Did the CDC favor social-justice optics over American lives?

December 24, 2020 • 1:45 pm

When I heard that Illinois was giving covid-vaccine priority to all “essential workers” over the aged, I was puzzled. Not because “essential” workers should all queue up behind older people, but because some “essential workers” weren’t really essential in a sense that should give them priority over older people whose chance of dying from the infection was much higher. “Essential workers” include, according to Yascha Mounk, bankers, liquor-store employees, hardware-store employees, and movie crews. On what grounds, especially considering the differential risk of death or serious illness, should these “essential workers” be given vaccination priority over adults with high-risk medical conditions or older folks (over 65, 70, or 75, depending on the state and the ordering)?

Yet that is what the CDC decided not long ago, realizing, even by their own accounting, that such a decision would cause more people to die than if the order was reversed. The decision to let people die was apparently based on social-justice considerations, as older people were deemed to be more white than were essential workers.

In this article from Persuasion, Yascha Mounk, Associate Professor of Practice at Johns Hopkins University’s School of Advanced International Studies, argues that such a decision is unethical. Click to read:

Mounk begins with some premises that he thinks people will agree on about what what is just and unjust:

. . . there are also some bedrock principles on which virtually all moral philosophers have long agreed.

The first is that we should avoid “leveling down” everyone’s quality of life for the purpose of achieving equality. It is unjust when some people have plenty of food while others are starving. But alleviating that inequality by making sure that an even greater number of people starve is clearly wrong. The second is that we should not use ascriptive characteristics like race or ethnicity to allocate medical resources. To save one patient rather than another based on the color of their skin rightly strikes most philosophers—and most Americans—as barbaric. The Centers for Disease Control have just thrown both of these principles overboard in the name of social justice.

In one of the most shocking moral misjudgments by a public body I have ever seen, the CDC invoked considerations of “social justice” to recommend providing vaccinations to essential workers before older Americans even though this would, according to its own models, lead to a much greater death toll. After a massive public outcry, the agency has adopted revised recommendations. But though these are a clear improvement, they still violate the two bedrock principles of allocative justice—and are likely to cause unnecessary suffering on a significant scale.

He then recounts a talk that Kathleen Dooling, a public-health official, gave at the CDC, a talk that wound up undergirding the initial order of non-healthcare-essential workers > older adults that the organization mandated for vaccination. The decision was based on “feasibility [ease of implementing vaccination in an identified population], science, and ethics.” Dooling presented a chart, below, purporting to show that implementation was easier in a group based solely on age (true: it’s substantially harder to identify “essential non-healthcare workers” as well as define whether someone has a “high-risk medical condition”), and the science itself, she said, showed no difference in outcomes based on priority.  (The “+” signs are indices of priority, and are somehow combined to create the order of vaccination.)

The “science” bit is especially wonky. Although older adults without comorbidities are given the same science rating as essential non-healthcare workers (column 1 versus 3), Mounk says this:

According to the CDC’s model, prioritizing essential workers over the elderly would therefore increase the overall number of deaths by between 0.5% and 6.5%. In other words, it would likely result in the preventable deaths of thousands of Americans.

Remember, that is a model that supposedly takes into account all scenarios for mortality, including deaths produced by non-vaccinated “essential non-healthcare workers” who spread the virus to others:

Thus, deciding to prioritize non-healthcare essential workers over adults over 65 rested on grounds of “ethics” is deciding to prioritize “ethical considerations” over life (as if differential death was not an ethical matter!) Mounk says the “ethics” came down to race:

And yet, the presentation concluded that science does not provide a reason to prioritize the elderly. For, as Kathleen Dooling wrote in one of the most jaw-dropping sentences I have ever seen in a document written by a public official, differences in expected consequences that could amount to thousands of additional deaths are “minimal.”

This allowed Dooling to focus on “ethical” principles in selecting the best course of action. Highlighting the most important consideration in red, Dooling emphasized that “racial and ethnic minority groups are underrepresented among adults > 65.” In other words, America’s elderly are too white to be considered a top priority for the distribution of the vaccine against Covid. It is on this basis that ACIP awarded three times as many points to prioritizing the more racially diverse group of essential workers, making the crucial difference in the overall determination. Astonishingly, the higher overall death toll that would have resulted from this course of action does not feature as an ethical reason to prioritize older Americans.

As far as I know, Mounck is correct is stating that this is the basis of the decision.  It is based on social-justice optics. Now nobody would want to take a path in which one could foresee a worse outcome—in terms of death or anything else—for members of different races. If one could predict that the death rate among such groups would differ as a result of such a policy decision, that would violate the ethical principles above. But that’s not the outcome here. In fact, as Mounck notes, the proportion of people of color among essential non-healthcare workers isn’t much different from their proportion among the elderly, and it’s in fact conceivable that prioritizing column 1 over column 3 could lead to the deaths of more people of color than the other way around!

The difference in the percentage of white people across age groups is comparatively small. The difference in the percentage of infected people who succumb to Covid across all age groups is massive. Giving the vaccine to African-American essential workers before elderly African-Americans would likely raise the overall death toll of African-Americans even if a somewhat greater number of African-Americans were to receive the vaccine as a result.

Indeed, a few people noticed and objected to this order:

In the days after ACIP published its preliminary recommendations, barely any epidemiologists or health officials publicly criticized its findings or its reasoning. But thankfully, prominent journalists like Zeynep TufeckiMatt Yglesias and Nate Silver publicly made the case against them. (So did I.)

You might look at the data in Silver’s tweet, since many people seem to trust him.

Finally, as the controversy grew, the CDC changed its recommendations, putting (after medical workers) Americans over 74 AND essential frontline workers in the second phase.  Mounk sees this as an improvement, but one that could still lead to higher deaths (for example, prioritizing frontline workers over those 65-74 could still lead to overall higher mortality).

Although I’m over 65, I don’t really have a dog in this fight. I will patiently wait my turn to be vaccinated whatever and whenever the state of Illinois decides. But what the CDC was trying to do originally—and may be doing to a lesser extent now—smacks of prioritizing the appearance of equity above the lives of Americans—and that includes black lives. I see no other explanation once you realize that the CDC is supposed to have done the math about overall deaths caused by their different strategies—and then opted for a ranking that would increase the number of dead. We all know the importance of optics (Glenn Loury calls it “ass covering”) over substantive and meaningful progress these days, especially when it comes to alleviating inequalities among groups. To use one example, optics rather than achievement is the basis of land acknowledgments.

In the end, Mounk uses this ranking as an example of why we shouldn’t even trust government institutions like the CDC, which is supposed to be using science to make its decisions. Although ethics has to figure in somewhere, if you can’t trust the CDC’s science, what can you trust? And I agree that there was a misstep in the CDC which only public scrutiny prevented. Mounk is especially exercised by the failure of the press to notice and call out the CDC’s priorities, unlike Nate Silver:

Until a few years ago, it was obvious to me that I can trust what is written in the newspaper or what I am told by public health authorities.

Now, I am losing that trust. I still believe that most people, including the journalists who write for established newspapers and the civil servants who staff federal agencies, are the heroes in their own stories. They genuinely mean well. And yet, I no longer trust any institution in American life to such an extent that I am willing to rely on its account of the world without looking into important matters on my own.

The reasons for this mistrust are perfectly encapsulated in the reports that mainstream newspapers published about the CDC’s recommendation. The write-up in the New York Times, for example, barely mentions the committee’s last-minute change of heart. A faithful reader of the newspaper of record would not even know that an important public body was, until it received massive criticism from the public, about to sacrifice thousands of American lives on the altar of a dangerous and deeply illiberal ideology.

Weigh in below; is Mounk’s take right or wrong?

