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This narrative – that "others," often from far-flung places, are to blame for epidemics – is a dramatic example of a long tradition of hatred. In 14th-century Europe, Jewish communities were wrongfully accused of poisoning wells to spread the Black Death. In 1900, Chinese people were unfairly vilified for an outbreak of the plague in San Francisco's Chinatown. And in the '80s, Haitians were blamed for bringing HIV/AIDS to the U.S., a theory that's considered unsubstantiated by many global health experts.

Some public health practitioners say the global health system is partially responsible for perpetuating these ideas.According to Abraar Karan, a doctor at the Brigham and Women's Hospital and Harvard Medical School, the notion persists in global health that "the West is the best." This led to an assumption early on in the pandemic that COVID-19 spread to the rest of the world because China wasn't able to control it.

China's response was not without fault. The government's decision to silence doctors and not warn the public about a likely pandemic for six days in mid-January caused more than 3,000 people to become infected within a week, according to a report by the Associated Press, and created ripe conditions for global spread. Some of the aggressive measures China took to control the epidemic – confining people to their homes, for example — have been described as "draconian" and a violation of civil rights, even if they ultimately proved effective.

But it soon became clear that assumptions about the superiority of Western health systems were false when China and other Asian countries, along with many African countries, controlled outbreaks far more effectively and faster than Western countries did, says Karan.

Some politicians, including former President Donald Trump publicly blamed China for the pandemic, calling this novel coronavirus the "Chinese Virus" or the "Wuhan Virus." They consistently pushed that narrative even after the World Health Organization (WHO) warned as early as March 2020, when the pandemic was declared, that such language would encourage racial profiling and stigmatization against Asians. Trump has continued to use stigmatizing language in the wake of the Atlanta shooting, using the phrase "China virus" during a March 16 call to Fox News.

A report by researchers at the University of California at San Francisco (UCSF), released this month, directly linked Trump's first tweet about a "Chinese virus" to a significant increase in anti-Asian hashtags. According to a separate report by the Center for the Study of Hate and Extremism, anti-Asian hate crimes in 16 U.S. cities increased 149 percent in 2020, from 49 to 122.

Suspicion tends to manifest more during times of vulnerability, like in wartime or during a pandemic, says ElsaMarie D'Silva, an Aspen Institute New Voices fellow from India who studies violence and harassment issues. It just so happened that COVID-19 was originally identified in China, but, as NPR's Jason Beaubien has reported, some of the early clusters of cases elsewhere came from jet setters who traveled to Europe and ski destinations.

the West is usually regarded as the hub of expertise and knowledge, says Sriram Shamasunder, an associate professor of medicine at UCSF, and there's a sense among Western health workers that epidemics occur in impoverished contexts because the people there engage in primitive behaviors and just don't care as much about health.

In the early days of COVID-19, skepticism by Western public health officials about the efficacy of Asian mask protocols hindered the U.S.'s ability to control the pandemic. Additionally, stereotypes about who was and wasn't at risk had significant consequences, says Nancy Kass, deputy director for public health at the Johns Hopkins Berman Institute of Bioethics.

According to Kass, doctors initially only considered a possible COVID-19 diagnosis among people who had recently flown back from China. That narrow focus caused the U.S. to misdiagnose patients who presented with what we now call classic COVID symptoms simply because they hadn't traveled from China.

It's reminiscent of the HIV/AIDS epidemic in the 1980s, Kass says. Because itwas so widely billed as a "gay disease," there are many documented cases of heterosexual women who presented with symptoms but weren't diagnosed until they were on their deathbeds.

That's not to say that we should ignore facts and patterns about new diseases. For example, Kass says it's appropriate to warn pregnant women about the risks of traveling to countries where the Zika virus, which is linked to birth and developmental defects, is present.

But there's a difference, she says, between making sure people have enough information to understand a disease and attaching a label, like "Chinese virus," that is inaccurate and that leads to stereotyping.

Karan says we also need to shift our approach to epidemics. In the case of COVID-19 and other outbreaks, Western countries often think of them as a national security issue, closing borders and blaming the countries where the disease was first reported. This approach encourages stigmatization, he says.

Instead, Karan suggests reframing the discussion to focus on global solidarity, which promotes the idea that we are all in this together. One way for wealthy countries to demonstrate solidarity now, Karan says, is by supporting the equitable and speedy distribution of vaccines among countries globally as well as among communities within their own borders.Without such commitments in place, "it prompts the question, whose lives matter most?" says Shamasunder.

Ultimately, the global health community – and Western society as a whole – has to discard its deep-rooted mindset of coloniality and tendency to scapegoat others, says Hswen. The public health community can start by talking more about the historic racism and atrocities that have been tied to diseases.

