Equity Isn’t Just Ethical, It’s Stupid

PXL_20210411_081540077~2Or, The latest Covid insights from former CDC Director Tom Frieden. I may have tweaked his headline just a little; but it is a common error, so don't think I'm attacking him in particular. I suppose I have to give you the correct headline to show you the error: Equity Isn’t Just Ethical, It’s Essential. But perhaps you prefer the body: Vaccine equity is imperative. Now the most important point of this article and the reason I wrote it this week after planning not to write one: equity, equity, equity. First of all, we're not going to get equity, obviously; so it is fortunate that it isn't imperative. The rich world is going to get vaccinated first - those bits of it that aren't too stupid to accept the vaccine, of course; or unfortunate enough to have idiot bureaucrats in charge. And within the rich world, the better off are going to do better; as they always do; it is, after all, part of the definition of "better off".

I should give him a chance to make his point, for the sake of fairness. It is 100 million people in the U.S. have received at least one dose of vaccine. But about 50 million people over age 50 (~37 million age 50–64 and ~13 million age 60+) haven’t been vaccinated at all. Vaccinating these people, who are disproportionately Black and Latinx, will prevent many more deaths than vaccinating young people. And it's kinda fair. But the problem is firstly that he has vastly over-egged it; and secondly that if you spend too much time being equitable, you've got less to spend on general coverage; if we're talking about vaccination; more generally, obsessing over income or wealth inequality makes less sense than worrying about absolute poverty. Thirdly, in relation to his In other words, a single well-targeted vaccination could save 10 times more lives, and prevent 100 times more cases, than vaccinating a low-risk person in a low-risk community, there's the problem of actually executing his strategy, which requires much knowledge and planning resources.

The more general point is one I've made before: per Smith, what is required is tolerable justice.

Pictured: the Claw of the Conciliator.


* An Ageless Hypothetical by Bryan Caplan

* How people get rich now - Paul Graham

* Prospectus On Próspera - A look at Próspera, the charter city taking shape in Honduras; SSC / ACT

Democrats plan to unveil legislation to expand the US supreme court by four seats - although, since it's doomed, it is just posturing.

* Twit: Bezos trying to quantify how much value Amazon produced for different groups in 2020. Back of napkin math: $301 Billion of value created, of which shareholders see $21B. Amazon newsletter to shareholders.

* How I Became a Libertarian by Meir Kohn

No, Really, Why Are So Many Christians In Colombia Converting To Orthodox Judaism? - SSC / ACT

How inequality makes climate change worse... or A fairer economy would emit more CO2?


CapitalistImperialistPig said...

It's odd that you can completely miss the point despite quoting it explicitly: "In other words, a single well-targeted vaccination could save 10 times more lives, and prevent 100 times more cases, than vaccinating a low-risk person in a low-risk community."

Yes, it requires resources, but what doesn't? Even if you don't care about anybody but those as rich as yourself, the point of vaccination is that it doesn't just protect the the vaccinated - it protects the community. The longer an uncontrolled pandemic rages, the more dangerous mutants accumulate in the population and then spread even through the vaccinated. The mutant strain arising in Brazil or India or Britain can devastate even well-vaccinated persons elsewhere.

Amazing at it may seem to you, resources expended in planning and executing can be well spent. You are safe against measles, smallpox any many other devastating diseases because those wiser than yourself pursued global strategies.

Tom said...

There is no real world solution to the dilemma he faces that will not be criticized. Or litigated in Congress after the fact. Or spur numerous lawsuits.

He should just do his job as best he can, retire to somewhere off the beaten track, change his name and read lots of good books.

William M. Connolley said...

> the point of vaccination is that it doesn't just protect the the vaccinated - it protects the community

Indeed. So far so bleedin' obvious, which is why I didn't say it. But I think it argues for my view: just vaccinate as many people as you can, without agonising too carefully over the exact order. The UK seems to have done this fairly sensibly: mostly the wrinklies first, which is easy to do.