51 thoughts on “Did the CDC favor social-justice optics over American lives?

  1. My gut tells me that the 65-74 year-old people who will die unnecessarily as a result of this decision are going to be less white than the age group is overall. I think it was a bad decision anyway, but will it even lessen the racial disparity?

  2. For comparison – Here is the priority list created by the Canadian Govt.

    Stage 1: (In order)

    Residents and staff of congregate living settings that provide care for seniors

    Adults 70 years of age and older, beginning with adults 80 years of age and older, then decreasing the age limit by 5-year increments to age 70 years as supply becomes available

    Health care workers (including all those who work in health care settings and personal support workers whose work involves direct contact with patients)

    Adults in Indigenous communities where infection can have disproportionate consequences

    Stage 2:

    Health care workers not included in the initial rollout

    Residents and staff of all other congregate settings (e.g., quarters for migrant workers, correctional facilities, homeless shelters)

    Essential workers

    1. Here is the German list on who gets vaccine first.

      GROUP 1 — HIGHEST PRIORITY:

      1. Those over 80 years old.

      2. Care workers who work in elderly people’s homes or regularly look after the elderly or the mentally ill.

      3. Health care workers with a high risk of exposure to COVID-19, especially those working in intensive care units, emergency rooms, and first responders.

      4. Health care workers who primarily treat patients with a higher risk of dying from COVID-19.

      GROUP 2 — HIGHER PRIORITY:

      1. Those over 70 years old.

      2. Those with underlying health conditions that significantly increase the risk of dying from COVID-19. These include those with dementia or a similar mental health issue, those recovering from an organ transplant, and those with Down Syndrome.

      3. Those who live or work in close contact with people in care or pregnant women.

      4. Doctors and other health care workers who have a higher risk of exposure to COVID-19.

      5. Essential workers who maintain public hospital infrastructure.

      GROUP 3 — HIGH PRIORITY

      1. Those over 60 years old.

      2. People with underlying health conditions that significantly increase the risk of serious illness from COVID-19. These include, but are not limited to, people with diabetes, cancer, chronic kidney or liver conditions, HIV or other immune-deficiency conditions, heart conditions, asthma, and clinical obesity.

      3. Health care workers not already included in the first two groups.

      4. Those vital to maintaining the state apparatus, including the government, police, fire departments, disaster relief, and parliamentarians.

      5. Other critical infrastructure workers, including those maintaining power, water, and food supplies, telecommunication networks, the transport system, the pharmacy network, and refuse disposal.

      6. Teachers and daycare workers.

      7. Those in precarious part-time jobs, including meat-processors, and warehouse workers.

      8. Retail workers.

      https://www.dw.com/en/covid-german-regulations-on-who-gets-vaccine-first/a-55987647

  3. Not so long ago, arguments were being made that we needed to open up the economy more, even knowing that it would result in more deaths among elderly Americans. How is this different except that it can be portrayed as anti-white?

    1. That is a trade-off between the livelihoods of tens of millions of out-of-work people and the lives of maybe tens of thousands of people. There are pros and cons on both sides.

      What is the benefit in this case of deprioritizing the elderly because they’re whiter?

      1. Not really. The economy is in ruins because of the pandemic. You can’t mandate an open economy. The sooner you control the pandemic the sooner the economy recovers.

        1. Isn’t there some middle ground between mandating that people all go outside and shutting down restaurants? When we say we want things open, we aren’t saying that people should be required to do anything at all.

          Also, with how quickly this thing spreads you will never be able to control it. It’s just going to come right back as soon as you lift the lockdowns in an area, isn’t it? It should be clear by now that no disease has ever been eradicated just by sitting in place and waiting it out.

          1. Of course there’s “middle ground”. There’s a huge range in behavior changes. On one end you have the chaotic and pathetic American lack-of-strategy. On the other end you have countries like South Korea, Vietnam, and New Zealand where cases and deaths are low and economies are doing well.