Additionally, Karan says, leaders should reframe the pandemic for people: Instead of blaming Asians for the virus, blame the systems that weren't adequately prepared to respond to a pandemic.

Although WHO has had specific guidance since 2015 about not naming diseases after places, Hswen says the public health community at large should have spoken out earlier and stronger last year against racialized language and the ensuing violence. She says they should have anticipated the backlash against Asians and preempted it with public messaging and education about why neutral terms like "COVID-19" should be used instead of "Chinese virus."

Amid this tumult, a panel of scientists, legal experts and ethicists convened by NIH released a report in 1994 on research involving human embryos. The report called for federal funding to explore this “sensitive and vital area of biomedical science.” It also emphasized the need for regulation and voiced “serious ethical concerns” about sex selection in IVF.

in 1995, then-Reps. Jay Woodson Dickey Jr. (R-Ark.) and Roger Wicker (R-Miss.) added a provision to an appropriations bill that did the opposite of what the NIH paper proposed. Instead of supporting research and government regulation, it prohibited the expenditure of federal funds for any research that involves the creation or destruction of human embryos. The amendment was intended to help skittish lawmakers navigate a touchy issue, allowing them to vote against public funding for embryo research while permitting such research to continue in the private sphere.

The ban, which remains in effect, “laid the backdrop for a more hands-off regulatory approach,” said Michelle Bayefsky, a former bioethics fellow at NIH who has written a book about PGD.

Like the United States, Britain put together an expert panel to study assisted reproduction. The panel suggested the establishment of a public body to oversee human embryo research, regulate fertility clinics and take the lead on debates about new technologies. Parliament concurred and in 1990 established the Human Fertilization and Embryology Authority, the first statutory body of its kind and a model emulated by other countries.

That's far more than can be accommodated initially.

When you add all the priority groups together, they account for half of all U.S. adults

Priority groups include "those who have the highest risk of exposure, those who are at risk for severe morbidity and mortality ... [and also] the workforce that's needed for us to maintain our both health and economic status,"

The general consensus among bioethicists is that the first doses should go to front-line health workers. "Obviously they are being placed at high risk of infection, because they're taking care of people who are infected and infectious

But even within this seemingly clear category, there are questions about who a front-line health worker is. The definition extends beyond doctors and nurses to encompass hospital staff who care for and clean up after COVID-19 patients, nursing home workers and possibly pharmacy staff and emergency medical responders, according to preliminary guidelines from the CDC. Morticians and funeral home workers may also qualify, according to a draft report from the National Academies of Sciences, Engineering and Medicine, because they handle COVID-19 victims' bodies.

"Health care worker vaccination sounds simple, but if we don't have enough doses, we still have to be really judicious in how we're implementing," Lee said. If everyone who might qualify as a health worker exceeds the initial supply, state and local authorities might have to ration distribution further — for instance, restricting the vaccine to parts of a state that are being hit the hardest.

So who should get it next?

A lot of the decisions will depend on the characteristics of the vaccine itself.

Factors still unknown include who a vaccine is most effective for, who can reasonably access the vaccine and whether people will line up in droves to get it.

suggests that a vaccine could be available to all Americans within 12 to 18 months of its approval

Several organizations have produced reports on prioritizing vaccine distribution, but it's the CDC and its advisory committee that have the greatest influence over how a vaccine is used and distributed in the U.S. by health departments, hospitals and doctors' offices. When ACIP does vote, the committee's advice will provide critical information that state and local health agencies will use to figure out whom to give the first vaccines to and how to reach them.

And while there’s no reason to suspect that a third dose would be particularly unsafe in healthy people, the FDA hasn’t explicitly declared it safe.

How exactly you get your booster shot matters too. Say you don’t qualify for an extra shot and one falls into your lap anyway. Taking it isn’t necessarily a moral error as long as you’re truthful, Faith Fletcher, an assistant professor at Baylor College of Medicine’s Center for Medical Ethics and Health Policy, told me. But lying about your health or vaccine status is strictly out, she said, because it undermines the rules and guidelines that public-health officials design “to really maximize the greatest good among the greatest amount of people.”

The real moral failure, Fletcher said, is a systemic one: the fact that shots are falling into the laps of the healthy and vaccinated, rather than programs that bring vaccines to essential workers at their jobs, or to Black Americans at barber shops and stylists, or to walk-up and mobile clinics that can reach people who don’t have internet access.

When I reached out to Walgreens, CVS, and Rite Aid, representatives from all three pharmacy chains insisted that their stores are following the rules, but acknowledged that they’re relying on customers to tell the truth.

Asking patients to do anything more in order to get the vaccine would be a mistake, Jason Schwartz, a vaccine-policy expert at the Yale School of Public Health, told me. “It’s far more important to get folks vaccinated and to take down barriers that could keep folks who want to get vaccinated from getting [their shots], even if it means that some folks may be playing fast and loose with their own eligibility,” he said.

