Umair Irfan joins Dara and Matt to discuss some challenges and obstacles to prioritization and distribution of the Covid vaccine, in the U.S. and elsewhere.
Matt Yglesias (@mattyglesias), Slowboring.com
Dara Lind (@DLind), Immigration Reporter, ProPublica
Umair Irfan (@umairfan), Science Reporter, Vox
Erikk Geannikis, Editor and Producer
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think they met you're selling yourself a little short, because I think you were actually the first person who I saw making it clear that lake we should be so lucky to have demand outstripped supply for these. Let's make sure that the supply is unlock and then we can figure it out and that ended the demand is high enough, and then we can figure out how to match those. Do I was worried about cheating. You know that
not so much that they come
cheating measure would mean
impossible to even do anything,
Hello observed on the box media protesting and met with places for public as darent Lindh and Boxes America fun. We wanted to talk today about sweating,
we back back and weeds in the interim
but we ve been on break vaccines have been approved and people have started to get vaccinated, far covered nineteen, which is great and yet
if you had been reading stories in December, when they were talking about twenty million people might be vaccinated by the end of the year. That has not come to fruition, not even close
and we ve even seen notches
it was anticipated was you know it takes a while to make these things have to be distributed, etc,
but a number of states seem to be having trouble just like using the doses of vaccine that have been
into them. So gloomier has been reporting on this a lot and like what what he's gonna like what what happened to my twenty million shop,
well they learn that it's a lot easier said than done. I mean yes, as you know that I mean with the goal, was to get twenty million by the end of December and right now I think we're close to about five million.
Shots administered so allowing us it's about you about a quarter of where we want to actually be,
The manufacturer say that they actually gotten pretty close to actually making those numbers. The issue is on the administration side, basically getting it to the hospitals and clinics that are administering it and then from there actually getting it into patients, arms and that's where the hiccup seem to be
You may recall that you know
small some states for reporting their allocations were cut and then Pfizer. The manufacturer was saying that there is a whole bunch of unclean doses at their warehouses, which indicates that there are some sort of mismanagement of miscommunication and then on the front lines of this vaccine administration. What we're seeing is that, basically,
A lot of doctors in hospitals are not really that well equipped to administrate there having shortages of personnel. They dont have the facilities to actually store this in some of these vaccines have various of stringent storage requirements and then also they're having a hard time sorting out who should actually get them. This is one of the other big hurdles like with influenza. For instance, you know you can just going to see vs and get the shop and in five or ten minutes here, you have actually thought a questionnaire you have to
He put on a list. You have to actually see what your priorities are in different states are setting different guidelines. Some of them are taking these priority listings very seriously. Others are basically saying if you're over the age of sixty five, it's on first come first served basis, and then you ve had also scandals where you ve had hospitals, thou re, basically allocating doses, four friends and family rather than people at high risk.
So the fact that we have such a disparate,
situation of this, that we have no central, cohesive plan for rolling out. These vaccines means that we have the sort of scatter shot approach and that's just left a lot of vaccines are used.
It seems that there are two different kinds of problems here. Right. One is the kind of brought umbrella of our
act scenes getting to the places where they could be administered. Are they being stored properly, the kind of physical infrastructure of
how our power these being distributed, and then there is this second
question of who is you know, even if you had everything set up so that a maximum number of people could be getting vaccines? Who are those people? How do they know and
are those that people who are actually coming forward and Lake related Lee are people who are you know?
affirmatively, refusing to take the vaccine that therefore indicating that there are much bigger problems. What kind of broad uptake then we would have anticipated. The merit sounds like you're kind of saying that we definitely we can't tell how big the second problem is yet because the first problem is so big. There were just not to a point where we would be able to do broad distribution, even if we knew exactly who was supposed to get them. First. Is that correct
yeah I mean, there's been a lot of energy invested into coming up with these sophisticated strategies, for you know how to vaccinate who should be prioritized, and you know the idea of whether we should be reducing fatalities or whether we should be reducing transmission, but all that's kind of mood. If you can't really get the vaccines to the places they need to go in the first place and you're having hiccups,
just the basic administration of this, like you had vaccine doses that were thrown away because there weren't able to be used in time. You had you know and a couple clinics where people were actually. I think there is one case in Wisconsin where a nurse deliberately spoiled vaccines, so I mean the fact is that they haven't done enough to build trust. They haven't done enough to train. People, did administer this and then just
Like the very basics of scale, I mean we're talking about immunize and potentially millions of people over the next few months. A lot of facilities are not set up to do this, like even influenza, which is recommended for everyone over the age of six months. Where
really doing millions of doses of that on a regular, ongoing basis. How we read that throughput of that is much lower months have slowly, who is the head of operation Warp Speed said this is anywhere from three to four times as large as our effort to
Immunize against influenza every year. So, while we have experience with rolling out vaccines on honorary,
basis. This is still on an unprecedented scale and the backdrop right is: it
the United States does not.
A horror of government public health people who, like could be dispatched to do this
and I think, a little bit contrary to the impression of a casual news. Consumer might have had
Operation warp speed did not work on their ride, like these
federal approach was to divide
The vaccine, to get it approved and then a logistical effort to deliver doses, to hospitals, basically ready to state
health officials and then states. You know who presume,
for months were aware that at some point
vaccine would be dumped on their doorstep. They didn't particularly do anything to like build capacity,
right. There's no conscription of nurses to go work. Eighteen hour shifts vaccinated.
