By a 13-1 vote, an “independent expert” panel of the U.S. Centers for Disease Control and Prevention (”CDC”) just recommended who should enjoy priority for rollout of COVID vaccines.
What would we do without experts?
Two drug companies, Pfizer and Moderna, have requested and expect emergency approval of their COVID-19 vaccines. These companies estimate having enough vaccine by January to inoculate 22.5 million Americans.
Depending on your needs and priorities, that number might seem like a lot, or a little.
As reported, the panel prioritized the nation’s 21 million health care workers, along with three million mostly elderly people living in nursing homes and other long-term care facilities.
In other words, if you’re not a health care worker or in a nursing home, you’re not getting vaccinated until February, at the earliest.
Does that make sense?
Not entirely. Here’s why.
Cost/Benefit Ethics — Deciding What To Prioritize Tells Us Whom To Prioritize
In a 4-hour-long virtual meeting, the panel defended prioritizing groups at the highest risk of becoming seriously ill or dying from COVID-19. The panel reasoned that protecting them first would, in turn, reduce the burden on society.
From the perspective of cost/benefit ethics, minimizing the overall societal impact of COVID-19 is the right goal. But health experts have consistently considered only very narrow categories of impact, which look almost exclusively at direct health-related harms from COVID-19.
Tunnel vision will not produce an ethical cost/benefit outcome. Is there a better way to pursue the overall societal goal, as well as the subsidiary goal of minimizing direct harms?
Facing the Arithmetic
Fighting a pandemic is like fighting a war. There’s no room for sentimentality. During the Civil War, Lincoln searched for a Union general who could “face the arithmetic” of the casualties and suffering needed to win the war sooner by relentlessly taking the fight to the enemy. Lincoln understood that by bringing the war to a speedier close, such a general would actually reduce total casualties and suffering.
Facing the arithmetic of COVID makes us consider not just those at high risk for serious illness or death, but those who provide key services (not just healthcare) and those who super-spread the virus.
In prioritizing healthcare workers and nursing-home residents, the panel recommendations ostensibly focus on high risk, without balancing other factors or means of protection.
Not all healthcare workers are at high risk, in a position to super-spread the virus, or provide essential services. Why prioritize these workers as a block?
At the same time, it’s true that nursing-home residents are generally at high risk. But, many have been in nursing homes for several months without getting COVID-19. This means that other preventive means may already protect them adequately. In addition, in facing the arithmetic, we must admit that some nursing-home residents will shortly die from other complications or simply old age. Might there not be some persons whose inoculation will do society more good?
Here’s a graphic that takes a stab at prioritizing the three central factors:
Unlike the panel recommendations, this graph recognizes the importance of inoculating super-spreaders. Inoculating an at-risk individual provides only 1-to-1 protection (1 vaccination protects one person). Eliminating potential super-spreaders through inoculation provides 1-to-many protection.
Making bureaucrats and pharma executives eat their own cooking
Both the panel recommendations and the above graphic assume the vaccines will be safe. They may not.
Perhaps we should add a first-priority group for inoculation (Group 0): the people who have approved the vaccines and/or require others to take them:
Tired Of Getting Stuck
People are not only tired of dealing with COVID-19. They are tired of deferring to experts with tunnel vision or an inflated sense of their own predictive powers.
Thankfully, the panel’s recommendations are only recommendations. The nation’s governors will make the calls in their respective states. One of the many benefits of the federal system is the ability to experiment and to adapt to local conditions.
The CDC panelists have voiced their opinions. In democracies, everyone should have his or her say.
Make yours known, too.
The column first appeared in Forbes.com. Reprinted with permission.