​​lying (overtly or by omission) to get a third dose can mess up the data on how well third shots are performing among the immunocompromised and how well a two-dose regimen is protecting those with healthy immune systems.

On an even more basic level, under-the-table boosting could skew data on national vaccination rates, making public-health authorities think more people have gotten their first or second shots than is actually the case. Essentially, getting a third shot before the CDC’s go-ahead can make it harder for health officials to determine when and if everyone else will really need them.

You can understand why the booster bandits have done what they’ve done: Getting another shot offers a sense of safety and control, however fleeting. After 18 months of pandemic life, it’s hard to begrudge anyone that. But the rule-breaking and the lying could help keep us all from really getting the virus under control for that much longer.

For researchers concerned with more immediate AI risks, such as bias, disinformation and job displacement, the voices of doom are a distraction. Professor Brent Mittelstadt, director of research at the Oxford Internet Institute, said the warnings of “the existential risks community” are overblown. “The problem is you can’t disprove the future scenarios . . . in the same way you can’t disprove science fiction.” Emily Bender, a professor of linguistics at the University of Washington, believes the doomsters are propagating “unhinged AI hype, helping those building this stuff sell it”.

Those urging us to stop, pause and think again have a useful card up our sleeves: the people building these models do not fully understand them. AI like ChatGPT is made up of huge neural networks that can defy their creators by coming up with “emergent properties”.

Google’s PaLM model started translating Bengali despite not being trained to do so

Let’s not forget the excitement, because that is also part of Moloch, driving us forward. The lure of AI’s promises for humanity has been hinted at by DeepMind’s AlphaFold breakthrough, which predicted the 3D structures of nearly all the proteins known to humanity.

Noam Shazeer, a former Google engineer credited with setting large language models such as ChatGPT on their present path, was asked by The Sunday Times how the models worked. He replied: “I don’t think anybody really understands how they work, just like nobody really understands how the brain works. It’s pretty much alchemy.”

The industry is turning itself to understanding what has been created, but some predict it will take years, decades even.

Alex Heath, deputy editor of The Verge, who recently attended an AI conference in San Francisco. “It’s clear the people working on generative AI are uneasy about the worst-case scenario of it destroying us all. These fears are much more pronounced in private than they are in public.” One figure building an AI product “said over lunch with a straight face that he is savoring the time before he is killed by AI”.

Greg Brockman, co-founder of OpenAI, told the TED2023 conference this week: “We hear from people who are excited, we hear from people who are concerned. We hear from people who feel both those emotions at once. And, honestly, that’s how we feel.”

A CBS interviewer challenged Sundar Pichai, Google’s chief executive, this week: “You don’t fully understand how it works, and yet you’ve turned it loose on society?

In 2020 there wasn’t a single drug in clinical trials developed using an AI-first approach. Today there are 18

Consider this from Bill Gates last month: “I think in the next five to ten years, AI-driven software will finally deliver on the promise of revolutionising the way people teach and learn.”

If the industry is aware of the risks, is it doing enough to mitigate them? Microsoft recently cut its ethics team, and researchers building AI outnumber those focused on safety by 30-to-1,

The concentration of AI power, which worries so many, also presents an opportunity to more easily develop some global rules. But there is little agreement on direction. Europe is proposing a centrally defined, top-down approach. Britain wants an innovation-friendly environment where rules are defined by each industry regulator. The US commerce department is consulting on whether risky AI models should be certified. China is proposing strict controls on generative AI that could upend social order.

Part of the drive to act now is to ensure we learn the lessons of social media. Twenty years after creating it, we are trying to put it back in a legal straitjacket after learning that its algorithms understand us only too well. “Social media was the first contact between AI and humanity, and humanity lost,” Yuval Harari, the Sapiens author,

Others point to bioethics, especially international agreements on human cloning. Tegmark said last week: “You could make so much money on human cloning. Why aren’t we doing it? Because biologists thought hard about this and felt this is way too risky. They got together in the Seventies and decided, let’s not do this because it’s too unpredictable. We could lose control over what happens to our species. So they paused.” Even China signed up.

One voice urging calm is Yann LeCun, Meta’s chief AI scientist. He has labelled ChatGPT a “flashy demo” and “not a particularly interesting scientific advance”. He tweeted: “A GPT-4-powered robot couldn’t clear up the dinner table and fill up the dishwasher, which any ten-year-old can do. And it couldn’t drive a car, which any 18-year-old can learn to do in 20 hours of practice. We’re still missing something big for human-level AI.” If this is sour grapes and he’s wrong, Moloch already has us in its thrall.