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	<title type="text">Abigail Higgins | Vox</title>
	<subtitle type="text">Our world has too much noise and too little context. Vox helps you understand what matters.</subtitle>

	<updated>2018-12-26T20:44:39+00:00</updated>

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				<name>Abigail Higgins</name>
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			<title type="html"><![CDATA[Why do people hate vegans so much?]]></title>
			<link rel="alternate" type="text/html" href="https://www.vox.com/future-perfect/2018/11/2/18055532/vegans-vegetarian-research-uk" />
			<id>https://www.vox.com/future-perfect/2018/11/2/18055532/vegans-vegetarian-research-uk</id>
			<updated>2018-11-10T09:42:25-05:00</updated>
			<published>2018-11-10T09:42:22-05:00</published>
			<category scheme="https://www.vox.com" term="Culture" /><category scheme="https://www.vox.com" term="Food" /><category scheme="https://www.vox.com" term="Future Perfect" /><category scheme="https://www.vox.com" term="Science" />
							<summary type="html"><![CDATA[Food critic William Sitwell isn&#8217;t the first person to express hatred toward vegans, but he might be the first to lose his job for it. Sitwell stepped down from his job as editor of Waitrose Food, the magazine of a UK supermarket chain, after his email response to a freelance journalist pitching a series on [&#8230;]]]></summary>
			
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<img alt="" data-caption="Protesters hold placards and banners during an animal rights march on October 29, 2016, in London. | Jack Taylor/Getty Images" data-portal-copyright="Jack Taylor/Getty Images" data-has-syndication-rights="1" src="https://platform.vox.com/wp-content/uploads/sites/2/chorus/uploads/chorus_asset/file/13378153/619015634.jpg.jpg?quality=90&#038;strip=all&#038;crop=0,0,100,100" />
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	Protesters hold placards and banners during an animal rights march on October 29, 2016, in London. | Jack Taylor/Getty Images	</figcaption>
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<p>Food critic William Sitwell isn&rsquo;t the first person to express hatred toward vegans, but he might be the first to lose his job for it.</p>

<p>Sitwell stepped down from his job as editor of Waitrose Food, the magazine of a UK supermarket chain, after his email<strong> </strong>response to a freelance journalist pitching a series on plant-based recipes went public.</p>

<p>&ldquo;How about a series on killing vegans one by one. Ways to trap them? How to interrogate them properly? Expose their hypocrisy? Force-feed them meat? Make them eat steak and drink red wine?&rdquo; <a href="https://www.buzzfeed.com/markdistefano/waitrose-food-killing-vegans-freelance-journalist?ref=hpsplash">he wrote</a>.</p>

<p>Selene Nelson, the vegan freelance writer, was understandably shocked &mdash; and made the email public. &ldquo;I&rsquo;ve never seen anything like it,&rdquo; she <a href="https://www.buzzfeed.com/markdistefano/waitrose-food-killing-vegans-freelance-journalist?ref=hpsplash">told BuzzFeed News</a>, which published  Sitwell&rsquo;s email. &ldquo;I&rsquo;ve written about many divisive topics, like capital punishment and murder cases and domestic violence, and I&rsquo;ve never had a response like that to any of my articles or pitches.&rdquo;</p>

<p>Sitwell&rsquo;s response created a media firestorm, and Waitrose was quick to distance itself, saying in a <a href="https://waitrosecare.secure.force.com/waitroseCARE/articles/FAQs/Waitrose-Partners-Food-Magazine-Statement/?l=en_US&amp;c=External_Support_Articles:Trading_Policy_Statements&amp;fs=Search&amp;pn=1">statement</a>, &ldquo;Even though this was a private email, William&rsquo;s gone too far, and his words are extremely inappropriate, insensitive and absolutely do not represent our views.&rdquo;</p>

<p>Sitwell apologized immediately after the email was made public, calling it an &ldquo;ill-judged joke&rdquo; <a href="https://www.buzzfeed.com/markdistefano/waitrose-food-killing-vegans-freelance-journalist">and claiming that</a> &ldquo;I love and respect people of all appetites be they vegan, vegetarian or meat eaters.&rdquo; But when the controversy didn&rsquo;t die down, he was forced to leave the magazine.</p>
<h2 class="wp-block-heading">The challenge vegans face</h2>
<p>Sitwell&rsquo;s response was beyond the pale, but he&rsquo;s not alone in expressing dislike for vegans.</p>

<p>Matt Ball of One Step for Animals wrote that &ldquo;vegans are viewed more negatively than atheists, immigrants, homosexuals, and asexuals,&rdquo; citing a recent <a href="https://journals.sagepub.com/doi/abs/10.1177/1368430215618253">study</a> by Cara MacInnis and Gordon Hodson. &ldquo;The only group viewed more negatively than vegans were drug addicts,&rdquo; Ball added. He also cited another <a href="https://www.marketingweek.com/2017/10/23/brands-effectively-tap-flexitarian-trend/">analysis</a> that found that &ldquo;labeling a product &lsquo;vegan&rsquo; causes its sales to drop by 70%.&rdquo;</p>

<p>Anthony Bourdain once<strong> </strong><a href="https://www.goodreads.com/quotes/37262-vegetarians-and-their-hezbollah-like-splinter-faction-the-vegans-are-a-persistent">wrote</a> that &ldquo;vegetarians are the enemy of everything good and decent in the human spirit&rdquo;&nbsp;and called vegans their &ldquo;Hezbollah-like splinter faction.&rdquo;</p>

<p>So why all the vitriol?</p>

<p>We still don&rsquo;t know exactly, but there are a few theories. One is that vegans make people feel guilty. People tend to interpret someone&rsquo;s choice not to eat meat as condemnation of their own choices, which can make them <a href="http://veganstrategist.org/2017/06/28/one-reason-why-people-dont-like-vegans/">pretty defensive</a>.</p>

<p>Other people have suggested that it comes from the <a href="https://www.elephantjournal.com/2017/07/the-underlying-reason-why-people-hate-vegans/">cognitive dissonance</a> that eating meat produces: Most of us like animals, so eating them feels kind of messed up &mdash; even if we don&rsquo;t realize it. Vegans also represent a <a href="https://www.crsociety.org/topic/12378-it-ain%E2%80%99t-easy-eating-greens-evidence-of-bias-toward-vegetarians-and-vegans-from-both-source-and-target/">threat to the status quo</a>, and cultural changes make people anxious.</p>

<p>Plus, even vegans will admit that sometimes, they can be kind of annoying.</p>

<p>&ldquo;For the three decades I&rsquo;ve been an advocate, there has&nbsp;<em>always&nbsp;</em>been a segment of vegans who have built vast and elaborate rationalizations for basing their &lsquo;activism&rsquo;&nbsp;on screaming and hatred (and attacking anyone who is not sufficiently pure and dogmatic),&rdquo; <a href="http://www.mattball.org/2017/05/how-vegans-hurt-animals.html">writes Matt Ball</a> of the One Step for Animals.</p>

<p>Given all of this, it may not be surprising that the number of vegetarians, let alone vegans, in the US hasn&rsquo;t really increased. One <a href="https://animalcharityevaluators.org/blog/is-the-percentage-of-vegetarians-and-vegans-in-the-u-s-increasing/">analysis</a> of survey data found that only 1 percent of adults identify themselves as vegetarians and also report not eating meat (as opposed to saying they&rsquo;re vegetarian but sometimes eating meat). That figure has held steady for more than two decades now.</p>

<p>But what has changed &mdash; and what Sitwell may be behind the times on &mdash; is how much the demand for plant-based food has increased: exactly the kind of trend Nelson was presumably pegging her pitch to.</p>

<p>Plant-based meat sales rose <a href="https://www.gfi.org/newly-released-market-data-shows-soaring">23 percent</a> over the previous year. Plant-based food sales top <a href="https://www.gfi.org/newly-released-market-data-shows-soaring">$3.7 billion</a> in the US alone. A study done by Waitrose shows that <a href="https://www.theguardian.com/business/2018/nov/01/third-of-britons-have-stopped-or-reduced-meat-eating-vegan-vegetarian-report">one in five</a> adults follow a flexitarian diet, or reducing the amount of meat they eat.</p>

<p>Those trends make sense &mdash; there&rsquo;s growing consensus that eating less meat is better for us and for the planet. A <a href="https://www.nhs.uk/news/diabetes/vegan-diet-helps-people-better-manage-type-2-diabetes/">UK study</a> released<strong> </strong>just last week found that plant-based diets can improve mental well-being and quality of life, decrease risk of diabetes, and help with weight loss. Eating less meat and dairy also play a <a href="https://www.vox.com/a/weather-climate-change-us-cities-global-warming">huge role</a> in reducing the impact of <a href="https://www.vox.com/videos/2017/12/12/16762900/mediterranean-diet-pescatarian-climate-change">climate change</a>.</p>

<p><a href="https://www.vox.com/future-perfect/2018/10/31/18026418/vegan-vegetarian-animal-welfare-corporate-advocacy">Companies</a> are waking up to these changing attitudes. The American fast-food chain White Castle started offering a plant-based burger last spring and <a href="https://www.fastcompany.com/90205310/how-white-castle-slid-into-vegan-territory">more than doubled</a> its sales goals. Sonic, the popular American burger joint, jumped on the flexitarian bandwagon at the same time, but instead of offering a meatless burger, it started <a href="https://www.npr.org/sections/thesalt/2018/03/02/590253046/heres-why-environmentalists-are-cheering-the-latest-burger-at-sonic-drive-in">offering a burger</a> with less meat by blending beef with mushrooms.</p>

<p>In fact, Waitrose itself has responded to these cultural shifts. Just last month, it <a href="http://waitrose.pressarea.com/pressrelease/details/78/PRODUCT%20NEWS_12/10203">reported</a> that its sales of vegetarian and vegan products were up 85 percent from the previous year, and that it would launch its own line of 25 vegan and vegetarian products. Unlike other companies, Waitrose wasn&rsquo;t shy about slapping on the &ldquo;vegan&rdquo; label. The Times of London even called veganism one of the <a href="https://www.thetimes.co.uk/article/dumplings-and-vegan-double-acts-the-foodie-trends-of-2018-d6bdmrxgj">foodie trends</a> of 2018. The author of that piece? Sitwell himself.</p>

<p>Sitwell, for his part, has <a href="https://www.instagram.com/p/Bpl8Kfwncyg/?taken-by=williamsitwell">apologized</a> &ldquo;to any food- and life-loving vegan who was genuinely offended by remarks written by me as an ill-judged joke in a private email and now widely reported.&rdquo; His apology was embedded in an Instagram post that featured a photo of the cover of a past issue of the magazine that advertised &ldquo;40 gloriously meat-free recipes.&rdquo; Sitwell added that the magazine had refused advertising for meat-based products to produce that issue.</p>

<p>That Sitwell had to step down and issue such a fulsome apology may be yet another sign that attitudes around veganism are changing.</p>

<p><em>This post was updated to clarify sourcing.</em></p>
<hr class="wp-block-separator" />
<p><a href="https://www.vox.com/future-perfect-newsletter"><em>Sign up for the Future Perfect newsletter.</em></a><em> Twice a week, you&rsquo;ll get a roundup of ideas and solutions for tackling our biggest challenges: improving public health, decreasing human and animal suffering, easing catastrophic risks, and &mdash; to put it simply &mdash; getting better at doing good.</em></p>
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				<name>Abigail Higgins</name>
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			<title type="html"><![CDATA[How the “white-savior industrial complex” failed Liberia’s girls]]></title>
			<link rel="alternate" type="text/html" href="https://www.vox.com/future-perfect/2018/10/24/17995536/liberia-girls-more-than-me-katie-meyler" />
			<id>https://www.vox.com/future-perfect/2018/10/24/17995536/liberia-girls-more-than-me-katie-meyler</id>
			<updated>2018-11-10T09:47:41-05:00</updated>
			<published>2018-10-24T16:40:02-04:00</published>
			<category scheme="https://www.vox.com" term="Future Perfect" /><category scheme="https://www.vox.com" term="Politics" /><category scheme="https://www.vox.com" term="World Politics" />
							<summary type="html"><![CDATA[Hundreds of Liberians marched through the streets of the capital city Monrovia late last week, clad in black and waving placards that read &#8220;No excuse for rape,&#8221; &#8220;Fix the system,&#8221; and &#8220;Shame on you Katie Meyler.&#8221; The name on that last sign was the focus of the crowd&#8217;s anger. Katie Meyler is a young American [&#8230;]]]></summary>
			
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<img alt="" data-caption="A girl peels oranges for sale on January 31, 2015, in the West Point township of Monrovia, Liberia. | John Moore/Getty Images" data-portal-copyright="John Moore/Getty Images" data-has-syndication-rights="1" src="https://platform.vox.com/wp-content/uploads/sites/2/chorus/uploads/chorus_asset/file/13327281/462619056.jpg.jpg?quality=90&#038;strip=all&#038;crop=0,0,100,100" />
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	A girl peels oranges for sale on January 31, 2015, in the West Point township of Monrovia, Liberia. | John Moore/Getty Images	</figcaption>
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<p>Hundreds of Liberians <a href="https://www.facebook.com/propublica/videos/liberians-protest-more-than-me-after-propublica-investigation/283633002360365/">marched</a> through the streets of the capital city Monrovia late last week, clad in black and waving placards that read &ldquo;No excuse for rape,&rdquo; &ldquo;Fix the system,&rdquo; and &ldquo;Shame on you Katie Meyler.&rdquo;</p>

<p>The name on that last sign was the focus of the crowd&rsquo;s anger. Katie Meyler is a young American woman who, until recently, ran a charity in Liberia called More Than Me, a nonprofit that took in and educated poor Liberian girls at high risk of sexual exploitation.</p>

<p>For years, Meyler was celebrated in the <a href="https://www.nbcnews.com/video/american-woman-helps-forgotten-liberian-kids-344716867542?v=raila">media</a> and philanthropy world for More Than Me&rsquo;s work. She<strong> </strong>raised more than $8 million, including almost $600,000 from the US government, and opened 19 schools responsible for more than 4,000 students. But a <a href="https://features.propublica.org/liberia/unprotected-more-than-me-katie-meyler-liberia-sexual-exploitation/">ProPublica investigation</a> published October 11 found that amid that success, the<strong> </strong>girls her charity was supposed to be protecting were being raped by the man who helped found it.</p>

<p>That man, Macintosh Johnson, had AIDS when he died in 2014. One of the girls who ended up testifying against him in court tested positive for HIV.</p>

<p><a href="https://cdn2.hubspot.net/hubfs/3409632/Article%20Response/10.12.2018%20MTM%20Webpage%20Message.pdf">In a statement</a> following the ProPublica report, <a href="http://morethanme.org/safeguarding/">More Than Me said</a>: &ldquo;We are deeply, profoundly sorry. To all the girls who were raped by Macintosh Johnson in 2014 and before: we failed you. We gave Johnson power that he exploited to abuse children.&rdquo;&nbsp;</p>

<p>MTM&rsquo;s Liberian advisory board recommended an independent investigation, and in a <a href="https://cdn2.hubspot.net/hubfs/3409632/Article%20Response/Letter%20from%20Katie%20Meyler%20-%20October%2014,%202018.pdf">letter to the board</a>, Meyler wrote that stepping &ldquo;aside while the investigation is underway will further the goal of a thorough and impartial review.&rdquo; She added that she was &ldquo;confident that the results from this investigation will outline the best way forward for More Than Me.&rdquo;</p>

<p>Looking back, Meyler&rsquo;s trajectory is staggering. She went from being a 26-year-old intern at  an evangelical charity during her first trip to Liberia in 2006 to receiving $1 million in 2012 to start her own school from the American Giving Awards, sponsored by JPMorgan Chase. By 2014, the Ebola outbreak would hit Liberia and Meyler would be named one of Time magazine&rsquo;s <a href="http://time.com/time-person-of-the-year-ebola-fighters/">People of the Year</a> for her role in the response.</p>