            What is a guarantee for failure is to pretend that the problem isn’t serious, that it will just go away like a miracle, and that herd immunity is a strategy.

            1. Yes, and ignore the success in other countries which many of the anti-maskers choose to do. They talk about the balance between the hurting the economy and and the death rate as if it were a zero-sum game. They conveniently ignore the fact that New Zealand, for example, contained the virus and thereby helped their economy.

    2. opening the economy would result in more deaths of the elderly who chose to ignore the best advice to keep themselves safe

      1. Or have the unfortunate luck to encounter an infected person through no fault of their own. If only those who were willfully hostile to safety protocols were affected I’d agree with you. But countless others also sicken and die.

  4. I think he is correct, the CDC’s decision should always be based on the least dead. I do get the feeling our ability to vaccinate the entire population is much harder than people think and will take much longer. I see signs of chaos and confusion already and it just got underway a short time ago. After working on the hospital and other health care staff I don’t see much going on here. They are suppose to be moving through the nursing homes and assisted living facilities where so much death has taken place but it has not started yet far as I can tell. The assisted living facility where my wife’s mother lives has done nothing so far. I assume they are waiting for Wallgreens who is scheduled to do it. I asked at a CVS if they knew when they were going to start – they said they have no idea. Meanwhile we see all kinds of politicians jumping the line and getting vaccinated. Why not do it like most all health care in America and just go by income.

  5. I agree with Mounk that this is a symptom of creeping wokeness that has now moved from the (relatively innocuous) realm of campus politics to policy-making bodies that make life-or-death decisions and that’s particularly worrying.

    I’m not a medical ethicist (nor would I want that job!), but I do think it makes sense to consider expected years of quality life remaining as a factor in whom we vaccinate first; for example, if a 90 yr old with advanced disease will live an expected 3 more years, his priority shouldn’t be as high as an 80 yr old in good health with 15 expected years of life perhaps?! On the other hand, the risk of severe covid decreases dramatically with age, so that must be weighed as well.

    Trying to correct for social injustice is impossible to do in a fair way, and the idea of it is chilling. We are one step away from “vaccinate black people first as an apology for slavery.” That would be extremely unethical and ironically would arose even more distrust from blacks who already have their doubts about the medical community: they might even be more disinclined to take a vaccine if the CDC said “we’re doing blacks first.” Might understandably remind one of the Tuskegee Experiment!

  6. I think their decision matrix is one row too long. After you’ve done the “science” row, which I take to be how many lives would be saved if perfectly implemented, and the “implementation” row, which adjusts for likely actual results of trying to enforce the rule, then you’ve already covered the ethics. In principle I would advocate life-years saved rather than lives saved as the measure, but it works out the same in practice, when the elderly are at very far greater risk.

  7. I’m over 80 in age. But thus far, I have been able to avoid infection by following social distancing guidelines. I do depend on essential workers who, by the nature of their work, cannot social distance as effectively.

    I wonder whether you are too concerned about getting perfect rules, and not concerned enough about getting rules that are easy to follow. If we make this too complicated, then it will be harder to even get started.

    1. I wonder whether you are too concerned about getting perfect rules, and not concerned enough about getting rules that are easy to follow.

      There’s a lot to be said for that. Elsewhere I commented that after the immediate task of vaccinating the vaccinaters, the next task should be vaccinating the most vulnerable and those working with them (if the vaccinater goes to a ward or residential centre), or the most vulnerable and whoever accompanies them to the vaccination centre (in the other case), since by definition, those are the most fraught of “front line” workers.
      The only way a banker (or, TBH, off-licence worker) could get a vaccination earlier than their age cohort deserves would be if they, themselves, took an older relative to a vaccination centre.
      There is a minor route for abuse in there, but frankly, it’s a loophole not worth designing a chastity belt for. Let the Rollers be circling around the block of the OAP’s home. BFD. We’ll run out of bankers before we run out of OAPs.

