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The CDC tried to have non-medical essential workers ahead in line of seniors. The argument was that, although more people would die (including more African Ame

The CDC tried to have non-medical essential workers ahead in line of seniors. The argument was that, although more people would die (including more African Americans), it would even out black vs white ppl deaths metric. [edit] source: https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2020-11/COVID-04-Dooling.pdf https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-...

selljamhere 6y ago
I don’t see any arguments in those slides about trying to “even out black vs white ppl deaths metric.” Social inequality is one of several factors included in their ethical and logistical plan, but interpreting that as an implied black vs white issue seems like a very uncharitable view of the author’s intent.
- danarmak 6y ago
  Page 31, table row "mitigate health inequities" says: An upside (green) of vaccinating essential workers (non-healthcare) first: "Racial and ethnic minority groups disproportionately represented in many essential industries. ~1/4 of essential workers live in low-income families." A downside (red) of vaccinating adults age >65 first: "Racial and ethnic minority groups under-represented among adults >65". The next page (32) concludes that "mitigating health inequities" (what the paper calls Ethics) is the metric with the biggest difference in outcome, in favor of non-essential workers. A bigger difference in outcome than the one for "maximize benefits and minimize harms" i.e. preventing the largest amount of deaths. Of course, the presentation doesn't define how these two different things are supposed to be compared. But its recommendation is that "Ethics" outweighs "Science" (their terms, not mine), and therefore populations with larger ethnic minority and low income representation should be vaccinated ahead of those at higher risk from the disease.
  - zaroth 6y ago
    This is one of the better critiques I’ve found of the CDC’s very absurd position: https://www.persuasion.community/p/why-im-losing-trust-in-the-institutions https://www.persuasion.community/p/why-im-losing-trust-in-th... Literally their plan was to kill a greater number of people “because ethics”. It goes against well established pillars of ethical logic against “leveling” outcomes by intentionally making things worse for a group that is better off, and against the most fundamental tenant of medicine to do no harm. You must apportion a limited supply of life saving medicine to the population most likely to benefit from it. To claim that apportioning the medicine to a population which is orders of magnitudes less likely to benefit from it, knowing that a greater number of people will die as a result, is an abject ethical failure. Even accounting for the smaller minority share of the elderly population, you still kill more minorities overall by apportioning the vaccine to essential workers ahead of the elderly, because the death rate is so heavily skewed based on age.
    - erentz 6y ago
      Be warned Yascha has become (or always was, I'm not sure) a grifter hack. He jumped on the cancel culture grift now he's joining in with other armchair epidemiologists such as Matty Yglesias and Nate Silver in misreading slides and propagating a made up controversy about vaccine distribution. The ACIP meeting was recorded and open to journalists. They could go review it, but strangely they didn't. I don't see them reporting video from the meeting where they say anything of the sort your're suggesting. EDIT: This whole thing is nothing but semi-sophisticated click bait and this is objectively untrue: > "When the CDC is willing to kill thousands of people in the name of social justice, it's hard to know whom or what to trust. > So I wrote about its shocking failure of judgment, and my crisis of faith in America’s institutions, for @JoinPersuasion." -- Yascha Mounk, Dec 23, 2020 [1] Others here have already explained this and shown the priority list from CDC. [1] https://twitter.com/yascha_mounk/status/1341866668528717824 https://twitter.com/yascha_mounk/status/1341866668528717824
  - ubercore 6y ago
    They don't say ethics outweighs science, do they? They're just two axes on which to evaluate the model. You're coming to some interesting conclusions from those slides, unless I'm misreading something.
    - MichaelZuo 6y ago
      I can see where the poster got confused, the powerpoint slides have some sloppy logic. Though whether that’s because of the people or because of the loose thinking caused by slides, or both, is hard to say.
    - kyboren 6y ago
      They do not say ethics outweighs science. Dooling simply ignores the science[0] (slide 23) and gives equal "maximize benefits and minimize harms" merit (3 pluses) to vaccinating 65+ and vaccinating essential workers, despite recognizing on slide 21 that with a disease-blocking vaccine, "Initially vaccinating age ≥65 in Phase 1b averts approximately 2–6.5% more deaths, compared to targeting high-risk adults or essential workers". The tipping point then comes from the equal-weighted (why?) metric of "Mitigate health inequities", where she gives essential workers three pluses but 65+ only one plus. This gives "essential workers" 9 pluses total, greater than the 6 pluses for 65+. It is frankly shocking that a person can recognize one course of action will clearly save the most lives, then assign an arbitrary score that puts that course of action as equally beneficial as the "woke" course of action--for no reason--and then invent another arbitrary category of equal importance that gives more weight to the "woke" course of action because there aren't enough brown people in the 65+ bucket. It's even more shocking that this fundamentally irrational and (poorly) racially-motivated reasoning was unanimously approved[1] by the committee. [0]: https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2020-11/COVID-04-Dooling.pdf https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-... [1]: https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6950e2-H.pdf https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6950e2-H.pdf
    - danarmak 6y ago