<p>It&rsquo;s shocking now that no one seemed to question, at least publicly, whether a young American woman with no experience in education or health was qualified to be running a school and a medical center serving thousands of Liberians. But if<strong> </strong>you&rsquo;ve spent time in Africa in proximity to the Western charity machine Meyler was a product of, then it&rsquo;s not shocking at all.</p>

<p>I was a young, white American woman living in Kenya during her rise to fame, and I was often asked, both in the US and in Kenya, whether I was going to start my own NGO, despite the fact that I was a journalist with little experience or interest in the nonprofit world. Such questions evinced a presumption of my innate moral fiber &mdash; not to mention a complacency in the belief that any white Westerner was capable of starting an NGO, regardless of qualification or mission.</p>

<p>I have no doubt that at 26 years old, I could have gotten funding to start my own NGO, even though I had no experience in nonprofits. I knew many other young Americans who got funded. If people tell you enough times that you&rsquo;re qualified to do something, sometimes you start to believe them.</p>

<p>In a <a href="https://www.theatlantic.com/international/archive/2012/03/the-white-savior-industrial-complex/254843/?single_page=true">2012 Atlantic</a> piece, Teju Cole called the phenomenon the &ldquo;White Savior Industrial Complex.&rdquo; It is &ldquo;a liberated space in which the usual rules do not apply: a nobody from America or Europe can go to Africa and become a godlike savior or, at the very least, have his or her emotional needs satisfied.&rdquo;</p>

<p>We should be upset by Meyler&rsquo;s story. But we should be more upset with what her story is emblematic of: a Western charity machine, propped up by an eager media, that valorizes inexperienced American do-gooders and that<strong> </strong>values heartwarming stories over impact.</p>
<h2 class="wp-block-heading">Rewarding inexperience and ignoring warning signs</h2>
<p>In a tale that would become central to Meyler&rsquo;s narrative, spun dozens of times in speeches across the US, Meyler herself questioned whether she was qualified to start her own NGO. But a friend <a href="https://features.propublica.org/liberia/unprotected-more-than-me-katie-meyler-liberia-sexual-exploitation/">told her</a>, &ldquo;Get over yourself! It&rsquo;s not about you!&rdquo; and that tough-love pep talk<strong> </strong>quashed her doubt.</p>

<p>Meyler would have done well to heed her own alarm bells.<strong> </strong>In retrospect, the cracks in Meyler&rsquo;s organization were glaring. If she had tried to do the same thing in the US, it never would have gotten off the ground.</p>

<p>Meyler had no experience in education or management<strong> </strong>herself, and the board she recruited only compounded the incompetence. <a href="https://features.propublica.org/liberia/unprotected-more-than-me-katie-meyler-liberia-sexual-exploitation/">According to ProPublica</a>:</p>
<blockquote class="wp-block-quote has-text-align-none is-layout-flow wp-block-quote-is-layout-flow">
<p>The board included Skip Borghese, an Italian prince who marketed cosmetics on the Home Shopping Network; his wife, Katie Borghese, a close friend of Meyler&rsquo;s, who ran a perfume company; Chidegar &ldquo;Chid&rdquo; Liberty, a Liberian-American who left Liberia as an infant but returned in 2009 to start a fair-trade clothing business; and Saul Garlick, an American whose startup organized entrepreneurship experiences in Africa for U.S. students.</p>
</blockquote>
<p>The school was staffed mostly by American teaching fellows and, barring one position, no teaching experience was required when it started hiring. The first principal was a 31-year-old high school English teacher with no administrative experience. These low standards, particularly for staffers,<strong> </strong>might sound surprising, but in my experience they&rsquo;re not actually uncommon for charities started by foreigners in Africa.</p>

<p>Warning signs cropped up quickly: The charity&rsquo;s country director wrote a memo in the early months documenting her concerns about girls being taken from their homes without guardian consent and spending the night at staff houses, including Meyler&rsquo;s and Johnson&rsquo;s. Money was going missing.</p>

<p>Then there was Meyler&rsquo;s foray into Ebola relief. When West Africa was hit by a widespread outbreak of <a href="https://www.cdc.gov/mmwr/preview/mmwrhtml/mm63e1114a4.htm">Ebola in 2014</a>, Meyler started organizing Ebola-relief efforts in Liberia:<strong> </strong>complex work that requires high levels of expertise and is better left to the professionals.</p>

<p>According to the <a href="https://features.propublica.org/liberia/unprotected-more-than-me-katie-meyler-liberia-sexual-exploitation/">ProPublica<strong> </strong>investigation</a>, MTM never received approval to have an Ebola care facility. In the early days of the outbreak the school itself didn&rsquo;t even have accreditation from the Ministry of Education. One Ministry of Health official said at the time that Meyler appeared to have a &ldquo;pattern of disregard for laws.&rdquo; But that didn&rsquo;t stop the <a href="http://time.com/time-person-of-the-year-ebola-fighters/">media from hailing</a> her do-gooding efforts.</p>
<h2 class="wp-block-heading">More Than Me’s pattern of negligence is appalling — but it isn’t new</h2>
<p>Taken together, the levels of negligence at More Than Me<strong> </strong>are shocking. But Meyler&rsquo;s story is emblematic of a larger rot within a sector of American philanthropy: the fetishization of young and inexperienced do-gooders setting out to change developing countries, regardless of whether they are qualified to do so.</p>

<p>For evidence of the trend, you don&rsquo;t need to look farther than some recent scandals that rocked international philanthropy.</p>

<p>Greg Mortenson was a mountain climber who, after failing to summit K2, the world&rsquo;s second highest mountain, promised a Pakistani villager he met on his descent that he&rsquo;d return to build a school for girls. He went on to found the Central Asia Institute, which by 2010 reported that it had built more than 171 schools that provided education to more than 64,000 children, including 54,000 girls.</p>

<p>He fundraised by speaking to audiences at churches, schools, and philanthropic dinners across the United States, much in the same way that Meyler did, and chronicled his story in the best-selling book <a href="https://www.amazon.com/Three-Cups-Tea-Mission-Promote/dp/0143038257/ref=pd_lpo_sbs_14_t_0?_encoding=UTF8&amp;psc=1&amp;refRID=F9D8F2XW80XD9M9RFQ9B"><em>Three Cups of Tea</em></a><em>. </em>He was also written up in glowing terms by publications like the <a href="https://www.nytimes.com/2010/10/21/opinion/21kristof.html">New York Times</a> and <a href="https://www.npr.org/templates/story/story.php?storyId=101780727">NPR</a>, and given millions of dollars to continue his work.</p>

<p>His was an incredible story &mdash; and a lot of it was a lie. <a href="https://www.washingtonpost.com/...greg-mortenson-in.../AFxToE6D_blog.html">Multiple investigations revealed</a> not only that Mortenson lied about his origin story but that he had allegedly <a href="https://www.npr.org/sections/thetwo-way/2012/04/05/150070507/three-cups-author-mismanaged-charity-will-repay-1-million">misspent millions</a> of the organization&rsquo;s dollars.</p>

<p>An even more notorious recent example was the Invisible Children NGO, which came to public view through its viral campaign in 2012 to &ldquo;<a href="https://www.youtube.com/watch?v=Y4MnpzG5Sqc">Stop Kony</a>.&rdquo; The organization was <a href="https://invisiblechildren.com/our-story/">founded in 2004</a> by a group of young <a href="https://www.washingtonpost.com/news/monkey-cage/wp/2014/12/30/why-did-invisible-children-dissolve/?utm_term=.7620ee20b375">American filmmakers</a> who wanted to stop Joseph Kony&rsquo;s brutal Lord&rsquo;s Resistance Army (LRA) in Northern Uganda.</p>

<p>The video was viewed more than 100 million times in one week, becoming at the time<strong> </strong>the <a href="http://newsfeed.time.com/2012/03/12/kony-2012-documentary-becomes-most-viral-video-in-history/">most viral video ever</a>. It helped the organization raise <a href="https://www.npr.org/sections/thetwo-way/2014/12/15/370824018/organization-behind-kony-2012-set-to-close-its-doors-in-2015">more than $30 million</a> and had a profound <a href="https://www.washingtonpost.com/news/monkey-cage/wp/2014/12/30/why-did-invisible-children-dissolve/?utm_term=.d8fd96219b19">impact</a> on US foreign policy in the region. One of the founders <a href="https://www.washingtonpost.com/news/monkey-cage/wp/2014/12/30/why-did-invisible-children-dissolve/?utm_term=.d8fd96219b19">claimed</a> the organization had lowered the number of internally displaced people (IDP) in Uganda by 98 percent.</p>

<p>But the film dangerously oversimplified events in the region, including the fact that Kony probably wasn&rsquo;t even in <a href="https://foreignpolicy.com/2012/03/07/guest-post-joseph-kony-is-not-in-uganda-and-other-complicated-things/">Uganda</a> at the time. And the organization&rsquo;s impact is questionable (it certainly <a href="https://www.washingtonpost.com/news/monkey-cage/wp/2014/12/30/why-did-invisible-children-dissolve/?utm_term=.7620ee20b375">wasn&rsquo;t responsible</a> for slashing the number of IDPs to that degree). Donors accused the organization of misleading them by <a href="http://www.humanosphere.org/world-politics/2014/12/overspending-decline-funding-force-invisible-children-announce-2015-closure/">spending money on advocacy</a> rather than actually helping LRA victims as their video claimed. Invisible Children <a href="http://www.humanosphere.org/world-politics/2014/12/overspending-decline-funding-force-invisible-children-announce-2015-closure/">denied</a> this.<strong> </strong>According to<strong> </strong>the CEO, they <a href="https://www.npr.org/sections/thetwo-way/2014/12/15/370824018/organization-behind-kony-2012-set-to-close-its-doors-in-2015">spent all of the money</a> raised by the video in 18-24 months.</p>

<p>These are just a couple of the more prominent examples. Meyler and More Than Me now take their place alongside them.</p>
<h2 class="wp-block-heading">The “white-savior industrial complex”</h2>
<p>The fallout over the ProPublica investigation continues to roil<strong> </strong>Liberia. The government has <a href="https://www.reuters.com/article/us-liberia-school-sexualabuse/liberia-launches-investigation-into-u-s-charity-after-rape-allegations-idUSKCN1MT2ZE?il=0">launched an investigation</a> into the charity and the Minister of Gender, Children and Social Protection Williametta&nbsp;Saydee Tarr said the government would be requesting Meyler&rsquo;s cell phone records.</p>

<p>Meyler has <a href="https://www.bbc.com/news/world-us-canada-45869800">temporarily resigned</a> as CEO and the board chair has <a href="https://www.washingtonpost.com/world/africa/liberia-investigates-us-backed-charity-after-alleged-rapes/2018/10/16/34e4ed9e-d126-11e8-a4db-184311d27129_story.html">also resigned</a>.</p>

<p>While Liberians work to unravel how More Than Me went so wrong, the rest of us<strong> </strong>would do well to examine the larger system that Meyler was a product of. In a 2010 article, New York Times columnist <a href="https://www.nytimes.com/2010/10/24/magazine/24volunteerism-t.html?_r=1&amp;mtrref=undefined">Nicholas Kristof</a> dubbed the trend the &ldquo;DIY Foreign-Aid Revolution.&rdquo; He wrote that &ldquo;it&rsquo;s not only presidents and United Nations officials who chip away at global challenges. Passionate individuals with great ideas can do the same, especially in the age of the Internet and social media.&rdquo;</p>

<p>But where some see a parade of goodness making the world a better place, others perceive more problematic scenarios. Journalist Courtney Martin refers to &ldquo;the reductive seduction of other people&rsquo;s problems,&rdquo; in <a href="https://brightthemag.com/the-reductive-seduction-of-other-people-s-problems-3c07b307732d">an essay</a> in which she points out that it would be absurd for a Ugandan college student who saw a mass shooting in the US to decide to go to the United States to get gun legislation passed. Meyler being tasked with fixing girls&rsquo; education in Liberia was no less absurd.</p>

<p><a href="https://www.aljazeera.com/indepth/opinion/foreign-gooders-harm-good-liberia-181014075252621.html">Robtel Neajai Pailey,</a> a Liberian academic, is more blunt:<strong> </strong>Meyler &ldquo;reveals our warped tendencies to glorify foreigners for swooping into poor countries under the guise of doing good.&rdquo;</p>

<p>For all the problems that she brought,<strong> </strong>Meyler (and the dozens of others like her) isn&rsquo;t malicious. She and many others like her are driven by a genuine desire to help. But altruism that isn&rsquo;t fortified by rigor or metrics can lead to disastrous results.</p>

<p>It&rsquo;s the same impulse <a href="https://www.nytimes.com/2016/03/22/magazine/the-voluntourists-dilemma.html">behind voluntourism</a>, the widespread practice of Westerners traveling to developing countries to see the world and do some good by volunteering in orphanages or building schools while on vacation. (The practice is actually where Meyler got her start, when she fundraised in high school to send herself to Central America to volunteer with street children.)</p>

<p>Jacob Kushner, <a href="https://www.nytimes.com/2016/03/22/magazine/the-voluntourists-dilemma.html">writing in the New York Times Magazine</a> about the practice, argues: &ldquo;Unsatisfying as it may be, we ought to acknowledge the truth that we, as amateurs, often don&rsquo;t have much to offer. Perhaps we ought to abandon the assumption that we, simply by being privileged enough to travel the world, are somehow qualified to help ease the world&rsquo;s ills.&rdquo;</p>

<p>Those are wise words, but they can be hard to heed when the White Savior Industrial Complex is constantly<strong> </strong>churning out new avatars.<strong> </strong>There&rsquo;s a slew of awards, fellowships, TED Talks, and funds directed at people like Meyler. Many American readers are eager for simplistic stories with a relatable hero (read: white and middle class) and media organizations are slow to fact check international stories &mdash; particularly of the feel-good variety. (<a href="https://nonprofitchronicles.com/2018/10/22/more-than-me-a-tragic-failure-of-philanthropy/">Marc Gunther</a>, in a piece published Monday, went through the major sources of the millions of dollars in funds that flowed More Than Me&rsquo;s way.)</p>

<p>There&rsquo;s a lot of anger directed at Katie Meyler right now, and rightfully so. But we&rsquo;d do well to zoom out a bit. Katie Meyler created More Than Me, but the white savior industrial complex created her &mdash; and there&rsquo;s a lot more of us complicit in that than we&rsquo;d like to admit.</p>
<hr class="wp-block-separator" />
<p><a href="https://www.vox.com/future-perfect-newsletter"><em>Sign up for the Future Perfect newsletter.</em></a><em> Twice a week, you&rsquo;ll get a roundup of ideas and solutions for tackling our biggest challenges: improving public health, decreasing human and animal suffering, easing catastrophic risks, and &mdash; to put it simply &mdash; getting better at doing good.</em></p>
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									</content>
			
					</entry>
			<entry>
			
			<author>
				<name>Abigail Higgins</name>
			</author>
			
			<title type="html"><![CDATA[Self-lubricating condoms, explained]]></title>
			<link rel="alternate" type="text/html" href="https://www.vox.com/future-perfect/2018/10/23/17996212/condoms-sex-pregnancy-hiv-aids-health" />
			<id>https://www.vox.com/future-perfect/2018/10/23/17996212/condoms-sex-pregnancy-hiv-aids-health</id>
			<updated>2018-10-22T16:08:13-04:00</updated>
			<published>2018-10-23T10:00:01-04:00</published>
			<category scheme="https://www.vox.com" term="Future Perfect" /><category scheme="https://www.vox.com" term="Health" /><category scheme="https://www.vox.com" term="Health Care" /><category scheme="https://www.vox.com" term="Policy" /><category scheme="https://www.vox.com" term="Politics" /><category scheme="https://www.vox.com" term="Public Health" /><category scheme="https://www.vox.com" term="Science" />
							<summary type="html"><![CDATA[Researchers at Boston University discovered a way to make condoms that self-lubricate on contact &#8212; a discovery that could encourage more people to use condoms and reduce rates of unintended pregnancies and sexually transmitted infections. The study was published Wednesday in Royal Society Open Science. Condoms are one of the most cost-effective global health interventions. [&#8230;]]]></summary>
			
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<img alt="" data-caption="" data-portal-copyright="Christina Animashaun/Vox" data-has-syndication-rights="1" src="https://platform.vox.com/wp-content/uploads/sites/2/chorus/uploads/chorus_asset/file/13315249/condom_lead_art_1.jpg?quality=90&#038;strip=all&#038;crop=0,0,100,100" />
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<p>Researchers at Boston University discovered a way to make condoms that self-lubricate on contact &mdash; a discovery that could encourage more people to use condoms and reduce rates of unintended pregnancies and sexually transmitted infections.</p>

<p><a href="http://rsos.royalsocietypublishing.org/content/5/10/180291">The study</a> was published Wednesday in <em>Royal Society Open Science</em>.</p>

<p>Condoms are one of the most cost-effective global health interventions. When used properly, they&rsquo;re <a href="https://www.plannedparenthood.org/learn/birth-control/condom/how-effective-are-condoms">98 percent</a> effective at preventing pregnancy and <a href="https://www.fda.gov/forpatients/illness/hivaids/ucm126372.htm#facts">highly effective</a> at preventing the transmission of HIV/AIDS. UNAIDS estimates that condom use has averted <a href="http://www.unaids.org/en/resources/presscentre/featurestories/2016/october/20161002_condoms">45 million HIV</a> infections since 1990.</p>

<p>While unintended pregnancy rates are declining, <a href="https://www.guttmacher.org/news-release/2018/unintended-pregnancy-rates-declined-globally-1990-2014">44 percent</a> of pregnancies worldwide are still unintended. HIV rates are also declining, but there were still 1.8 million new HIV infections last year.<strong> </strong><a href="https://www.cdc.gov/nchs/data/nhsr/nhsr105.pdf">About a third</a> of American men aged 15&ndash;44 used a condom the last time they had sex. Globally, some <a href="http://www.unaids.org/en/resources/presscentre/featurestories/2018/july/20180723_condoms-AIDS2018">40 percent</a> of men and women didn&rsquo;t use a condom the last time they had sex with a non-regular partner.</p>

<p>So why aren&rsquo;t people using them? The reasons are complex: There&rsquo;s social and cultural stigma attached to condoms in many countries, other people struggle to afford them, and some people don&rsquo;t use them because they&rsquo;re with a monogamous partner or because they&rsquo;re trying to get pregnant.</p>

<p>But one important reason is that people say sexual intercourse doesn&rsquo;t feel as good while wearing a condom. In <a href="http://journals.sagepub.com/doi/abs/10.1258/ijsa.2008.008120">one study</a> in the UK, 77 percent of men and 40 percent of women said condoms reduced pleasure. In eight sub-Saharan African countries, the <a href="https://www.psi.org/publication/reasons-for-non-use-of-condoms-in-eight-countries-in-sub-saharan-africa/">number one reason</a> for not using condoms with a casual partner was disliking them, which included the perception that they reduced pleasure. Studies in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3206429/">Nepal</a> and <a href="http://journals.sagepub.com/doi/full/10.1177/1557988318756132">Indonesia</a> of female sex workers showed that male clients resisted condom use because of reduced pleasure.</p>

<p>Another problem with condoms is that they break. Latex acts as a great barrier, but<strong> </strong>it can also increase friction and cause condoms to rupture. Lubricants can reduce that friction and increase pleasure, but using them requires an extra step and money.</p>

<p>Self-lubricating condoms, on which clinical trials will start next year, could be a major breakthrough: 73 percent of people surveyed said they preferred the way the self-lubricating condoms felt and that they would be more likely to use these condoms. The study relied on a small sample size &mdash; only 33 people &mdash; but results hew to a<strong> </strong><a href="http://rsos.royalsocietypublishing.org/content/5/10/180291">national survey</a> of Americans that found that 61.5 percent of women and 66.1 percent of men said lubricated sex felt better.</p>

<p>Another benefit is that these condoms keep their lubrication a lot longer &mdash; up to 1,000 thrusts, according to the research, which is twice as long as normal water-based lubricants.</p>
<h2 class="wp-block-heading">Improving upon an ancient technology</h2>
<p>Considering how important they are, condoms are still pretty primitive; they haven&rsquo;t advanced a whole lot since the ancient Romans were using <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3649591/">animal</a> bladders.</p>

<p>&ldquo;The last advance in condom technology is more than 50 years ago, and that was when silicon oil got introduced as a lubricant,&rdquo; <a href="http://people.bu.edu/mgrin/about.html">professor Mark Grinstaff</a>, a co-author of the Boston University study, <a href="https://www.theguardian.com/society/2018/oct/17/self-lubricating-condom-encourage-safe-sex-outlast-stamina">told the Guardian</a>. &ldquo;We are using our grandparents&rsquo; technology in the 21st century, which is crazy.&rdquo;</p>

<p>In 2013, the Bill and Melinda Gates Foundation put out a call for proposals to change this, soliciting designs for condoms that preserved or enhanced pleasure. They received <a href="https://thinkprogress.org/bill-and-melinda-gates-contest-to-build-a-better-condom-got-over-800-submissions-9854c02dc911/">over 800 submissions</a> and chose 11 projects, including the researchers from Boston University, to give $100,000 each in seed funding to start research, with the possibility of an additional $1 million.</p>

<p>The <a href="http://theweek.com/articles/455793/meet-11-condoms-future-selected-by-bill-gates">recipients included</a> one project that aimed to put a modern twist on traditional lambskin condoms by using collagen fibers from bovine tendons, which they hoped would replicate the feel of human skin. Another project proposed a condom that would tighten around the penis during sex like shrink wrap, increasing pleasure. A couple of the projects proposed condoms with applicators, another that &ldquo;clings like Saran Wrap rather than squeezes,&rdquo; and others that warm on contact.</p>

<p>Five years later, most of the projects have yet to come to fruition, making the research out of Boston that much<strong> </strong>more exciting.</p>

<p>The man responsible for the bovine condom idea, Mark McGlothlin, president of Apex Medical Technologies, <a href="https://mic.com/articles/128850/bill-and-melinda-gates-foundation-condom-contest-where-are-they-now#.GM3QWvXWp">told Mic</a> in 2015 that, for all the publicity Gates received for the project, the funding wasn&rsquo;t enough to get products to market. Getting products through the Federal Drug Administration approval process can take years, if not decades &mdash; particularly with something as sensitive as condoms. As a result, a lot of the research has <a href="https://www.wsj.com/articles/the-quest-to-build-a-better-condom-1508504401">petered out</a>.</p>

<p>Still, some of the other products remain in development. Lakshminarayanan Ragupathy of HLL Lifecare Ltd. is <a href="https://motherboard.vice.com/en_us/article/pgkwqv/where-are-our-next-generation-condoms">still developing</a> one of the heat-sensitive condoms and also began work on developing a <a href="https://gcgh.grandchallenges.org/grant/polyglycerol-sebacate-based-condoms">biodegradable condom</a>, as most condoms take years to decompose.</p>

<p>Another <a href="https://globalchallenges.uow.edu.au/impact/UOW219621.html">recipient</a> of Gates funding in Australia is working to make condoms from hydrogels, which are more &ldquo;skin-like&rdquo; than latex or rubber. They&rsquo;re still in development, but researchers hope the product could have worldwide impact because it would &ldquo;decrease the spread of disease and unwanted pregnancy without compromising sensation.&rdquo;</p>

<p>Indeed, condoms save lives &mdash; but only when people want to use them.</p>
<hr class="wp-block-separator" />
<p><a href="https://www.vox.com/future-perfect-newsletter"><em>Sign up for the Future Perfect newsletter</em></a><em>. Twice a week, you&rsquo;ll get a roundup of ideas and solutions for tackling our biggest challenges: improving public health, decreasing human and animal suffering, easing catastrophic risks, and &mdash; to put it simply &mdash; getting better at doing good.</em></p>
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									</content>
			
					</entry>
			<entry>
			
			<author>
				<name>Abigail Higgins</name>
			</author>
			
			<title type="html"><![CDATA[Scientists have estimated the cost of stopping 11 diseases that could kill millions in a pandemic]]></title>
			<link rel="alternate" type="text/html" href="https://www.vox.com/future-perfect/2018/10/22/17999676/vaccine-ebola-pandemic-disease-zika-epidemic-sars" />
			<id>https://www.vox.com/future-perfect/2018/10/22/17999676/vaccine-ebola-pandemic-disease-zika-epidemic-sars</id>
			<updated>2018-11-10T09:50:13-05:00</updated>
			<published>2018-10-22T14:00:01-04:00</published>
			<category scheme="https://www.vox.com" term="Future Perfect" /><category scheme="https://www.vox.com" term="Health" /><category scheme="https://www.vox.com" term="Health Care" /><category scheme="https://www.vox.com" term="Policy" /><category scheme="https://www.vox.com" term="Politics" /><category scheme="https://www.vox.com" term="Public Health" /><category scheme="https://www.vox.com" term="Science" />
							<summary type="html"><![CDATA[One of the best ways to save humanity from a global pandemic in the future is by developing infectious disease vaccines now. But research has been sluggish, partly because no one knows how much producing such vaccines would cost. That changed last week when researchers from the Coalition for Epidemic Preparedness Innovations (CEPI) published a [&#8230;]]]></summary>
			
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<img alt="" data-caption="A nurse administers an injection in an Ebola study in 2015 in Monrovia, Liberia. | John Moore/Getty Images" data-portal-copyright="John Moore/Getty Images" data-has-syndication-rights="1" src="https://platform.vox.com/wp-content/uploads/sites/2/chorus/uploads/chorus_asset/file/13300635/462658344.jpg.jpg?quality=90&#038;strip=all&#038;crop=0,0,100,100" />
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	A nurse administers an injection in an Ebola study in 2015 in Monrovia, Liberia. | John Moore/Getty Images	</figcaption>
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<p>One of the best ways to save humanity from a global pandemic in the future is by developing infectious disease vaccines now. But research has been sluggish, partly because no one knows how much producing such vaccines would cost.</p>

<p>That changed last week when researchers from the Coalition for Epidemic Preparedness Innovations (CEPI) published a <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30346-2/fulltext">study in <em>Lancet</em></a><strong> </strong>estimating the cost of developing vaccines for diseases that have the potential to escalate into global humanitarian crises.</p>

<p>Preventing pandemics is extremely important work: In the next two decades, experts believe, there is a reasonable probability of a pandemic that&nbsp;<a href="https://www.businessinsider.com/bill-gates-op-ed-bio-terrorism-epidemic-world-threat-2017-2">kills more than 30 million people worldwide</a>. Compare that to the 2014 Ebola outbreak, which killed <a href="https://www.cdc.gov/vhf/ebola/history/2014-2016-outbreak/case-counts.html">more than 11,000 people</a><a href="https://www.vox.com/2014/9/23/6832023/ebola-virus-global-health-panic"> across three countries</a> &mdash; partially because we didn&rsquo;t have a vaccine at the time.</p>

<p>But vaccines are expensive and hard to get off the ground. According to the <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30346-2/fulltext">Lancet</a>, &ldquo;In general, vaccine development from discovery to licensure can cost billions of dollars, can take over 10 years to complete, and has an average 94% chance of failure.&rdquo; It&rsquo;s a risky investment not many people want to make &mdash; until, of course, there&rsquo;s a deadly outbreak like in 2014. By then, it&rsquo;s often already too late.</p>

<p>Thanks to CEPI&rsquo;s research, we now know the minimum cost of developing at least one vaccine for each of the 11 diseases experts have highlighted as pandemic risks: $2.8 billion to $3.7 billion. That sounds expensive, but so are pandemics: The 2003 SARS outbreak in East Asia <a href="http://www.worldbank.org/en/news/feature/2013/03/05/flu-outbreaks-reminder-of-pandemic-threat">cost $54 billion</a>. Moreover, if early development prevents us from experiencing another <a href="https://www.vox.com/future-perfect/2018/10/15/17948062/pandemic-flu-ebola-h1n1-outbreak-infectious-disease">Spanish flu</a>, which killed nearly one of out of every 20 people in 1918, then it&rsquo;s actually a bargain.</p>
<h2 class="wp-block-heading">It’s hard to get funding for rare diseases until there’s an epidemic</h2>
<p>The researchers chose the pathogens based on a list the <a href="http://www.who.int/blueprint/about/r_d_blueprint_plan_of_action.pdf?ua=1">World Health Organization</a> developed after the 2014 Ebola outbreak of the 11 pathogens that it believed were the most likely to cause severe outbreaks in the near future. The list included:</p>
<ul class="wp-block-list"><li>Crimean Congo hemorrhagic fever</li><li>chikungunya</li><li>Ebola</li><li>Lassa fever</li><li>Marburg</li><li>Middle East respiratory syndrome coronavirus</li><li>Nipah</li><li>Rift Valley fever</li><li>severe acute respiratory syndrome</li><li>severe fever with thrombocytopenia syndrome</li><li>Zika</li></ul>
<p>That list changed a bit when it was <a href="http://www.who.int/blueprint/priority-diseases/en/">updated this year</a>, but all of the diseases remain of &ldquo;considerable epidemic preparedness importance.&rdquo;</p>

<p>These are mostly relatively rare diseases that tend to strike poorer countries. <a href="http://www.who.int/news-room/fact-sheets/detail/chikungunya">Chikungunya</a> occurs mostly in Africa and Asia, and while <a href="https://www.reuters.com/article/us-sudan-health-chikungunya/sudan-reports-outbreak-of-mosquito-borne-chikungunya-disease-in-eastern-state-idUSKCN1M52MB">Sudan had a recent outbreak</a>, deaths from the disease aren&rsquo;t common. <a href="http://www.who.int/en/news-room/fact-sheets/detail/lassa-fever">Lassa fever</a> only exists in West Africa, and there have been periodic outbreaks in Nigeria for the past few years, including the <a href="https://www.npr.org/sections/goatsandsoda/2018/03/19/587603462/nigeria-faces-mystiifying-spike-in-deadly-lassa-fever">worst outbreak</a> in March that killed <a href="https://www.who.int/csr/don/20-april-2018-lassa-fever-nigeria/en/">more than 100</a> people.</p>

<p>Rift Valley Fever doesn&rsquo;t even affect humans usually. It&rsquo;s a disease that primarily affects animals in sub-Saharan Africa and major outbreaks have occurred in Kenya, Somalia, and Tanzania. It&rsquo;s not common, but humans can get it from mosquito bites or from handling the tissue of infected animals,<strong> </strong>and when they do, <a href="https://www.cdc.gov/vhf/rvf/index.html">it&rsquo;s deadly</a>.</p>

<p>Because these diseases cause relatively few deaths (for now) and primarily strike the poor, it&rsquo;s hard to get funding for them, especially the billions required for vaccine development.</p>

<p>But that could change. <a href="https://www.vox.com/cards/ebola-facts-you-need-to-know/what-is-the-ebola-virus">Ebola</a> was a relatively obscure tropical disease, until it wasn&rsquo;t. We also saw what happened when <a href="https://www.vox.com/2016/1/20/10795562/zika-virus-cdc-mosquitoes-birth-defects">Zika</a> went from obscurity to international public health concern. We don&rsquo;t know what the next Ebola will be, or how bad it will be. The best thing we can do now is find a vaccine before we do.</p>
<h2 class="wp-block-heading">How likely is a global pandemic? Pretty likely.</h2>
<p>The risks of a global pandemic may seem remote but it&rsquo;s no lower now than it was 100 years ago, <a href="https://www.vox.com/future-perfect/2018/10/15/17948062/pandemic-flu-ebola-h1n1-outbreak-infectious-disease">writes Klain</a>. While advances in modern medicine, like antibiotics, protect us from disease, other realities of modern life don&rsquo;t.</p>

