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So maybe because I've worked in public health this is not particularly bothersome. We already trade off deaths vs other values. Increased speed limits leads to economic gain but more deaths. Another hospital in an urban area will save more lives than funding one in a rural area. Deaths simply are a trade off at a population level. People here argued we should have allowed more Covid deaths in older populations in order to preserve the economy and rights of free movement et al.
Having said that, from the point of view of vaccines, they have two purposes, protect the individual who takes the vaccine and try to achieve herd immunity (or at least reduced spread). Black communities were among those worst at taking up the vaccine (for a few reasons). With increased obesity and other health conditions, even low risk black age groups are at higher risk than similar white (or asian) age groups.
"In people 65 years and older, Blacks are nearly 5 times more likely to die of COVID-19 than Whites. This increased risk of COVID-19 mortality in Blacks is even worse in younger populations—up to a 10-times greater risk in adults 35 to 64 years old. In fact, younger Blacks are dying from COVID-19 at a rate greater than older Whites. For example, Blacks 55 to 64 years old are dying from COVID-19 at rate two-times greater than Whites a decade older."
So their community is less likely to have protective levels of vaccination, more likely to get sicker than an equivalent white person and more likely to die. They're also disproportionately more likely to work in a customer service or retail role and therefore get exposed. Are you sure that it would be the wrong decision to push more vaccines that way, even if all we were looking at was deaths prevented?
If ethnicity impacts outcomes then logically it should be at least a factor when looking at policy. How much of a factor depends on what you're trying to achieve.
I considered it for a time, but was put off by many prevailing attitudes. I regret that now; I should've went into the field to try and counterweight the worst of those attitudes. I didn't and don't have the thirst for attention to do so, though.
This would be one of those times where how you discuss a problem is incredibly relevant even if the downstream effects are approximately the same, and I should've quoted the offensiveness instead of leaving it (for once!) unquoted.
So I would like to say you have convinced me there is a way that the different prioritization is actually defensible. I can see why one might, especially early on, distribute vaccines in a racially biased manner. As is so often the case, the pseudonymous rando is a much better advocate for a given cause than the credentialed experts cited in the Paper of Record.
Unfortunately, that is not the way the credentialed experts in the Paper of Record described it and so, I present the source of my everlasting hatred for them:
What a putrid soul it must take to think and speak that way.
Their goal is, as they stated themselves, not to save lives. It is to "reduce health equities." In the way of that equity cartoon, you can hand the short man a ladder or machete the tall man at the knees. Their choice is to machete the tall man at the knees, and for that they should be condemned. They are the primary reason I have an immediate and vehement distrust of anyone using the phrase "health equity."
I see no viable defense and, frankly, have no interest in a defense of such people, any more than I would have interest in a defense of King Leopold's actions in the Congo. For better and worse, people rarely receive the fate they deserve.
For what it's worth, the article taken as a whole is interesting, and the author was clearly deliberate in positioning the back and forth of good argumentation versus abject horrors.
So obviously you feel strongly about it and I don't want to rile you up. But I don't see too much objectionable here. Levelling the playing field is about taking into account the differences here. He even says it, the white populations are healthier so they live longer, so if you just take into account age, you will miss out on morbidity increasing factors which in the United States are drawn heavily along racial lines because your underclass is heavily skewed black. Likewise with teachers, middle class white people with degrees are likely to suffer from fewer health issues than non-middle class, non white, non degree holders. All of this appears to be factual information.
I think that equity phrase/cartoon is hijacking your perception a little here. The equity cartoon isn't a one to one description of how equity would work in the real world when carried out by real people, nor do people always mean the same thing when they say equity. The actual positions they were advocating are nowhere similar to taking a machete to a tall person. They are actually advocating for something closer to the original equality cartoon, with vaccines instead of boxes. The tall people are still going to be tall. The healthier groups are still going to be healthier, they would have to be making the healthier group intrinsically less healthy in the name of equity for the machete to apply. Like putting immuno-suppressants in the water, so that the death rates were equalized with the worse off populations or something by making them worse (a al Harrison Bergeron).