Everybody right. So things are
in the hands of hospitals. It seems like mostly and their doling out vaccines
I mean I don't know it it at a somewhat leisurely pace right
This, like nobody exactly in charge,
right again, there's no upside wait. Some
for very good reason? We are not just auctioning doses of the vaccine to the highest bidder, but if
were doing that you could make in credit,
we'd large sums of money by administrate vaccines to people
and then you would have a strong incentive to like do it as fast as possible and like call people into work overtime because you be selling the hottest commodity and the market, but like right now, there's no. This ignore particular upside to you as a hospital administrator to get people vaccinated over Christmas.
So if people want to have Christmas off which, like normal people, do it seems like they just can it took the day off, I mean it
its useful to describe operation warp speed, not just as a no kind of deregulatory effort, which I think it is because the Trump administration was so vocal about trying to expedite approvals
that's, what took b
the focus of attention, but there was an effort to actually you know, set state allocations and get them there, and if you think, logically about that being that
at which the process broke down. Ok, yes, hospitals.
Dishes to everything you ve, addressed Matt, like are currently meant. More many hospitals in the United States are currently dealing with a worse.
Corona like are more overwhelmed by corona virus cases than they have been before. It's not clear how LOS Angeles County, which is absolutely underwater right now
on Toby cases would be expected to kind of speeding up this additional energy to come up with a good vaccine distribution plan state
events in- oh, yes, the there wasn't be investment in they weren't throwing money at cold storage chain.
To make sure that they would be able to store in a vaccine, but also state governments have been absolutely strap for cash for the last six months and were asking the federal government, not fur specifically for help with vaccine storage, but for
direct aid that was going to allow them to do any thing, and the federal government was not responsive to that's. What's not that surprising that a state government that feels very cash strapped and unable to do big things and hospitals that feel very
personnel strapped and unable to kind of spin off more resources. Aren't you know, are at work
putting in the pro active energy on this. That doesn't necessarily mean that there is more that can be done. I mean the folks who I've talked to who have actually gotten vaccinated have said, I
be more than happy to you knows, takes in volunteer shifts and help me there there. The thing about many of the people who have been vaccinated of our being themselves, healthcare professionals- is that there is. You know there is a pool of people there and you can definitely even imagine a world in which the kind of
Fourth, it was put into getting participants for vaccine trials was put into just making sure that people who signed up were captured by its also,
that surprising that in
absence of central planning. This has happened and it's worth pointing out that this inner again, this isn't just a matter of the
administration didn't think that central planning was the federal government's role. It just assumed that it could take it up to
State line, and that the state government
Take it from there right. Eliminating one thing I would add is that, like our health care system is very itemised, we have three thousand counties across the country and, as you know, there also cash strapped as well, and so they have no money to really scale up a lot of this administration that that you noted- and there were efforts at doing so earlier in the pandemic, with the previous relief bills. But those run the order of like hundreds of millions of dollars across the whole country, and we needed you know on the order of billions of dollars in terms of shoring up this kind of infrastructure and
only recently started coming through and of building that up now that you have some money allocated is still going to take time, which means
you know they were. They were trying to do. A lot with very little and
and we're seeing the results now
kind of like training. Do you need to it
studies vaccines. This is something that I've been about all sort of an unsure about looking at the site like who, what is it? What does it take to them
Somebody I mean in terms of the actual injection I mean the procedure is not super sophisticated. It sam. You know you Mew sanitized the spot that your injecting and then you I'm. U no use typical saran Jen inject into the muscle.
The bigger issue is going to be. You know complying with all the health care regulations things. I keep all laws, also
The intake requirements that we were talking about earlier? Basically, that you know you want to make sure you're administering the vaccine to the right people, and so
there have been talk about. You know, building up a medical reserve core, basically building some sort of cadre of volunteers who can administer these vaccines? You don't have to be, you know a certified nurse or any other kind of health care professionals, but you do need some degree of training in order to
a properly adhere to sterile procedure and all the documentation that's necessary.
But this is something that you know could potentially be knocked out in a weekend workshop. This is something that you could really I'm train a group of people in and as long as you have been supervised, while you could have
You know a group of people that can you know definitely.
Extend your reach as far as being able to vaccinate more people, it's just that that infrastructure in terms of just training, those volunteers and getting that those people out there is not there
In theory, it's easier to create that infrastructure than it is to you know: distribute Lake, cold storage lockers to a bunch of hospitals insofar as it's easier to quicker to recruit people than their manufacture. Things right so is there? Is that really so much of the bottleneck that it would be sufficient, or is that something that itself needs to be downstream of just the physical questions of do the hospitals that are receiving vaccines? Have the ability to store them worlds?
probably be a mix of both. I mean, as you know, two. Yes, somebody's vaccines have very stringent cold storage requirements. The Pfizer biotech vaccine, for instance, require storage and minus seventy degrees celsius, which is roughly dry ice temperatures. Now they develop these container that they say they can store the vaccine and for up to ten days, but
You know me that you are honoured
deadline for how quickly you can use those vaccines. I mean the bigger challenge. Still here is a little bit further upstream in terms of the administration in terms of allocating where these vaccines are going in the first place, I mean, if, if the manufacturer is saying we have unclean doses, I mean
then that that seems like that's it to be a bigger problem than than getting people to administer it. On the front lines, I mean that the fact is that we're not being able to get it from the factories to the storage facilities to the operators. If we're having hiccups that far upstream than then those seem to be the bigger challenges than the higher priorities at the moment, I think
Prioritization question is interesting because that
I don't know anything about like vaccine logistics is really hard, but prior authorization debates is sort of like finding easy for anybody who understands statistics in half
A little bit to weigh on- and I felt like when this was originally being conceived,
Besides the sheared premise of everybody right whether they wanted to try to
our ties the most vulnerable or prioritize those most likely to spread. Was that
would be incredible. Scarcity of doses right am I dislike robustly.
