How can we hide the fact that Republican conservatives are first in line for the vaccine?


Ross Douthat does it again. He’s spewed out a pointless screed in which he tediously tells us that science isn’t pure, that somehow you have to engage with social values and not just simply calculable formulas of utility, and I can agree with all that. I think I’ve been saying it myself for years, that what we do with science and how we implement is shaped by culture, and there’s no denying it. But Douthat has an agenda lurking under the glurge, and being Douthat he can’t just come out and say what it is. So I read his whole essay, painful as it was, and emerged out the other side wondering what he’s advocating.

And to the extent that trust the science just means that Dr. Anthony Fauci is a better guide to epidemiological trends than someone the president liked on cable news, then it’s a sound and unobjectionable idea.

But for many crucial decisions of the last year, that unobjectionable version of trust the science didn’t get you very far. And when it had more sweeping implications, what the slogan implied was often much more dubious: a deference to the science bureaucracy during a crisis when bureaucratic norms needed to give way; an attempt by para-scientific enterprises to trade on (or trade away) science’s credibility for the sake of political agendas; and an abdication by elected officials of responsibility for decisions that are fundamentally political in nature.

We’re only in the second or third paragraph, and the murk is already growing. What “science bureaucracy” are you objecting to, Ross? There is one, of course — in a society dependent on science, but where the public is generally ignorant and misinformed, it’s inevitable that institutions have to form to provide good information to politicians. I’d love to see greater democratization of science, but the existence of a “science bureaucracy” is a product of the American environment.

But what “political agenda” are you complaining about? What credibility is being traded away? And of course elected officials, politicians, are making political decisions. Isn’t that obvious?

Then, finally, we get the issue that’s got him wound up: it’s the question of who gets the coronavirus first.

But the further you get from the laboratory work, the more complicated and less clearly scientific the key issues become. The timeline on which vaccines have become available, for instance, reflects an attempt to balance the rules of bureaucratic science, their priority on safety and certainty of knowledge, with the urgency of trying something to halt a disease that’s killing thousands of Americans every day. Many scientific factors weigh in that balance, but so do all kinds of extra-scientific variables: moral assumptions about what kinds of vaccine testing we should pursue (one reason we didn’t get the “challenge trials” that might have delivered a vaccine much earlier); legal assumptions about who should be allowed to experiment with unproven treatments; political assumptions about how much bureaucratic hoop-jumping it takes to persuade Americans that a vaccine is safe.

Yes? We know. There are all kinds of regulatory hoops to jump through before you toss a new medication out to the public. The ethics of science are complicated and interact messily with with social values. We didn’t do those “challenge trials” because we have a long established policy of testing with randomized controlled trials before general release, and challenge trials require intentionally exposing subjects to the virus and your relatively untested vaccine simultaneously. Yeah, it’s a political and ethical decision. What do you propose to do instead? I’m still at a loss about what Douthat is complaining about.

Then it turns out that what’s really chafing poor Ross is that the liberals had a hand in making decisions.

Then there’s the now-pressing question of who actually gets the vaccine first, which has been taken up at the Centers for Disease Control and Prevention in a way that throws the limits of science-trusting into even sharper relief. Last month their Advisory Committee on Immunization Practices produced a working document that’s a masterpiece of para-scientific effort, in which questions that are legitimately medical and scientific (who will the vaccine help the most), questions that are more logistical and sociological (which pattern of distribution will be easier to put in place) and moral questions about who deserves a vaccine are all jumbled up, assessed with a form of pseudo-rigor that resembles someone bluffing the way through a McKinsey job interview and then used to justify the conclusion that we should vaccinate essential workers before seniors … because seniors are more likely to be privileged and white.

That “working document”? It’s a set of powerpoint slides that explains how the CDC made decisions about how to prioritize who gets vaccinated. It explicitly points out all the things Douthat has said: that there are issues of science, ethics, and implementation that need to be balanced, and it goes through their process in an abbreviated, powerpointy way. It’s not the clearest way to explain their reasoning, but the whole point of the document is to point out that there are all these non-scientific concerns that must be considered. Again, what is he complaining about? Isn’t that what he was talking about in the first half of the essay?

But then we get to the real issue for Douthat: “the conclusion that we should vaccinate essential workers before seniors … because seniors are more likely to be privileged and white.” It’s all identity politics! They’re discriminating against white people!

Except…the document doesn’t say that.

On one page it lists three ethical principles of concern: “maximize benefits and minimize harms,” “promote justice,” and “mitigate health inequities.” Then, in a table, it assesses each of those principles for essential workers, high-risk adults, and the elderly. And then under “health inequities” and the elderly, it says “Racial and ethnic minority groups under-represented among adults >65”. That’s it. It states a simple fact about demographics of the disease. It was clearly not the major reason for the priorities that were set. It’s just one factor that ought to be considered.