    2. I too am over 80 and I anticipate wearing a mask and social distancing for some time yet. So far its worked for me very well. I am still living in my own home so I don’t expect to be considered of immediate concern.

    3. They acknowledge that essential (non-healthcare) workers being vaccinated first would likely prevent more infections than other strategies, based on their models. What they seem to be saying (starting around slide 18) is that their models still show they can save more lives by focusing on older people. If we take care of all of you, the idea there is that it really doesn’t matter how many of the rest of us get sick.

      Slide 31 is where this really goes off into crazy-land when they decide to take away some points because your age group has too many white people.

      https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2020-11/COVID-04-Dooling.pdf

  8. Many serious ethicists do use the metric of years of lives saved (see e.g. Peter Singer) and would disagree with Mr. Silver.
    As for the current discussions, there are different degrees of “essential” that need to be taken into account. And the article is breathless in saying the CDC almost caused countless deaths. No matter in what order you vaccinate the various groups, the decision will “cause” deaths in those near the back of the line.
    One thing I’ve come to appreciate is that the CDC has a very hard job.

    1. I agree with years saved as a metric. Healthy years? No. My 93 year old mother deserves to live despite having a very hard time walking. But years saved, yes.

      I have some concern, maybe unfounded, about giving the vaccine, outside a clinical study, to people who are far older than anyone in the clinical studies.

      If these were the sort of reasons experts used to prioritize bus drivers over a lot of the elderly, I would be fine with that.

      However, making guesses about disparate racial impact, and acting on that, is morally wrong.

      One irony is that naked racial preference would save lives. But that’s politically impossible. The politically possible indirect racial preference would cost lives.

  9. Well, I won’t say what my sciences are, since I want to remain anonymous on here, but I will say that my peers would’ve been reluctant to oppose the CDC due to a) the pressures Trump has placed on governmental agencies, b) because my fields are increasingly hotbeds of wokeness, and c) because of the energy, time, and commitment it would take to think through what the CDC had originally planned is onerous. Like most people, even those in my fields rely on public health agencies to dispense summary statements, believing they have made their decisions rationally. Even though I see it as plausible if not likely true that the CDC misguidedly prioritized wokeness over the elderly originally, I have not had the time to look into it.

    I will say that most scientists in public health have not yet considered that what they see are ethical decisions could lead to greater failures. Most who are woke in science are not trained in philosophy. They are trained socially in activism, which sees itself as having expertise in certain aspects of post-modern theory. This leads to an arrogance and ignorance among elite scientists.

    And who has the time to tackle it all? I, for one, am immersed in a grant, a paper, and about 10 new analyses. No time. So no serious public comment on the CDC and vaccine prioritizing from me. No time to actually address it and do my job.

  10. We can certainly have a conversation about what the most ethical decision is regarding how efficacy should be measured (e.g. lives saved vs. “quality years” saved), but I don’t think we can say it’s ethical in any way to decide that one group should get priority because of their race. I was pretty shocked when I read the CDC’s report and saw that chart. And I would say to our host that he may be mistaken that it’s about “optics” or “appearance of equity.” There’s a very high probability that the people who contributed to this document genuinely believe that the race of the people who will be saved — and the race of those who will die — is an important factor to be considered, and that the wokeness termites have torn further into our institutions than we may have thought.

    1. If race is taken into account, then the CDC might have to make a choice between 1.) making up for historical inequality imposed on People of Color by vaccinating them before they vaccinate white people and 2.) increasing present-day resentment against People of Color by vaccinating them before they vaccinate white people.

      I’m not sure the majority of POC would opt for the first one. Maybe.

  11. Yikes. Have not digested all of this and I certainly knew none of it when I suggested giving the CDC the benefit of the doubt on another thread.
    I do know that “years of healthy life lost” is very commonly a key metric in epidemiological studies.