And so we were really saying like was who's can be allowed to get those, but it looks like in the actual administering did their spin at least like to row box. Ride like wine is. Some people are particularly nursing home AIDS who everybody agrees, should qualify
I took the shot, maybe dont want it and then also that trying to survive do the compliance checklist is making it difficult for hospitals
to administer the shots right, and so we had Andrew Cuomo threatening
tough legal action against people who dose the wrong people with vaccine.
Which sort of makes sense right, I mean you, don't want to see supplies diverted to like the development director of the hospital rather than a threat.
Nine workers, at the same time, if you mean-
every shot take. Twenty
and its longer than an otherwise might because you're doing a lot of paperwork and sort of reject gang
like did the cost of that can also be really hard,
right I mean, and so this
Maybe it's really confounded my expectation, but but it seems like
It seems a Google baby, we're thinking about the privatisation question that the wrong way around right and that we need to think about what sort of speed the process along more than who gets
not exactly because because, like the worst thing is for the this stuff, that has become very cold and tragic way. I mean
I do think there met your soldiers of a little short because I think you were actually you know
first person who I saw during the prioritization debates, making it clear that Lake
we should be so lucky to have demand outstrip supply for these. Let's make sure that the supply is unlock, and then we can figure it out and ended. The demand is high enough, and then we can figure out how to match those. Do I was worried about cheating. You know that
not so much that they come
cheating measure would make it impossible to even do any.
And I do think that it's really that be the the
Cuomo Lake punished
hospitals strategy, especially because one of the punishments being proposed is that they stop receiving doses of the vaccine, and it's very hard for me to understand from an equity standpoint. How, if you have a hospital that should be giving vaccines to group action, is instead giving vaccines to group why withholding vaccines from them entirely doesn't further
disadvantaged group acts and
honestly. When you put it this way, it's not something that should have been that surprising to anybody, but the extent to which failure.
Of very clear, simple communication about when you should get the vaccine. When you should start like
calling your hospital and asking if they have the vaccine. When you will be allowed to get the vaccine, if you want it, I it's. It is not surprising that that has created massive problems, given them how much we ve seen the absence or presence of clear communication about basics of public health having been in an import, a rolling the theme of this pandemic, but you know, I think that that there are so many downstream consequences of that. It's not just the.
Workers hugh everyone agrees? We should be getting vaccinated, who are actively refusing, but also the folks who are nominally in groups that would allow enow it like in in a classification. The would allow them to get backs needed now it because they are not
front line. Healthcare workers dealing with covered patients, don't feel that its their turn. Don't feel that they deserve it want to make sure that it goes to the neediest people. First, there are
obviously, cases in which people may not be aware whether they ve you know what category they fall into, because there's no effort a proactive communication, that's kind of breaking the whole question of what,
already effects of.
Seeing stories about healthcare workers, not wanting the vaccine, and you know to what extent is that it.
Problem for the rest of the for the rest of the system, which actually think is probably worth getting into a little bit on its own, but this
fairly, easy to fix right it. Wouldn't it's not that hard to come up with. You know,
even if that's not going to match unity,
It's going to get out.
Strip the number of actual doses available to be injected into arms. It's not it wouldn't be that difficult to imagine a campaign that was like. If you fit one of these criteria, you should call your hospital and you'll be put on the vaccine. Waiting less GINO and you'll be the first ones to get served like. There are easy ways to work around this, but again mad it, as you were saying that with that would have required thinking less about you know,
We assume everyone's gonna be lined up outside the door. Who do we let in first and more about how do we make sure there is a line so that nothing is expiring? On the shelf yeah, I think one instructive example here might be looking at the country of Israel, which has one of the highest rates of vaccination in terms of per capita back centuries of their population in the world. Right now, and they do have you know our priority list, but they're not very precious about it. In fact, you know that there are a lot of reports where, like near the end of the day, nurses will walk out of the hospital and look at anybody on the street and offer them the vaccine, like literally pizza, delivery drivers because they're like we have axing doses that are about to expire,
Would you like to come in and get a shot? Here's your slip come back in four weeks to get your follow up
and you know, by prioritizing aggressively, to getting shot into people's arms. You know they get their vaccination rate up, even though these are not necessarily the highest priority people. You know you are going to have twenty year olds in thirty year, olds were relatively healthy where that are vaccinated, but it's
not necessarily at the expense of somebody at higher risk, its basically role,
to a vaccine being wasted or unused, and so, when you frame it that way, I think
and you start not being as precious about prioritizing the.
We keep all you know you can actually get to a higher vaccination written that might be a strategy worth considering beetle
to me once more striking about the israeli case.
It's not even though the prior disease,
in staff, but that you all day
thought in advance as a you always do in Israel. You say wall what's gonna happen on sugar.
And they called in some of the orthodox authorities and they had them sprinkle the matter.
Dust were I forget what the hebrew word is: I'm jewish by the way, I'm not I'm not making light.
But there's like a proviso that, like you, can do work, that is life saving activity on the Sabbath that that is considered
Kate. I'll bet. You need like a ruling from some authorities there, like notice cats, and so they they got there.