> resources expended in planning and executing can be well spent

More of the bleedin' obvious I'm afraid; though better written as "can".

Phil said...

In this case, it isn't "bleedin' obvious", as this is a different disease than most diseases that we vaccinate against.

It is more like the "Russian Flu" of 1889. Initially killed people, as it was novel, no pre-existing exposures to provide partial immunity. Deaths were mostly the old, mostly by lung issues and some puzzling heart problems and some puzzling long cases. Now, likely is one of the circulating cold viruses. Sniffles and such.

If SARS-Cov2 aka COVID19 is similar and once everyone has been vaccinated once and/or survived the disease, then it might become just another "cold" virus. Hardly noticeable.

The future isn't known, but vaccination might be a one and done, even though the disease continues to spread widely. The coronaviruses that cause the cold don't seem to get long lasting complete immunity from past infections, rather just long lasting immunity from severe cases and death. If this is true, we likely can't prevent this from circulating widely. But the consequences are not major.

Phil said...

Death rate was also similar for "Russian Flu".


Death rate of 0.6% for the first wave. I'd say that there would have been later deaths, but less quantifiable.

Phil said...

I misquoted the death rate above. 0.6% was for excess mortality, not the same thing as case death rate.


Estimates case death rate as 0.1% to 0.2%.

CapitalistImperialistPig said...

I think Dr. C. is changing his tune. First he says "equity is stupid." Now he says vaccinate as many as possible - a form of equity, I think, that can be contrasted with his original "vaccinate the rich" advocacy. The author he despises argues for vaccination of those most likely to get and spread the disease. Now he could have argued that that was impossible (which would be false, but at least have a veneer of plausibility), but he didn't - instead opting for epithet spewing.

I think that you would have been better off to cool your jets.

William M. Connolley said...

> "equity is stupid."

That was the headline; an amusing [sic] word-play on the article I was quoting. You should know not to trust headlines by now. But if you want the shift explicit: obsessing over equity is stupid; masturbation for the woke classes.

> original "vaccinate the rich" advocacy

Actually I didn't advocate that; I merely pointed out that it was what was happening. and if we interpret "the rich" in a global sense, then it is Yanqui govt policy: feel free to complain to Biden or Fauci if you disagree with their policy. Or how about writing to them about the pile of AZ vaccine they're sitting on with no intent to use, the murdering fuckwits?

> could have argued that that was impossible

I argued that it wasn't going to happen, not that it was impossible. Do let us all see a copy of your letter to your Prez, or Senator, or Fauci, when you can be bothered to try to convince them.

William M. Connolley said...

Another fine example of being "over ethical" being stupid is Johnson & Johnson Covid vaccine to be paused in US over blood clots.

Phil said...

Trust is such a fragile thing.

Meeting to discuss restarting J&J is today.


"But Paul Offit, a vaccine researcher at the Children’s Hospital of Philadelphia, says suspending use of the J&J vaccine while more data is gathered was the right decision. “I think this was the only thing they could do,” he says."

Women under 50 probably want to get a Moderna or Pfizer,as the risk/reward ratio is better.

CapitalistImperialistPig said...

If you think all the experts are idiots (or "fuckwits") it is just possible that you might not be the smartest person in the room. Dunning-Kruger can affect even Oxford PhDs and sometimes, even Nobel Prize winners.

William M. Connolley said...

*All* experts? But: why not express your own opinion re your hoarding of a vaccine you're not going to use... do you have no opinion of your own you'd care to commit to: is it sensible, or is it stupid? And, of course, I don't have a PhD, being from Oxford.

CapitalistImperialistPig said...

PhD -> DPh OMG!

Stockpiling a vaccine when you have a shortage is not crazy. Delaying use of a vaccine you have stockpiled when it's side effects are poorly known might not be optimal from a disinterested public health standpoint, but in a country where a substantial minority are buying into a hysterical anti-vaccine campaign promoted by a major political party requires other considerations.

If it were up to me, I would turn the Astra-Zeneca loose, but that is not a strategy without risks either. I've already talked enough about what I think of your original choice of words.