  12. If it were me making these decisions, I would put healthcare professionals dealing with COVID19 patients first, other front line healthcare professionals second.

    Then I would put in place a calculation based on risk x potential years of life lost. A twenty year old stands to lose a lot more than an 80 year old, but is far less likely to die if they do get COVID 19.

    The tricky bit comes because I would include personal contacts in the equation. For example, a plumber might be at low risk, hence near the back of the queue, but plumbers have to go into people’s houses to fix water leaks and boilers and toilets. There is a risk to each person they meet in the course of their essential work, so I would bump them up the list.

    Incidentally, in the UK, black and some Asian people seem to be far more vulnerable to COVID19 than white people. Given that a black 40 year old person is more likely to die of COVID19 than a white 40 year old person (all else being equal) it seems prudent to vaccinate the black person first. Nothing to do with being woke, it’s just the right thing to do.

    1. Yes, if you’re comparing a 40 year-old white person with a 40 year-old black person, you could make a life-years-saved argument to vaccinate the 40 year-old black person first. But we aren’t living in that world where the choice is only between otherwise identical cohorts that differ only in race. They differ in race *and* in age, among other things, and covid19 mortality is *way* more dependent on age (at least above 40 or 50 or so) than it is dependent on race.

  13. My guess is that the the dynamics of disease and human behavior (spreading, vaccine-shyness, etc.) are so complex and our understanding of them so weak, that it won’t much matter what our vaccination policy is. It might even be best to simply vaccinate people as fast as possible, first come, first served. Or perhaps we vaccinate first those willing to tell a friend that they got vaccinated. On the other hand, choosing the policy that is acceptable to the most people might be the way to go. I’m glad that I don’t have to decide. Just jab me!

  14. I am older and near the top of the line. But I am comfortable, secluded and unlikely to spread the virus. If I had my druthers, the poor bastards delivering my packages, bagging my groceries or picking up my trash should go before me.

  15. First, do no harm. There is also this from the Free Beacon. It certainly seems that the CDC prioritized non-medical concerns. That should be a non-starter.

  16. This is the UK priority list:

    1. Residents in a care home for older adults and their carers
    2. All those 80 years of age and over and frontline health and social care workers
    3. all those 75 years of age and over
    4. all those 70 years of age and over and clinically extremely vulnerable individuals.
    5. All those 65 years of age and over
    6. All individuals aged 16 years to 64 years with underlying health conditions which put them at higher risk of serious disease and mortality
    7. All those 60 years of age and over
    8. All those 55 years of age and over
    9. all those 50 years of age and over.

    Definitions of clinically vulnerable people and underlying health conditions are here https://tinyurl.com/yarw6mrs

    There was an actuary on BBC radio who said that the first 2 categories of people comprised 66% of the deaths so far and that all categories amount to 99%.

  17. Also depends on which CDC you are speaking of – this is Tr*mp’s CDC, which swings to and fro. In the past 4 years, a lot of the shine has gone off the institution. It will take time (and the new administration) to rebuild it.

  18. The data in the Nate Silver tweet also shows that being male is a risk factor (1.3). I am guessing that sex is not being included in the prioritizing or ethics, however.

    I’m not sure what the data says about whether a vaccinated person is less likely to pass the disease along, but I would expect that is true. Vaccinating “essential” workers makes sense to me because they are the ones who have the most contact with other people. Making them less likely to get everyone else sick sounds like a good idea.

    Every vaccination reduces the risk for everyone else a little bit. The main thing is to get lots of people vaccinated, the sooner the better.

  19. That’s some bonkers stuff right there. I’m inclined to agree with PCC (E) and to have Zeynep Tufeki, Nate Silver and Y. Mounk on my side only further stiffens my opinion.
    Thank you for alerting us to this.

    I’m a pretty much retired 50 year old male (smoker – ) in NYC – I already live like a hermit. I can wait. and I don’t think we smokers should be allowed to queue jump. We should be allowed to smoke outside but not queue jump.

