hell of a lot better than the alternatives being discussed."

He's also saying that trying to chase that due to the fallibility of our infrastructure, trying to chase that 100% perfect plan may be a bad idea in general.

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Yup, the key thing is the CDC isn't considering this idealized plan that Tad thinks would save more lifes than the elderly. Their preferred approach leaves more dead.

Matt is of course right that this is bad policy. I'll add I'm always skeptical of chasing highly complex plans that may work better than simple solutions which we know will be highly effective. It is better to go for the A- plan if it guarantees at worst a B+ outcome rather than an A+ plan that could have a C outcome.

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You're misunderstanding his argument. He's not arguing that we should consider political outcomes- the entire piece is a response and rejection of the CDC taking such political considerations into account. His point is that of the actual options that are available to society (while conceding that a utopian society with an omniscient CDC that can perfectly plan this out would be the "best" scenario, but recognizing that such an option is an impossibility in the real world) that making age the determinative factor is the way to save the most lives in the shortest time, and that the calculus on this isn't even close- you will end up saving dramatically more lives by doing this when compared to any other real world policy option.

You seem to be holding on to a misreading of a few of the things he included in the piece in order to have walked away with a reading of his argument that is almost 180 degrees away from what he was actually saying.

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"That's because you are focused on the vaccine's distribution as a *political* event,"

I have no idea how you got that from the article. He's making a case for a distribution scheme that saves the most lives over the course of the next few months.

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“ life-saving value third” - wait what? How did you get that from the post? I don’t think anyone is saying to put life-saving value third.

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Put differently: from your own perspective, you might prefer a system in which the medical ethicists design a system without regard for the political consequences, and then President Joe says, "that's malarkey: let's do it in the most transparent, incorruptible, equitable manner, which is strictly by age." They do the medical ethics without regard to the political culture they find themselves in; he does the politics, and overrides them.

The alternative, in which the medical ethicists freelance as political theorists, comes close to a situation that you have condemned with respect to mask-usage, in which the epidemiologists free-lanced as social psychologists and told people that masks were not important, hoping that way to reserve them for healthcare workers. But epidemiologists are not very good at social psychology, and should have stuck to their lane. I should think that you would give the same advice to medical ethicists.

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Even without expressly political considerations, you still have to have a system that's practical to put in place. And even without that, there's still the entire portion of Matt's post where he argues that prioritizing essential workers would actually result in more deaths.

So while I think it may be fair to say that there is a political component entwined in Matt's argument, it's certainly not the only argument he's making, and I don't even think it's his main one.

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You should re-read the piece. Matt's whole criticism of the CDC's plan is that they're making considerations of things other than health outcomes (arguably acting as 'freelance as political theorists').

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The deck is from the vaccine ethics advisory committee, not Matt.

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No, the dek is MY's description of his own plan, and a criticism of the plan by the vaccine ethics advisory committee. MY thinks his plan is simple, and their plan is not simple enough.

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My apologies, I see what you're saying now. In my defense, though, "dek" is journalism jargon.

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I fail to see your point. Prioritizing the elderly (as most countries are doing) will save the most lives. If the goal is to save lives, that's what you do. Is that the goal?

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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.

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founding

This tweet thread summarizes the NYTimes article quoting 3 such people: https://twitter.com/JCompson_III/status/1339814373121011712

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Jesus, that thread is racist

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That is some galaxy brain stupidity in that thread. Do people read that and find it persuasive?

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thanks

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