In 2015, Dayna Bowen Matthew, the dean of George Washington University Law School, published a paper concerning racial disparities in health care. She traced those disparities back to the Founding Fathers and argued their persistence today reflects the “structural violence” of American society.
Matthew was 1 of 11 people who helped draft the Centers for Disease Control’s ethical framework for allocating COVID-19 vaccines. She is also listed as a “health equity” consultant to the Advisory Committee on Immunization Practices, which voted in November to vaccinate essential workers before the elderly, partly on the grounds that the elderly skew white—only to pull back Sunday in the face of outrage from across the political spectrum.
The committee openly acknowledged that its initial plan would result in more deaths than “vaccinating older adults first.” But, the panel said, the plan would reduce racial disparities—something they deemed more important than saving lives—because essential workers, unlike adults over 65, are disproportionately black and Hispanic, the two groups that have borne the brunt of the pandemic.
How did the committee reach that conclusion? According to meeting minutes, presentation slides, public statements, and even civil-rights directives, the now-scuttled plan didn’t come out of thin air. Rather, it reflects the reductive, racialist worldview that is rapidly gaining ground in education, media, nonprofits, and now the U.S federal government—a worldview with concrete policy implications and concrete human costs.
That policy agenda was seeded by outside consultants like Matthew, who told the New York Times that racial inequality “requires us to prioritize by race.” But it was also seeded by the CDC itself, which in September hosted a series of trainings on “racism, sexism, and other systems of structured inequality,” in direct violation of President Trump’s executive order barring such programs from government agencies. And it was even seeded by the chairman of the CDC committee, José Romero, who said in July that minorities “need to be moved to the forefront” of the vaccination line.
The result was an explicitly race-conscious plan that would have prioritized shrinking the case gap between races over saving the most lives.
This plan contained glaring double standards, such as an assumption that age-based policies would be discriminatory but that race-based ones wouldn’t be. It relied on omission, distortion, and equivocation to make a highly contentious judgment seem self-evident, building bureaucratic consensus upon shaky foundations that were anything but apolitical or science-based.
That consensus coalesced in September, when committee members met to discuss their framework for “vaccine equity and prioritization.”
At the meeting, Sara Oliver, an epidemiologist with the CDC, delivered a presentation on the criteria the government should consider when developing a plan for rolling out a coronavirus vaccine. She began by reviewing three other frameworks—from the World Health Organization, the Johns Hopkins Bloomberg School of Public Health, and the National Academies of Science, Engineering and Medicine (NASEM)—on which her working group had drawn in formulating its own principles.
“Equity,” Oliver emphasized, was a “crosscutting consideration for all three frameworks,” suggesting that the CDC would be in good company if it prioritized that value.
But all three frameworks also considered harm reduction to be an important goal. In fact, they tended to prioritize saving lives over reducing disparities, a point Oliver either ignored or overlooked.