Should people die for the sake of equity? This week, the hot-button news item was that the CDC included race-based criteria for adjudicating who would get the first wave of vaccinations for COVID-19 (Ref. slides 6, 9, 31, 32, 33, and especially 34). The controversy, in short, was that minorities were overrepresented in the young essential worker population and underrepresented in the elderly at-risk populations. Therefore, they conclude, a racial equity-based distribution plan would prioritize essential workers over the elderly.
The implication? Some young mid-twenties non-healthcare workers (firefighters, teachers, utilitymen) would be getting the vaccine in Phase 1b before the high-risk elderly in Phase 1c. This caused quite a stir in both moderate and conservative circles. People recognized that this meant that old people would die for the purpose of racial equity. To understand the scale of the problem, by the study’s numbers, someone in the 65-79 age group is nearly 50 times more likely to die than someone in the 25-34 age group.
Unless I’m mistakenly torturing statistics here, that means every vaccine given to a 30-year old schoolteacher instead of a 65-year old senior is about 50 times more likely to result in death. Put another way, under the CDC suggestions, thousands of people will die for the cause of racial equity. The failure here, and in most of critical race theory politics, exhibits the fallacy of composition. They apply what may be true for an individual mistakenly to a group of individuals.
When determining how to triage individuals, you might determine that Jill is more at risk than Jack. With the goal of saving lives, she should get the vaccine. This does make sense.
When determining how to triage groups, you might determine that minorities are more at risk than majorities. With the goal of saving lives, they should get the vaccine. This does not make sense.
Why? What’s the difference? Well, administering vaccines is not a group-level action. It happens one-at-a-time, to individuals. Every time a needle is stuck into an arm, one person is being protected at expense of another. Group-level effects do not belong dictating individual actions.
Doesn’t this reasoning also invalidate the counter-narrative? The narrative that suggests the groups of the elderly age should be treated before the groups of essential workers? Kind of. It does insofar as that, were we to evaluate individual-to-individual, you might find an essential worker more at risk than seniors. A twenty-year old grocery clerk with extreme auto-immune disorders and a history of lung disease may be more at risk than a particularly sprightly 65-year old. In this case, with the goal of saving lives, the at-risk grocery-clerk should be triaged first.
What’s the difference then? Well, so far as we can tell, the difference is that age is way, WAY more correlated with death than race. But more than just correlation, the mechanisms of disease play differently in the case of age than in the case of race. Senescence in the immune and respiratory systems is what’s going to kill you, not melanin content in one’s skin. While the best triage would work individual-by-individual, the age-based approach undoubtedly saves thousands more lives than a race-based one. By the study’s own science.
The best real argument for triaging essential workers over the elderly is that even though elderly populations are more likely to die if they catch COVID-19, they are more likely to catch it if exposed to essential workers who could act as super-spreaders. Therefore, one might save lives by prioritizing the people who scan our food, deliver our mail, and teach our kids. This could make sense, but I don’t see this argument being put forth. Furthermore, it is unrelated to the critique at play: that race does not belong in the life-and-death calculation of vaccine triage.
The calculus changes if saving lives is no longer the goal. If letting elderly people die specifically in the name of racial equity is the goal, then I probably have no audience with you. Still, this too is fraught, as more minority elderly will die than minority youth will be saved. In absolute numbers, this “race-based essential worker” approach is a lose-lose.
Group inequities can’t be solved by individual actions. Doubly so when the individuals at play may not embody the group-level attribute, such as young minorities not embodying a greater overall mortality rate when compared to the aged. If you find this convincing, consider that the scale of life-and-death stakes are not the only level at which this critique applies. Affirmative action in schools is the same—every rich, educated, and privileged minority student who is let into college on the basis of affirmative action means one less poor, struggling (and otherwise underprivileged) white student given the chance to escape poverty on their merits. The fallacy of composition is in play whenever attributing to the sum of parts that which may only be true of a single constituent.
Groups and individuals are different, and they ought to be treated as such.
EDIT: food for thought below.