      You're right, my comment was partly wrong (and it's too late to edit it). They don't say that Ethics outweighs Science as a subject matter. They say that Science predicts all three proposals are equally good, and therefore Ethics gets the deciding vote. (I disagree with the claim that the choice of which group to vaccinate first won't strongly affect the total number of infections and deaths. But that's a different argument.) And then, within the Ethics group, they say that the deciding ethical factor in favor of vaccinating essential workers is that they have a higher proportion of minorities and low-income families than the other groups (of high-risk and of old people). They don't give any reasoning, so it's hard to argue with this. Unlike the Science section, which links a study that models deaths prevented by targeted vaccination. The Ethics section lists some unsupported and unquantified claims (table on slide 31) and at the same time judges which outcomes are better. Crucially, the first line of this table says that ethically it's equally good to either "Preserve services essential to the COVID-19 response and overall functioning of society", or to "Reduce morbidity and mortality in persons with highest burden of COVID-19 hospitalization and death". Why? Based on what refutable data or model or ethical theory? Who knows. Of course, this is a summary presentation; there may have been something behind it that they didn't refer or link to.
  - kube-system 6y ago
    Adults in the US get universal single-payer health insurance at age 65, and that group is disproportionately white. They also point out that access to healthcare is required for a diagnosis that would place someone in the high-risk group. This is something you'd want to consider if you are in any way interested in evaluating institutional racism. I think it is entirely fair to consider whether a policy institutionalizes that a person at high risk because of age is more important to save than person at high risk because of undiagnosed condition. .... or whether the groups that society expects to go to work in person should be protected over groups who have already been given social benefits that are intended to enable them to avoid going to work. This is, as the powerpoint outlines, a purely ethical, and non-scientific evaluation of the situation. The scientific arguments are in their respective sections. > But its recommendation is that "Ethics" outweighs "Science" (their terms, not mine) I don't see this anywhere in the document.
- jdkee 6y ago
  "“Older populations are whiter, ” Harald Schmidt told the New York Times. “Society is structured in a way that enables them to live longer. Instead of giving additional health benefits to those who already had more of them, we can start to level the playing field a bit.” See https://www.nytimes.com/2020/12/05/health/covid-vaccine-first.html https://www.nytimes.com/2020/12/05/health/covid-vaccine-firs...
mrighele 6y ago
I thought that the point of vaccinating essential workers first is that they are those that are more likely to spread the virus so by starting with them you stop the virus before it reaches the seniors. Depending on the factors (% of seniors vs. essential workers, availability of vaccine) I can see either approach being more effective.
- iso1210 6y ago
  Not aware of evidence that vaccination stops or reduces spread. Given that asymptomatic and presymptomatic people are the main spreaders, it's certainly not a given. Vaccinating front line health and care workers does make sense for two reasons 1) Far more likely to catch it 2) Far more problematic if they catch it and are off ill because of it Other front line workers like police probably less important -- less likely to catch it, and not as problematic if large numbers are off ill as the people who fix it. Saving lives and reducing load on hospitals by vaccinating the over 70s is likely more beneficial.
  - cogman10 6y ago
    There's a 3rd reason. Healthcare workers are frequently working directly with high risk people. An asymptomatic infection of a healthcare worker could lead to a typhoid mary situation. Especially if they are in the right area of interaction (geriatric care, oncology).
    - iso1210 6y ago
      Firstly healthcare workers should be being tested on a very frequent basis to catch for asymptomatic cases (as well as tons of PPE), secondly there's no evidence the vaccine will stop that type of transmission.
      - cogman10 6y ago
        > Firstly healthcare workers should be being tested on a very frequent basis to catch for asymptomatic cases. Agreed. It's a good idea even if they have been vaccinated until community spread is way down. > secondly there's no evidence the vaccine will stop that type of transmission. Why do you say that? The vaccine should trigger a strong immune response which should keep most people from getting infected. That's my assumption anyways. Seems like the multi-prong approach here is the most helpful anyways. Vaccine + testing + masks to eliminate spread as much as possible in vulnerable communities.
deleted 6y ago
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neuronexmachina 6y ago
Here's a more recent presentation from the ACIP working group: https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2020-12/slides-12-20/02-COVID-Dooling.pdf https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-... The order the working group currently proposes: 1a: health care personnel, long-term care facility residents 1b: frontline essential workers, persons aged 75 years and older 1c: persons aged 65-74 years, persons aged 16-64 years with high-risk conditions, essential workers not recommended in phase 1b 2: all people aged 16 years and older not in phase 1, who are recommended for vaccination The parent comment is also mischaracterizing the reasons the presentation gives for putting essential workers at the same priority as persons aged 65-74. Here's what it says (page 33): * Essential Workers are at high risk of exposure. Prevention of disease will reduce transmission * Preserves services essential to the COVID-19 response and overall functioning of society. “Multiplier effect” * Workers unable to work from home * High level of interaction with public or others in the workplace * May be unable to control social distancing * Frequently interact with others in the workplace * Racial and ethnic minority groups disproportionately represented in many essential industries * ~1/4 of essential workers live in low-income families

selljamhere 6y ago

I don’t see any arguments in those slides about trying to “even out black vs white ppl deaths metric.” Social inequality is one of several factors included in their ethical and logistical plan, but interpreting that as an implied black vs white issue seems like a very uncharitable view of the author’s intent.

danarmak 6y ago
Page 31, table row "mitigate health inequities" says: An upside (green) of vaccinating essential workers (non-healthcare) first: "Racial and ethnic minority groups disproportionately represented in many essential industries. ~1/4 of essential workers live in low-income families." A downside (red) of vaccinating adults age >65 first: "Racial and ethnic minority groups under-represented among adults >65". The next page (32) concludes that "mitigating health inequities" (what the paper calls Ethics) is the metric with the biggest difference in outcome, in favor of non-essential workers. A bigger difference in outcome than the one for "maximize benefits and minimize harms" i.e. preventing the largest amount of deaths. Of course, the presentation doesn't define how these two different things are supposed to be compared. But its recommendation is that "Ethics" outweighs "Science" (their terms, not mine), and therefore populations with larger ethnic minority and low income representation should be vaccinated ahead of those at higher risk from the disease.
- zaroth 6y ago
  This is one of the better critiques I’ve found of the CDC’s very absurd position: https://www.persuasion.community/p/why-im-losing-trust-in-the-institutions https://www.persuasion.community/p/why-im-losing-trust-in-th... Literally their plan was to kill a greater number of people “because ethics”. It goes against well established pillars of ethical logic against “leveling” outcomes by intentionally making things worse for a group that is better off, and against the most fundamental tenant of medicine to do no harm. You must apportion a limited supply of life saving medicine to the population most likely to benefit from it. To claim that apportioning the medicine to a population which is orders of magnitudes less likely to benefit from it, knowing that a greater number of people will die as a result, is an abject ethical failure. Even accounting for the smaller minority share of the elderly population, you still kill more minorities overall by apportioning the vaccine to essential workers ahead of the elderly, because the death rate is so heavily skewed based on age.
  - erentz 6y ago
    Be warned Yascha has become (or always was, I'm not sure) a grifter hack. He jumped on the cancel culture grift now he's joining in with other armchair epidemiologists such as Matty Yglesias and Nate Silver in misreading slides and propagating a made up controversy about vaccine distribution. The ACIP meeting was recorded and open to journalists. They could go review it, but strangely they didn't. I don't see them reporting video from the meeting where they say anything of the sort your're suggesting. EDIT: This whole thing is nothing but semi-sophisticated click bait and this is objectively untrue: > "When the CDC is willing to kill thousands of people in the name of social justice, it's hard to know whom or what to trust. > So I wrote about its shocking failure of judgment, and my crisis of faith in America’s institutions, for @JoinPersuasion." -- Yascha Mounk, Dec 23, 2020 [1] Others here have already explained this and shown the priority list from CDC. [1] https://twitter.com/yascha_mounk/status/1341866668528717824 https://twitter.com/yascha_mounk/status/1341866668528717824
- ubercore 6y ago
  They don't say ethics outweighs science, do they? They're just two axes on which to evaluate the model. You're coming to some interesting conclusions from those slides, unless I'm misreading something.
  - MichaelZuo 6y ago
    I can see where the poster got confused, the powerpoint slides have some sloppy logic. Though whether that’s because of the people or because of the loose thinking caused by slides, or both, is hard to say.
  - kyboren 6y ago