William M. Connolley said...

Meanwhile, Dems pour fuel on the fire of instability: Ed Markey calls the SCOTUS "illegitimate". When Trump calls the election "stolen" all good people can immeadiately see that this is bad: it leads to lack of respect for stable democratic institutions, blah blah blah. But when EM says that R's "stole" two seats... that's just fine?

Tom said...

Markey has not been shy about displaying his ignorance/idiocy. One thinks back to the arguments he used while pushing Cap and Trade legislation...

The Fools In Town Are On Our Side. Something to remember.

Phil said...

The view of the vaccines has gotten clearer.

AZ and J&J both seem cause the same rare clotting disease. The solution might be to reduce dosing.

"On 9 April in The New England Journal of Medicine, one research team published its observations on 11 Vaxzevria recipients in Germany and Austria and another published data on five patients in Norway. Both found that symptoms resemble a rare reaction to the drug heparin, called heparin-induced thrombocytopenia (HIT), in which the immune system makes antibodies to a complex of heparin and a protein called platelet factor 4 (PF4), triggering platelets to form dangerous clots throughout the body. Sickened vaccine recipients also had antibodies to PF4, the researchers found. They propose calling the syndrome vaccine-induced immune thrombotic thrombocytopenia."

Tom said...

Honest question here, based on reading the initial articles a week or so ago. Has anyone gotten clots that was not a female on the Pill?

Gator said...

Comparing Trump/2020 election and SCOTUS is ludicrous.

Trump - zero evidence of any fraud. Deliberate campaign to promote the idea that the election was stolen, starting back in the 2016 election when he accidentally won the election.

SCOTUS - McConnell refused to act on a nominee under Obama, rushed in people under Trump. And more than just SCOTUS. McConnell pursued a deliberate strategy of not approving candidates to federal courts under Obama while going out of his way to promote unqualified people under Trump.

William M. Connolley said...

So... you don't like what I'm saying, that is clear, but your own position is unclear. Are you saying that you don't object to EM's comments because they are ineffective, or because they are true? Specifically, do you agree with his claim that SCOTUS is illegitimate? That seats were stolen?

Phil said...

Rules were bent, perhaps not broken.

Bad faith isn't quite theft. Not quite. Getting close.

SCOTUS, like all government, is based on the consent of the governed. A minority chose the majority of the Supreme Court. Or more correctly, a President elected by a minority of voters appointed and a Senate elected by a minority of voters confirmed the majority of the Supreme Court. This is new low in American Politics. The government's legitimacy and moral right to use state power is only justified and lawful when consented to by the people or society over which that political power is exercised.

If the majority of the people don't have a say in government, how can this be consent to be so governed?

How small of minority rule would _you_ accept? If you were not part of that minority? How different would the answer be if you were part of that minority?

The Supreme Court can decide to become illegitimate by rules abhorred by the majority. Abortion, gun "rights", religion. Their choice.

Trump's loss was clearly and unambiguously a loss. Trump is a fraud and a cheat.

William M. Connolley said...

Errm so you too aren't happy, but are also unable to answer my questions, which I'll repeat, and number for ease of reference: "(1) Are you saying that you don't object to EM's comments because they are ineffective, or because they are true? (2) Specifically, do you agree with his claim that SCOTUS is illegitimate? (3) That seats were stolen?"

As for your questions:

> If the majority of the people don't have a say in government, how can this be consent to be so governed?

Refer to Hobbes (and, many others before or since): consent can be explicit or implicit. As you grow up, and come to adulthood, if you settle down and make no explicit objection to the rules: then you have consented.

> How small of minority rule would _you_ accept?

I think the question is confused. We're (you're - since we're talking about the USA here, not the UK) not in a situation of limited francise, with only certain classes permitted to vote (ignoring children and a few other exceptions). Essentially, everyone gets to vote. But in all circumstances a small minority - the executive - actually rules. Your model seems to be the very bad one that banana republics use - that which ever party wins the election rules only in favour of those who voted for them.