<p>&ldquo;Global transportation networks can bring a virus from a remote corner of the world to one of its most populous cities in less than 24 hours. The clustering of more people into cities &mdash; especially supercities in Asia &mdash; creates fertile grounds for such diseases to spread quickly,&rdquo; says Klain. Climate change also means mosquitos are reaching new populations, and growing <a href="https://www.vox.com/2016/9/20/12979968/antibiotic-resistance-superbugs-un">antibiotic resistance</a> threatens to reverse public health<strong> </strong>gains.</p>

<p>We&rsquo;ve seen the way pandemics can spiral out of control: as with the <a href="https://www.vox.com/2015/12/1/9814026/world-aids-day-2015-hiv-awareness">HIV/AIDS</a> epidemic, SARS in 2002, <a href="https://www.vox.com/policy-and-politics/2018/2/12/17004788/trump-flu-season-cdc-shot">H1N1</a> flu in 2009, <a href="https://www.vox.com/2014/5/16/5721150/mers-camels-viruses-sars">MERS</a> in 2012, and <a href="https://www.vox.com/2014/9/23/6832023/ebola-virus-global-health-panic">Ebola</a> in 2014.</p>

<p>It wasn&rsquo;t until Ebola started escalating &mdash; at one point projected to infect one million people &mdash; that vaccine research <a href="https://www.vox.com/science-and-health/2016/12/22/14039628/rvsv-zebov-ebola-vaccine-trial-effective">kicked into gear</a>. The <a href="https://www.newyorker.com/business/currency/race-ebola-vaccine">public and private sector</a> poured resources into developing the vaccine and the typically lengthy approval process was fast-tracked.</p>

<p>And it worked. When an <a href="https://www.vox.com/science-and-health/2018/5/16/17356464/ebola-virus-vaccine">outbreak struck</a> the Democratic Republic of Congo earlier this year, vaccines were deployed to the country and were instrumental in containing the outbreak.</p>

<p>But a lot of people had to die before there was enough pressure to develop the vaccine.</p>

<p>&ldquo;Had a&nbsp;vaccine&nbsp;been available earlier in the&nbsp;<a href="https://www.vox.com/science-and-health/2016/12/22/14039628/rvsv-zebov-ebola-vaccine-trial-effective">Ebola</a>&nbsp;epidemic, thousands of lives might have been saved,&rdquo; said Dr. Jeremy Farrar, the director of the Wellcome Trust, a global charitable foundation that funds research on Ebola <a href="https://www.vox.com/science-and-health/2016/12/22/14039628/rvsv-zebov-ebola-vaccine-trial-effective">after the effective vaccine was developed</a> in 2016. &ldquo;We have to get ahead of the curve and make promising diagnostics, drugs, and&nbsp;vaccines&nbsp;for diseases we know could be a threat in the future.&rdquo;&nbsp;</p>

<p>Knowing the cost of developing these vaccines could help prompt an important paradigm shift: preventing pandemics before they start.</p>
<hr class="wp-block-separator" />
<p><a href="https://www.vox.com/future-perfect-newsletter"><em>Sign up for the Future Perfect newsletter.</em></a><em> Twice a week, you&rsquo;ll get a roundup of ideas and solutions for tackling our biggest challenges: improving public health, decreasing human and animal suffering, easing catastrophic risks, and &mdash; to put it simply &mdash; getting better at doing good.</em></p>
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									</content>
			
					</entry>
			<entry>
			
			<author>
				<name>Abigail Higgins</name>
			</author>
			
			<title type="html"><![CDATA[10 ways the world is most likely to end, explained by scientists]]></title>
			<link rel="alternate" type="text/html" href="https://www.vox.com/future-perfect/2018/10/18/17957162/nuclear-war-asteroid-volcano-science-climate-change" />
			<id>https://www.vox.com/future-perfect/2018/10/18/17957162/nuclear-war-asteroid-volcano-science-climate-change</id>
			<updated>2018-12-26T15:44:39-05:00</updated>
			<published>2018-10-18T11:00:02-04:00</published>
			<category scheme="https://www.vox.com" term="Explainers" /><category scheme="https://www.vox.com" term="Future Perfect" /><category scheme="https://www.vox.com" term="Science" />
							<summary type="html"><![CDATA[Remember when the possibility of nuclear war seemed remote? The fact that it doesn&#8217;t anymore shows how quickly threats to humanity can change and how important they are to pay attention to. The Global Challenges Foundation, which works to reduce the global problems that threaten humanity, compiles an annual report on global catastrophic risks. The [&#8230;]]]></summary>
			
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<figure>

<img alt="" data-caption="South Korean conservative protesters participate in a rally a day after North Korea announced it had conducted a third nuclear test on February 13, 2013, in Seoul.  | Chung Sung-Jun/Getty Images" data-portal-copyright="Chung Sung-Jun/Getty Images" data-has-syndication-rights="1" src="https://platform.vox.com/wp-content/uploads/sites/2/chorus/uploads/chorus_asset/file/13288975/161611068.jpg.jpg?quality=90&#038;strip=all&#038;crop=0,0,100,100" />
	<figcaption>
	South Korean conservative protesters participate in a rally a day after North Korea announced it had conducted a third nuclear test on February 13, 2013, in Seoul.  | Chung Sung-Jun/Getty Images	</figcaption>
</figure>
<p>Remember when the possibility of nuclear war seemed remote? The fact that <a href="https://www.vox.com/world/2018/2/7/16974772/north-korea-war-trump-kim-nuclear-weapon">it doesn&rsquo;t anymore</a> shows how quickly threats to humanity can change and how important they are to pay attention to.</p>

<p>The <a href="https://globalchallenges.org/">Global Challenges Foundation</a>, which works to reduce the global problems that threaten humanity, compiles an <a href="https://globalchallenges.org/our-work/annual-report/annual-report-2018">annual report</a> on global catastrophic risks. The<strong> </strong>group released the 2018 edition in September, and the litany is harrowing: Chemical warfare, supervolcanic eruptions, asteroid collisions, and the looming effects of climate change threaten to cause everything from civilizational collapse to human extinction.</p>

<p>Some of these risks sound like science fiction, but so did weapons of mass destruction and climate change 100 years ago. As Allan Dafoe and Anders Sandberg of the Future of Humanity Institute write, our brains aren&rsquo;t good at thinking about catastrophic risk because they either &ldquo;completely neglect or massively overweight&rdquo; things that are low probability. So the report, overseen by a team at GCF but with each section written by leading experts, combines historical evidence and scientific data&nbsp;to determine the biggest threats.</p>

<p>The good news for us is that scientists think the <a href="https://www.sciencemag.org/news/2014/01/earth-wont-die-soon-thought">world will be habitable</a> for at least a few hundred million more years.<strong> </strong>The bad news is there&rsquo;s a lot that could change that. The risk of the threats highlighted in the report actually causing mass casualties are still small, but that doesn&rsquo;t mean they&rsquo;re not important to pay attention to &mdash; especially when the worst-case scenario means human extinction.</p>

<p>Here&rsquo;s what should be keeping you up at night and what, realistically, might cause humans to go the way of dinosaurs.</p>
<h2 class="wp-block-heading"><strong>1) Nuclear war</strong></h2>
<p>A nuclear detonation from one of today&rsquo;s more powerful weapons would cause a<strong> </strong>fatality rate of 80 to 95 percent in the blast zone stretching out to a radius of 4 kilometers &mdash; although &ldquo;severe damage&rdquo; could reach six times as far.</p>

<p>But it isn&rsquo;t just the immediate deaths we need<strong> </strong>to worry about &mdash; it&rsquo;s the <a href="https://www.vox.com/future-perfect/2018/10/19/17873822/nuclear-war-weapons-bombs-how-kill">nuclear winter</a>. This is when the clouds of dust and smoke released shroud the planet and block out the sun,<strong> </strong>causing<strong> </strong>temperatures to drop, possibly for years. If 4,000 nuclear weapons were detonated &mdash; a possibility in the event of all-out nuclear war between the US and Russia, which hold the vast majority of the world&rsquo;s stockpile &mdash; an untold number of people would be killed, and temperatures could drop by 8 degrees Celsius over four to five years. Humans wouldn&rsquo;t be able to grow food; chaos and violence would ensue.</p>

<p>A big worry here is the arsenal of nukes. While numbers have fallen over several decades, the United States and Russia have<strong> </strong>just under 7,000<strong> </strong>warheads<strong> </strong>each, the largest collections in the world. The UK, France, China, <a href="https://www.vox.com/2018/4/2/17096566/pakistan-india-nuclear-war-submarine-enemies">India</a>, <a href="https://www.vox.com/2018/4/2/17096566/pakistan-india-nuclear-war-submarine-enemies">Pakistan</a>, <a href="https://www.youtube.com/watch?v=NwbYpdGpx8U">North Korea</a>, and Israel all have nuclear weapons.</p>

<p>Hundreds of nuclear weapons are ready to be released <a href="https://art19.com/shows/today-explained/episodes/93aad331-3f2b-4c2b-9b62-243026be233e">within minutes</a>, a troubling<strong> </strong>fact considering that the biggest threat of nuclear war may be an accident or miscommunication. A few times since the 1960s, Russian officers (and, in 1995, the president) <a href="https://www.vox.com/2018/9/26/17905796/nuclear-war-1983-stanislav-petrov-soviet-union">narrowly decided not to launch a nuclear weapon</a> in response to what they&rsquo;d later find out were false alarms.</p>
<h2 class="wp-block-heading"><strong>2) Biological and chemical warfare</strong></h2>
<p>Unlike nuclear weapons, which require complex engineering, <a href="https://www.vox.com/future-perfect/2018/12/6/18127430/superbugs-biotech-pathogens-biological-warfare-pandemic">biological and chemical warfare can be developed at a relatively low cost and with relatively attainable materials</a>.</p>

<p>In the past few years, the Syrian government has used chemical weapons in the civil war that has ravaged the country. These chemical attacks using sarin and chlorine have appalled the international community, and underscored the damage chemical weapons can do. Weaponized toxic chemicals could do tremendous harm to a localized target &mdash; say, if the toxins were released into the air or into the water supply.</p>

<p>Biological weapons represent a greater catastrophic threat. Advances in synthetic biology have made very real the possibility of malicious actors creating harmful pathogens for weaponization &mdash; or innocent researchers accidentally releasing a lethal infectious bug out into the world. In the event of a fast-moving pandemic, <a href="https://www.vox.com/future-perfect/2018/10/15/17948062/pandemic-flu-ebola-h1n1-outbreak-infectious-disease">the world would be pretty vulnerable</a>.</p>
<h2 class="wp-block-heading"><strong>3) Catastrophic climate change</strong></h2>
<p>A United Nations panel of scientists released a report last week saying that we <a href="https://www.vox.com/2018/10/8/17948832/climate-change-global-warming-un-ipcc-report">only have 12 years</a> to keep global warming to moderate levels.</p>

<p>Projections of the effects of climate change vary depending on how much the Earth warms (usually modeled on an increase of 1 to 3 degree Celsius). None of the scenarios look good.</p>

<p>At best, we&rsquo;re looking at more frequent and severe tropical cyclones. Midrange predictions include the loss of the majority of global<strong> </strong>agricultural land and freshwater sources, with major coastal cities like New York and Mumbai ending up underwater. At worst, human civilization would come to an end.</p>

<p>Even if current global commitments to reduce carbon emissions are kept, there is a one-third chance of the Earth&rsquo;s temperature increasing by 3<strong>&deg;</strong>C, which would cause most of Florida and Bangladesh to drown.</p>

<p>Catastrophic climate change is also not something we&rsquo;re dedicating nearly enough attention to. The author of this section in the report,<strong> </strong>Dr.&nbsp;Leena Srivastava, the acting director of general at the Energy and Resources Institute, points out that we&rsquo;ve put enough time and resources into airplane safety that only 27 planes crash a year. But &ldquo;if dying in a flight accident was as likely as a 3&deg;C global temperature increase, then the number of people dying in airplanes every year would be 15 [million].&rdquo;</p>
<h2 class="wp-block-heading"><strong>4) Ecological collapse</strong></h2><img src="https://platform.vox.com/wp-content/uploads/sites/2/chorus/uploads/chorus_asset/file/13288905/55985243.jpg.jpg?quality=90&#038;strip=all&#038;crop=0,0,100,100" alt="Salton Sea Plan Calls For 200,000 Homes On Former Atomic Weapons Site" title="Salton Sea Plan Calls For 200,000 Homes On Former Atomic Weapons Site" data-has-syndication-rights="1" data-caption="A tree killed by rising saltwater is seen beyond a mud flat at dawn on the east shore of the Salton Sea on October 22, 2005. across the lake from Salton City, California. | David McNew/Getty Images" data-portal-copyright="David McNew/Getty Images" />
<p>Ecosystems are the delicate community of living organisms, like humans and animals, interacting<strong> </strong>with their nonliving environment, like air and water. Ecosystems can recover from a certain amount of impact from humans, like temperature increases or habitat loss, but there&rsquo;s a tipping point at which they can&rsquo;t &mdash; and according to the report, we might be reaching that tipping point.</p>

<p>Lake Chad in West Africa<strong> </strong>is an example of ecological collapse. Sixty years of drought, overuse of water, and the impacts of climate change have reduced the lake by 90 percent. Its massive reduction has adversely affected the livelihoods of more than 40 million people in Chad, Nigeria, Niger, and Cameroon that depend on it.</p>

<p>Scholars believe this moment in history constitutes a new geological era, called the <a href="https://www.vox.com/2015/4/2/8335915/anthropocene-debate">Anthropocene</a>. In this new era, humans are the primary change agents, rapidly degrading what makes the planet habitable, intensifying greenhouse gas concentration, and damaging<strong> </strong>the health of marine ecosystems.</p>
<h2 class="wp-block-heading"><strong>5) Pandemics</strong></h2>
<p>Twice in modern history, plagues have swept across the world, killing an estimated 15 percent of the population in a few decades. They occurred way back in the fifth and 14th centuries, respectively<strong> &mdash; </strong>but there is a serious risk that <a href="https://www.vox.com/future-perfect/2018/10/15/17948062/pandemic-flu-ebola-h1n1-outbreak-infectious-disease">a new infectious disease</a> could cause another outbreak, especially with today&rsquo;s urban and mobile global population.</p>

<p>Luckily, deadly diseases with the capacity to spread globally are rare. But they do happen &mdash; a century ago, the Spanish flu killed more than 50 million people. Outbreaks of SARS and Ebola in recent years also ring alarm bells.</p>

<p>Antibiotics, our greatest defense against disease, are becoming less effective as some strains of bacteria become resistant to them. Antibiotic-resistant bacteria are responsible for an estimated 700,000 annual deaths. If we don&rsquo;t develop new advances against antibiotic resistance, that number is estimated to reach 10 million by 2050.</p>
<h2 class="wp-block-heading"><strong>6) Asteroid impact</strong></h2>
<p>Asteroids are rocks that revolve around the sun and that occasionally collide with the Earth. An <a href="https://www.vox.com/science-and-health/2017/7/3/15903154/asteroid-death-one-chart">asteroid</a> large enough to cause a global catastrophe hits Earth every 120,000 years, scientists estimate. It&rsquo;s likely what killed the dinosaurs, and if an asteroid even one-tenth the size of the one that caused their extinction hit Earth today, the results would be devastating. Scientists estimate it could release enough particles to block the sun for months and cause a famine killing hundreds of millions.</p>