So that everybody, no slight gas like keep coming to work on saturdays and on Fridays, after Sundown, keep doing
explanations and you don't that's a big deal. Theirs.
Ways questions and in Israel about what you should should be allowed to do on saturdays and and they made a sort of clear state
and about that, whereas the United States,
had a much more kind of relaxed approach. I think to actually doing the work of vaccine
duration, Israel just attack this problem with a greater degree of urgency than alot of american sorted
states really dead, I'm at some of that has to do with the money you know and other things, because he people you can just conjure up staff had nowhere. I any fun. Let's have a brain.
Now, though- and I want to ask me about a couple- other vaccine thinks
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I've just been a little mildly curious about this. Remember like what's up with these other vaccine that they have approved in the UK, but that American.
You later signal to like this is the asked Rosetta University of Oxford vaccine
like the Madonna vaccine and the Pfizer biotech vaccine. There have been approved under emergencies. In the U S, these are able all using completely new technologies.
The astronomical vaccine uses a different new technology. The Madonna and Pfizer vaccines both use messenger RNA as their platform, which is
a strand of genetic material that is inserted into the body and in the body starts manufacturing components of the virus.
The astronomical Oxford University vaccine, this uses and add no virus as a vector. So basically, what they do is they take another virus. They re programme it so that it actually is
The information for making a part of the Sars Covey to virus the virus that causes covered nineteen
and the advantage of this strategy is that, because this packaging, this adverse packaging exists in nature, its shelf,
stable it tends to do really well at borders. Refrigerator temperatures you dont have to keep it at these ultra cold temperatures and because its using
I naturally occurring virus to package at you know, you can also reduce some of them any factor in costs, and so this vaccine has a much better cost advantage. It's about three to four dollars per dose, whereas the m already vaccines are between fifteen to twenty five dollars per does, which you know if you scale that up for millions, if not billions of doses. You know this is a huge
financial margin, and so this is the vaccine that a lot of
developing countries and a groups are really leaning on. This is the one that they're talking about as their priority for distribution, because it's the one that has the floor.
Was constraints at the lowest cost part. The reason that it was approved in the United Kingdom is that the UK, their regulatory body does approvals differently than the food and Drug Administration, the? U S, they do things on a rolling basis
and they are pulled from two different clinical trials. There was a clinical trial in the United Kingdom and one in Brazil that they drew information from,
these trials had some issues with them. I mean in one of them. Aid actually had a dosing mistake where they live
if they gave a much smaller first dose than they were initially anticipating and for some reason that actually lead to a much stronger efficacy. Now
with the proper dosing regiment, and they also used to different kinds of placebo controls.
And so for, for those reasons, the FDA was a little bit sketchy about using that information to grant an approval and in the United States there is also another independent.
The retrial that's going on right now and
officials in the. U S say that they will use that as their bases for approval. The results from that probably will not shake out for a few more weeks. Maybe it might be a couple months, and so that's why the? U S is
being a little bit more hesitant with this vaccine, but the UK is charging had so
is the the
concern about the Baghdad that the vaccine might be
save for that it might not work like. What's what what what
risk should we understand the UK to be taken by sorting giving the green light to the space time. Flawed.
I mean it's generally hard to tell how efficacious did I mean? That's what I mean.
Point of these early clinical trials is right. These trials are designed to answer several questions, but the first one is: how well does this work right? That's the first and point of her
a point and we got very strong signals with the image of a in the Pfizer biotech vaccine roughly in the ninety five percent. Efficacy range against preventing
covered nineteen disease, but
got mixed results with this disastrous Attica, Oxford vaccine, because in one of the trials it was roughly around sixty five percent and another trial is around ninety percent and they average it out to about seventy percent efficacy. So,
not quite sure exactly how that shakes out. It is that's the main and point that you want to consider, especially when you're done
The cost, benefit analysis of how well
this workforce at risk? Are you taking? You know that that becomes a little bit harder to make when the benefit overall benefit is not ass, clear and it seems to be a little bit lower so
that that's that's the main rest. But beyond that I mean it's a little bit more difficult to tell I mean like in terms of
reactor generosity or in terms of people having adverse reactions, you tend to see those pretty early were after somebody's vaccinated, and you haven't really seen
its complications with this vaccine or with any of the vaccines we ve it authorize. So far I mean to me: one is allergic reactions and a few people who have a history
Anil access and maybe why I think at least one person who didn't have had severe allergic reactions, but there are very, very tiny minority.
Of cases, and so in terms of like
reactions right away, that's ten
you're pretty low risk. The other risk that Europe kind find a mitigate is long term risk. Basically, what happens over the course of months and years,
and that something that you can only see by waiting in seeing essentially just have to wait that duration of time to see, if there's any complications and also see how durable that immunity is
in terms of the overall risk. As you know, the yeah- not it's not- that high
if we want to talk a little bit about the whole side effects question, because it gets into
you know the the
big hard difficulty at.
Part of this, which is just even
if every lever that can be pulled,
my government gets pulled, is public trust going to be high enough to have high uptake and mere I'm wondering how you think about this is a science rapporteur, because I personally and thinking back to the white Paper, we looked at a few weeks ago, Matt on media coverage of covert nineteen. I have been surprised at the number.
stories, I've seen that are anecdotal reports of you know, o
This one person had side effects. I
stand like, as as rapporteur. I understand that that's a very difficult
to you, you know,
strain yourself from doing because you don't want to be.
