The costs of not maximizing aggregate utility
By Scott Sumner
Many people don’t like utilitarianism. They advocate alternative (often deontological) approaches to ethics. In 2020, we saw the immense costs of some of those misguided ethical systems.
Scott Aaronson has an excellent post that begins with a discussion of why he believes our response to Covid was inexcusably slow. He discusses challenge trials of vaccines, and also a WWII-style plan to build manufacturing capacity just in case the vaccines were successful. But he also considers possible objections to his arguments, such as the fact that moving faster imposes risks:
Let me now respond to three counterarguments that would surely come up in the comments if I didn’t address them.
1. The Argument from Actual Risk. Every time this subject arises, someone patiently explains to me that, since a vaccine gets administered to billions of healthy people, the standards for its safety and efficacy need to be even higher than they are for ordinary medicines. Of course that’s true, and it strikes me as an excellent reason not to inject people with a completely untested vaccine! All I ask is that the people who are, or could be, harmed by a faulty vaccine, be weighed on the same moral scale as the people harmed by covid itself. As an example, we know that the Phase III clinical trials were repeatedly halted for days or weeks because of a single participant developing strange symptoms—often a participant who’d received the placebo rather than the actual vaccine! That person matters. Any future vaccine recipient who might develop similar symptoms matters. But the 10,000 people who die of covid every single day we delay, along with the hundreds of millions more impoverished, kept out of school, etc., matter equally. If we threw them all onto the same utilitarian scale, would we be making the same tradeoffs that we are now? I feel like the question answers itself.
And it’s not just vaccine development; we’ve also prioritized “ethics” over saving lives in the distribution of the vaccine:
Update (Jan. 1, 2021): If you want a sense of the on-the-ground realities of administering the vaccine in the US, check out this long post by Zvi Mowshowitz. Briefly, it looks like in my post, I gave those in charge way too much benefit of the doubt (!!). The Trump administration pledged to administer 20 million vaccines by the end of 2020; instead it administered fewer than 3 million. Crucially, this is not because of any problem with manufacturing or supply, but just because of pure bureaucratic blank-facedness. Incredibly, even as the pandemic rages, most of the vaccines are sitting in storage, at severe risk of spoiling … and officials’ primary concern is not to administer the precious doses, but just to make sure no one gets a dose “out of turn.” In contrast to Israel, where they’re now administering vaccines 24/7, including on Shabbat, with the goal being to get through the entire population as quickly as possible, in the US they’re moving at a snail’s pace and took off for the holidays. In Wisconsin, a pharmacist intentionally spoiled hundreds of doses; in West Virginia, they mistakenly gave antibody treatments instead of vaccines. There are no longer any terms to understand what’s happening other than those of black comedy.
Everyone is entitled to choose their own preferred ethical system as a guide to their daily life. But there is only one reliable ethical system to be used in public policy—maximizing aggregate utility. As soon as you ignore that goal, you end up killing lots of people for no good reason.
In retrospect, none of this should have been a surprise (although I admit to being caught off guard.) I had assumed that our disgraceful policy of banning kidney markets was a one-off exception. Now I see that the same instinct that leads to tens of thousands of excess deaths of people with kidneys disease also pervades our entire public health system.
Aaronson understands that this failure goes well beyond one individual or even one country; it’s a broader failure of society:
Furthermore, I could easily believe that there’s no one agent—neither Pfizer nor BioNTech nor Moderna, neither the CDC nor FDA nor other health or regulatory agencies, neither Bill Gates nor Moncef Slaoui—who could’ve unilaterally sped things up very much. If one of them tried, they would’ve simply been ostracized by the other parts of the system, and they probably all understood that. It might have taken a whole different civilization, with different attitudes about utility and risk.
At the same time, I do believe that utilitarianism is gradually gaining ground. But there’s still much more work to be done.
HT: Matt Yglesias