Readers —

It’s Quinn. These essays are usually behind our paywall, but we’ll occasionally share one with everyone.

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Thanks for giving a shit.

— Quinn

GIVE A LITTLE

You’ve never had a better opportunity to improve one person’s life than you do right now.

I would argue, in fact, that there’s never been a better time to improve one person’s life than there is today.

Sounds crazy, right, considering all the destructive nonsense?

Here’s three (fine, four) reasons why I’m right:

1. We’ve come so far. At the baseline, we are comically healthier than even our grandparents could have ever imagined
   

2. Along the way, we’ve learned so much about what works and what doesn’t (even if some of what works, like chemotherapy, still feels like a barbaric v1)
   

3. Even pre-Trump 2.0, there was enormous opportunity to improve on and invest more in what works
   

4. Whatever happens with USAID, the NIH, NOAA, CDC, the Paris Agreement, the WHO, and more — you can help fill in the gaps. You can improve one person’s life right now.

Quick context:

I understand that I’ve repeated this over and over but considering, you know, everything, it’s always important to remember: we didn’t use to wash our hands.

Sure, sex is great, but have you ever not died before you were five?

Have you ever not had to lose your leg because of a light abrasion, not gotten diphtheria, malaria, polio, HIV, chickenpox, HPV, or measles?

Not grown up hungry, in a house with lead paint, not been on the receiving end of the wrong blood type in a transfusion after the leeches didn’t do the job, not grown up drinking carcinogen water delivered by lead pipes, not grown up riding your bike behind a mosquito truck in the acid rain?

Not started smoking and get lung cancer, not had to use fish intestines or an amulet as birth control?

And then slept in an air conditioned room in the dead of summer with a roof over your head that’s not insulated with asbestos?

Every single day you poop in a toilet filled with potable water that whisks your poop away to a water recycling facility instead of downstream where your cousin drinks it.

Just look at these charts from our friends at Our World in Data.

We have learned so much, and applied what we learned — in the global north and west, first, of course — and then everywhere else.

We have saved hundreds and hundreds of millions of lives.

Mr. Rogers said it best, “Anyone who does anything to help a child in his life is a hero."

We have taken what we’ve learned and in most cases, demanded they become the obvious baseline — mandatory, fundamental interventions — all in less than one or two hundred years. 

From David Wallace Wells at the NYT:

Look at how successful Gavi, the Vaccine Alliance, has been since only 1999.

Now: Have we achieved that baseline everywhere? Of course not. Almost 40% of Sub-Saharan Africa still lives in extreme poverty.

But do we know exactly what the intervention processes are, in isolation? You bet. 

Are they infinitely more complicated to fund, deliver, and execute, at home and abroad, because of politics, because of greed, because of mis- and disinformation, and because we’re humans with a huge variety of belief systems and trust issues? Check.

But we have to keep at it, because setting healthier baselines — especially for childhood illnesses and/or infectious disease — lets us not only prevent dumb shit none of us should ever have to think about again, but once widely established, we are significantly more resilient, which lets us in good faith reach even further, for the crazy sci-fi shit. 

Sure, sex is great, and treated malaria bed nets are incredibly effective and cost-effective, but what if we made mosquitoes — those motherfuckers — unable to carry malaria at all? 

Sure, chemotherapy has saved generations of cancer patients, but holy shit wouldn’t more widely-applicable immunotherapy or, I don’t know, an mRNA vaccine for pancreatic cancer, be a hell of a lot less traumatic?

Are there lots of ethical questions when it comes to, say, gene drives, or who gets access to promising clinical trials? Of course.

Do we do a good job of wrestling with those? Nope! 

Which is just another reason why focusing on affordable baseline interventions continues to be the very best bang for our buck. And it’s why other, less prolific but still incredibly obvious interventions like clean indoor air and TB diagnostic tests and treatments (cough, Cepheid and Danaher) that actually, truly, cure people should have our full attention. 

They increase life expectancy, they increase education, they lower family health care expenditures (if they have health care at all). They raise the baseline.

We know what to do.

So much progress made. So far to go. 

COVID exposed a whole hell of a lot of issues in our public health and medicine supply chains and delivery, but the harshest light was shone on our horrifyingly inevitable refusal to distribute life-saving vaccines equitably around the world.

