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Comment by selljamhere | Hacker News Reader

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.

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"“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-firs...

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.

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-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.

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

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.

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.

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-... [1]: https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6950e2-H.pdf

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.

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.

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