Suppressing news, and it does seem that this is you know it?
because it is unusual, it is to a certain degree newsworthy but like how do you as a science reporter balance the need to not kind of arm p,
Who might be arguing that the vaccine is more dangerous than it in fact, is versus the desire to not hide the truth from people by not letting them know when there are scientific cases.
Maybe that's that's a great question in its hard needle to thread, but what one not epidemiologists Tommy's I treat people like adults, you know you, you talk to your readers and try to
the risk as well as you can for them? You dont want to hide them. You dont want to mislead people about patent
problems, but you also don't wanna overstate them. There are risks with every vaccine. You know these is. This is a medical intervention. This is a pharmaceutical. This is a drug that you're injecting into your body, and there are people that will react adversely to it. This is a known issue with vaccines in the United States. We have the vaccine injury compensation fund. Basically, we know that
If we administer vaccines was many people's possible we're going to have a certain rate of complications, and we want to make sure that we compensated
harmed by that is part of our public health strategy right with a dead, that's factored into it. We want to get those complications as low as possible, but we know that there are not zero
That's true. These vaccines, as well now because they're using a new technology. There are,
You know, potentials for risks that we have not anticipated, and it seems
like early on we're, seeing that these vaccines are a little bit more. What scientists call reacted Genic. Basically, they provoke,
slightly stronger response right away. People have a bit more of a sore arm or a headache or a fever, and some doctors are saying, like you know, if you're gonna get this vaccine scheduled a day off work, so you want to
Let people know what to expect, because you don't want them to be surprised by what happens, and you also because these are two does vaccines. You wanna make sure they come back and saw. Somebody has a reaction. You want them to understand that you know this is normal. This is within than normal parameters, and you should still come back and get the follow up and whatever reactions are experiencing is still far better than getting this disease itself
and then also for the more severe complications like these severe allergic reactions. We ve seen a couple viewed over reports about you know.
Television or send that if you have a history of severe allergies, then you should probably avoid these vaccines and that's probably the best course of action at the moment.
If you got a media level, that the headline of some of these stories about the severe
site. Fags has been really is possible. I mean
I think of your return. Was you have to ask yourself rightly if you
heard story. There was, I see
bodies toaster didn't work and they got burned liquid. You write an article
like this one toaster didn't work right. You might investigate right. Like does this brand of toasters?
have some kind of catastrophically. High error rate, like did the consumer product Safety Commission like forget, to evaluate the toaster the night she happened
spread like a note if you want to do a story about your side effects, because people are curious,
Sweet of you d write up on Monday. It's like how many p
have have severe side effects and it turns out to be one in a million which turns out to be for people like
We ve given formal. You doses like ok, fine, like that's a true accurate story, but if you
What's a good you put in a headline is, is do is right and you know lots of people have over the years criticized like it bleeds. It leads as a local news mantra,
because these millions of people in the natural area and the fact that one of them may be got murdered.
Is not necessarily tell you like
what's happening in your society today, right where's like us,
Mystical story like murders, Europe forty percent year on year. Like that, that's a store, you know, and people people should be surprised,
and I have been taken aback
given how I think, like a lot of media people's membranes vested in like doing responsible public health over the course of this pandemic.
Away? That's that's good and desirable, but then
the wire services like really kind of one wild and the first couple weeks of just reporting
I mean there's hundreds of millions of people in the United States like bad things are happening to somebody every kind of day
A out behind
allergic reactions to clementines, like I don't know like you, need it.
I've given people perspective
like you, really not advancing now. Yes, I definitely think that this is yet more evidence that so much of the conversation about like
de I coverage purports to be about the text of the way articles are written but are in fact about the way
You know the kind of adults
meadow data of an article, including the headline, including whether its push notified- I add my part.
Got a push notification from Ed NEWS Organization that sends out a lot of that that that has a very broad audience for its push notifications about,
a pair of adverse reactions to the vaccine and by deeming that push notification worthy you're. Sending another signal about how important this data point. As I bet you know, I
I also think that to assume
an extent this is this? Is the
you have drunk under a street late problem right, like you're looking for the keys under the street late, not because you think you drop them under this related because that's where there is light
I think a lot of the concern about media coverage of this as legitimate as it is an obvious that, like I've heard it up, is
Wait you direct
the concern that there is going to be low trust in this vaccine to something that can be discussed
controlled right like like do because there are people who are amenable to media criticism. There is a certain extent to like work: the rafts in the right direction.
Rather than deal with the fact that the apparent fact that there may infer
to be a lot of people who
full of the vaccine, and also distrustful of those media outlets, and in oh Mary, you mentioned the sabotage caisson was concerned. There is also the case in Colorado of Healthcare Professional, refusing to like deliberately spoiling a bunch of vaccines, although not then injecting them, and you know between that and the attic data of low uptake among eligible workers that appears to be driven by they just don't want to do it. How much of a sense do we have right now of how big a problem is people just dont trust this thing, and how do you deal with that?