<p>NASA announced in 2011 that it had mapped more than 90 percent of objects in space larger than 1 kilometer in diameter, and that none of them are <a href="https://www.pri.org/stories/2011-09-30/nasa-asteroid-threat-less-feared">likely to hit Earth</a>. But there&rsquo;s still a lot we don&rsquo;t know about smaller objects that, while unlikely to cause a global catastrophe, could have a big enough local impact to <a href="https://www.vox.com/a/asteroid-day">disrupt social and economic systems</a>.</p>
<h2 class="wp-block-heading"><strong>7) Supervolcanic eruption</strong></h2><img src="https://platform.vox.com/wp-content/uploads/sites/2/chorus/uploads/chorus_asset/file/13288887/962886202.jpg.jpg?quality=90&#038;strip=all&#038;crop=0,0,100,100" alt="Hawaii’s Kilauea Volcano Erupts Forcing Evacuations" title="Hawaii’s Kilauea Volcano Erupts Forcing Evacuations" data-has-syndication-rights="1" data-caption="Onlookers and media gather as lava from a Kilauea volcano fissure erupts in Leilani Estates, on Hawaii’s Big Island, on May 26, 2018. | Mario Tama/Getty Images" data-portal-copyright="Mario Tama/Getty Images" />
<p>A supervolcanic explosion 74,000 years ago ejected so much debris into the atmosphere that scientists believe it caused the Earth to cool by several degrees Celsius. Some experts believe this caused the greatest mass plant and animal extinction in human history, bringing the species to the brink of extinction.</p>

<p>How likely is that to happen today? It&rsquo;s hard to say since we don&rsquo;t have much to compare it to, but data suggests a supervolcanic eruption occurs on average every 17,000 years. If that&rsquo;s true, then we&rsquo;re overdue &mdash; the last one we know of was 26,500 years ago in New Zealand.</p>

<p>We don&rsquo;t have a way to anticipate eruptions more than a few weeks or months in advance, and we don&rsquo;t really have any way to reduce the likelihood of eruption right now, but scientists are monitoring several areas of risk, including Yellowstone in the US.</p>
<h2 class="wp-block-heading"><strong>8) Solar geoengineering</strong></h2>
<p>There&rsquo;s a dramatic option for stopping, or even reversing, rising global temperatures, but it comes with significant possible risk.</p>

<p>Solar geoengineering would reflect light and heat away from Earth and back into space by injecting aerosols into the stratosphere, the second layer of Earth&rsquo;s atmosphere. For now, it only exists in computer models, but the first experiment is being planned by Harvard researchers.</p>

<p>Solar geoengineering is one of two emerging technologies that could manipulate the atmosphere and reduce climate risk. The other is directly removing carbon dioxide from the atmosphere, which doesn&rsquo;t currently exist on a big enough scale.</p>

<p>If solar geoengineering were deployed, it would affect the entire atmosphere and be humanity&rsquo;s largest-ever global endeavor. While it is the only known technique that could stop rising temperatures, there&rsquo;s still a lot we don&rsquo;t know, including whether it could destabilize local and global climate or ecosystems. Manipulation on this scale without understanding the effects could turn out to<strong> </strong>be catastrophic for the human race. The technology could also be cheap enough (as low as $10 billion a year) that it could be wielded by one country or a wealthy individual, introducing the possibility of reckless use.</p>
<h2 class="wp-block-heading"><strong>9) Artificial intelligence</strong></h2>
<p>Artificial intelligence (AI) is progressing rapidly. Surveyed scientists estimate, on average, that there is a <a href="https://aiimpacts.org/2016-expert-survey-on-progress-in-ai/">50 percent</a> chance of AI being able to perform most tasks as well as, or better than, humans by 2050, with at least a 5 percent chance of surpassing human intelligence a couple of years after that.</p>

<p>There&rsquo;s a common misconception that <a href="https://www.vox.com/future-perfect/2018/12/21/18126576/ai-artificial-intelligence-machine-learning-safety-alignment">the risk of AI</a> is that it will become malevolent. The bigger concern is that it will <a href="https://www.vox.com/future-perfect/2018/10/16/17978596/stephen-hawking-ai-climate-change-robots-future-universe-earth">become too good at its job</a>. As the report says: &ldquo;If you ask an obedient, intelligent car to take you to the airport as fast as possible, it might get you there chased by helicopters and covered in vomit, doing not what you wanted but literally what you asked for.&rdquo;</p>

<p>The implications become much more frightening when you consider AI weapons in the hands of the wrong person, or an AI arms race leading to an AI war.</p>
<h2 class="wp-block-heading"><strong>10) Unknown risks</strong></h2>
<p>It wasn&rsquo;t that long ago that climate change and nuclear warfare were largely unheard of. Today, they&rsquo;re risks we&rsquo;ve already seen the devastating effects of &mdash; and that we worry could get much worse. Because of this, there&rsquo;s a possibility that we haven&rsquo;t even conceived of what is most likely to kill us.</p>
<hr class="wp-block-separator" />
<p><a href="https://www.vox.com/future-perfect-newsletter"><em>Sign up for the Future Perfect newsletter.</em></a><em> Twice a week, you&rsquo;ll get a roundup of ideas and solutions for tackling our biggest challenges: improving public health, decreasing human and animal suffering, easing catastrophic risks, and &mdash; to put it simply &mdash; getting better at doing good.</em></p>
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					</entry>
			<entry>
			
			<author>
				<name>Abigail Higgins</name>
			</author>
			
			<title type="html"><![CDATA[Stephen Hawking’s final warning for humanity: AI is coming for us]]></title>
			<link rel="alternate" type="text/html" href="https://www.vox.com/future-perfect/2018/10/16/17978596/stephen-hawking-ai-climate-change-robots-future-universe-earth" />
			<id>https://www.vox.com/future-perfect/2018/10/16/17978596/stephen-hawking-ai-climate-change-robots-future-universe-earth</id>
			<updated>2018-10-16T14:35:26-04:00</updated>
			<published>2018-10-16T15:00:02-04:00</published>
			<category scheme="https://www.vox.com" term="Future Perfect" /><category scheme="https://www.vox.com" term="Science" /><category scheme="https://www.vox.com" term="Technology" />
							<summary type="html"><![CDATA[Stephen Hawking has a final message for humanity: If robots don&#8217;t get us, climate change will. Hawking, who died at age 76 of a degenerative neurological disease earlier this year, offers his parting thoughts in a posthumously published book called Brief Answers To The Big Questions, which comes out Tuesday. It&#8217;s a message worth heeding [&#8230;]]]></summary>
			
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<img alt="" data-caption="Professor Stephen Hawking onstage during the New Space Exploration Initiative ‘Breakthrough Starshot’ Announcement at One World Observatory on April 12, 2016, in New York City. | Jemal Countess/Getty Images" data-portal-copyright="Jemal Countess/Getty Images" data-has-syndication-rights="1" src="https://platform.vox.com/wp-content/uploads/sites/2/chorus/uploads/chorus_asset/file/13280763/520676582.jpg.jpg?quality=90&#038;strip=all&#038;crop=0,0,100,100" />
	<figcaption>
	Professor Stephen Hawking onstage during the New Space Exploration Initiative ‘Breakthrough Starshot’ Announcement at One World Observatory on April 12, 2016, in New York City. | Jemal Countess/Getty Images	</figcaption>
</figure>
<p>Stephen Hawking has a final message for humanity: If robots don&rsquo;t get us, climate change will.</p>

<p>Hawking, who <a href="https://www.vox.com/science-and-health/2018/3/14/17118626/stephen-hawking-death-life-science-black-holes">died at age 76</a> of a degenerative neurological disease earlier this year, offers his parting thoughts in a<strong> </strong>posthumously published<strong> </strong>book called <a href="https://www.amazon.com/dp/B07D6BBGKL/ref=dp-kindle-redirect?_encoding=UTF8&amp;btkr=1"><em>Brief Answers To The Big Questions</em></a>, which comes out Tuesday. It&rsquo;s a message worth heeding from a man who is probably the most renowned scientist since Einstein, best known for his discovery of <a href="https://www.vox.com/science-and-health/2018/3/14/17118626/stephen-hawking-death-life-science-black-holes">how black holes function</a>. Hawking&rsquo;s book <a href="https://www.penguinrandomhouse.com/books/77010/a-brief-history-of-time-by-stephen-hawking/9780553109535/'"><em>A Brief History of Time</em></a><em> </em>sold <a href="https://www.vox.com/science-and-health/2018/3/14/17118626/stephen-hawking-death-life-science-black-holes">more than 10 million copies</a> and tackled questions as big as &ldquo;How did the universe begin?&rdquo; and &ldquo;What will happen when it ends?&rdquo; in language simple enough for the average reader.</p>

<p>In an excerpt published in <a href="https://www.thetimes.co.uk/article/stephen-hawking-ai-will-robots-outsmart-us-big-questions-facing-humanity-q95gdtq6w">the Times of London</a> over the weekend, he&rsquo;s funny and optimistic, even as he warns us that artificial intelligence is likely to outsmart us, that the wealthy are bound to develop into a<strong> </strong>superhuman species, and that the planet is hurtling toward total inhabitability.</p>

<p>Hawking&rsquo;s book is ultimately a verdict on humanity&rsquo;s future. At first blush, the verdict is that we&rsquo;re doomed. But dig deeper and there&rsquo;s something else here too, a faith that human wisdom and innovation will thwart our own destruction, even when we seem hellbent on bringing it about.</p>
<h2 class="wp-block-heading">The robots might be coming for us</h2>
<p>Hawking&rsquo;s biggest warning is about the rise of<strong> </strong>artificial intelligence: It will either be the best thing that&rsquo;s ever happened to us, or it will be the worst thing. If we&rsquo;re not careful, it very well may be the last thing.</p>

<p>Artificial intelligence holds great opportunity for humanity, encompassing everything from Google&rsquo;s algorithms to self-driving cars to facial recognition software. The AI we have today, however, is still in its<strong> </strong>primitive stages. Experts worry about what will happen when that intelligence outpaces us. Or, as Hawking puts it, &ldquo;Whereas the short-term impact of AI depends on who controls it, the long-term impact depends on whether it can be controlled at all.&rdquo;</p>

<p>This might sound like the stuff of science fiction, but Hawking says dismissing it as such &ldquo;would be a mistake, and potentially our worst mistake ever.&rdquo;</p>

<p>Compared to robots, we humans are pretty clunky. Limited by the slow pace of evolution, it takes us generations to iterate. Robots, on the other hand, can improve upon their own design a lot faster, and soon, they&rsquo;ll probably be able to do so without our help. Hawking says this will create an &ldquo;intelligence explosion&rdquo; in which machines could exceed our intelligence &ldquo;by more than ours exceeds that of snails.&rdquo;</p>

<p>A lot of people think that the threat of AI centers on it becoming malevolent rather than benevolent. Hawking disabuses us of this concern, saying that the &ldquo;real risk with AI isn&rsquo;t malice, but competence.&rdquo; Basically, AI will be very good at accomplishing its goals; if humans get in the way, we could be in trouble.</p>

<p>&ldquo;You&rsquo;re probably not an evil ant-hater who steps on ants out of malice, but if you&rsquo;re in charge of a hydroelectric green-energy project and there&rsquo;s an anthill in the region to be flooded, too bad for the ants. Let&rsquo;s not place humanity in the position of those ants,&rdquo; Hawking writes.</p>

<p>For those still unpersuaded, he suggests a different metaphor.<strong> </strong>&ldquo;Why are we so worried about AI? Surely humans are always able to pull the plug?&rdquo; a hypothetical person asks him.</p>

<p>Hawking answers: &ldquo;People asked a computer, &lsquo;Is there a God?&rsquo; And the computer said, &lsquo;There is now,&rsquo; and fused the plug.&rdquo;</p>
<h2 class="wp-block-heading">The end of life on earth?</h2>
<p>If it&rsquo;s not the robots, it is &ldquo;almost inevitable that either a nuclear confrontation or environmental catastrophe will cripple the Earth at some point in the next 1,000 years,&rdquo; Hawking writes.</p>

<p>His warning comes on the heels of last week&rsquo;s alarming&nbsp;<a href="http://www.ipcc.ch/report/sr15/"><strong>Intergovernmental Panel on Climate Change</strong></a>&nbsp;(IPCC) report warning that we only <a href="https://www.vox.com/2018/10/8/17948832/climate-change-global-warming-un-ipcc-report">have 12 years</a> to make changes massive enough to keep global warming to moderate levels. Without such changes, extended droughts, more frequent tropical storms, and rising sea levels will only be the beginning.</p>

<p>Runaway climate change is the biggest threat to our planet, he says, and we are acting with &ldquo;reckless indifference to our future on planet Earth.&rdquo;</p>

<p>In fact, we might not have a future at all, he says, warning us not to put all our eggs &ldquo;in one basket.&rdquo; And yes, that basket is planet Earth. Even if humans figure out a way escape, &ldquo;the millions of species that inhabit the Earth&rdquo; will be doomed, he says. &ldquo;And that will be on our conscience as a race.&rdquo;</p>

<p>Another warning isn&rsquo;t any less menacing. We are entering a new phase of &ldquo;self-designed evolution.&rdquo; This stage means we will soon be able to cast off the chains of traditional evolution and start changing and improving our own DNA now &mdash; not in hundreds of thousands of years.</p>

<p>As with AI, the ability to edit our own DNA holds the potential to fix humanity&rsquo;s greatest problems. First, and likely not in the distant future, we&rsquo;ll be able to repair genetic defects, editing out genes for things like muscular dystrophy and amyotrophic lateral sclerosis, or ALS, the disease he was diagnosed with in 1963. Hawking says that within this century, we&rsquo;ll be able to edit intelligence, memory, and length of life. And that&rsquo;s when things could get really complicated.</p>

<p>Hawking calls the people who will do this &ldquo;superhumans,&rdquo; and they&rsquo;re likely to be the world&rsquo;s wealthy elites. Regular old humans won&rsquo;t be able to compete, and will probably &ldquo;die out, or become unimportant.&rdquo; At the same time, superhumans will likely be &ldquo;colonizing other planets and stars.&rdquo;</p>

<p>If that all sounds pretty depressing, it is. But even as Hawking serves up an apocalyptic prognosis for the planet and everyone on it, his brand of<strong> </strong>optimism comes<strong> </strong>through. He has faith that &ldquo;our ingenious race will have found a way to slip the surly bonds of Earth and will therefore survive the disaster.&rdquo;</p>

<p>He even believes that, instead of being terrifying, these possibilities are thrilling and that it &ldquo;greatly increases the chances of inspiring the new Einstein. Wherever she might be.&rdquo;</p>

<p>Figuring out a way off of planet Earth, and maybe even the solar system, is an opportunity to do what the moon landings did: &ldquo;elevate humanity, bring people and nations together, usher in new discoveries and new technologies.&rdquo;</p>
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					</entry>
			<entry>
			
			<author>
				<name>Abigail Higgins</name>
			</author>
			
			<title type="html"><![CDATA[Heart disease used to be an ailment of the rich. But it’s now striking the world’s poor.]]></title>
			<link rel="alternate" type="text/html" href="https://www.vox.com/future-perfect/2018/10/15/17953028/heart-disease-rich-poor-aids-malaria" />
			<id>https://www.vox.com/future-perfect/2018/10/15/17953028/heart-disease-rich-poor-aids-malaria</id>
			<updated>2018-10-15T11:45:49-04:00</updated>
			<published>2018-10-15T06:00:02-04:00</published>
			<category scheme="https://www.vox.com" term="Explainers" /><category scheme="https://www.vox.com" term="Future Perfect" /><category scheme="https://www.vox.com" term="Health" /><category scheme="https://www.vox.com" term="Health Care" /><category scheme="https://www.vox.com" term="Policy" /><category scheme="https://www.vox.com" term="Politics" /><category scheme="https://www.vox.com" term="Public Health" /><category scheme="https://www.vox.com" term="World Politics" />
							<summary type="html"><![CDATA[In 2016, an estimated 1 million people died of HIV/AIDS, 445,000 people died of malaria, and 1.7 million died of tuberculosis. Nearly 18 million died of heart disease. And more than three-quarters of those deaths occurred in the developing world. If you ask someone to list the most lethal global health problems facing the world [&#8230;]]]></summary>
			