But Douthat (and Matthew Yglesias, but fuck Yglesias) basically wants to claim that this is evidence that it’s the liberals are being racist.

As Matthew Yglesias noted, this (provisional, it should be stressed) recommendation is a remarkable example of how a certain kind of progressive moral thinking ignores the actual needs of racial minorities. Because if you vaccinate working-age people before you vaccinate older people, you will actually end up not vaccinating the most vulnerable minority population, African-American seniors — so more minorities might die for the sake of a racial balance in overall vaccination rates.

No, it’s clear from the table that a major factor in the final decision was the multiplier effect — that benefits to health care workers spread rapidly to assist all the other groups. Sure, we could decide to “mitigate health inequities” by insisting that old black people are first in line, but who is going to give them their vaccine? Who’s going to make sure they follow the protocol? That’s why the CDC puts health care workers in front, because maintaining that group helps all groups. And it’s all the fault of those liberals!

But for liberals, especially blue-state politicians and officials, the failure has more often involved invoking capital-S Science to evade their own responsibilities: pretending that a certain kind of scientific knowledge, ideally backed by impeccable credentials, can substitute for prudential and moral judgments that we are all qualified to argue over, and that our elected leaders, not our scientists, have the final responsibility to make.

This conclusion does not make any sense. Douthat starts this essay by explaining that there isn’t a simple scientific answer for social problems; then he cites a CDC document that shows they are well aware of this problem, and that they are weighing ethical and logistical concerns in addition to the scientific matters; and then he says damn those liberals who want to run roughshod over morality with capital-S Science!

My head hurts. He just wrote a lot of words that didn’t make a coherent point, and he doesn’t say what action is needed to correct for the problem, whatever it is. It’s a lot of finger-wagging at scientists and liberals, with vague intimations that they’re doing a racism against white people, and the implication that their rules for prioritizing the order of vaccinations aren’t good. I don’t get it…wait. There is an explanation for that essay. He’s a conservative, trying to muddy the waters about who should get vaccinated, and claiming the decision-making process is tainted with liberal bias. Why would he do that?

There sure has been a lot of obvious line-jumping by conservative science-denialists lately. Somebody is thinking it would be useful to sow doubt about how the line is ordered.

In that entire CDC working document, they failed to consider the plight of white dumbass pig castrators. LIBERAL BIAS! If they weren’t so infatuated with capital-S Science they would have been able to justify treating these parasites first.

Comments

  1. kome says

    I’ve said it before, I’ll say it again: there is no bigger existential threat to humanity than political conservatism (regardless of party, regardless of which nation’s version of conservatism).

  2. Snarki, child of Loki says

    Is there ANY problem in America today that would not be solved, or at least ameliorated, by the simple expedient of “slaughtering Republicans”?

    Drawing a blank here.

  3. leerudolph says

    Snarki@2: In the short term, it would vastly increase the dangers faced by America’s already immiserated slaughterhouse workers.

  4. raven says

    I’m still at a loss about what Douthat is complaining about.

    Douthat is very dumb.
    You are trying to read the mind of a slime mold.

    The issue with vaccinating essential workers especially health care workers has nothing to do with race. Many of those are…white.

  5. Artor says

    I’m sure it comes as no surprise to PZ or the readers here that Ross (Don’t) Douthat is a low-grade moron, with no hope of ever graduating to any higher grade of moron.

  6. chrislawson says

    Tune in next week, when Douthat argues that giving fire protection gear to firefighters is a liberal conspiracy.

  7. blf says

    Snarki@2, “Is there ANY problem in America today that would not be solved, or at least ameliorated, by the simple expedient of ‘slaughtering Republicans’?”

    The mildly deranged penguin has been in contact with the various Organisations maintaining the blockage and boycott of the Solar System (or, in some cases, the entire Milky Way), to check if this would help to relax the ban on contact with Sense (not to mention Sentient Life). It’s still being debated, but perhaps not… The planet is too infested with stooopidity for the partial and temporary suppression by ethically questionable means of one (admittedly very destructive) hive to merit anything other than very carefully sanitised contact by specially-trained extreme crisis advisors.

  8. PaulBC says

    Off topic except for Ross “Don’t” Douthat.

    Douthat is a professional concern troll. He made this amazing claim recently

    The liberals urging constant vigilance and outrage against Trump’s challenge to the 2020 outcome are trying to see this project of resistance through to its Biden-inauguration end. Meanwhile, the Trumpian side is trying to imitate it, since lurking below the right’s fantasy politics is a more cynical assumption that it’s a great idea, a highly effective political counterpunch, for Republicans to act like Biden is an anti-president, a Great Pretender — because that’s what liberals did to Trump and it obviously worked.