Rather than giving something to the worse off populations to reduce their death rates to similar to the taller population. That's the definition of the ladder analogy really. They advocate to make the short person taller (healthier) rather than make the tall person shorter (unhealthier). The latter would be equity as described by the (I agree) objectionable cartoon. If they were recommending making white people more vulnerable to the disease, so that they died in rough equity with black people, I completely agree that would be very objectionable! That would be taking a machete to the legs of the tall. But that's not the recommendation they are making. The vaccine is the boxes or ladders. If you didn't give them to anybody, the tall person would still be tall and the short person would still be short.
Which isn't to say they don't have objectionable views in general, or that they are definitely correct. I'd want to take a much deeper dive into specific proposals and trade offs, and confirm numbers and the like, but I don't think they show much sign of being outright evil monsters. At worst they believe the boxes version of equity, while you believe the machete version of equity.
Note: The Equality vs Equity cartoon a woke person is likely to point to doesn't involve any machetes at all. It just shows shifting one box from the tall man (equality) to the short man (equity) so the short man has two and the tall man has zero. But I've gone with the (more critical of equity) version you describe to keep the analogy rolling along.
https://pressbooks.openedmb.ca/app/uploads/sites/52/2023/01/image1.jpeg
I expressed my anger and still you replied; I appreciate that and will strive for a more even tone this exchange.
Perhaps you're right and I find the whole concept so odious that I am unable to extend charity that they deserve. I also think charity can be a trap when one extends it well past the point one should.
Age was by far the number one predictive factor in covid mortality; controlling for the most significant factor has some... questionable limits? I will extend enough charity to say that I'm saying this with years of hindsight instead of months, so perhaps Schmidt was merely misinformed.
I understand what you're saying about not focusing solely on age, and I agree other factors matter, but the way Schmidt and Lipsitch discuss it sticks in my craw.
The more I read back and rewrite this response, I am regretting introducing the metaphor because it's too one-dimensional, and the more I think about this the more it's the same old issue with intersectionality being nonfunctional. The "correct" matrix of ideal vaccine distribution would be horribly complicated and likely politically impossible.
Why should teachers be deprioritized for whiteness when they're going to be in high-risk environments, and spreading it to black kids who will then spread it to their higher-risk families? So one would assume given Lipsitch says most teachers are white. Excluding them is a strongly racist proposition if one is considering second and third order effects of vaccinations and spread.
It is a notoriously slippery phrase from a notoriously slippery ideology. It means everything and nothing, and no one knows how the equity eschaton would be immanentized.
So is the phrase just useless, an applause/boo light? As a writer I think one should pin down whatever they think it means, and let the chips fall where they may in the degree to which that does or does not match sources they may be citing.
I know what you mean but I would still like to clarify I don't believe in equity at all; I think the concept is far too slippery, a la "true communism has never been tried."
I do not trust people that claim to believe the boxes version to not, whenever convenient, turn to the machete. That is the fundamental assumption of ideas rooted in disparate impact: it doesn't matter how you get to the same outcomes. There is more than one way to skin a cat, more than one way to equalize heights and health outcomes.
Or less violently and more realistically, they resort to indifference. That is, Schmidt has built a career on the 'marginalized,' and that seems to displace concerns about "how do we save the most lives" and "maybe age is the number one factor in covid mortality." He has chosen populations he cares about, and populations to which he is indifferent.
Hmm. Action/inaction questions are such a sticky problem. While withholding vaccines from a particularly sensitive group because of their race isn't as actively making them more vulnerable as, say, sending sick people to nursing homes or infecting them all with an autoimmune disease, I am less than confident it's a valuable moral distinction in this case.
An actual woke believer will not choose the edited version of the cartoon, no. Mao thought the Great Leap Forward was a good thing, et cetera and so forth with history's other examples of horrors spawned by "good intentions."
This is a reasonable point! And indeed if you read Schmidt's paper his final recommendation is healthcare workers and essential workers who are likely to be exposed to and spread the disease to multiple people. While he discusses race as an impact his final recommendation doesn't actually suggest making the distribution race based directly at all.
Now part of that is because retail, grocery store workers and the like skew minority in the US in any case, but his final position in his paper does indeed seem to be there is no need to discriminate on race. I don't know whether the article only asked him about the race part or only used his answer for that part, but his papers recommendation does not suggest discriminating on race for vaccine distribution in the end.