    D.A.
    NYC

  20. These are the groups that are going to get the vaccine first in South Africa.

    “The first group comprises frontline healthcare workers and non-professional health workers.
    The second group comprises people who are aged 75 years and older, and the elderly who live in old age care homes as well as the staff.
    This would be followed by essential workers, defined as people carrying out jobs deemed vital to keep the country afloat.
    Next in line would be prisoners and people who are institutionalised.”

    Which seems like a pretty decent order of priority to me.

  21. The New York Times didn’t miss the implication. They gave at least equal time to people promoting it. One article says “Older populations are whiter. 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.”

    They also said, regarding prioritizing essential workers, that it should be done carefully because, among other reasons, many are white. For example, “Teachers have middle-class salaries, are very often white, and they have college degrees. Of course they should be treated better, but they are not among the most mistreated of workers.”

    They quote another who is apparently concerned primarily with what will be best for ‘black and brown’ people. It also seems that their occupation with lower-income people is driven by the fact that they are disproportionately non-white rather than a special concern for the health of the impoverished.

  22. I admit to not finishing the article. There’s no need to, because it’s so obvious what it’s gonna say: “________ is racist.” In this case we fill in the blank with the CDC, racists du jour. Don’t worry, your name is gonna appear there sooner or later.

  23. I don’t see any evidence in that article’s linked CDC presentation that they’re favoring “social justice” or engaging in anti-white racism. To be honest, that claim feels absurd: Donald Trump is the chief executive over the CDC, and he has repeatedly pushed them to prioritize reopening the economy over reducing mortality. If there is a sinister goal behind favoring “essential workers” over at-risk populations, that would be it.

    For what it’s worth, here’s the same author’s updated version of that presentation from a couple weeks later. It places residents of long-term care facilities (and healthcare workers) in phase 1a ahead of “frontline” essential workers in phase 1b. Seniors over 75 years old are also in phase 1b, ahead of all other “essential workers” in phase 1c.

    https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2020-12/slides-12-20/02-COVID-Dooling.pdf

    It would still be much better, of course, to contain the spread of COVID-19 through other methods than vaccinations, and then dedicate all of phase 1 to healthcare, at risk groups, and only those specific jobs (like bus drivers, security guards, and grocery store cashiers) that are most at risk of spreading COVID to at-risk populations. But the only person with the authority to do that nationwide has refused to do so.

  24. From Dr. Joshua Schiffer, an infectious disease researcher at the Fred Hutchinson Cancer Institute: “Vaccines can prevent an exposed individual from developing symptoms of a disease. But whether that vaccine prevents an infection — and thereby stops the disease from spreading to others — presents a gap in the literature, Schiffer said.” When the CDC determined its recommended immunization priority list, science would not have supported an assumption that immunizing any individual will prevent transmission to other individuals.
    https://www.geekwire.com/2020/can-vaccinated-people-still-transmit-covid-19-answer-key-herd-immunity-research-finds/

    1. I think there’s a difference between Dr. Schiffer pointing out that there’s a gap in our understanding of how much vaccines prevent spread, and believing there’s no scientific basis for vaccines preventing the spread of diseases at all. Studies can only reasonably measure symptoms in the individuals taking part in them, and can’t reasonably measure (with proper controls) the infection rates among everyone else those people interact with.

      But smallpox was annihilated by its vaccine, and did not come roaring back when routine childhood vaccinations stopped in 1972. That’s very clear evidence that vaccines do actually stop their spread.

      And herd immunity could not exist if vaccines didn’t reduce the amount that diseases spread. They would simply spread, asymptomatically but unchecked, through the entire vaccinated population until every non-vaccinated person gets exposed. But in reality, herd immunity does happen when 70-90% of the population gets vaccinated (depending on the vaccine).

      So in the absence of evidence to the contrary, I think CDC officials should work on the assumption that a vaccine *does* prevent spread (just by an uncertain amount), and include people most at risk of spreading the disease.