I mean it's hard to say. If you look at the appalling
earlier on a pandemic, and now you see that you know people are more interested in taking a vaccine now than they were maybe three or four months ago, and so so the confidence in a vaccine has kind of gone up
and- and I think that the food and Drug administration for some of its earlier missteps earlier
the pandemic when they approved questionable drugs they ve, been, they ve, been sticklers for sticking to you know their guidelines now for these vaccines almost, I think somebody somewhat argue to a fault,
and that's what they say is going to help them boost confidence that basically, that they're not going to yield on what their parameters for safety and efficacy actually are
but that's I mean you're going to be in also in ongoing challenge. I mean it has. As you know it, you know, ass complications arise as as more people take these vaccines. There's going to be also a plethora of annex data of people having you know, maybe,
some of the mild side effect some of the more severe side effects or some people just be no spreading more misinformation. That's that's going to be an ongoing process
in a single member about liking or transmitting this information is. It is practical as well, because, right now these vaccines are being authorized under emergency use, which means
their authorized. Basically, you have to make that cost benefit analysis, that the benefits outweigh the risks and so say, for example, pregnant women.
Pregnant women were deliberately excluded from clinical trials right, you don't want to run medical experiments on
pregnant women, you don't want to run medical experiments on children. You dont want to run medical experiments on people who are being compromised, but these are
people groups that could actually benefit from a vaccine, and so now they have that discretion. So if you are a pregnant woman
and you have the option of getting a vaccine- that's never been tested on pregnant women. Like what data do you draw on right? You need to have some sort of reference point, for what was the complication rates are what the risk factors are, because, ultimately, you are going to have to make a decision one way or another eventually Reno. There are still talk about whether or not we should be vaccinating children, or at least you know, teenagers, because they are the ones that are that could potentially be spraying the disease. I mean like what information that we have on that its very limited, but
and because they were largely excluded from trials. We don't have good data, but eventually they will have to. You know extrapolate from what's out there and so,
yes, I mean I understand, is theirs- is impulse to have this pro social reporting,
You know a static, or this idea that you know you want and encourage people to do the right thing through your reporting and things that benefit society. But
at the same time, also like it, it is also very important to be you know as clear, headed and clear eyed about what that risks actually are, because they do have practical benefits as well.
Sometime when Joe Biden has blessed us with like a slow news month? I think, like
actually the whole question of clinical try.
I was for pregnant women is a fascinating, Elsie issue, because
As you say. It's like this, so many good reasons to not run them, but then
lest of medications for which it
I can you take this if you're pregnant dislike question mark question mark is so incredibly long, and you know it includes,
seems like all kinds of ITALY.
President things that they really help people in its it's. It's a kind of like dark zone of public policy.
Nobody, nobody like wants to open up the doors to like dodgy seeming experiments,
also nobody wants, did to gonna go first and their staff
You I was it would, with the reluctance reports, I'd read: seventy six where they write all we ve got forty percent of healthcare workers. You dont want to take it. I said.
You somebody a friend of mine who is a psychologist.
She had been offered the vaccine and she declined it and
and are superficial. Read of the dad. People would be like a hot health care worker who doesn't want the vaccine, but she
The thought that, like everybody, was clamouring to get this thing and now
she's, really just seeing patients on zoom and it really deserve it.
You wanna take somebody else's spot, didn't we
we read in the newspaper the following day: deadline
actually only happen.
Of the available doses, will be given to everybody,
I came back around, was again just give it to me. You know later
but so that we like she was trying to step aside. I also heard somebody works for a labour union that represents a lot of nursing home AIDS and the West
that a lot of his members have already had covered.
And so they were saying that day I mean, I think, is unclear. If its will, they didn't want to run the risk of the vaccine
in or they just didn't, want to soak up the supply the one way or another? It was like the conventional wisdom among the staff at this facility
Was it like a huge epidemic had blown through it all had it.
A lot of their people in their care had passed away. Many had not the staff you know had largely,
but I've one way the other like. What was the point of doing the huge vaccination drive there, which didn't
I mean that strike me as a crazy. Why
thought I mean. I know your questions
How long acquired immunity lasted Et Cetera, but like probabilistic me right?
especially in the absence of clear affirmative communication from the government that, even if you've had this, you should be lining up to get the vaccine right. I mean, I don't know.
Did you see blogger? You know not an obvious,
to me Ray. I shouldn't they pass them
to somebody else. So I think that that anyway, I definitely the extent to which this is genuine reticence versus the kind of
You go first through the door route. You know, courtesy routine, that can be pretty easily sorted out. Is that will probably become much clearer in the next couple of days or weeks? But I
Do you think that it's worth paying serious attention to the few cases that we do know of of health,
are professionals, affirmatively, refusing or or worse, meddling with the vaccine, because for one thing like, obviously, if someone is tampering with the vaccine before injecting it to make it less
active, that is going to have massive effect both for the people. Who are you
are now at risk of getting infected, even though they think they ve been vaccinated. That will then have effects of making people think that the vaccine isn't worth it and lower uptake, and it also just complicates the question of how much can we really be talking about the media as the relevant proposal entity right? Because, if you think about that, but the assumption there is that we are in the bin,
of informing potential consumers of the vaccine, not potential administrators of it. They are assumed to be professionals who are, like all you know, lined up and doing the pro social thing and in line with what best,
practices in their industry tell them, and if that is not the case, if there are, in fact in our health care being a massive industry in the United States and there being a lot of people on the
lines who have gotten into that profession for reasons other than they have the same belief in capital S, science and the validity of clinical trials, and all of that that people who are making decisions at the CDC do then,
we have a bigger problem.
And it's not. I mean obviously it's it's a covert vaccine problem, but it's also just public trust.
Not just its expertise but like in the person whose administering the vaccine to you- and I just its varied.
Difficult to weigh the kind of how serious this versus how much of an outlier is it. But then
I think, is something that needs to be grappled with is very different from just people not wanting to take it themselves. For whatever reason, let's
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I'm about to put tourism scandinavian names, everybody, our favorite,
This week's white paper is the unequal distribution of opportunity, a national audit study of bureaucratic discrimination in primary school access. It's written by an apologies to the Danes, whose names I'm about to mispronounced augments, less Olsson and Joan
hold Keys Anderson as well as Donald Moynihan, from Georgetown and
The study use is primary schools in Denmark as a way to look at how we are familiar with in a we ve talked about this, a bunch on the weeds about it as white papers and kind of an inn. Intersecting policy debates about the use of audit studies to measure discrimination right like if you put a black name on top of tourism, favours a white name. What is that, due to job offers, that kind of thing in the context of government there's been research on that
especially in the United States, but its law.
Been been through the mechanism of am
pretending to be a constituent of yours, and I want some information on how I can vote or how I can attend,
the how I can enrolling public schools and so what your measuring berries, how likely is
politicians, office or the bureaucracy to respond to that request for information. What they're doing in this study is. Instead,
using the way that the danish public,
whole system works too.
Email and ask? Do you have space for my third greater? We would like to change schools and what they find in. That is that the number of emails where it is coming from a
stereotypically muslim name of the parent who is who is making this request are much more likely to receive irresponsive. No sorry, we don't have any room for your kid and slightly less likely to receive a kind of clear. Yes, you know please come
but much more likely to get that clear rejection? Then parents with stereotypically danish names. This is its useful, because it's not you know the kind of
asked for information School of audit studies, measuring something that is at the core of what the bureaucracy does right. Yes, it's an important function of constituent relations for our congressional office to be willing to tell somebody, regardless of what party it looks like they might vote for. Here is how you can vote, but when you're
looking at something like this, where it is an actual decision with a cost that
phrase is much more serious concerns about who are the people who you're rejecting out of hand? Who are the people who you're kind of allowing to continue to go through the process? And how easy are you making it for them? Are you asking when you if they did find that the
in the muslim name case. They were much more likely to get kind of. These simple follow up questions about like tell me where your child is now how you know how old are they? What's their name that weren't, obviously
anyway, the same as a straight up rejection, but that might raise the cost of continuing to comply and might make it
may create a chilling effect in willingness to take advantage of these government services, to which everybody is ostensibly equally entitled at you
the interesting window into nordic governance. I thing, which is that you know if you, if you think
of terms of broad stereotypes. Wait. The nordic countries have a larger public sector
It's also generally do not perceived by people to be more effective than the american wine. If you ve ever been to those countries and tried to investigate this year,
see that part of it is that it is a less bureaucratic kind of system which is not I'm currently in
mean for a few weeks. And similarly, if you in writing,
town officials. Here, it's
it small town and light there more helpful there. More proactive density officials in DC
and it's easy to see. This relates to vaccine administrations. Well, that Europe, a more flexible and empowered civil.
Service can be much more helpful and much more effective than an incredibly wool bound and bureaucratic one, but it can also use that power in a highly description.
Tori Manner rights in the United States. I think that this would happen because, if you want it
two reassigned. Your kid to a different school in a large urban public schools.
Direct there will not be anybody. Could you can email at all right
There's a big central office is a really annoying process, but its equally annoy forever.
To go through the my school DC water right. It's completely do personalized and somewhat annoying, but, like that's, the point of like strict bureaucratic rules is to be fair rather than to be a sort of bringing up a random principle and he's like our well enough. I want to get my school and then a kind of
whereas I'll be I'll be helpful, seems he seems like a nice little haired or something there, and and don't want
think. That's a real tradeoff. We face in the public sector that, when you give people more degrees of freedom deserve use their best judgment, they can probably too
a better job, but they also get to define like what they think the better job it
a lot of effort. Races
in danish public life, is really really high. I should also say like much less stigmatized than in,
United States and you know so, I think not
surprising that people will sort of use their discretion in it.
Save ways than a really can be harmful. To I mean harmful to the people affected press are harmful to the sort of Norman
the goals of integration and social cohesion that danish politicians tell themselves their training
AIDS, so I mean, I definitely think that this is. It is true that greater degrees,
discretion make it,
easier for that discretion to be using discriminatory manner, but I do think that
your account kind of under states, the extent to which
in a process that is difficult for everybody differ
you'll compliance costs matter. So much more right in it
difficult for anybody to navigate the system. Then how welcoming is the person who is trying to
help you navigate it, and this is where you know. Their requests for information that have been the focus of other studies do become very important in
not just as signals of do read the government like you, but as
We are going to lower the amount of effort that it requires for you to get this thing be entitled to, and so that you know looking at that and
you're gonna, who is being asked to provide more information who is being treated with a degree of initial scepticism who is being told that they should or should not be eligible for things. You know, and they theirs
Obviously a lot
The extent to which immigration policy has a NATO has as a lot of this kind of like bureaucratic step for
a chilling effect issues and in order to test site something that was fairly well covered during the trumpet ministration?
appears to have been a drop off,
in public benefits, use among immigrant families after the proposal of a regulation that would make it harder for people to get green cards if they use benefits in the past. The overlap of those two was very minimal right that the benefits that people weren't decent rolling from things that would actually disqualify them in the future of mutually they weren't eligible for them at all, but because you're dealing with a population that has to do other things with its life other than figure out exactly which government benefits they are eligible for. The lack of clear, proactive communication or feeling like the government was going to be on their side. Do you know, does a lot of the work there, so I do think it's worth.
Think I mean I think that, ultimately, I'm not sure that the nordic model of you assume the government's going to beat, make it easy for you and they just have the ability to make it harder for some people is going to be that much more discriminatory than a system in which its difficult for everyone and some
get the benefit of the doubt and making it a little bit easier or getting some help. My thoughts,
Well, I mean one thing looking at his paper that I just I was kind of interesting is that they tried to quantify tone and just how friendly people worth via via email, which is always just kind of interesting, because that was just not a metric that I would have ever
to consider when it talks about allocating public services, but you know they Dade note in there.
For that you know. This is something that see no significant, it's kind of hard to quantify, but it is it. It doesn't that being a barrier when you're treated with initial hostility or with you know this cold formal,
bureaucratic, speed, verses. You know hello, high and being addressed by your name,
and so I am looking at the results here doesn't look like there was that big of a difference between the Muslim named group and the people with small stereotypically danish names, but
You know they did. It is the fact that they chose to highlight this. I thought was a kind of significant that or just interesting that this is one of the variables that might be worth looking into a little bit further, something that has
a little bit less of director tangible impact, but something that could on balance or in aggregate actually have
more significant implications,
yeah, and I will that just because that's exactly the kind of thing we're like. I look at that. No papering, though, how on earth
Did you measure this in a way you can be sure you weren't just reflecting what you wanted to see and like Methodological II, the papers authors make it.
Here the day,
Dave they removed all identifying information from the responses so that it wasn't clear what name schools
They were responding to before sending them to the people who are responsible for four coding.
Interactions is formal versus informal versus Ino versus
on friendly and that there was a very, very high degree of correspondence between what Lake quarter a gave, an interaction and what could be gave it, which is.
various suggestive that, to the extent that they are seeing difference is the most obvious one being the difference in much more likely to be asked simple questions. There was a little a slight difference in danish
are given a little more of an informal greeting versus the formal, like dear so, and so, and
to the extent that those differences are prey.
And in the final paper, it does appear that that is not the result of people trying to read into its red discrimination into neutral exchange,
because they weren't necessarily aware which of those were supposed to be discriminatory. Citizens
the broader thought? But you know these
a lot of talk this year about
shall justice, and things like that, and I keep thinking that are underrated idea, would be to actually put money in resources into the civil rights Division of the Justice Department running a lot more audit stakes and with such is being done by random academics, but got up and envy yard. This is a pretty well developed analogy at this point
People who understand I to run these studies, how persuasive they are, but inside
a couple. Danish academics with one Irish born living in amerika-
public administration scholar, George Town tonight, off random, stating that danish public schools
Does it doesn't necessarily achieve anything?
in the way that doing the same kind of research but like from a regulatory and can see you
if it's too should in an organised way wade.
In some ways it's like
hello almost compared to some of the big topics that have been under discussion this year, but all
who seems much more like actually doable like you could write a line IDA into an appropriations bill barking up the tea, a man. You know you can hire a few people,
good, maybe lefferts lawsuits, maybe just at Paris some people.
Some institutions, but it just it seems like a potentially promising way to drive real
change, what's going on and expose very serious problems, so I dunno, but that out there for
members, I mean I think, for that to be worthwhile, though you would,
to have more uniformity and clarity among federal,
court jurisdictions over when statistical evidence of disparate impact is sufficient in demonstrating discriminated discrimination, because there are various methodological ways that you can try to
identify the mechanism by which discrimination is happening in an audit study, but at the end of the day, your evidence is still you know,
brought evidence of disparate impact, which not every
in the EU. Has many many courts? In fact, I do not consider sufficient to demonstrate that it did. A population is being treated unfairly or statistical. Evidence of discrimination is different from statistical evidence of disparate.
Yes by I mean it
This kind of gets into. I think, a broader discussion of how social science expertise is treated in in the context of the judiciary, because you can't actually like an audit study is not direct. Evidence of discrimination is a plausible hypothesis of discrimination based on direct evidence of desperate impact of that
a concern and the other problem with discounting you enow evident statistical evidence of desperate impact as a very suggests?
stiff piece of evidence, for discrimination is that you know. One of the mechanisms that discussed in this paper is the idea of statistical discrimination which isn't just like discrimination. That's revealed through statistics, but
discriminating against an individual because of your assumptions about what their group is more or less likely to do in the future. One of the things that they did here
What is including some of these letters to school districts align about you know my might childs teachers say that he works very hard, but we're still not happy with our school to see. If there was a difference in you know
muslim students were more likely to get offered places if there was that evidence that they were going to be dragging down any one school performance, and it didn't turn out that that was a substantial factor, but it's definitely something that you want to be sure. Is you know you? You want to be sure to
figure out whether discrimination is being based on some kind of quota for rational. You know: well, people an extra are more likely to be. Why so? We're not so we'd better, and I assume that this person is going to be the exception verses. What they call taste based discrimination, which is the kind of capital, are racism that you know it
everybody is able to agree as racism which had just rooted in fundamental animus.
Therefore quarter inferior harder to change by showing that, in a counter evidence bait in cases where the existing statistical evidence reveals in existing inequalities. Perpetuating those inequalities by relying on the evidence becomes a problem in and of itself as it
place to stop. Thank you. So much Omar for enlightening us about many things. Thanks also to our brand new producer, Eric Tenika, who were really excited to have on board, the weeds is glad to get back to the news here, two thousand and twelve one thanks always to our sponsors on Friday.
Transcript generated on 2021-05-13.