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<img alt="" data-caption="Locals wait to order at a fast-food restaurant in a shopping center in Bangalore, India. | Uriel Sinai/Getty Images" data-portal-copyright="Uriel Sinai/Getty Images" data-has-syndication-rights="1" src="https://platform.vox.com/wp-content/uploads/sites/2/chorus/uploads/chorus_asset/file/13248087/80725259.jpg.jpg?quality=90&#038;strip=all&#038;crop=0,0,100,100" />
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	Locals wait to order at a fast-food restaurant in a shopping center in Bangalore, India. | Uriel Sinai/Getty Images	</figcaption>
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<p>In 2016, an estimated <a href="http://www.who.int/gho/hiv/epidemic_status/deaths/en/">1 million</a> people died of HIV/AIDS, <a href="http://www.who.int/news-room/fact-sheets/detail/malaria">445,000</a> people died of malaria, and <a href="https://www.cdc.gov/tb/statistics/default.htm">1.7 million</a> died of tuberculosis.</p>

<p>Nearly <a href="http://www.who.int/cardiovascular_diseases/en/">18 million</a> died of heart disease. And more than <a href="http://www.who.int/cardiovascular_diseases/en/">three-quarters</a> of those deaths occurred in the developing world.</p>

<p>If you ask someone to list the most lethal global health problems facing the world today, something as mundane as heart disease doesn&rsquo;t typically top the list. Yet there it sits, responsible for <a href="http://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)">one-third</a> of all global deaths.</p>

<p>What&rsquo;s more, in poor countries, those deaths are happening earlier. In wealthy regions like the US and Europe, heart disease tends to burden the elderly (only 15 to 20 percent of deaths from heart disease are under 70). But in poor countries today,<strong> </strong>more than half of people who die from<strong> </strong>heart disease are under 70 &mdash; some of them well under. Those people are also the poorest in those countries; wealthier people have access to preventive medicine and lifestyles that keep the disease at bay. And the problem is only <a href="https://www.sanofi.com/en/about-us/healthcare-solutions/the-rise-and-rise-of-chronic-diseases-in-africa/">projected to get worse</a>: In Africa, deaths from chronic diseases, almost half of which are from heart disease, are forecast to increase by a third in less than<strong> </strong>a decade.</p>

<p>Heart disease, which is still thought of as a lifestyle disease of wealthy Americans who are eating more, exercising less, and living longer, is now very much a disease of the world&rsquo;s poorest.</p>

<p>Getting the problem under control is going to be hard, especially if action remains as sluggish as it has been. Less than <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jch.13195">1 percent</a> of the $35 billion spent each year on health development assistance went to preventing heart disease, and that number has barely budged since 2000. HIV/AIDS, on the other hand, which represents 4 percent of the global disease burden, received <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5496084/">29 percent</a> of global funds.</p>

<p>The world is changing: People are living longer than ever before, and for the first time in history, more people live in cities than in rural areas, making lifestyles more sedentary and the environment worse. Fast food is saturating every corner of the globe, meaning not just that McDonald&rsquo;s is more ubiquitous but that cheap, fried starches are the most affordable way for people to feed themselves.</p>

<p>But perceptions of what kills poor people around the world have been slow to change. Most of the attention and funding for global health has gone to infectious diseases like <a href="https://www.thelancet.com/journals/landia/article/PIIS2213-8587(16)30420-X/fulltext">HIV/AIDS</a>, <a href="https://www.gatesfoundation.org/What-We-Do/Global-Health/Malaria">malaria</a>, and even <a href="https://www.washingtonpost.com/news/to-your-health/wp/2014/09/05/how-ebola-the-kardashian-of-diseases-is-stealing-attention-from-illnesses-that-kill-more-people/?utm_term=.a28a392b68c2">Ebola</a>.<strong> </strong>Yet the nature of global disease is changing fast, and it&rsquo;s changing fastest in poor countries.<strong> </strong>And neglecting the fact that heart disease is a major killer of the world&rsquo;s poor means missing out on the opportunity to save millions of lives with simple interventions.</p>
<h2 class="wp-block-heading">What makes heart disease so deadly</h2>
<p>Heart disease is technically a <a href="https://www.mayoclinic.org/diseases-conditions/heart-disease/symptoms-causes/syc-20353118">subset of cardiovascular disease</a>, but the two are often used interchangeably to refer to a handful of conditions that affect the heart. The deadliest involve narrowed or blocked blood vessels or arteries that can lead to heart attack or stroke, which cause the vast majority of global deaths from heart disease.</p>

<p>Heart disease is actually very treatable and, more importantly, preventable &mdash; if caught early. It can be prevented, and even reversed, with lifestyle changes like eating more fruits and vegetables and less sugar, quitting smoking, consuming less alcohol, and getting more physical activity. In addition, there are medications to lower blood pressure<strong> </strong>and cholesterol that are relatively inexpensive.</p>

<p>Once heart disease advances, things get more complicated and expensive &mdash; although it is still treatable with procedures like stent insertion to expand arteries or heart bypass surgery for when arteries are blocked.</p>

<p>But the countries that are experiencing the fastest increase in noncommunicable diseases &mdash; which include heart disease as well as other chronic diseases like cancer and diabetes &mdash; are the ones with health care systems that<strong> </strong>are <a href="https://www.cfr.org/article/changing-demographics-global-health">least prepared</a> to deal with it.</p>

<p>The changes are also happening very fast: In 1990, chronic disease caused about a quarter of deaths and disabilities in poor countries. By 2040, they are expected to be responsible for <a href="https://www.cfr.org/article/changing-demographics-global-health">80 percent</a> in some countries. Part of this is a good thing: Fewer people are dying of infectious diseases like HIV and malaria, and hence the proportion of deaths from heart disease goes up. But the shift from infectious to noncommunicable disease is happening <a href="https://www.cfr.org/article/changing-demographics-global-health">three to four times faster</a> than it happened in wealthy nations, leaving health systems struggling to catch up.</p>

<p>Theoretically, eliminating behavioral contributors to heart disease, like smoking or eating fatty foods, is the best public health intervention against heart disease &mdash; but that&rsquo;s a lot easier said than done.</p>

<p>The reason is that changing people&rsquo;s behavior is really difficult, especially when it <a href="https://www.sciencedirect.com/science/article/pii/S0033350616300178#bib6">comes to health</a>. Moreover, focusing on behavioral changes obscures how much the deck is stacked against people, particularly the poor. In some countries around the world, <a href="https://www.newsweek.com/sugar-sweetened-beverages-soda-cheaper-obesity-cancer-diabetes-594827">soda is cheaper</a> than bottled water, making it a growing mainstay in the diets of adults and children alike in poor countries. Air pollution is worst in the <a href="https://jamanetwork.com/journals/jama/article-abstract/2533515">world&rsquo;s poorest cities</a>: Living in a place like Mexico City is equivalent to smoking 6.5 <a href="https://www.weforum.org/agenda/2018/05/if-you-live-in-a-big-city-you-already-smoke-every-day/">cigarettes a day</a>, and living in New Delhi, India, is equivalent to smoking 25 a day.</p>

<p>Liberalized trade has opened up markets in poor countries, making unhealthy food cheaper. In South Africa, eating healthier <a href="http://www.hsrc.ac.za/en/research-outputs/view/5305">costs 69 percent more</a>.<em> </em>Globally, big tobacco and international fast-food chains wield enormous<strong> </strong>political and economic power that is altering lifestyles and, in turn, influencing public health.</p>

<p>Taken together, these factors are pretty overwhelming, which makes heart disease seem a lot harder to combat than its infectious counterparts. That may be part of why there is still so much focus on combating infectious disease: We know how to do it. Distributing mosquito nets to rural villages in Africa has clearly been shown to <a href="https://www.givewell.org/charities/amf">reduce infant mortality</a> and overall infection rates. Promoting condom use has clearly been effective in reducing rates of HIV/AIDS infection.</p>

<p>But while fighting heart disease is hard, it really may not be as hard as other global health challenges we&rsquo;ve successfully met. As Thomas J. Bollyky, the author of <a href="https://www.amazon.com/Plagues-Paradox-Progress-Healthier-Worrisome/dp/0262038455/"><em>Plagues and the Paradox of Progress</em></a><em>: Why the World Is Getting Healthier in Worrisome Ways</em>, pointed out to me, getting over <a href="http://www.unaids.org/sites/default/files/media_asset/unaids-data-2018_en.pdf">21 million people</a> on antiretroviral (ARV) treatment for HIV wasn&rsquo;t easy either. HIV treatment involves taking a cocktail of medications every day for the rest of a patient&rsquo;s life. The medications have side effects, such as fatigue and nausea, and have to be taken with adequate nutrition, which is particularly difficult in some places in rural Africa. Despite all of this, new HIV infection rates have almost been cut in half since 1996 &mdash; in no small part because so many people are on ARVs that, if taken correctly, make it almost impossible to pass on the disease.</p>

<p>There&rsquo;s no reason we couldn&rsquo;t make the same progress against heart disease.</p>
<h2 class="wp-block-heading">Saving lives with pills and paperwork</h2><img src="https://platform.vox.com/wp-content/uploads/sites/2/chorus/uploads/chorus_asset/file/13249303/514495180.jpg.jpg?quality=90&#038;strip=all&#038;crop=0,0,100,100" alt="Blood Pressure in Myanmar" title="Blood Pressure in Myanmar" data-has-syndication-rights="1" data-caption="A doctor at a medical clinic checks a member of Parliament’s blood pressure on March 9, 2016, in Naypyidaw, Myanmar. | Lauren DeCicca/Getty Images" data-portal-copyright="Lauren DeCicca/Getty Images" />
<p>Environmental and demographic changes are part of why heart disease has spun so far out of control. But a bigger reason &mdash; and the one that has made heart disease so deadly &mdash; is that poor countries don&rsquo;t have the kind of preventive care that helps stop heart disease long before it&rsquo;s advanced enough to result in a heart attack or a stroke.</p>

<p>&ldquo;When you boil it<strong> </strong>down, the real narrative about noncommunicable diseases is, sadly, the same narrative that exists in other areas of global health: It&rsquo;s driven by poverty and inequity and lack of access to the medical tools that exist in high-income countries,&rdquo; says Bollyky.</p>

<p>Think about how many times you get your blood pressure taken: every time you go to the doctor, whether it&rsquo;s for a regular checkup or for something more serious.</p>

<p>That&rsquo;s because having high blood pressure puts you at risk for heart disease. And if you catch it early, as many Americans do now, blood pressure medication and lifestyle changes, like quitting smoking or exercising more, can nip the problem in the bud. &nbsp;</p>

<p>Deaths from heart disease in wealthy countries like the United States are a quarter of what they used to be in the 1980s. Half of that reduction is a result of preventive medicine, including screening people for risk factors like high cholesterol or high blood pressure and getting them on medications like ACE inhibitors and beta blockers &mdash; medications that are off-patent and inexpensive, in some cases costing less than $5 a month.<strong> </strong></p>

<p><a href="https://www.cfr.org/report/emerging-global-health-crisis">One study</a> shows that managing heart attacks with low-cost drugs produces<em> </em>$25 in health and economic savings for every dollar of investment. Even aspirin, which costs<strong> </strong>a little over <a href="https://www.goodrx.com/aspirin">a dollar</a> for a month&rsquo;s supply, can reduce the risk of heart attack in people who have already had one and increase survival rates if taken right after a heart attack. It could save thousands of lives if it were always stocked in clinics across the developing world.</p>

<p>But while medications are cheap and effective, getting those medications to the people who need them<strong> </strong>can be difficult. And with many people in the developing world living on less than a few dollars a day, the cost can still be prohibitive.<strong> </strong>Almost <a href="https://theconversation.com/more-africans-are-accessing-health-care-but-states-still-have-work-to-do-59767">half of Africans</a> go without basic medicine or medical care, and <a href="https://www.healthaffairs.org/doi/10.1377/hlthaff.2015.0349">some 10 percent</a> of people in developing countries are getting preventive treatment for heart disease.</p>

<p>Pharmacies are few and far between in developing countries. Where they do exist, they<strong> </strong>frequently run out of medication. As Dr. Thomas Gaziano, who studies cost-effective interventions to heart disease and other noncommunicable diseases at Harvard University, said to me, people can&rsquo;t stop by Walgreens or CVS on their way home from work or have their medications mailed to them. Getting medication often means taking a day off work to trek to the nearest pharmacy, which involves spending money on transportation and often waiting in a long line. Because medical supplies are irregular in the developing world, it isn&rsquo;t uncommon for the medication you need to be out of stock by the time you get there.</p>

<p>Another issue is the lack of doctors and nurses to identify who needs these medications. The <a href="https://qz.com/520230/africa-has-about-one-doctor-for-every-5000-people/">World Health Organization estimates</a> that sub-Saharan Africa has a deficit of 1.8 million health workers, a number they project will rise to 4.3 million by 2035.</p>

<p>Those two factors &mdash; remote locations and overburdened health care systems in the developing world &mdash; are an argument for using community health care workers, an increasingly common strategy for poor countries to address the shortage of health care professionals.</p>

<p>These are people from the community who don&rsquo;t have any formal medical training but who can provide health care information or distribute basic medical supplies. In fact, <a href="https://implementationscience.biomedcentral.com/articles/10.1186/s13012-018-0762-5">community health workers</a> have been part of the success in getting HIV-positive Africans on ARV treatment and keeping them on it consistently. The advantage to using them is that they&rsquo;re cheaper&mdash; sometimes they even work on a volunteer basis &mdash; and they can go directly to people&rsquo;s houses, saving patients a costly and sometimes fruitless trip to the doctor.</p>

<p>The good thing about heart disease is that risk factors are relatively easy to spot. They include things like obesity or a history of diabetes. <a href="https://www.healthaffairs.org/doi/10.1377/hlthaff.2015.0349">One study</a> done in South Africa, Mexico, and Guatemala showed that community health workers using a set of questions on a piece of paper or a mobile phone app could visit patients in their home, ask the questions, and determine whether the patient is high-risk as effectively as a doctor or a nurse. Once patients were informed they were high-risk, 30 to 70 percent of them sought care at a health center, where a high percentage went on to receive appropriate care.</p>

<p>A growing number of countries are deploying community health workers in the fight against heart disease and other chronic ailments. <a href="https://www.healthaffairs.org/doi/10.1377/hlthaff.2015.0349">South Africa</a>, which has one of the fastest-growing rates of deaths from heart disease in the world, is restructuring its health care system and is planning to deploy 700,000 community health workers by 2030.</p>

<p>One more<strong> </strong>cost-effective intervention for heart disease, and one favored by the World Health Organization, is heavily taxing tobacco products. Cigarette smoking is a major cause of heart disease, and while smoking in the United States is going down, it is increasing in much of the developing world. In Africa, it has risen by <a href="https://qz.com/africa/1228845/africas-smoking-is-up-50-even-as-it-drops-in-wealthy-continents/">50 percent</a> in 35 years.</p>