Now having said that his recommendation turns out to be wrong anyway. There are 2 main vaccine pandemic responses 1) Vaccinate the most vulnerable (this directly reduces deaths) 2) Vaccinate the most likely people to spread the disease, workers who come into contact with many people. The 2nd saves lives indirectly by restricting spread even though you are primarily vaccinating people who individually are not at much risk of the disease.
However it has to be with a vaccine that is effective enough and taken up enough to get to herd immunity levels. Without that option 1) is generally your best shot. But Schmidt was making that recommendation before the vaccines were created so presumably we can't hold him responsible for the fact the vaccines were not as effective as option 2) requires, he didn't know that at the time.
I'm starting to feel like some Motte two-buttons meme: "who is worse, the journalist or the public health expert?" Just joking. Well. Maybe 50/50.
Now that the conversation has run its course, I'll say one last time how much I appreciate your patience and thoughtfulness. We don't always agree but I always enjoy our conversations here.
Likewise! And I appreciate you always trying to take the heat out of things, it's not easy. I've rewritten and deleted my own share of posts on things that are hot button topics for me, so I know it's not necessarily easy!
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That's one way of putting it, but another way of putting it is that such a distribution is effectively punishing white people for being too healthy.
Essentially, "you're not dying enough, so you can't have a vaccine". The underlying problem that the machete version of the cartoon is trying to point out is that attempting to compensate for different base health by race is in practice going to mean depriving people from healthier groups of care that they would receive in a colour-blind society, until and unless they start dying at an equitable rate.
Absolutely. And that is a reasonable critique of the position. Especially if you pointed out significant parts of the poor health is behavioural! I'm not saying they are correct, I am saying its a reasonable non evil position to hold. With scarce resources some people are not going to be treated. But note that is also the basic decision we came to with age. Younger people had to wait to get vaccinated. So were we punishing young people for being too healthy? Or is it simply the pragmatic choice to try and equalize death rates between different age groups? We did deprive young people of care they would have got in an age blind society then presumably. Is that ok but race skewing isn't? Or are neither ok?
Like I said in the other thread its not just about race, its also age, and class and job role. Should you vaccinate a farmer or a barista? The farmer is likely to be more important to food security, but a barista is likely to be exposed to and expose many more people. Depending on your goals/priorities you can make a reasonable case for either.
Ah, apologies.
I personally think that the position’s semi-evilness comes from its reasonableness. It’s a perfectly reasonable chain of thought that ends up denying white people care because they aren’t yet dying in sufficient quantities.
Broadly I would say that the case of old versus young was so stark that it was ok to deprioritise them. And in general one is normally able to avoid such problems by having sufficient manufactured medicine.
But in general when things like this come up, I think that it is best to avoid temptation by not discriminating, to the extent possible.
Sure like I say, by the numbers they might be wrong. But presumably that means you accept the principle that if say 25yo black Americans were dying at the same rate as 85yo white people from Covid then it might have been reasonable at the outset to reserve vaccines for white people over 65 and black people over 25, befoe you start expanding it to white people 45 and so on. That if the difference was as stark as age turned out to be, that their argument would have been justified.
Which means i think its hard to call it evil. At least for me. But thats value not fact dependent, so certainly arguable.
Sort of. Broadly, I believe that young people weren’t in serious danger so depriving them of the vaccine for a while was fine. Rather, young people weren’t being deprived per se. Whereas your white guy over 45 was still in some need of a vaccine and depriving them is therefore a problem.
If the disparity was massive enough I imagine I’d bite that bullet and give the vaccines to the young black people first out of obvious necessity.
My understanding is that the disparities weren’t that wide and that in the cultural moment professionals were sort of overjoyed to find a reason to demonstrate their anti-racist credentials by giving black people preference in a matter of life and death. Which obviously affects my perception.
Sure, the disparities were not that wide (as far as I know). But do note the article is from before there was a vaccine at all, as they were discussing how it should be allocated when they had them, so reasonably early on.
Having said that if you actually read the paper and not the media phrasing even Dr Schmidts final recommendation was fairly anodyne. Prioritize healthcare workers and then essential workers who are likely to spread to multiple people (so a retail worker who has to come into contact with lots of people each day over say a farmer). In the end he didn't actually recommend that it be decided by race at all. Just worker type. He just talked about it being a factor to consider in his paper, which is the bit he was then asked to comment on for the article, or the article only published his quotes on that section perhaps.
The media version of X may not really represent X very well in actuality.
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