The correctly phrased version of your question (or so I guess) is how small a minority of the proportion of those eligible to vote (or do you mean proportion of those who actually vote? I can't tell), end up supporting whoever wins, is acceptable? The answer to that is that the split in the USA is clearly within reasonable bounds.

Tom said...

The US is in a period hinting at great change. (Seriously. With Joe flipping Biden, of all things.)

In times of great change there is an argument to be made for following established rules, at least until the dust settles.

So, yeah. McConnell played dirty pool. Let him have his Supreme Court.

Phil said...

1) I don't object to EM's comments as they are partially true. I also would not make those comments as they are partially true.

2) Specifically, SCOTUS has lost legitimacy. Yes/No answers to questions without binary values are not realistic.

3) Again, yes/no answers to questions without binary values are not realistic. Bad faith isn't quite theft.

"The answer to that is that the split in the USA is clearly within reasonable bounds."

Limited franchise is still reality, Jim Crow ain't dead yet.

The President, Congress and the Senate majorities are currently chosen by a majority of those that voted.

Rule vs franchise:

You like the idea of minority franchise, don't you? The correct minority, of course.

The elected representatives are called public servants here, not rulers. "Government of the people, by the people, for the people".

William M. Connolley said...

> In times of great change there is an argument to be made for following established rules, at least until the dust settles.

I agree; though perhaps replacing "great change" by "uncertainty" or somesuch. But the idea that EM apparently has - the other side played dirty so we shall rip up rules and declare anything we dislike illegitimate - is foolish and dangerous (if anyone listens to you).

> Limited franchise is still reality, Jim Crow ain't dead yet.

I think that is objectively false.

> You like the idea of minority franchise, don't you?

The idea is definitely tempting. I can't recall ever having spoken in favour, though. If you're thinking of Book review: Starship Troopers you'll find I say Of the political philosophy, it is of a limited franchise, a topic perpetually recurred to by folks who dislike the excesses of democracy (among which I count myself; I've not I think suggested limiting franchise, which I think doomed, but more limiting governmental power).

Gator said...

Yes, when one side is acting like anti-democratic thugs, then I'm not so worried about the Dems "pour[ing] fuel on the fire of instability." (What a misunderstanding of US politics! Did you read the article? The article was all about how Biden was creating a commission to kill the idea.) Trump actually convinced people to violently invade the capitol building during a session of congress mandated by the constitution to confirm the presidential election. So, yeah, not worried about EM. We've had four years of excusing Trump and his ilk.

Re Jim Crow, please accept that you know next to nothing about US politics, especially at the state and county level. Why would you? So maybe when someone says "Jim Crow is not dead" you might reply "Wow, that's surprising! Whatever do you mean?" rather than "You're wrong in some very nitpicky, literal way haha". It just makes you sound like an ignorant dick, which I assume you are not in real life.

CapitalistImperialistPig said...

The US constructed a government that allocates electoral power on the basis of states rather than population. That feature of the Constitution was adopted mostly to soothe the slave states that feared abolition. Bush II and Trump got fewer votes than the Dems they defeated. Republicans got a majority of the Supreme Court by changing Senate rules and long established precedents. In that respect Markey is absolutely correct.

Is changing the size of the Supreme Court, something that has happened several times in the past, the right remedy? I don't know, but it is a useful sword to hang over a court that gets too far out of step with the nation. The present court has frequently trampled precedent and democratic principles, mainly by gutting the voting rights law and turning elections over to the plutocrats, and has shown an appetite for eroding religious liberty and civil rights, so is radically reactionary in its nature.

The same thing was true in the great depression, when a reactionary court systematically attacked the New Deal. At that time, the threat to expand the Court served to cool its jets. Maybe that could happen again.

William M. Connolley said...

This is currently my Google hit for "SCOTUS" so I'll leave this here:

The Imperial Supreme Court in Harvard Law Review. It is wrong, obvs, but I think indicative of the errors that typical wrong people are making.