    I’m sure Douthat’s memory goes back more than four years, though he’s clearly hoping his readers’ doesn’t. The “resistance” document was based entirely on the premise of treating Trump the way Obama was treated, and applying pressure using tactics similar to the Tea Party in 2010, because they worked. Birtherism was the claim that Obama was an illegitimate “pretender” to the office. Mitch McConnell himself declared his intent to make Obama a one-term president.

    So whether it worked or not, it was a conscious tit-for-tat. To suggest that that its greatest risk is encouraging a tit-for-tat by Trump supporters is incredibly disingenuous. We know already that they will do this without any extra encouragement. I’m not entirely sure of his rhetorical purpose, and stopped reading at that point, but I guess the idea is that no matter what happens, it will be the fault of liberals.

  9. Rich Woods says

    @chrislawson #6:

    giving fire protection gear to firefighters is a liberal conspiracy.

    Breathing apparatus must be supplied to all of the black residents of every tower block across the nation before any firefighter can receive it. To do otherwise would be racist.

  10. microraptor says

    And on the opposite end of things, we have Representative Ilhan Omar declaring that she will not get vaccinated early because members of Congress are not more important than frontline worker.

    It’s nice to see someone with integrity once in a while.

  11. Jazzlet says

    @ Raven, hey slime moulds can solve mazes, don’t insult them by suggesting Douthat’s’mind’ is at all like them.

  12. PaulBC says

    @11 I personally don’t mind anyone in the public eye getting the vaccine just to improve acceptance once it becomes generally available. I know that’s a weaselly position to take, but I’m not really going to criticize AOC. For that matter, I don’t criticize Ilhan Omar for taking a principled stance, though their positions seem contradictory. I hope Omar continues to be very cautious, since she remains more of a hazard to others than if she had been vaccinated.

    I get that for the time being, it is a zero-sum game between frontline health providers or anyone else. But with millions of doses, the zero-sum element is pretty small. The result should be a delay, not a denial. Just make more vaccine. How long will it take in aggregate to finish vaccinating the highest priority people? That’s the important question. If a certain amount of favoritism pushes the needle back by a day or two, we have proof once again that life is unfair, but it’s not like you have search hard for such proof.

  13. sophiab says

    If your protection systems are ok, health workers don’t need to be first. If not, you add extra strength to your health system.

    I live in a semi sane European country, health workers are not first, because they are not dying in droves

  14. xohjoh2n says

    @14 You say that, but telephone sanitisers might be a particularly good idea right now. Remember that it was the “A ark” people that fucked up, got it wrong, and ended up destroying their civilisation…

  15. unclefrogy says

    @11
    it might be more cost effective to make more “A” arks first as they will be smaller and need not be as large
    uncle frogy

  16. wzrd1 says

    @sophiab, we have two daughters, both worked at the same hospital. One is currently unemployed, due to the lingering effects from having contracted COVID-19 from the COVID floor she had housekeeping duties on and lax adherence with protocols designed to prevent transmission of the virus. Management did address the issue once they realized that they had an infection cluster on their hands.
    Our eldest is a nurse in the emergency department, who contracted a mild infection with the virus and is back to work. Her husband just completed quarantine with a mild case of COVID-19 as well. He is a ward clerk at the same facility.
    Reuse of PPE is still an ongoing issue, of sufficient severity that our eldest purchased her own N95 respirator.

    Given those infections that were acquired in the hospital, I’m inclined to vaccinate health care workers, lest we run out of workers to vaccinate everyone else.
    Followed by essential workers, breaking one of several infection chains. Then, the far less mobile and increasingly protected by the two primary common exposure groups, the elderly.
    After those, my elevated risk group, younger, but with significant comorbidities.
    By that point, we should have sufficient doses manufactured to cover the remaining populace in fairly short order.

  17. says

    for liberals, especially blue-state politicians and officials, the failure has more often involved invoking capital-S Science to evade their own responsibilities: pretending that a certain kind of scientific knowledge, ideally backed by impeccable credentials, can substitute for prudential and moral judgments that we are all qualified to argue over,

    Jesus fucking bowling balls up the ass, NO.

    I haven’t made a career out of ethics consulting, but I have done professional ethics consulting. I am not and have never been a professor of ethics, but I have taught a course on feminist ethics.

    I’m at the very low margin of people who might be qualified to describe themselves as ethicists and I can tell you that even without anything remotely close to the level of expertise of career professors of ethics, not everyone is qualified to argue over moral judgements. Indeed if I bothered to take a few minutes, I could track down references to papers I’ve cited in my own work that provide fairly reasonable evidence tending to show that the (possibly vast) majority of people can’t even accurately describe why how they make moral decisions in advance of making them, and after making them many still can’t seem to provide general rules for how they would decide the next moral question presented to them.