<p>Getting the political support for this kind of intervention is difficult, especially in poor countries whose governments are<strong> </strong><a href="https://www.theguardian.com/world/2017/jul/12/big-tobacco-dirty-war-africa-market">increasingly targeted</a><strong> </strong>by the tobacco lobby.<strong> </strong>But it might be worth a try: Studies have shown that making cigarettes more expensive through taxes leads to a <a href="https://www.ncbi.nlm.nih.gov/pubmed/21115556">clear and marked</a> reduction in the number of smokers.</p>
<h2 class="wp-block-heading">Heart disease is a disease of poverty, not luxury</h2>
<p>Heart disease is still thought of as a disease of excess, rather than deprivation. That misconception is costing lives &mdash; and it will likely cost many more if things don&rsquo;t change. Between 1990 and 2040, the countries that are estimated to have the <a href="https://www.cfr.org/article/changing-demographics-global-health">greatest increase</a> in deaths and disability from chronic disease are Bangladesh, Ethiopia, Myanmar, Iran, Indonesia, Pakistan, and India. Sub-Saharan African countries are also expected to see significant increases, and their health care systems are <a href="https://www.cfr.org/article/changing-demographics-global-health">particularly ill-equipped</a> to deal with these changes.</p>

<p>It&rsquo;s also worth noting that the effort to combat heart disease could more than pay for itself. Effective management of high blood pressure alone could save <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jch.13195">$100 billion in health care costs</a> per year.</p>

<p>It wasn&rsquo;t that long ago that HIV/AIDS seemed as intractable and complicated as chronic diseases do now. HIV/AIDS is still a crisis &mdash; but it&rsquo;s a crisis that the global community has had some success in tackling because we concentrated our efforts on it.</p>

<p>We need to devote that same energy and attention to heart disease. It has been driven<strong> </strong>by some pretty powerful factors<strong> </strong>&mdash; urbanization, big tobacco, and Burger King<strong> </strong>&mdash; but we also haven&rsquo;t tried very hard to fight it, at least in the developing world. And that&rsquo;s what needs to change.</p>
<hr class="wp-block-separator" />
<p><a href="https://www.vox.com/future-perfect-newsletter"><em>Sign up for the Future Perfect newsletter.</em></a><em> Twice a week, you&rsquo;ll get a roundup of ideas and solutions for tackling our biggest challenges: improving public health, decreasing human and animal suffering, easing catastrophic risks, and &mdash; to put it simply &mdash; getting better at doing good.</em></p>
						]]>
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					</entry>
			<entry>
			
			<author>
				<name>Abigail Higgins</name>
			</author>
			
			<title type="html"><![CDATA[Flu shots are important — especially for pregnant women in poor countries]]></title>
			<link rel="alternate" type="text/html" href="https://www.vox.com/2018/10/5/17934170/flu-shots-vaccine-pregnancy-pandemic" />
			<id>https://www.vox.com/2018/10/5/17934170/flu-shots-vaccine-pregnancy-pandemic</id>
			<updated>2018-10-05T12:18:45-04:00</updated>
			<published>2018-10-05T12:30:02-04:00</published>
			<category scheme="https://www.vox.com" term="Future Perfect" /><category scheme="https://www.vox.com" term="Health" /><category scheme="https://www.vox.com" term="Health Care" /><category scheme="https://www.vox.com" term="Policy" /><category scheme="https://www.vox.com" term="Politics" /><category scheme="https://www.vox.com" term="Public Health" /><category scheme="https://www.vox.com" term="Science" /><category scheme="https://www.vox.com" term="World Politics" />
							<summary type="html"><![CDATA[Following the deadliest flu season in decades last year, doctors have begun urging Americans to get vaccinated. But there&#8217;s a largely unreached population that many experts, including those at the World Health Organization (WHO), are thinking about: expectant mothers in the developing world. The rate of flu-related hospitalizations is more than three times higher in [&#8230;]]]></summary>
			
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<img alt="" data-caption="Simone Groper prepares to receive a flu shot at a Walgreens pharmacy on January 22, 2018 in San Francisco, California.  | Justin Sullivan/Getty Images" data-portal-copyright="Justin Sullivan/Getty Images" data-has-syndication-rights="1" src="https://platform.vox.com/wp-content/uploads/sites/2/chorus/uploads/chorus_asset/file/13221383/908889582.jpg.jpg?quality=90&#038;strip=all&#038;crop=0,0,100,100" />
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	Simone Groper prepares to receive a flu shot at a Walgreens pharmacy on January 22, 2018 in San Francisco, California.  | Justin Sullivan/Getty Images	</figcaption>
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<p>Following the deadliest flu season in decades last year, doctors have begun urging Americans to get vaccinated. But there&rsquo;s a largely unreached population that many experts, <a href="http://apps.who.int/iris/bitstream/handle/10665/250084/who-ivb-16.06-eng.pdf?sequence=1">including those at the World Health Organization</a> (WHO), are thinking about: expectant mothers in the developing world.</p>

<p>The rate of flu-related hospitalizations is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5791002/">more than three times higher</a> in lower- and middle-income countries than high-income countries, and both infants and pregnant women are at a higher risk for developing life-threatening flu.</p>

<p>Unfortunately, while there&rsquo;s an effective flu vaccine, it doesn&rsquo;t work for infants less than 6 months old. But<strong> </strong>there&rsquo;s a way to vaccinate infants that can also protect pregnant women: in utero.</p>

<p>If an expectant mother is vaccinated, not only will she be protected against the flu &mdash; she will also pass those antibodies on to the fetus. That protection extends into the first, most vulnerable, months of an infant&rsquo;s life, multiplying the effects of the intervention.</p>

<p>There&rsquo;s still a lot we don&rsquo;t know about flu epidemics in developing countries, as most research has focused on Europe and the US. <a href="https://www.ncbi.nlm.nih.gov/pubmed/22078723">A 2011 analysis</a> estimates that there are between<strong> </strong>28,000 and 111,500 annual deaths of children under age 5 from influenza and that 99 percent of those deaths were in developing countries. Some <a href="https://www.project-syndicate.org/commentary/lowering-infant-mortality-breastfeeding-vaccinations-by-melvin-sanicas-2018-07">experts believe</a> maternal vaccinations could be a powerful and low-cost strategy to save the lives of tens of thousands of children.</p>

<p>While flu vaccinations are fairly cheap (in <a href="https://www.cdc.gov/vaccines/programs/vfc/awardees/vaccine-management/price-list/index.html">the US</a> they&rsquo;re less than $20;<strong> </strong>in <a href="http://mshpriceguide.org/en/single-drug-information/?DMFId=792&amp;searchYear=2014">South Africa</a> they&rsquo;re less than $5), they&rsquo;re extremely limited in the developing world &mdash; which makes targeting a high-risk group with a double return even more important.</p>

<p>Pregnant women are more likely to already be plugged into the health care system, making it easier to target them for a vaccine. Moreover, a push to expand maternal flu vaccines could be a building block for improving developing countries&rsquo; currently limited infrastructure to protect themselves against a global flu pandemic.</p>
<h2 class="wp-block-heading">Flu is universal, but the risk of dying from it isn’t</h2>
<p>The flu is a contagious respiratory infection that, <a href="http://www.who.int/ith/diseases/influenza_seasonal/en/">according to WHO</a>, typically infects an estimated 5-10 percent of adults and 20-30 percent of children each year. It typically causes fever, sore throat, headaches, and a cough, and while it&rsquo;s not fun, it&rsquo;s usually not deadly. However, there are an estimated <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5791002/#ref-42">3-5 million</a> cases of severe illness and <a href="https://wwwnc.cdc.gov/eid/article/24/7/17-1270_article">290,000-650,000</a> deaths from the flu each year. Last year, the United States had its deadliest flu season in decades, with <a href="https://www.vox.com/2018/9/27/17910318/80000-americans-died-last-year-get-your-flu-shot">80,000 deaths</a>.</p>

<p>As global research on flu slowly increases, studies are beginning to show that the burden of life-threatening flu is more concentrated in developing countries than was originally thought. <a href="http://www.cidrap.umn.edu/news-perspective/2017/12/studies-spotlight-heavy-burden-severe-flu-developing-nations">Young children</a> and pregnant women in the developing world<strong> </strong>are believed to be at very high risk, making them an important target for vaccination.</p>

<p>Getting a seasonal flu vaccine is the most effective way to prevent the flu. While <a href="https://www.cdc.gov/flu/professionals/vaccination/effectiveness-studies.htm">effectiveness varies</a> from season to season, the vaccine in the US can reduce the risk of getting the flu by <a href="https://www.cdc.gov/flu/about/qa/vaccineeffect.htm">40-60 percent</a>. Vaccination rates in the United States and Europe are relatively high, <a href="https://www.cdc.gov/flu/fluvaxview/nifs-estimates-nov2017.htm">38</a> percent in the US last year.</p>

<p>Although doctors wish those rates were a lot higher, they look good compared to the <a href="https://books.google.com/books?id=akOMAgAAQBAJ&amp;dq=95%25+of+influenza+doses+were+used+in+the+Americas,+Europe,+and+western+Pacific&amp;source=gbs_navlinks_s">rest of the world</a>. Some <a href="https://www.acsh.org/news/2018/02/02/influenza-vaccination-global-not-same-12504">95 percent</a> of influenza vaccine doses were used in the Americas, Europe, and the West Pacific last year. The scant remaining 5 percent of doses are split between Southeast Asia, the East Mediterranean, and Africa.</p>

<p>There are a few reasons vaccination rates are so much lower in the developing world. For one, while flu outbreaks tend to happen seasonally in temperate climates, they happen <a href="http://www.who.int/news-room/fact-sheets/detail/influenza-(seasonal)">more randomly</a> in tropical climates, making them harder to predict and making targeted campaigns harder to plan.</p>

<p>The <a href="https://www.acsh.org/news/2018/02/02/influenza-vaccination-global-not-same-12504">bigger reason</a>, however, is that vaccinations require infrastructure, which developing countries have less of. For one, vaccinations require cold storage, which is tough in places that experience frequent electrical outages.</p>

<p>There&rsquo;s also a correlation between education and vaccination rates; the less educated a population, the lower the rates of flu vaccination. And vaccine campaigns require government support. The only countries that have achieved 30 percent or higher rates of vaccination have had national strategies for doing so.</p>
<h2 class="wp-block-heading">Maternal vaccination’s multiplying effect</h2>
<p>The tiny number of vaccines available in the developing world is an argument for targeting pregnant women. With so few vaccines available, it&rsquo;s crucial that they do the most good possible. Pregnant women are also more likely to be receiving targeted maternal health care. <a href="http://apps.who.int/iris/bitstream/handle/10665/250084/who-ivb-16.06-eng.pdf?sequence=1">WHO estimates</a> that 82 percent of pregnant women attend at least one prenatal visit, making giving her the vaccine easier, especially in a country without an infrastructure for a nationwide vaccination campaign.</p>

<p>While studies of maternal flu immunizations are still limited, the ones we have show that they could have a big payoff. <a href="https://www.ncbi.nlm.nih.gov/pubmed/18799552">One study</a> in Bangladesh showed a 63 percent reduction in flu cases among infants born to vaccinated mothers, a 36 percent reduction in the number of serious respiratory illnesses for mothers, and a 28 percent reduction in those illnesses among infants.</p>

<p>The same immunization can also help protect against pneumonia, a common cause of childhood deaths. <a href="https://journals.lww.com/pidj/Abstract/2018/05000/Maternal_Influenza_Immunization_and_Prevention_of.12.aspx">An analysis</a> of trials in Nepal, Mali, and South Africa showed that infants whose mothers had been vaccinated when they were pregnant were 20 percent less likely to develop pneumonia.</p>

<p>One of the biggest needs is increased research and improved surveillance of the flu in the developing world, something the WHO and the US Centers for Disease Control and Prevention are <a href="https://www.cdc.gov/media/releases/2017/p1213-flu-death-estimate.html">both prioritizing</a>. Further confirmation of the heavy burden of severe flu in developing countries will make it easier to get the funding necessary to expand vaccination campaigns in those regions.</p>

<p>While saving lives in the short term is a strong argument for maternal vaccinations, there&rsquo;s also a longer-term, life-saving calculation that experts are making by targeting this population. Scientists worry that there is significant risk in the coming years and decades of a global flu outbreak similar to the 1918 Spanish flu pandemic that claimed <a href="https://www.nature.com/articles/d41586-018-01070-w">50-100 million lives</a>. Given the challenges of vaccination distribution in the developing world, entire swathes of the globe will be largely defenseless should another pandemic occur.</p>

<p><a href="http://apps.who.int/iris/bitstream/handle/10665/250084/who-ivb-16.06-eng.pdf?sequence=1">WHO hopes</a> that supporting developing countries in creating national programs targeting pregnant women for immunization can provide a sort of testing ground for larger flu immunizations programs. On a smaller scale, developing countries can begin to train health care staff, procure necessary equipment for vaccine storage, develop supply chains, and build trust in the vaccine among the general population.</p>

<p>Because pregnant women are more likely to be regularly seeing a health care provider, experts hope that targeting them will increase demand for vaccines, which could spur governments to increase procurement and develop national distribution plans.</p>

<p>There&rsquo;s still a lot more research that&rsquo;s needed on the effects of flu in the developing world, but the evidence we do have makes it pretty clear that pregnant women are a promising population to focus on for high impact, for now and for the future.</p>
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			<entry>
			
			<author>
				<name>Abigail Higgins</name>
			</author>
			
			<title type="html"><![CDATA[The World Bank and tech companies want to use AI to predict famine]]></title>
			<link rel="alternate" type="text/html" href="https://www.vox.com/policy-and-politics/2018/9/29/17915222/famine-world-bank-south-sudan-yemen-food-crisis-conflict" />
			<id>https://www.vox.com/policy-and-politics/2018/9/29/17915222/famine-world-bank-south-sudan-yemen-food-crisis-conflict</id>
			<updated>2018-09-28T17:06:36-04:00</updated>
			<published>2018-09-29T08:30:01-04:00</published>
			<category scheme="https://www.vox.com" term="Politics" />
							<summary type="html"><![CDATA[At this week&#8217;s United Nations General Assembly, the World Bank, the United Nations, and the Red Cross teamed up with tech giants Amazon, Microsoft, and Google to announce an unlikely new tool to stop famine before it starts: artificial intelligence. The Famine Action Mechanism (FAM), as they&#8217;re calling it, is the first global tool dedicated [&#8230;]]]></summary>
			
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<img alt="" data-caption="Women and children stand in line for food aid on August 14, 2011, in Mogadishu, Somalia. | John Moore/Getty Images" data-portal-copyright="John Moore/Getty Images" data-has-syndication-rights="1" src="https://platform.vox.com/wp-content/uploads/sites/2/chorus/uploads/chorus_asset/file/13177163/121131230.jpg.jpg?quality=90&#038;strip=all&#038;crop=0,0,100,100" />
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	Women and children stand in line for food aid on August 14, 2011, in Mogadishu, Somalia. | John Moore/Getty Images	</figcaption>
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<p>At this week&rsquo;s United Nations General Assembly, the World Bank, the United Nations, and the Red Cross teamed up with tech giants Amazon, Microsoft, and Google <a href="http://www.worldbank.org/en/news/press-release/2018/09/23/united-nations-world-bank-humanitarian-organizations-launch-innovative-partnership-to-end-famine">to announce</a> an unlikely new tool to stop famine before it starts: artificial intelligence.</p>

<p>The Famine Action Mechanism (FAM), as they&rsquo;re calling it, is the first global tool dedicated to preventing future famines &mdash; no small news in a world where <a href="http://www1.wfp.org/zero-hunger">one in nine</a> people don&rsquo;t have enough food.<strong> </strong>Building off of previous famine-prediction strategies, the tool will combine satellite data of things like rainfall and crop health with social media and news reports of more human factors, like violence or changing food prices.<strong> </strong>It will also establish a fund that will be automatically dispersed to a food crisis as soon as it meets certain criteria, speeding up the often-lengthy process for funding famine relief.</p>

