CDC’s groupthink proves dangerous
WASHINGTON — If you watch the YouTube video of the now-infamous November meeting of the CDC’s Advisory Committee on Immunization Practices, you’ll hear Chairman José Romero thank everyone for a “robust discussion.” Shortly thereafter, the committee unanimously agreed that essential workers should get vaccinated ahead of the elderly, even though they’d been told this would mean up to 6% more deaths. This decision was supported in part by noting that
America’s essential workers are more racially diverse than its senior citizens.
On Dec. 20, after the public belatedly noticed this attempted geronticide, the advisory panel walked it back, so I need not point out the many flaws of this reasoning. Instead, let’s dwell on the equally flawed process by which the committee reached its decision, because that itself is a symptom of much deeper problems that have plagued us since the beginning of the pandemic.
As James Surowiecki, author of “The Wisdom of Crowds,” pointed out, when a large group acts as though a complicated problem is a no-brainer, that doesn’t mean the solution is obvious; it means something has gone badly wrong. The specific failure might be as banal as groupthink or as worrying as the possibility that some of the gushing endorsements were due less to deep conviction than fear of offending professional colleagues.
Either way, despite Romero’s accolade, the discussion of whether to prioritize essential workers was anything but robust. The committee left only 10 minutes for it, during which not one of those 14 intelligent and dedicated health professionals suggested adopting the plan that kills the fewest people. Nor did anyone run out of time to make that point. Ten minutes was actually a little too much for what turned out to be a pro forma opportunity to get on the record endorsing the plan, and particularly its emphasis on racial and economic equity in health care. A condensed but highly representative sample:
“This is where we can really elevate the issue of health equity” “If we’re serious about valuing equity … we need to have that baked in early on in the vaccination program.”
“Strongly agree … for equity reasons …”
“I think equity is a priority.”
“I want to applaud the entire conversation today around the emphasis on equity and identifying that the racial, ethnic and low-income disparities in the impact of covid warrants prioritization of essential workers.”
It’s striking how many people commented on this question, and with such otherwise-content-free affirmations. It’s also striking that the same group reversed itself 13 to 1 only a month later, after it turned out there were also reputational consequences for endorsing this particular quest for equity.
Equity is clearly a pressing public health problem. COVID-19 has disproportionately affected Black and other minority communities — who already suffered generally worse health outcomes — and fixing that disparity should be a priority. But it’s not puzzling how the committee decided this was the most equitable plan, given that deprioritizing seniors would also deprioritize older minorities, the highest-risk group, and quite probably result in more deaths among those people.
Moreover, advancing equity and saving lives both require gaining, and keeping, the public trust, including among groups who were bound to be upset if seniors were deprioritized because of their relative Whiteness. The committee had just seen data indicating that most people thought seniors were the second-highest priority group, right after health-care workers, and yet no one suggested the easy, popular route that also saved the most lives. In almost every other context for the past nine months, public health experts have insisted that minimizing deaths should override other concerns, even quite important ones. So how, in this case, did equity conquer death?
Unfortunately, the vaccine committee’s turnaround is just one of a string of related errors. Looking back over the past nine months, it’s as if the public health community deliberately decided to alienate large groups of Americans, usually in the name of saving someone else.
The World Health Organization told us travel bans don’t work, apparently because they harm tourist economies; then we were told masks don’t work, apparently because experts worried that hoarding them would leave health-care workers without personal protective equipment; the public health community fell suddenly silent about the dangers of large gatherings during the George Floyd protests; a presentation to a government advisory committee actually described thousands of potential additional deaths as “minimal” compared with pursuing racial and economic equity; Anthony Fauci admitted he’d been lowballing his estimates of the point at which we’ll reach herd immunity.
Each one was another disaster of public communications, a body blow to the credibility health authorities need to persuade people to stay home, wear masks, get vaccinated. Collectively, they suggest a community of experts with a lot of public health models but no good mental model of the public. They may be talking at us, but they’re really talking only to each other.