comment by Douglas_Knight ·
2020-06-27T02:09:00.723Z · LW(p) · GW(p)
Are there compendiums or classifications of trolley problems?
What is the most extreme real-world trolley problem? By "real-world" I mean something that really happens, emphasis on the plural. I don't want one-off examples where one person has the moral luck of having to face it and everyone else can breathe easy that they didn't have to think about it. I want examples where there is a definite, known policy. By "extreme," I mean something that really pushes people's buttons. By a classification, I mean a classification of which features make it more like a visceral trolley problem and which more like a blurry statistical haze that allows trading lives.
I propose a candidate: the dengue vaccine. In any event, I think people will find it interesting.
Dengue fever is an often-fatal mosquito-born tropical viral disease. People develop immunity, so we could make a vaccine. Obvious candidate, except ... Since we are all now experts in antibodies, we all know about the crazy phenomenon of antibody-dependent enhancement, mainly observed in dengue. It is not one virus, but four closely related strains with different envelope proteins and different immunity. If you get one, it's a non-lethal disease and you become immune to that strain. But you're still vulnerable to the other strains and, for not entirely clear reasons, infection with a new strain is much worse.
If you've already had some variant of dengue, any vaccine is better than none. But if you've never been exposed, it might be worse than not vaccinating. So of course the vaccine is a combination of all four variants. What if each of the four vaccines had a 95% chance of working, independent? Then someone receiving the vaccine would have about a 20% chance of not being vaccinated for all four. Let's say that's worse than nothing. Vaccinating everyone is a trolley problem benefiting people who have been exposed at the expense of those who have not been exposed. Both the benefit and harm is statistical (you don't know that you'll ever get dengue in the future), but the two groups of people can be identified ahead of time, not in a God's eye view of who will be bitten, but in a really potentially testable way. You could just test people for antibodies. If you're first-world-rich, perhaps a tourist from the first world, you can get repeated testing for antibodies and if you ever test positive, then you should get the vaccine. But the testing is more expensive than the vaccine (and logistically complicated) and Filipinos are poor, so we're not going to pay to test them. Should we choose some simple criterion like an age threshold and living in a badly hit area and just vaccinate everyone?
This was a hypothetical and I'm not sure if people were ever faced with this decision. If so, they decided not to pull the switch and instead kept working on the vaccine until it was much better than 95% effective. It was so effective (at least as measured by producing antibodies) enough that they rounded it off to 100% declared the problem solved and vaccinated a bunch of Filipinos who were old enough that they'd probably had it once.
And then the data trickled in and it saved lots of (net) lives, but it wasn't quite as good as hoped. People who had been vaccinated still got dengue, just not as often. But surely that meant that people who hadn't been exposed before were promoting mild to severe dengue? This seems pretty obvious, but they put their fingers in their ears and waited for the data to pin that down. That waiting, or maybe something else, burned their credibility and now the WHO policy is that you shouldn't give anyone the vaccine without an antibody test. Practically speaking, that means no vaccines.
This is a trolley problem that happened in the real world and the fact that the groups of people are potentially knowable seems to really important to reluctance to switching tracks. But the rejection of the vaccine is not purely the result of the trolley problem, but also about burnt credibility.Replies from: ChristianKl
↑ comment by ChristianKl ·
2020-07-22T10:09:45.773Z · LW(p) · GW(p)
But the testing is more expensive than the vaccine (and logistically complicated) and Filipinos are poor, so we're not going to pay to test them. Should we choose some simple criterion like an age threshold and living in a badly hit area and just vaccinate everyone?
While testing is more expensive then the vaccine it's something like $10 which is a third of the daily wage of am average Filipino. If you can communicate that the vaccine would matter a lot and testing for it is really good it seems to me like you could get people to pay for it.