<p>For a <a href="http://fews.net/IPC">famine</a> to be <a href="https://www.npr.org/sections/goatsandsoda/2017/02/23/516642447/who-declares-a-famine-and-what-does-that-actually-mean">declared</a> in a country or region, three criteria have to be met: At least one in five households has an extreme lack of food; over 30 percent of children under five have acute malnutrition; and two out of 10,000 people die each day.  (Famine declarations are issued jointly<strong> </strong>by United Nations agencies, the affected governments, and the Famine Early Warnings Systems Network (FEWSNET).)<strong> </strong>By that definition, there are no famines in the world right now, but conflict is threatening to plunge South Sudan, Nigeria, and Yemen into one, and many parts of the world are suffering from food insecurity.</p>

<p>It&rsquo;s usually not until a famine is well underway that the United Nations and donor agencies begin soliciting funding. By that time, the damage has already been done. Thousands have usually already died and, for those that survive, the damage extends far into the future: for children born during a famine, their lifetime incomes are reduced by approximately <a href="http://www.worldbank.org/en/news/speech/2018/09/23/world-bank-group-president-jim-yong-kim-opening-remarks-at-the-event-partnering-to-address-severe-food-insecurity-at-the-united-nations-general-assembly">13 percent</a>.</p>

<p>That&rsquo;s the outcome that the FAM was created to prevent. But it faces quite a challenge &mdash; predicting famine is complicated, and even when it&rsquo;s possible, it&rsquo;s a whole lot harder to act on those predictions.</p>

<p>&ldquo;If we can better predict when and where future famines will occur, we can save lives by responding earlier and more effectively,&rdquo; said Brad Smith, president of Microsoft, <a href="http://www.worldbank.org/en/news/press-release/2018/09/23/united-nations-world-bank-humanitarian-organizations-launch-innovative-partnership-to-end-famine">in a statement announcing the initiative</a>. &ldquo;Artificial intelligence and machine learning hold huge promise for forecasting and detecting early signs of food shortages, like crop failures, droughts, natural disasters, and conflicts.&rdquo;</p>

<p>It&rsquo;s that last part&mdash;&ldquo;conflicts&rdquo;&mdash;that could prove especially challenging for a mechanism like FAM.</p>
<h2 class="wp-block-heading">Why famines are hard to predict</h2>
<p>The reason famines are so hard to stop is that they&rsquo;re caused by that most unpredictable of factors: people.</p>

<p>&ldquo;Overwhelmingly, famines in particular, but humanitarian emergencies in general, are politically caused. It&rsquo;s only a relatively small minority &mdash; and virtually none in modern history &mdash; that were caused exclusively, or even predominantly, by natural adversity,&rdquo; Alex DeWaal, author of <em>Mass Starvation: The History and Future of Famine</em>, told me.</p>

<p>Many people assume famine is caused mainly by drought, but that really hasn&rsquo;t been the case since the Industrial Revolution. Today, famines almost always involve conflict.</p>

<p>In February 2017, the United Nations <a href="https://news.un.org/en/story/2017/02/551812-famine-declared-region-south-sudan-un">declared famine</a> in <a href="https://www.vox.com/videos/2017/6/13/15786058/war-famines-threatening-sudan-somalia-nigeria-yemen">South Sudan</a>. The country has been embroiled in a civil war since 2013 between pro-government and rebel factions drawn along ethnic lines. Shortly after famine was declared, government troops expelled aid workers delivering desperately needed food aid to areas they suspected were supporting rebel troops. The United States warned South Sudan it may be engaging in &ldquo;<a href="https://www.reuters.com/article/us-southsudan-security-un-idUSKBN16U32C?utm_source=34553&amp;utm_medium=partner">deliberate</a>&rdquo; starvation tactics. Famine eventually abated last year, but the country is now teetering on the brink again.</p>

<p>That experience points to the unique challenge of famine forecasting.<strong> </strong>&ldquo;We have the best science in the world backing up the assumptions we make about rainfall,&rdquo; says Chris Hillbruner, a senior advisor<strong> </strong>at FEWSNET, an organization that has been working on forecasting famine and food insecurity for decades. &ldquo;But it&rsquo;s a lot harder to build assumptions about what is going to happen with a conflict issue or a political issue six months or eight months in the future.&rdquo;</p>

<p>And even when you can predict a famine, it can be a challenge to act on those forecasts. Earlier this week, United Nations humanitarian chief Mark Lowcock <a href="https://reliefweb.int/report/yemen/briefing-security-council-humanitarian-situation-yemen-under-secretary-general">sounded the alarm</a> that Yemen, one of the world&rsquo;s worst <a href="https://www.aljazeera.com/news/2018/09/yemen-undeniably-world-worst-humanitarian-crisis-wfp-180928051150315.html">humanitarian disasters</a> where 75 percent of the country needs assistance, is on the <a href="https://www.theguardian.com/world/2018/sep/24/deadly-yemen-famine-could-strike-at-any-time-warns-un-boss">brink of famine</a>. Unfortunately, it&rsquo;s a perfect example of when an early warning just isn&rsquo;t that useful.</p>

<p>Fighting in its main port city is strangling one of the only roads delivering aid to the capital city of Sana&rsquo;a, and as the economy careens closer to collapse, food prices have <a href="https://www.theguardian.com/world/2018/sep/24/deadly-yemen-famine-could-strike-at-any-time-warns-un-boss">increased by a third</a>. Warring parties have deliberately decreased access to food, most notably <a href="https://www.vox.com/world/2017/11/22/16680392/saudi-arabia-yemen-blockade-famine-casualties">Saudi Arabia</a>, which has established aerial and naval blockades against a country that imports 90 percent of its food.</p>

<p>Famine has been predicted; averting it will be a whole lot more complicated.</p>

<p>&ldquo;The big problem that the World Bank runs into is that any early warning or any automatic response cannot deal with is the political causes of famine,&rdquo; says DeWaal. And for all intents and purposes, those are the only significant causes of famine today.</p>
<h2 class="wp-block-heading">An earlier response is still better</h2>
<p>But just because forecasting and avoiding a famine is hard work doesn&rsquo;t make the Famine Action Mechanism a futile act.</p>

<p>DeWaal points out that the predictive power of the mechanism could still be useful for the slower burn of food insecurity (which means that while people are hungry, the requirements of a full-blown famine haven&rsquo;t been met) in relatively stable countries, such as Ethiopia or India. &ldquo;We all know that an early response is more efficient than a delayed one,&rdquo; says DeWaal.</p>

<p>In these cases, an early warning could allow governments to quickly stabilize the market to keep food prices from spiraling out of control, one of the biggest triggers of full-scale famine. Then, they can distribute emergency grain for livestock, whose death can ruin a farmer &mdash; and, on a wider scale, an economy &mdash; for generations. The last step is usually emergency food distribution &mdash; but by the time this step is triggered, it&rsquo;s usually too late.</p>

<p>A predictive mechanism could also be a useful way to trigger famine insurance, a strategy a <a href="https://www.recode.net/2018/9/24/17894440/jim-yong-kim-world-bank-group-famine-google-amazon-microsoft-data-famine-kara-swisher-podcast">growing number</a> of countries are using to mitigate the effects of humanitarian disasters.</p>

<p>&ldquo;What the Artemis analytical model tries to do is provide that trigger in as unambiguous a way as possible, activating insurances markets or disaster bonds on the basis of something concrete,&rdquo; says Daniel G. Maxwell, the Henry J. Leir Professor in Food Security at Tufts University,<strong> </strong>referring to the name of the predictive tool developed by the Silicon Valley side of the partnership.</p>

<p>There are questions about how useful the Famine Action Mechanism might be in preventing an actual famine. But it does seem promising as a tool to address something a little more mundane: hunger alleviation in poor but stable countries.</p>
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			<entry>
			
			<author>
				<name>Abigail Higgins</name>
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			<title type="html"><![CDATA[The deadliest infectious disease is becoming drug-resistant]]></title>
			<link rel="alternate" type="text/html" href="https://www.vox.com/policy-and-politics/2018/9/28/17914344/tuberculosis-united-nations-funding-india-china" />
			<id>https://www.vox.com/policy-and-politics/2018/9/28/17914344/tuberculosis-united-nations-funding-india-china</id>
			<updated>2018-09-28T14:22:31-04:00</updated>
			<published>2018-09-28T14:20:01-04:00</published>
			<category scheme="https://www.vox.com" term="Health" /><category scheme="https://www.vox.com" term="Health Care" /><category scheme="https://www.vox.com" term="Policy" /><category scheme="https://www.vox.com" term="Politics" /><category scheme="https://www.vox.com" term="Public Health" /><category scheme="https://www.vox.com" term="Science" />
							<summary type="html"><![CDATA[Tuberculosis (TB) isn&#8217;t a disease Americans hear about much about these days, but that&#8217;s not true for the rest of the world. TB is currently the deadliest infectious disease, responsible for 1.6 million deaths last year, most of them in the developing world. And that&#8217;s not the scariest part. A rapidly growing number of patients [&#8230;]]]></summary>
			
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<img alt="" data-caption="Patients wait for testing and medical treatment for tuberculosis at the Doctors Without Borders Kutupalong clinic on October 4, 2017, in Cox’s Bazar, Bangladesh. | Paula Bronstein/Getty Images" data-portal-copyright="Paula Bronstein/Getty Images" data-has-syndication-rights="1" src="https://platform.vox.com/wp-content/uploads/sites/2/chorus/uploads/chorus_asset/file/13176315/859162490.jpg.jpg?quality=90&#038;strip=all&#038;crop=0,0,100,100" />
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	Patients wait for testing and medical treatment for tuberculosis at the Doctors Without Borders Kutupalong clinic on October 4, 2017, in Cox’s Bazar, Bangladesh. | Paula Bronstein/Getty Images	</figcaption>
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<p>Tuberculosis (TB) isn&rsquo;t a disease Americans hear about much about these days, but that&rsquo;s not true for the rest of the world. TB is currently the <a href="https://www.msf.org/tuberculosis-new-report-highlights-need-better-tackle-world%E2%80%99s-deadliest-infectious-disease">deadliest infectious disease</a>, responsible for <a href="https://www.thelancet.com/series/tuberculosis-2018">1.6 million</a> deaths last year, most of them in the developing world.</p>

<p>And that&rsquo;s not the scariest part. A rapidly growing number of patients are developing drug-resistant tuberculosis, which kills <a href="https://www.bmj.com/content/353/bmj.i2863/rr-0">more people</a> than any other drug-resistant pathogen.</p>

<p>The persistence of TB is the reason the United Nations General Assembly held its first <a href="http://www.who.int/tb/features_archive/UNGA_HLM_ending_TB/en/">high-level meeting</a> on tuberculosis Wednesday, which experts hope will trigger an influx of cash and attention for the treatment and diagnosis of a neglected disease.</p>

<p>&ldquo;In the developed world, people weren&rsquo;t seeing it, and that&rsquo;s where most research occurs,&rdquo; says Dr. Eric Goosby, the United Nations special envoy on TB, on why the disease has received comparatively so little attention. &ldquo;It was something you taught medical students but didn&rsquo;t really see in the United States or Canada.&rdquo;</p>

<p>Another reason for the neglect is that other diseases grabbed much of the research community&rsquo;s attention in recent years. HIV, which was responsible for approximately <a href="http://www.unaids.org/en/resources/fact-sheet">1.3 million deaths</a> last year, has seen a lot of attention and resources channeled its way for decades, and has already been the subject of<strong> </strong>three of these high-level meetings (the first of which was <a href="http://ask.un.org/faq/108572">held in 2006</a>). Only now are people starting to recognize just how significant of a threat TB is.</p>

<p>&ldquo;Action isn&rsquo;t guaranteed, but these meetings usually translate into more attention, and with attention comes scale and push and more funding,&rdquo; Dr. Lucica Ditiu, the executive director of Stop TB, told me. Experts hope this meeting will lead to increased diagnosis and treatment of the <a href="https://www.un.org/pga/73/event-detail/fight-to-end-tuberculosis/">3.6 million people</a> who got TB in 2017 but never received either, as well as an infusion of funding for research to further a TB vaccine and improved treatment.</p>

<p>The meeting has already spurred some action: On Wednesday, the US Agency for International Development announced it was allocating <a href="https://www.usaid.gov/news-information/press-releases/sep-26-2018-usaid-administrator-mark-green-announces-new-approach-end-tuberculosis">up to $60 million</a> to fight TB around the world.</p>
<h2 class="wp-block-heading">Tuberculosis, explained</h2>
<p>TB is a <a href="https://www.mayoclinic.org/diseases-conditions/tuberculosis/symptoms-causes/syc-20351250">lung infection</a> that causes a hacking, sometimes bloody, cough, as well as weight loss, fever, and night sweats. It&rsquo;s caused by airborne bacteria, so people catch it from coughing, sneezing, or even talking, although you&rsquo;re most likely to get it from someone you live with. Infection is more likely in people with weakened immune systems, and more common in cramped living conditions.</p>

<p>&ldquo;The people with TB are not the ones that are in the media. They&rsquo;re not the ones that are very visible,&rdquo; Dr. Ditiu said. &ldquo;It&rsquo;s the most vulnerable groups, the poor ones, the ones on the outskirts of the city, immigrants, drug users.&rdquo;</p>

<p>It&rsquo;s a very treatable disease &mdash; but it&rsquo;s too rarely caught. Some <a href="https://unfoundation.org/blog/post/2018-must-year-action-tuberculosis/">40 percent</a> of TB cases are never treated or diagnosed, which means people are passing the disease onto others without realizing it. There&rsquo;s also a large number of people, a <a href="https://www.cdc.gov/tb/statistics/default.htm">staggering quarter</a> of the world&rsquo;s population, who are carrying a latent form of the disease that could crop up later in life when the individual&rsquo;s immune system is suppressed, such as during pregnancy or chemotherapy.</p>

<p>The overall mortality rate for TB is <a href="https://bmcinfectdis.biomedcentral.com/articles/10.1186/1471-2334-14-5">12 percent</a>, but that figure jumps for the millions of patients who don&rsquo;t receive treatment. Deaths from TB are <a href="http://www.who.int/tb/publications/2009/airborne/background/info/en/">concentrated in poor countries</a> in the global south, with India, China, Nigeria, South Africa, Brazil, and Bangladesh bearing the greatest burdens.</p>

<p>While we&rsquo;ve known how to treat TB for more than 40 years, according to Dr. Goosby, the cocktail of drugs<strong> </strong>hasn&rsquo;t developed much in that time, and the way to diagnose it has barely changed since the early 1900s. Treatment requires an antibiotic regimen of multiple drugs taken for a minimum of six months and, for cases of drug-resistant TB, as long as two years. For highly drug-resistant strains of TB, those treatments can jump to five years.</p>

<p>In 2016, there were <a href="http://www.who.int/tb/areas-of-work/drug-resistant-tb/en/">600,000</a> new cases of drug-resistant TB; 240,000 of those people died.</p>

<p>The length of the antibiotic regimens is the primary culprit for TB&rsquo;s growing drug resistance. If you&rsquo;ve ever forgotten to take the last few pills in a week-long antibiotic regimen, you can imagine how hard it is to get patients to complete a treatment that can last for years, especially in the countries with poor health care systems where TB is most prevalent.</p>

<p>When people stop antibiotics early, they&rsquo;re at a high risk of developing drug resistance and then passing that resistance on to others. Even worse, these drugs come with brutal side effects that include serious liver and kidney damage, and, for multidrug-resistant TB, <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32170-0/fulltext">half of patients</a> will lose their hearing.</p>

<p>It&rsquo;s not all bad news: When done correctly, TB treatment is more than <a href="http://www.who.int/bulletin/volumes/85/5/06-038927/en/">85 percent</a> effective, and since 2000, TB diagnosis and treatment has saved an estimated <a href="http://www.who.int/news-room/fact-sheets/detail/tuberculosis">54 million</a> lives.</p>

<p>With a little attention, TB treatment can move into the 21st century. &ldquo;I believe this high-level meeting will be the starting gun,&rdquo; added Goosby. &ldquo;It&rsquo;s the first time we&rsquo;ve introduced hope into the TB fight.&rdquo;</p>
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