The case against bioethicists
I recently listened to a podcast episode entitled Vaccine Hesitancy is Solvable where the podcast host said the following:
When I hear about white people who don't want to take the vaccine I just have a gut reaction: that's irrational, that's conspiracy thinking, they're anti-vaxxers, I have no sympathy whatsoever
He contrasts that to the sort of history you'll find documented in books like Medical Apartheid. He's certainly right that there are quite substantial differences, but I don't think it's too hard to argue that that white people might be justified in being concerned about how they'd be treated by the medical system at the moment. Consider how US federal government workers talked about prioritizing vaccinations based on how people were classified:
What debate looks like among public health officials in the federal government. Everyone agrees on the plan that kills more people as long as they're white, then they keep repeating the word "equity" as they congratulate themselves. https://t.co/S1tUOyNCoo pic.twitter.com/NW6A75DvgR
— Richard Hanania (@RichardHanania) December 28, 2020
It's actually worse than that. To quote Why I'm Losing Trust in the Institutions:
It gets even more shocking. 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.
In other words, the CDC was effectively about to recommend that a greater number of African-Americans die so that the share of African-Americans who receive the vaccine is slightly higher. In blatant violation of the “leveling down objection,” prioritizing essential workers in the name of equality would likely kill more people in all relevant demographic groups.
What did you here from the medical community? Barely a whisper ... it was only others which was a position that got Nate Silver the target of a pile-on by "experts":
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 Tufecki, Matt Yglesias and Nate Silver publicly made the case against them. (So did I.)
A day or so after the outcry changed its course slightly ... to include the elderly above a certain age threshold. But it gets worse again.
To speed up the disastrous rollout of the covid vaccine, federal guidelines will today recommend giving it to anyone over 65.
— Yascha Mounk (@Yascha_Mounk) January 12, 2021
Just a reminder that the key CDC committee *knew* this would make distribution easier but chose to ignore that kay factor on confused "ethical" ground. pic.twitter.com/VmGG8yExmc
i.e. After a couple of weeks trying out its slightly-less-bad strategy, what was happening? Hospiitals were sometimes forced to throw out unused supplies of the scarce vaccine if they couldn't find arms that met the crazy criteria to inject it in.
You were left with in a situation wherein pompous douchebags like the epidemiologist being retweeted here were writing telling others to stay in their lane:
That the person who wrote this thread thinks it constitutes any kind of refutation of the criticisms public health “experts” (actually “activists”) have deservedly come in for in recent days may be the most damning thing of all. https://t.co/kXVovo1BBG
— Damon Linker (@DamonLinker) December 20, 2020
... resulting in a situation wherein the official advice had to change not just once but twice to accomodate the criticism made by the original policy's critics. (Note: as mentioned here there were no logistics experts in the room). It's even sillier when you read up the background of the epidemiologist in quesion - i.e. he was an AIDS activist who was griping about failure to act early there and then trying to talk people out of reacting to COVID19.
... and then there's the group claiming not to have done what their slides showed they did:
But this was in ACIP's own November slides. The essential workers group gets 2 extra points over 65+ group due to its greater racial and ethnic diversity, causing it to score higher on "ethics" and overall, and was then proposed to be placed ahead in line. https://t.co/otXxwxNsAv https://t.co/O3EetdpVOz
— Josh Barro (@jbarro) December 20, 2020
And just to add a final way-in-which-it's-still-worse, if you look at life expectancy based on how people are grouped into racial categories in the US, you'll notice that life expectancy is higher for both Hispanic and Asian Americans than it is for White Americans. i.e. you were left with a policy recommendation which should not only be expected to result in a higher number of African-American deaths but also come at a disproportionate cost to the crowd that the media likes to refer to as Latinx (but which virtually no one else does).
The title here comes from this tweet which I can't quite decide whether or not to describe as "snarky":
It's possible that bioethicists save millions of lives in the aggregate. It's also possible that they cost millions of lives in the aggregate. Would a bioethicist permit bioethics to exist if it were a drug rather than an academic discipline?
— Byrne Hobart (@ByrneHobart) December 15, 2020
Overall bioethicists really haven't been putting forward a particularly good case for their existance. As a difference example, I find it interesting to think back to stories like Fact check: Coronavirus vaccine could come this year, Trump says. Experts say he needs a 'miracle' to be right.. They were far off in their estimates there, but things could have been so much faster. I'm not just talking of stalling the approvals process to try to create trust, I'm talking of the approvals process for a vaccine created in two days.
Take My vaccine crackpottery: a confession
I think that, in a well-run civilization, the first covid vaccines would’ve been tested and approved by around March or April 2020, while mass-manufacturing simultaneously ramped up with trillions of dollars’ investment. I think almost everyone on earth could have, and should have, already been vaccinated by now. I think a faster, “WWII-style” approach would’ve saved millions of lives, prevented economic destruction, and carried negligible risks compared to its benefits. I think this will be clear to future generations, who’ll write PhD theses exploring how it was possible that we invented multiple effective covid vaccines in mere days or weeks, but then simply sat on those vaccines for a year, ticking off boxes called “Phase I,” “Phase II,” etc. while civilization hung in the balance.
Human challenge trials which could probably have delivered on those timescales basically involve giving people the vaccinate and then exposing them to the infection. It's basically a risk of commission (those you actively exposed may die) vs. one of omission (many more die while waiting for a large enough set of your study participants to contract the disease through natural exposure). The public seems fairly comfortable with the risk/reward ratio of human challenge trials and they've had tens of thousands of volunteers but this seems something that it's the sort of thing it's near impossible to get past bioethicists.
(EDIT: Digging further through my notes noted that the UK is finally starting a human trial ... and as is noted there, with this approve the results that basically should have brought the vaccine instantly into use at least on a temporary basis based on predefined condition in November, could have been approved sometime in the May or June timeframe had this approach been tried.
sigh ... in this case I'm guessing the approvals process cost a million lives and probably trillions or tens of trillions of dollars relative a process that probably would have put probably 100 or so people at < 1% risk of death (assuming they're using those in lower risk categories ... so even a 1% risk there might be a significant overestimate).