  25. It is insane to vaccinate any of the 100 million or so Covid-recovered persons in the US, the vast majority of whom already have acquired immunity, before we vaccinate the 200 million or so people not yet immune. This is a far more serious failure of the CDC guidelines than how to fine-tune a vaccination program that doesn’t try to make this distinction. By the way, if Covid infection rates (not just mortality rates per infection) were higher among some populations, so that the percentage of Covid-recovered persons are higher in those populations, those populations should see a lower percentage of vaccinations in the first waves. If we have a policy of vaccinating only persons without immunity (while the vaccine can’t be immediately provided to everyone), the racial distribution of the vaccine will be pretty trivial. Fight this big battle before the much smaller battle about exactly which of the non-immune people get the vaccine earlier.

  26. Many of us in this thread have followed the CDC down the rabbit hole of balancing opening the economy with saving lives. Begging your pardon but that issue is secondary to the issue of having the government allocate critical health care resources on the basis of race, ethnicity, or gender. Examining how a computer program estimates a policy might move the equity needle one way or another is probably one of many valid ways to evaluate how a policy might play out. But a decision is unconscionable when it delays vaccinating a group of vulnerable people because of their ethnicity. Replace “white” with Native American” or “African American” and perhaps the unquestionable racism of the CDC policy-making process will become clear. The CDC decision making process will affect many national health care decisions besides the response to Covid. It’s decision to determine the direction of national health care policy by how a computer program estimates that policy might help various ethnic and racial groups will bear fruit in many health policy areas. We’ll see where it leads.

  27. In Virginia, the health dept & governor have decided to put prisoners (rapist, murderers, etc.) in front of police, firemen, teachers & those age 65-74. These prisoners can be isolated in different cell blocks or floors for protection. It disgusting that prisoners are given priority over law abiding citizens.

    1. They cannot be so isolated. Prisons are overcrowded. This isn’t a matter of justice, it is a question of stopping spread of the disease. It doesn’t remain confined within the walls of a prison.

      1. I agree. Plus they aren’t all rapists and murderers so that’s a completely disingenuous argument.

        I have a big problem with the idea that people in prisons, convicted of crimes and sentenced by a court of law, deserve more punishment than they are already getting. If you want sentencing guidelines to change, make your case, but these extra, randomly applied punishments are just not right.

        Cancel culture is a variant of this. Those that seek to cancel someone are basically saying that, although technically what someone has done is not a crime, I want to do everything I can to punish them. If you believe something should be a crime, change the laws to make it one. That way the arguments can be made by both sides. To punish someone outside the criminal justice system is vigilantism.

        1. First of all, I did not say they were all murderers & rapist. I said etc. which was meant to cover the various crimes. Secondly, it is an error to consider this as an additional punishment for prisoners. According to your reasoning, the police, firemen & age group 64-74 are being placed lower on the vaccine priority list as a punishment.

          1. So why mention murderers and rapists then? And what’s the source of your “disgust” if it is not because you are claiming that these people don’t deserve the vaccine for some reason? There is an argument that they should get it first as they are more vulnerable and/or more likely to spread the disease. It seems likely that this is why VA is doing this. Surely you don’t think it is because they like prisoners, murderers, and rapists more than cops, firemen, and seniors? So you find this argument disgusting? That seems like a strange response to an argument about vaccine priority based on science.

            1. “That seems like a strange response to an argument about vaccine priority based on science.” The “science” behind the CDC vaccine priority recommendations is not hard science. It is based on social science principles that don’t require replication or verification. We just saw a bunch of Americans believe that the election for President was stolen because surrogates used the same kind of “science” and statistics to “prove” massive election fraud. The CDC had an incredibly hard job but the record proves that mortality and health concerns were trumped by other concerns in its recommendations. And those concerns were expressed using blue smoke and mirrors statistics masquerading as science, at best.

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