    They do not say ethics outweighs science. Dooling simply ignores the science[0] (slide 23) and gives equal "maximize benefits and minimize harms" merit (3 pluses) to vaccinating 65+ and vaccinating essential workers, despite recognizing on slide 21 that with a disease-blocking vaccine, "Initially vaccinating age ≥65 in Phase 1b averts approximately 2–6.5% more deaths, compared to targeting high-risk adults or essential workers". The tipping point then comes from the equal-weighted (why?) metric of "Mitigate health inequities", where she gives essential workers three pluses but 65+ only one plus. This gives "essential workers" 9 pluses total, greater than the 6 pluses for 65+. It is frankly shocking that a person can recognize one course of action will clearly save the most lives, then assign an arbitrary score that puts that course of action as equally beneficial as the "woke" course of action--for no reason--and then invent another arbitrary category of equal importance that gives more weight to the "woke" course of action because there aren't enough brown people in the 65+ bucket. It's even more shocking that this fundamentally irrational and (poorly) racially-motivated reasoning was unanimously approved[1] by the committee. [0]: https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2020-11/COVID-04-Dooling.pdf https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-... [1]: https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6950e2-H.pdf https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6950e2-H.pdf
  - danarmak 6y ago
    You're right, my comment was partly wrong (and it's too late to edit it). They don't say that Ethics outweighs Science as a subject matter. They say that Science predicts all three proposals are equally good, and therefore Ethics gets the deciding vote. (I disagree with the claim that the choice of which group to vaccinate first won't strongly affect the total number of infections and deaths. But that's a different argument.) And then, within the Ethics group, they say that the deciding ethical factor in favor of vaccinating essential workers is that they have a higher proportion of minorities and low-income families than the other groups (of high-risk and of old people). They don't give any reasoning, so it's hard to argue with this. Unlike the Science section, which links a study that models deaths prevented by targeted vaccination. The Ethics section lists some unsupported and unquantified claims (table on slide 31) and at the same time judges which outcomes are better. Crucially, the first line of this table says that ethically it's equally good to either "Preserve services essential to the COVID-19 response and overall functioning of society", or to "Reduce morbidity and mortality in persons with highest burden of COVID-19 hospitalization and death". Why? Based on what refutable data or model or ethical theory? Who knows. Of course, this is a summary presentation; there may have been something behind it that they didn't refer or link to.
- kube-system 6y ago
  Adults in the US get universal single-payer health insurance at age 65, and that group is disproportionately white. They also point out that access to healthcare is required for a diagnosis that would place someone in the high-risk group. This is something you'd want to consider if you are in any way interested in evaluating institutional racism. I think it is entirely fair to consider whether a policy institutionalizes that a person at high risk because of age is more important to save than person at high risk because of undiagnosed condition. .... or whether the groups that society expects to go to work in person should be protected over groups who have already been given social benefits that are intended to enable them to avoid going to work. This is, as the powerpoint outlines, a purely ethical, and non-scientific evaluation of the situation. The scientific arguments are in their respective sections. > But its recommendation is that "Ethics" outweighs "Science" (their terms, not mine) I don't see this anywhere in the document.
jdkee 6y ago
"“Older populations are whiter, ” Harald Schmidt told the New York Times. “Society is structured in a way that enables them to live longer. Instead of giving additional health benefits to those who already had more of them, we can start to level the playing field a bit.” See https://www.nytimes.com/2020/12/05/health/covid-vaccine-first.html https://www.nytimes.com/2020/12/05/health/covid-vaccine-firs...

