As Nate Silver discourse intensifies, I just wanna remind people that Richard Epstein, non-epidemiologist, also made the argument that his credential was being smart and reading things, and he thought 500 people were gonna die in this pandemic.

The entire question of prioritization is a mess that I’m very glad I don’t have to deal with, but it’s not as simple as “who is the most vulnerable.”

Public health decisions are being made on the basis of a lot of incomplete information about the vaccine.

We don’t yet know what period of immunity the vaccine confers, or whether it reduces transmission and how much it reduces transmission by.

Public health has to take into account not just varying vulnerabilities, but also questions like ability to limit exposure and potential to transmit and retransmit and essential worker status and...so much.

If people like Nate Silver were actually providing recommendations that went strictly by death statistics, he wouldn’t just say “vaccinate the elderly first.” He would say “vaccinate the Black elderly first.”

Figuring out who gets the first doses of a vaccine in a deadly pandemic has to be a heartbreaking exercise, knowing that whoever you don’t choose will suffer.

It’s a constant shuffling of priorities that look like: Do you choose to vaccinate the USPS worker with preexisting conditions who has a lower chance of death, but if they’re working, may get people’s lifesaving medications to them on time?

Do you hope that maybe the vaccine helps limit transmission, and so you vaccinate a bunch of teachers to help reduce the spread at schools, which will prevent elderly from being infected by kids?

None of this is easy or just a direct readout of death statistics, and I know enough to know that there are a lot of really hard and heartbreaking questions that some people have spent their entire careers answering.

This is not to say that ACIP is above criticism. I think fair questions to ask would be things like, “given the racial disparity in COVID mortality, what are you doing to make sure those communities that were hardest hit will be first protected?”