    Seriously. People suck at this so much that the people who tell you that they determine human sex by looking at chromosomes without ever having karyotyped anyone at all actually come out almost equally expert in comparison.

    Ross Douthat in particular, with his greatest hits including a “pre hoc ergo propter hoc” masterpiece is, I would argue, particularly unqualified for the task even given the woeful level of competition.

  18. raven says

    I live in a semi sane European country, health workers are not first, because they are not dying in droves…

    Lucky for them although I don’t quite buy this.

    It definitely isn’t the case here.
    In fact, while the numbers aren’t too well known, at least several thousand health care workers have already died in the USA. The hospitals are occasionally way overcrowded with Covid-19 patients which means everything is chaotic and high levels of the virus are everywhere.

    No one should have to go to work with the possibility that this day is the start of their last few days on earth.
    I don’t have any problem with vaccinating health care workers first.

  19. raven says

    Fierce Healthcare
    More than 1,700 U.S. healthcare workers have died from COVID-19, nurses’ union says
    by Tina Reed | Sep 28, 2020 3:37pm

    More than 1,700 healthcare workers have died of COVID-19 since the pandemic began, according to a new report (PDF) from one of the largest nurses’ unions in the country.
    and
    Elsewhere, journalists from The Guardian and KHN, which have also been compiling a database, have counted at least 1,200 healthcare workers in the U.S. who’ve died from COVID-19 they contracted on the job. Those data were compiled through crowdsourcing and reports from colleagues, social media, online obituaries, workers unions and local media, they said.

    The number of US health care workers who have died is based on very incomplete and partial data.

    As of late September, the nurses union estimates 1,700. This is almost certainly an undercount.
    And since then, another 100,000 or so Americans have died of Covid-19.
    A very conservative estimate by now is that ca. 3,000 health care workers have died from Covid-19.
    The number who caught Covid-19 is going to be around 30,000, assuming 1% mortality.

    I don’t have a problem vaccinating health care workers first.

  20. whheydt says

    “A very conservative estimate by now is that ca. 3,000 health care workers have died from Covid-19.
    The number who caught Covid-19 is going to be around 30,000, assuming 1% mortality.”

    Actually…. With a 1% mortality rate, 3,000 deaths means 300,000 cases.

  21. chrislawson says

    sophiab@15–

    That is completely the wrong way around. Even in a fantastic public health system, frontline health workers should be among the first to be vaccinated because (i) they are exposed more than others even if they follow universal precautions, (ii) if they get sick, it creates huge problems for continued delivery of health services thereby undermining the vaccination program for everyone, and (iii) even if they catch the illness but don’t get symptoms, they can spread it to a vulnerable population.

    The only groups that should get priority alongside frontline health workers are (1) other emergency workers and genuinely essential workers (this does NOT include senators), and (2) community members in the middle of a ring vaccination.

    Do you have any evidence that your country is not prioritising health workers? Or an argument why your health system should be called “semisane” when it acts directly against the principles of public health?

  22. chrislawson says

    Rich Woods@9–

    A better analogy would be Mitch McConnell diverting breathing apparatus supplies to Republican politicians and superdonors while firefighters miss out…as an emergency measure in the middle of a firestorm.

  23. jmosthaf says

    sophiab @15:

    – I live in a semi sane European country, health workers are not first, because they are not dying in droves

    As a health care worker in a (relatively) sane European Country (Germany) the vaccination priority here is:
    Highest priority: >80 year old, health care worker in highly exposed and essential positions (paramedics, ER, ambulant care nurses, IC units…)
    High priority: >70 year old, high risk patients (transplant, dementia), persons caring for them, health care workers in medium exposed positions (medical doctors, nurses caring for disabled patients), police and health services, people living or working in homeless shelters
    Medium priority: >60 year old, medium risk patients (diabetes, adipositas, cancer, HIV…), low risk health care workers (labs, admin…), educational workers, people working “risky jobs”
    No special priority: Everyone else
    source

  24. Frederic Bourgault-Christie says

    It is classic sealioning.

    Douthat: “Science isn’t beyond dispute!”

    Everyone else: “The only people saying that are folks on your side of the aisle who think ‘Facts don’t care about your feelings’ is some pithy rejoinder. The rest of us know that it’s possible to be reductionist”.

    Douthat: “So the CDC is being racist!”

    People like him want to say that the ability to have a debate means that there are two equally valid sides. So he can just gesticulate to an alternative without offering one. He doesn’t offer alternative metrics. He doesn’t have the courage to say we should just fuck black people. He knows that if he just says there is a debate POSSIBLE that his bankrupt position gets to have false legitimacy.

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