Look, yes, Elon Musk and his merry band of Hitler Youth interns are a nightmare.

But — as much as that fascist wanna-be deserves a place in hell — we’d all be wrong to think his corrupt and willful destruction of state capacity were the only roadblocks to equitable global health. 

We’d be wrong to dream that maybe Medicaid paperwork was easy, that childcare and elderly care were accessible or affordable, that every kid could bring a healthy lunch to school.

Yes, of course government programs, domestic and abroad, can always be audited and improved on. Most of the time, there’s actually people who do exactly that. 

Are these global programs often too complex to fully appraise? Sure. Are there invested parties who intentionally make that process more difficult? Yep.

Great news!* Now that so many of those programs and institutions are being annihilated, we have an opportunity* to build even more effective, economical, and easier-to-use versions from the ashes. 

Will every civil servant, scientist, and humanitarian worker come running back if we can save democracy, too? Probably not! Will that make the rebuild a little tougher? Probably!

Sure, yes, 18F, the internal government team tasked with modernizing government tech and processes got fired, too, but we’ve got fifty states — plus at least three more districts and territories that should be — and their vitally important public utility commissions and public health departments, and something like 20,000 cities and towns, with school boards for most of them. 

We have an enormous, crippling need for millions more electricians, nurses and midwives, to wire and staff a million new community health clinics in partnership with organizations that know exactly how to operate with devastatingly few resources, like Partners in Health. 

There are always people in need of blood, of maternal health care, of inhalers and insulin, of tutoring, of food or diapers, of straight cash.

We know how to provide comprehensive care after a miscarriage, abortion, or safe delivery, and we know how impactful that care can be, especially in the first year after. 

We just choose not to do it.

These problems didn’t start yesterday. Despite everything, yesterday was a bazillion times better day to be born than almost any day before it.

There are always people in need, even here in the US, where we make it extremely expensive to be poor and/or sick.

There are always reputable, effective organizations here and abroad, like GiveDirectly, in constant need of funding and warm bodies, and even more orgs, trade schools, and community colleges, who could have such an impact with the right incentives, people, processes, and clear, desired outcomes.

I need you to understand that all of those people still need you, but that you can’t help all of those people by yourself. It has always required and will always require all of us to fight The Long Defeat, to feed Compound Action.

Don’t get me wrong, Compound Action is where it’s at. 

Every small, measurable action can compound over all of us and time into actual revolutions. But, again, whatever the fate of USAID, the NIH, the Paris Agreement, the WHO, mRNA cancer vaccines, life-saving peanut butter and TB treatments, and so much more, you can not only feed someone tonight, but give them hope.

You simply never know what small otherwise immeasurable act might keep hope going for one person, for one more day.

Look at Ady Barkan, or the late James Harrison. 

One man, armed (hey yo) with a rare antibody, saved over 2 million babies over the course of his life — and beginning just fifty-three years after we discovered human blood types even exist.

But he and none of us even knew that antibody existed until twelve years after he began giving blood, and fourteen years after he had a lung removed, had multiple blood transfusions of his own, and vowed to give back in the most obvious way he could.

But no single one of us — not Ady or James — or even a million of us can replace US federal government funding and staffing for any of these programs at home and abroad.

However many people will suffer from cuts to infectious disease research, the Department of Education and all its Pell Grants and student loans and special education funding, and VA will be at home, the impacts abroad will be magnitudes worse. The demolition could be devastating.

Without a functional Congress, our best chances to preserve these programs at-large seems to rest on the shoulders of a few judges. 

From GiveWell:

But while we’re fighting for our Congresspeople to show some fucking spine, we can simultaneously help one starfish, tonight.

In the words of Peter Singer, “My contribution cannot end a famine, but it can save the lives of several people who might otherwise starve.”

In the words of Hannah Ritchie, “For many of us, it doesn’t cost much to improve someone’s life, and we can do much more of it.”

You have to know this. You have to internalize and operationalize this.

From “For Ady”:

When we know what to do, and how to affect the most people, we can do so much.

We know how to show up. We know how to give.

Start where you are. Use what you have. Do what you can. For every agency they demolish, buy another meal, another bed net, call another one of your reps.

Knowing everything we know, including and especially what’s being torn apart, even and especially amid this epidemic of solitude — there’s never been a better time to commit to it, to each other.

— Quinn