mrighele 6y ago

I thought that the point of vaccinating essential workers first is that they are those that are more likely to spread the virus so by starting with them you stop the virus before it reaches the seniors. Depending on the factors (% of seniors vs. essential workers, availability of vaccine) I can see either approach being more effective.

iso1210 6y ago
Not aware of evidence that vaccination stops or reduces spread. Given that asymptomatic and presymptomatic people are the main spreaders, it's certainly not a given. Vaccinating front line health and care workers does make sense for two reasons 1) Far more likely to catch it 2) Far more problematic if they catch it and are off ill because of it Other front line workers like police probably less important -- less likely to catch it, and not as problematic if large numbers are off ill as the people who fix it. Saving lives and reducing load on hospitals by vaccinating the over 70s is likely more beneficial.
- cogman10 6y ago
  There's a 3rd reason. Healthcare workers are frequently working directly with high risk people. An asymptomatic infection of a healthcare worker could lead to a typhoid mary situation. Especially if they are in the right area of interaction (geriatric care, oncology).
  - iso1210 6y ago
    Firstly healthcare workers should be being tested on a very frequent basis to catch for asymptomatic cases (as well as tons of PPE), secondly there's no evidence the vaccine will stop that type of transmission.
    - cogman10 6y ago
      > Firstly healthcare workers should be being tested on a very frequent basis to catch for asymptomatic cases. Agreed. It's a good idea even if they have been vaccinated until community spread is way down. > secondly there's no evidence the vaccine will stop that type of transmission. Why do you say that? The vaccine should trigger a strong immune response which should keep most people from getting infected. That's my assumption anyways. Seems like the multi-prong approach here is the most helpful anyways. Vaccine + testing + masks to eliminate spread as much as possible in vulnerable communities.

deleted 6y ago

[deleted]

neuronexmachina 6y ago

Here's a more recent presentation from the ACIP working group: https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2020-12/slides-12-20/02-COVID-Dooling.pdf https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-... The order the working group currently proposes: 1a: health care personnel, long-term care facility residents 1b: frontline essential workers, persons aged 75 years and older 1c: persons aged 65-74 years, persons aged 16-64 years with high-risk conditions, essential workers not recommended in phase 1b 2: all people aged 16 years and older not in phase 1, who are recommended for vaccination The parent comment is also mischaracterizing the reasons the presentation gives for putting essential workers at the same priority as persons aged 65-74. Here's what it says (page 33): * Essential Workers are at high risk of exposure. Prevention of disease will reduce transmission * Preserves services essential to the COVID-19 response and overall functioning of society. “Multiplier effect” * Workers unable to work from home * High level of interaction with public or others in the workplace * May be unable to control social distancing * Frequently interact with others in the workplace * Racial and ethnic minority groups disproportionately represented in many essential industries * ~1/4 of essential workers live in low-income families