Quick takes

An excerpt about the creation of PEPFAR, from "Days of Fire" by Peter Baker. I found this moving.

Update (January 28): Marco Rubio has now issued a temporary waiver for "humanitarian programs that provide life-saving medicine, medical services, food, shelter and subsistence assistance."[1] PEPFAR's funding was recently paused as a result of the recent executive order on foreign aid.[2] (It was previously reauthorized until March 25, 2025.[3]) If not exempted, this would pause PEPFAR's work for three months, effective immediately. Marco Rubio has issued waivers for some forms of aid, including emergency food aid, and has the authority to issue a similar waiver for PEPFAR, allowing it to resume work immediately.[4] Rubio has previously expressed (relatively generic) positive sentiments about PEPFAR on Twitter,[5] and I don't have specific reason to think he's opposed to PEPFAR, as opposed to simply not caring strongly enough to give it a waiver without anyone encouraging him to. I think it is worth considering calling your representatives to suggest that they encourage Rubio to give PEPFAR a waiver, similarly to the waiver he provided to programs giving emergency food aid. I have a lot of uncertainty here — in particular, I'm not sure whether this is likely to persuade Rubio — but I think it is fairly unlikely to make things actively worse. I think the argument in favor of calling is likely stronger for people who are represented by Republicans in Congress; I expect Rubio would care much more about pressure from his own party than about pressure from the Democrats.   1. ^ https://apnews.com/article/trump-foreign-assistance-freeze-684ff394662986eb38e0c84d3e73350b 2. ^ My primary source for this quick take is Kelsey Piper's Twitter thread, as well as the Tweets it quotes and the articles it and the quoted Tweet link to. For a brief discussion of what PEPFAR is, see my previous Quick Take. 3. ^ https://www.kff.org/policy-watch/pepfars-short-term-reauthorization-sets-an-uncertain-course-for-its-long-term-future/ 4. ^ htt

During the animal welfare vs global health debate week, I was very reluctant to make a post or argument in favor of global health, the cause I work in and that animates me. Here are some reflections on why, that may or may not apply to other people: 1. Moral weights are tiresome to debate. If you (like me) do not have a good grasp of philosophy, it's an uphill struggle to grasp what RP's moral weights project means exactly, and where I would or would not buy into its assumptions. 2. I don't choose my donations/actions based on impartial cause prioritization. I think impartially within GHD (e.g. I don't prioritize interventions in India just because I'm from there, I treat health vs income moral weights much more analytically than species moral weights) but not for cross-cause comparison. I am okay with this. But it doesn't make for a persuasive case to other people. 3. It doesn't feel good to post something that you know will provoke a large volume of (friendly!) disagreement. I think of myself as a pretty disagreeable person, but I am still very averse to posting things that go against what almost everyone around me is saying, at least when I don't feel 100% confident in my thesis. I have found previous arguments about global health vs animal welfare to be especially exhausting and they did not lead to any convergence, so I don't see the upside that justifies the downside. 4. I don't fundamentally disagree with the narrow thesis that marginal money can do more good in animal welfare. I just feel disillusioned with the larger implications that global health is overfunded and not really worth the money we spend on it. I'm deliberately focusing on emotional/psychological inhibitions as opposed to analytical doubts I have about animal welfare. I do have some analytical doubts, but I think of them as secondary to the personal relationship I have with GHD.

The Global Fund and Gilead have announced that Lenacapavir, the new 6-month PrEP treatment for HIV, will be made available in 120 countries at no profit. Gilead originally agreed to license Lenacapavir, royalty-free, to local manufacturers, but have now also agreed to directly supply doses until those manufacturers reach capacity, likely for up to 2 million at-risk people. The Global Fund will direct resourcing and deliver doses. Extremely good news, and a possible silver lining after potentially losing PEPFAR.

Bill Gates: "My new deadline: 20 years to give away virtually all my wealth" - https://www.gatesnotes.com/home/home-page-topic/reader/n20-years-to-give-away-virtually-all-my-wealth

A new study in The Lancet estimates that high USAID spending saved over 91 million lives in the past 21 years, and that the cuts will kill 14 million by 2030. They estimate high USAID spending reduced all-cause mortality by 15%, and by 32% in under 5s.

USAID has announced that they've committed $4 million to fighting global lead poisoning!  USAID Administrator Samantha Power also called other donors to action, and announced that USAID will be the first bilateral donor agency to join the Global Alliance to Eliminate Lead Paint. The Center for Global Development (CGD) discusses the implications of the announcement here.  For context, lead poisoning seems to get ~$11-15 million per year right now, and has a huge toll. I'm really excited about this news. Also, thanks to @ryancbriggs for pointing out that this seems like "a huge win for risky policy change global health effective altruism" and referencing this grant: In December 2021, GiveWell (or the EA Funds Global Health and Development Fund?) gave a grant to CGD to "to support research into the effects of lead exposure on economic and educational outcomes, and run a working group that will author policy outreach documents and engage with global policymakers." In their writeup, they recorded a 10% "best case" forecast that in two years (by the end of the grant period), "The U.S. government, other international actors (e.g., bilateral and multilateral donors), and/or national LMIC governments take measurable action to reduce lead exposure—for example, through increased funding for lead mitigation and research, increased monitoring of lead exposure, and/or enactment of regulations." We've reached this best case and it's been almost exactly two years! (Attributing credit is really hard and I have no experience and little context in this area — as far as I know this could have happened without that grant or related advocacy. But it's still notable to me that a CGD report is cited in Power's announcement.)

I just learned that Trump signed an executive order last night withdrawing the US from the WHO; this is his second attempt to do so.  WHO thankfully weren't caught totally unprepared. Politico reports that last year they "launched an investment round seeking some $7 billion “to mobilize predictable and flexible resources from a broader base of donors” for the WHO’s core work between 2025 and 2028. As of late last year, the WHO said it had received commitments for at least half that amount". Full text of the executive order below: