There is something that kills more Americans every year than drug overdoses, than guns, than car accidents. It’s legal, doesn’t require a background check to buy, is widely advertised, and if you’re 21, you can probably buy it at your corner store. It’s called alcohol.

While cold beers, glasses of wine, and hard liquor cocktails are often treated as end-of-the-workday or weekend indulgences, alcohol is technically a psychoactive, addictive drug, one linked to over 50 fatal conditions, including heart disease; breast, pancreatic, and stomach cancers; liver disease; hypertension; and stroke. According to new data from the Centers for Disease Control (CDC), 178,000 people died in the US each year in 2020 and 2021 because of excessive alcohol use — a 29 percent increase from just five years before. Each year, those deaths shortened lives by an average of 23 years, resulting in an astounding 4 million years of potential life lost. As a result, alcohol is one of the leading causes of preventable death in the country. 

More and more research supports the conclusion that even light drinking — that is, less than 15 drinks a week for men or eight drinks a week for women — can contribute to an increased risk for heart disease and cancers. More recent medical recommendations in countries like Canada have increasingly tightened, moving toward the idea that there is no truly safe level of alcohol consumption.

But the dose is the poison, and those who are at the greatest risk are those who consistently binge drink. This group suffers from alcohol use disorder, a condition where someone consumes excessive amounts of alcohol to the point that it impairs their ability to stop or control their use despite negative social, occupational, or health consequences. And that group is larger than you might think: more than one in 12 people in the US have AUD, and it’s likely that figure underestimates the real breadth of the problem.

In the 20th century, binge drinking coupled with its negative repercussions was called alcohol abuse, alcohol dependence, alcohol addiction, or alcoholism. However, such diagnoses carry a shameful stigma and make unhealthy alcohol use seem like purely a bad choice, rather than the result of a brain-altering disease. By not indicating a range in how alcohol overuse can affect a person, these names also fell short of describing the condition of all people who drink in unhealthy ways. In 2013, the American Psychiatric Association began defining all forms of excessive alcohol use as alcohol use disorder, or AUD. 

“Decades ago alcohol use, and really all substance use disorders in general, were sort of viewed as personality flaws or moral failings,” Carrie Mintz, an assistant professor of psychiatry at Washington University in St. Louis, told Vox. “We really know now — especially from the past 50 years of increasing amounts of research and data — that these are really brain diseases. There are clear neurologic changes that occur with repeated pathologic use of a potentially addictive substance like alcohol.” 

But while America treats other dangerous substances, such as opioids, as a public health problem, alcohol use is not treated similarly as a crisis — legally, medically, or culturally. Rather, access to alcohol is only growing. The alcoholic beverage industry generated $250 billion in revenue in 2021, while the category of hard alcohol spirits has now surpassed beer in total sales, even as the number of breweries in the US grew from 3,305 in 2017 to 4,493 in 2020. Alcohol is generally taxed higher than other goods in part to limit its consumption, but since 2000, these taxes have lost much of their value — and with it, their ability to curb consumption — because they haven’t kept up with inflation rates and beverage costs.

“It’s a real blind spot in drug policy, that a huge number of people are not willing to see alcohol as a drug for which we have a pretty serious problem,” said Keith Humphreys, a professor of psychiatry and behavioral sciences at Stanford University. What this all means is that nearly a century since the founding of Alcoholics Anonymous — a program that studies show is the most effective at helping people achieve and maintain abstinence — the problem is only getting worse. 

But that may be changing. As researchers continue to delve into how alcohol use can hurt one’s overall health and lead to addiction, more people are looking for solutions — especially for the group of heavy drinkers who need it most. Beyond the therapeutic and social groups like AA that have long existed to support AUD sufferers, there is a trio of FDA-approved drugs that have a history of curbing alcohol abuse. Rumblings of Ozempic’s apparent off-label ability to curb alcohol cravings, as well as overeating, have put the spotlight back on the power of medical intervention with the help of a prescription. In the same way that we view medications like Prozac as tools for treating depression, these medications could be a key element in AUD treatment plans.  

But they remain vastly underused; while 14.1 million adults experienced AUD in the US in 2019, only 223,000 will ever be prescribed existing medications. The reasons for this vary; some patients don’t want to take a drug to treat their addiction, health care professionals lack awareness and training in treating AUD, and the ongoing stigma surrounding the disease makes it difficult for sufferers to seek help. 

What’s clear is that the cost of failing to effectively treat alcohol abuse is astronomical, adding up to tens of thousands of deaths a year. AUD breaks apart families and disrupts the workplace, causing 232 million missed work days annually. New treatments and even laws are emerging daily, but it’s important for health care professionals and those with AUD to remember that effective treatment options are already available. 

“I think it’s great that we have medications,” said Humphreys. “They all can be used much more than they are. None of them is at the level of antibiotics for infections. But they have a role, and it’s too bad we don’t use them more.”

What is AUD? 

Americans can purchase alcohol at restaurants, bars, liquor shops, grocery stores, gas stations, and in some states, even drive-throughs. Alcohol is everywhere. “At the end of the day, it is so baked into our society to use alcohol. Some people are going to drink it and never develop a problem, and other people are going to develop a problem,” said Mark Disselkoen, the senior project manager at the Center for the Application of Substance Abuse Technologies (CASAT) at the University of Nevada Reno. 

While AUD and its effects are widespread, those suffering the most from the disease are the most frequent and heaviest drinkers. Data from the late 2000s showed that the top 10 percent of American drinkers (approximately 24 million people) consumed an average of 74 alcoholic drinks a week, which means those with the most severe form of AUD purchase over half the alcohol bought in the country. 

The research since then only further proves the pervasive influence of alcohol in the US. Americans spend billions on alcohol every year, with approximately 65 percent of adults of legal drinking age in the US reporting they drink alcohol (the average American consumes 2.51 gallons of the substance annually).

And the numbers only got worse when Covid-19 swept across the country. In 2020, the first year of the pandemic, studies show that overall a quarter of Americans drank more than they usually did due to the stress of the pandemic. 

AUD remains most common in men, but the rate of alcohol-related deaths is growing faster for women, partially due to a general uptick in alcohol consumption by the group. This is an unfortunate shift, explained in part by women’s greater susceptibility to alcohol-related liver and heart disease, and cancers. 

Historically, repeated binge drinking episodes — periods where men drink five or more alcoholic beverages in two hours, or for women, four or more beverages in two hours — were called alcohol abuse or alcohol dependence. The DSM-IV (a widely used manual published by the American Psychiatric Association to help diagnose mental disorders) categorized alcohol use as either abuse — continued alcohol use despite negative consequences — or dependence, an increasing need for consumption to become intoxicated and avoid withdrawal symptoms, George Koob, director of the National Institute on Alcohol Abuse and Alcoholism, told Vox. 

But these outdated terms perpetuate negative connotations and stereotypes about people who drink, the experts Vox spoke to agreed. “The terms ‘alcohol abuse’ or ‘substance abuse’ are terms that we try to avoid,” said Kenneth Leonard, the director of the Clinical and Research Institute on Addictions at the University at Buffalo and the former president of the Division of Addictions of the American Psychological Association. “They have the impact of stigmatizing individuals who have an alcohol use or substance use disorder.” Additionally, because the word “abuse” is associated with violence, it leads to people seeking to punish those with AUD, rather than treat them, said Humphreys. 

In 2013, the APA replaced the DSM-IV with the DSM-5, which recategorized all forms of abuse as AUD, with cases ranging from mild to moderate or severe. The DSM-5 criteria include a series of yes-or-no questions about a patient’s drinking habits and the repercussions of those habits from the last year. 

Answering yes to two or three of the DSM-5 questions indicates mild AUD; answering yes to four or five of the questions indicates moderate AUD; and answering yes to six or more indicates severe AUD. 

The amount and type of alcohol someone consumes also affects where they fall on the spectrum for this disorder, said Disselkoen. When primary care physicians ask about alcohol consumption — which they should do at annual visits — they shouldn’t just ask how many alcoholic drinks are consumed per week or month, but also about the alcohol by volume (ABV) consumed. (Two glasses of wine with an ABV of 11 to 13 percent a night is very different from two cocktails with an average ABV of 25 percent a night.)

Nonetheless, some experts believe that not everyone who meets this criteria in the last 12 months should receive an AUD diagnosis. Older teens and college students who use alcohol more heavily while in a college party setting may not go on to develop lifelong AUD, for instance, said Sara Jo Nixon, a distinguished professor in psychiatry, neuroscience, and psychology and director of the University of Florida’s Center for Addiction Research and Education.

“Yes, there is this period of heavy partying, and it’s not without negative consequences, and so certainly, in that time span, you might think of [older teens and college students] as having met the criteria. But it doesn’t mean that they’re going to carry that throughout their lifetime,” she said.  

Still, sometimes preconceived notions of who suffers from AUD prevent people from identifying the disease. “Although we often think of individuals with an alcohol use disorder as being in their 40s or 50s, the disorder often began when they were in their 20s and may have progressed slowly from then on or progressed rapidly when a major life challenge occurred,” Leonard said. 

And sometimes other factors, such as socioeconomic status or race, affect whether or not someone’s AUD is discovered, said Humphreys. 

For example, Humphreys said, if someone like himself, a white Stanford professor, gets pulled over after drinking at a work holiday party, he may speak with the police officer and then continue on his way. But, if the police pulled over someone poor, Black, or driving a beat-up car, they may take them to jail and they would incur a documented case of harm from drinking. Latino and Hispanic men are up to 66 percent more likely to be convicted of a DUI than white men, a 2021 University of California Davis study found from alcohol-related crash data in California. 

About 18.7 million white people ages 12 and up experience AUD each year, accounting for the greatest number of AUD sufferers, the 2021 National Survey on Drug Use and Health found. However, those who identify as two or more races; American Indian or Alaska Native adults; and Native Hawaiian or other Pacific Islander adults report higher rates of AUD relative to their population sizes. 

How to treat the disorder 

In the last decade, the medical community has come to recognize AUD as a disease that (like all others) needs medical treatment through a range of interventions. With new treatments coming out every day, hope exists that in the years to come more and more people will receive the care they need. 

For those with the most severe forms of AUD, treatment aims at stopping the individual’s alcohol consumption entirely (while recognizing that having a drink or breaking abstinence isn’t a failure, but an almost inevitable part of the recovery cycle). 

“What’s happened in the last probably 50 years or so is there’s a more medicalized understanding,” said Humphreys. “So there’s been the rise of neuroscience that looks at things like how the brain changes with repeated administration of alcohol, how that limits things like self-control, how that increases phenomena like craving.” 

And as with any other mental health diagnosis, successful treatment for AUD often boils down to a combination of therapy and medication, the experts Vox spoke to said. Just as depression is treated with medication to balance chemicals in the brain, and therapy to help patients unlearn harmful behaviors, AUD often needs the same combination of treatments, said Disselkoen.  

The Federal Drug Administration approved the first medication to treat AUD, disulfiram, in 1951. Disulfiram, whose brand name is Antabuse, is a daily pill that causes someone to fall ill — face redness, headache, nausea, sweating, and more — if they drink even a small amount of alcohol. Disulfiram is safe and effective, but the same characteristic that makes it successful (the way it induces illness) also makes it unpopular among patients, said Nixon. 

Disulfiram is now a second-line option, with the two other FDA-approved medications, naltrexone and acamprosate, serving as first-line options. Naltrexone and acamprosate were approved in the 1990s and early 2000s respectively. 

Naltrexone, which comes in a pill and injectable form, blocks the buzz of opioids or alcohol, essentially preventing intoxication and therefore the desired effect of drinking or drug use. One flaw with naltrexone and disulfiram is that they stay in the body for relatively short periods of time, with the daily pills only treating AUD the day they are taken. If someone chooses not to take the pill one day — as studies have shown, patients don’t take it approximately 20 to 30 percent of the days — then their body will quickly begin to respond to drugs the way they did prior to taking the pill. (In contrast, the once-a-month injectable version consistently prevents someone from experiencing intoxication.) Another side effect is that in rare cases, the drug can damage the liver, which could compound damage from past alcohol consumption. 

In contrast, acamprosate, a pill taken three times a day and usually prescribed for up to 6 months at a time, is not metabolized in the liver. Rather than reducing craving or inducing illness, acamprosate merely restores the chemical balance of the brain. In time that helps the brain unlearn the cravings that consistent and intense alcohol use creates, ideally reducing addiction.

Disulfiram, naltrexone, and acamprosate are the only three medications approved by the FDA to treat AUD, but other off-label drugs can be prescribed. For example, the epilepsy medicine topiramate and even the diabetes medication Ozempic may reduce cravings and encourage sobriety. In a dozen experiments, the drugs reduced mice and rats’ consumption of alcohol. But given how the existing medicines aren’t sufficiently used, these new approaches may not reach the patients in need of them. 

In 2021, an estimated 61 percent of adults with a major depressive episode received treatment in the US, and globally, about 25 percent of those with anxiety disorders receive treatment. In contrast to these other mental health disorders, AUD is vastly undertreated. In 2021, less than 5 percent of people ages 12 and up with AUD received any kind of treatment, and even less, only 2 percent, were prescribed medication. 

This makes sense when you consider that of the approximately 940,000 physicians in the US, around 38,000 of them specialize in psychiatry, and approximately 3,000 specialize in addiction medicine. And today, patients don’t have the same longstanding relationships they once had with primary care physicians, with nearly half of adults under 30 saying in 2018 that they didn’t have a primary care doctor, Vox’s Dylan Scott previously reported. Instead, patients are turning to emergency rooms and urgent clinics that are not designed to treat underlying diseases, but rather the symptoms or repercussions of those illnesses. 

“A lot of doctors don’t want to treat alcohol problems,” said Humphreys. “I have a friend who used to say what’s strange about being a doctor is we’re the only profession that you can look a stranger in the eye, and say, ‘Go into that room and take off your clothes,’ and the person will do it. Yet those same people would say, ‘I could never ask somebody about their drinking, that’s too inappropriate.’ … that says a lot about just the deep discomfort a lot of doctors feel about them getting involved in someone’s drinking.” 

There’s no question disulfiram, naltrexone, and acamprosate are under-prescribed, but Disselkoen warns these drugs are not a “silver bullet” against AUD, just like antidepressants alone can’t always treat depression.

“There is no one-size-fits-all approach to the treatment of AUD,” said Koob. “The important thing is that individuals continue trying until they find an approach, or combination of approaches, that works for them.”

For those with a concurrent diagnosis of AUD and another mental health diagnosis, some form of therapy is often needed to treat both conditions. Mild AUD can be treated with a short mental health screening and intervention in a primary care doctor’s office. Meanwhile, for those with more severe cases of AUD, further treatment — cognitive behavior or motivational enhancement therapy — could help.  

And it’s important not to underestimate the importance of social groups. Alcoholics Anonymous (AA) is often successful in promoting abstinence, sometimes even more so than therapy. Reviews of the program have found that the practical advice, emotional support, and nonjudgmental space AA provides truly help those with AUD refrain from drinking. 

However, sobriety or abstinence from alcohol may no longer be the only form of recovery from AUD. Unlike in the past, today we understand that just like with most diseases, remission is possible, or rather that someone who suffers from AUD at one point in their life may recover and go on to not have AUD later in life. 

“Until relatively recently, the idea was a person with AUD had that disorder forever. That was sort of the mantra and the only way to recover was to not use at all,” said Nixon. “Individuals who did use were seen to relapse. Well, over time that’s evolved. And we now understand that a person might have a drink, that might be a slip, it might not mean they’re going to go into drinking at the same levels that they did before.”

Update, March 5, 2:30 pm: This piece was originally published on November 6, 2023, and has been updated to take into account new data on alcohol deaths from the CDC.

More than one in seven people in Botswana have HIV — the third highest rate in the world, falling only behind the other African countries of Eswatini and Lesotho in prevalence. 

The HIV virus attacks the immune system, leading to fever, muscle pains, mouth sores, diarrhea, and more. When left untreated, it can lead to acquired immunodeficiency syndrome (AIDS), a deadly condition that eliminates the body’s ability to fight off most infections. 

Moitshepi Matsheng saw the devastating effects of this epidemic in Botswana first-hand. “When I was 6 years old, my mother died of HIV, but I was never told what happened to her,” Matsheng said at the 10th UNESCO Youth Forum in 2017. After learning the true cause of her mother’s death as a teenager, Matsheng became passionate about ending the taboo around discussing safe sex and HIV. 

“Silence is the real killer, not HIV in itself,” Matsheng told me. 

Matsheng began studying law at the University of Botswana, where she met Noam Angrist, a Boston native and Massachusetts Institute of Technology graduate who was completing his Fulbright research at the university. The pair witnessed young female students run out of money at the end of the month and resort to “sugar daddies” to make ends meet. These older men preyed on the young female students, offering them gifts in exchange for sex (oftentimes unprotected). That same year, in 2014, Angrist told Matsheng about a research project in Kenya where a “sugar daddy” awareness class reduced teen pregnancy rates by 28 percent (with pregnancy serving as a proxy for unprotected sex that also leads to HIV cases).

Together, Angrist and Matsheng questioned why this awareness class had never been replicated or implemented on a larger scale. They saw a missed opportunity to save lives with safe sex education and came together to build what is now a trailblazing organization, Youth Impact. The nonprofit is based out of Botswana’s capital of Gaborone and aims to bridge the gap between research and action, taking data-backed health and education solutions and scaling them.

To see if it could replicate the success of the Kenyan research in Botswana, Youth Impact conducted a randomized control trial with 42,000 student participants between 2015 and 2016. Rather than promoting abstinence (the common form of sex education in the country), Youth Impact taught safe sex practices and about how dating younger, more age-appropriate partners is safer not only due to the power dynamics but also the lower risk of HIV. (Nearly 45 percent of 40-year-old men in Botswana are infected with HIV, which is nine times higher than rates in teenage boys.) Youth Impact’s trial revealed that peer educators — young people around the same age as the students — were most effective at teaching about safe sex and destigmatizing the discussion. 

Youth Impact now offers three programs: the safe-sex education program, a pandemic-induced distance learning initiative, and an education program aimed at improving students’ numeracy and literacy skills. Through a partnership with the Botswana government, the numeracy and literacy program, Teaching At The Right Level, is offered in approximately 50 percent of all primary schools, and by 2025 should be available in all primary schools. Botswana’s public school system enrolls approximately 522,000 students. 

A little less than a decade since its inception, the organization has reached over 100,000 youth in Southern Africa with its sexual health and basic numeracy intervention courses. And its work is now being expanded to Namibia, South Africa, and the Philippines. 

“Doctors both sometimes practice and do surgery, as well as research. But in the social sector, we have far too little crossover between research and practice,” Angrist told me. ”If you can carry the baton, in addition to passing it, then you can really connect the dots. Then the evidence actually meets the action.”

Growing up, Seye Abimbola would watch his mother perform free midwife services in their living room for those who needed it. In Nigeria, where roughly 793 women die per 100,000 live births and 14 women die each day from unsafe abortions, it was life-saving work. 

“This made me understand early on how health is made and unmade, what we now call the social and political determinants of health,” Abimbola, who is now the editor-in-chief of the British Medical Journal (BMJ) Global Health, told Public Health Post last year. 

The experience also helped set Abimbola on his career path: As a professor of public health and at BMJ Global Health, Abimbola aims to amplify marginalized voices and push global health research to be more equitable.

Founded in 2016 as an offshoot of the BMJ — one of the world’s oldest medical journals — BMJ Global Health is an online journal that publishes content related to, you guessed it, global health. The journal features papers and analyses on the Covid-19 pandemic response, HIV testing, AI and health, and much more.   

In 2015, when BMJ Global Health launched under Abimbola’s leadership, he told the George Institute for Global Health that the journal wanted a dedicated space for research that evaluates how factors such as income, education, and public policy can play a role in communities’ health. These social determinants — non-medical conditions in someone’s environment — play a significant role in people’s ability to survive and thrive.  

Throughout his career, first at the Ministry of Health in Nigeria and now as an associate professor at the University of Sydney School of Public Health in Australia, Abimbola has emphasized the need for “divestment and decentralization” in global health research. 

In practice, this means that, for example, a study in Nigeria should not be targeted to an audience in London, he told Public Health Post. If targeted to people living in Nigeria, the research could have a tangible influence on health outcomes for those living in the country.

For example, research on how to prevent Covid cases in Nigerian communities should be published on a platform accessible to those communities. That way, the practices that research identifies could actually be adopted. If the research is published with an organization based half a world away, the work will do little to actually address the health crisis.

“I can’t think of any scenario where I should do a study in Nigeria with the primary purpose of impressing someone in London,” Abimbola continued. “If we define that as a big chunk of the problem, then we have to find a way to refocus our attention to the right audiences, which would be the local ones in this instance. I should be trying to impress the local people.” 

He believes the same mentality needs to be applied to the language used in the research. Terms such as “low- and middle-income countries” divide the world into “unnatural categories,” he argues. This, in turn, shapes the questions scientists and researchers ask and therefore what gets studied. 

“The academic global health literature marginalizes a lot of conversations that should be primary — for example, on the role that social learning plays in how knowledge is used to achieve equity,” he wrote in an editorial for BMJ in 2021. “The academic global health literature needs to develop just and inclusive ways of reckoning with knowledge, of all kinds.”

Every year, the pregnancy condition preeclampsia kills 76,000 mothers and 500,000 infants. 

Ashley Muteti, a public relations specialist in Kenya, survived the condition — a hypertensive disorder that causes high blood pressure — twice in her 20s. Preeclampsia is one of the leading causes of maternal death globally, capable of causing internal bleeding, seizures, stroke, premature birth, and more. In Kenya, 530 women died per 100,000 live births in 2020.

When she was just 25 years old, Muteti was diagnosed with preeclampsia after experiencing extreme pain during her seventh month of pregnancy. She was carrying her first child, a daughter named Zuri. Due to her high blood pressure, Muteti was admitted to the hospital for a month and gave birth prematurely on March 8, 2018. 

While Muteti survived the pregnancy, Zuri passed away due to necrotizing enterocolitis (a condition where intestinal tissue dies) 49 days after her birth. A year later, in her daughter’s memory, Muteti started the Nairobi-based organization Zuri Nzilani Foundation, which aims to educate pregnant women and health care providers on hypertension in pregnancy, and to advocate for women with these complications at the local and national level. 

“Preeclampsia and other hypertensive disorders in pregnancy is a fairly new subject here in my country, Kenya,” Muteti said in a video for the Preeclampsia Foundation. “Not much education has been created about the condition and that’s where here at Zuri Nzilani Foundation, we are very keen to create awareness about hypertensive disorders in pregnancy. This is because most of the women learn about it when it’s already too late.”

Since its inception, the foundation has created support groups for women and their families, run educational campaigns, and lobbied for better health care for mothers in Kenya. 

Muteti helped convene the first pan-African conference on hypertension in pregnancy in 2021 and plans an annual conference on hypertensive disorders in pregnancy, which brings together medical practitioners, gynecologists, health care workers, nurses, pregnant women, and women of childbearing age to raise awareness on hypertension disorders. 

With only 500 OB-GYNs across the entire country of 54 million people, childbirth remains far too dangerous. The lack of specialized health care workers in Kenya is especially concerning for women who may have hypertensive disorders or pregnancy-related diabetes (which up to 18 out of 100 pregnant people in the country will experience). The signs of these can be similar to those of normal pregnancy, including swelling, headaches, and nausea. Without adequate neonatal care (at least eight doctor visits according to the WHO), these conditions can go undetected and worsen, Muteti told Vox in March. 

This is why outside of its national advocacy work, the Zuri Nzilani Foundation also creates social support groups for pregnant mothers — groups that can be the difference between life and death. In September 2022, a foundation support group member was sent home from a hospital despite experiencing high blood pressure. Her fellow group members mobilized to quickly find a gynecologist who could refer her to a facility. The woman gave birth shortly thereafter, saving her and her baby’s life. 

In a culture where pregnancy loss is stigmatized, speaking about it openly is another way Muteti is changing outcomes for pregnant women across Kenya. “People think because you’re going through a particular condition in pregnancy, you have been bewitched or someone has looked at you with an evil eye,” Muteti previously told Vox. “Women in our support groups actually lose their husbands and lose their marriages because they’ve gone through multiple pregnancy losses.”

Muteti says the Zuri Nzilani Foundation’s work is done both in the name of her daughter and in the name of ensuring “that no mother will die as a result of bringing life into this world.”

When interviewing a CEO, you don’t normally expect them to say that their greatest aspiration is to “go out of business.” And yet that’s exactly what Scott O’Neill told me when I interviewed him earlier this year about his non-profit, the World Mosquito Program (WMP). 

For O’Neill, who founded WMP, going out of business means eliminating many of the world’s mosquito-borne illnesses, like dengue, yellow fever, chikungunya, and Zika virus. It’s a lofty goal — today over 1 million people die annually from these diseases — but the World Mosquito Program may have the key to reaching it.

“I’ve been working on this my whole career,” said O’Neill. “I have been particularly interested in an approach that’s practical for developing countries that don’t have a lot of money to think about a public health solution for these diseases.” 

But what sets the program apart from other anti-dengue initiatives is that O’Neill isn’t focused on traditional prevention or treatment methods like vaccines or drugs. Nor is he trying to directly kill mosquitoes through insecticides. Rather, WMP actually mates mosquitos. 

Wolbachia is a harmless, naturally occurring bacteria in many insects. When the Aedes mosquito (the species that carries many deadly viruses) is infected with Wolbachia, the bacterium competes with viruses, like dengue and Zika. Because it’s believed Wolbachia induces an antiviral response in mosquitos, it prevents the insects from becoming carriers of diseases when they bite an infected person.

The program breeds Aedes mosquitos for Wolbachia and then introduces them into the natural environment, which transforms the natural population of mosquitos into Wolbachia carriers. Once the Wolbachia-positive mosquitos are self-sustaining in the wild, then rates of dengue, yellow fever, Zika, and more decrease.

“It’s exactly the same rationale for how vaccination works for humans. So you don’t need to vaccinate 100 percent of the people in the population to give protection to the whole population,” O’Neill told Vox.

Notably, Wolbachia treatment can’t prevent malaria — as that disease stems from a parasite, not a virus, and is carried by a different mosquito. But there is hope that as research mounts the treatment could be used to combat malaria in the future.

WMP launched in Australia in 2011 to combat dengue in the area and, since then, the Cairns region in the country has reported no local dengue outbreaks. In the decade since, WMP expanded its work to 13 countries, including Mexico, Laos, and Fiji. And earlier this year, WMP announced that it is preparing to open its largest “mosquito factory” in Brazil in 2024 to combat dengue in the country, which had the second-highest rate of cases in the world last year.

New vaccines against dengue fever have shown increasing promise in recent years, but they’re not foolproof. The plethora of ways the viruses work through the immune system complicates how mosquito-borne illnesses can be treated. To make matters worse, the increasing scope of mosquitos’ territory also factors into the prevalence of these diseases. Infectious disease experts fear that even with more effective vaccines, we won’t be able to distribute them fast enough to keep up with evolving diseases — and growing mosquito populations.

If greenhouse gas emissions (and the resulting climate change) continue at current levels, 49 percent of the world will live in areas with Aedes mosquitos by 2050, a 2019 study published in Nature Microbiology found. Urban areas previously outside the Aedes mosquito scope, such as those in the southern United States and Europe, will battle these pests in the decades to come.

O’Neill views WMP’s approach as a cost-effective and socially acceptable alternative to practices like genetic modification, where unnatural bacteria or other changes are made to the mosquitos.

WMP estimates their approach costs $2 to $3 per person to implement while outside estimates place the cost at $15 per person. For an urban area of 50,000 people, this would mean WMP’s approach costs anywhere from $100,000 to $750,000 in its initial implementation. In contrast, implementing a genetic modification program — where mosquitos are essentially implanted with an artificial kill switch that prevents them from reaching reproductive age — in a city of 50,000 would cost approximately $1.9 million in the first year.

In 2021, when the biotech firm Oxitec planned on releasing these genetically modified mosquitos into the Florida Keys, the project was criticized by locals for its potential to cause unforeseen health or ecological repercussions, with over 200,000 people signing a petition against the release (despite this pushback the program did move forward as planned). Genetic modification could result in new breeds of mosquito emerging, alter the infectiousness of carried illnesses, or even change how the mosquito carries such viruses.

WMP’s approach faces a different set of challenges. The process takes longer, and lab-raised mosquitos don’t always thrive as well in the wild compared to their naturally reared counterparts. The viruses that this treatment defends against will also continue to evolve in an attempt to outmaneuver Wolbachia.

Still, WMP’s work is one of the most promising tools the world has to fight mosquito-borne diseases.

“It’s a challenging prospect for people to understand,” O’Neill told CBC. “But when people live in transmission areas and are fearful of the disease and the impacts it can have on families, people are desperate and hungry for new approaches.”

Six out of ten US households donate to charity every year. Yet, under a quarter of Americans volunteered their time in 2021, according to a joint report from AmeriCorps and the US Census Bureau. 

Donating is a great way to help your community, but volunteering can help you truly become a part of it. Its benefits extend beyond those who are helped: In a post-lockdown world — where 58 percent of adults report feeling lonely — volunteering could cement much-needed connections. Additionally, research shows volunteering actually boosts our overall physical and mental health and increases our sense of pride, motivation, and support. 

“What brings me back here every single day is really the people,” said Juliana Soltys, a former volunteer and now the volunteer manager at Haley House, a Boston-based nonprofit that runs a soup kitchen, cooking classes, affordable housing units, and more for houseless individuals. “Every individual volunteer matters to us and we are just very grateful to have them in our space and getting to know them on a more personal level as well.” 

But despite the very real need and the potential benefits for all involved, volunteering isn’t as popular as it used to be. Since 2000, the number of Americans volunteering fell, reports the Chronicle of Philanthropy. Between 2003 and 2005, more than 28 percent of Americans volunteered, according to the Do Good Institute. By the end of 2020, that number dwindled to less than 25 percent. 2020, of course, saw a decline in community participation due to the pandemic — but even now, in a post-pandemic world, nonprofits are struggling to find the necessary number of volunteers. 

Volunteering can be a tough squeeze. For many, a lack of time or an inflexible schedule poses a hurdle. Then there’s the issue of finding an organization that aligns with your values. But the good news is volunteers are needed in so many different ways, from building homes to working from home. You don’t have to sacrifice other parts of your life to make an impact — you just need to be a bit creative to find the opportunities that fit your schedule, skills, and interests. 

“I think too often we have misconceptions about volunteering,” Barbara Huelat, an author, hospice volunteer, and dementia caregiver, told Vox. “If you keep both your eyes and your heart open, you will see needs that need to be met, and it will bring you great joy to be able to jump in and do it.”  

How do you find the right community?  

Just like when you’re deciding where to send your money, selecting the organization or the causes you want to aid — animals in need, kids in under-served schools, people escaping domestic abuse — is the first step to getting involved.

When you donate money, you’re probably concerned about where that money goes, or if it’s doing the most good it possibly can. Those worries matter: The most effective charities produce 100 times as much benefit as the average organization, Future Perfect writers Dylan Matthews and Sigal Samuel previously reported. No one wants to feel like their money isn’t helping — or worse, wasted.

Online platforms like GiveWell and Charity Navigator can help you find top-rated organizations globally. If your priority is to make the most significant impact with your time, these websites could help guide you. (Disclosure: GiveWell is also an advertiser on Vox podcasts.)

Meanwhile, VolunteerMatch won’t necessarily help you identify the most effective organizations, but it does let you look for opportunities that fit your location, causes of interest, and skills (and it allows you to filter for remote options). 

Sometimes other groups that you’re already a part of, like recreational sports teams or book clubs, can lead you to your volunteer community. Some of the largest sources of volunteers for Habitat for Humanity, a nonprofit organization that helps provide and build affordable homes, have been school groups and churches, said Boram Kim, the senior director of volunteer and institutional engagement at Habitat for Humanity International.  

Let’s say you already know which organization you want to volunteer for, but feel hesitant because you’re not sure you have the skills needed to help. Reach out anyway, the experts Vox spoke to agreed. 

For example, the task of building a home for Habitat for Humanity can seem daunting, especially if you’ve never even used a hammer. But there’s no reason to think you can’t help, Kim said. Prior to helping on a build, the organization ensures volunteers are trained and comfortable with the tasks they’ll be completing. 

Similarly, new volunteers at Haley House receive a video orientation about what to expect before their first shift and at least one to two staff members work alongside the volunteers each shift to answer questions. When you’re volunteering, you’re never alone. 

“Often people think they need special qualifications. They don’t,” said Randy Allison, a lifelong volunteer and founder of Alter X Company, an apparel company that donates 20 percent of its sales to a variety of causes. “Most often the greatest qualification is time and availability. Organizations need people to help fulfill their service-oriented mission often with limited financial and personnel resources to accomplish them.” 

When it comes to volunteering, picking a cause you’re invested in is one step — the other is ensuring you’re comfortable with commitment. If you’re allergic to dogs, walking senior dogs at the shelter isn’t the best way to invest your time. Yes, there can be a lot of pressure to choose the most urgent issues, like gun violence or the opioid crisis. But ultimately, enjoying the work you’ll do is vital for maintaining the commitment to yourself and others

“I think one of the things you really have to do is be cognizant of what you want to do,”  said Huelat. “You should really be finding what brings you joy, and what’s meaningful for you, and where your expertise is.” 

How to make volunteering fit with your skills and schedule 

When you hear the word “volunteering,” what comes to mind? 

Maybe you picture the packed cafeteria of your local soup kitchen, or an afterschool program where tutors help young kids with their math and reading homework, or a team of red-vested disaster relief volunteers handing out supplies and looking for survivors after a hurricane.  

Your vision probably does not include the work behind the scenes that funds that cafeteria, organizes those student-tutor matches, or assigns the Red Cross volunteers. Yet, every organization needs people to complete those tasks, and many of these tasks can be completed from anywhere and at any time. These opportunities while not as flashy, are necessary for organizations trying to do the most good with the resources they have.  

“Volunteers are the backbone of every nonprofit organization,” said Joshua Fields, co-founder and CEO of the Next Step Programs, a nonprofit that works with young adults who have intellectual disabilities to help them transition out of high school. “Without the support and dedication of volunteers from the community, it would be impossible to make as big of an impact as many organizations do.”  

For example, some Next Step Programs volunteers invest their time remotely, helping with fundraising or social media messaging. These posts help the organization attract donations and more volunteers, and still allow someone to connect and interact with the team remotely. “These types of tasks can be completed from the comfort of folks’ homes, and often time at one’s own schedule,” said Fields. 

Similarly at Haley House, volunteers can help plan events, the organization’s annual concert fundraiser, and help with social media posts from anywhere in the world. Soltys says it’s just a matter of reaching out and finding the right place in the organization for the individual. 

Other virtual volunteer opportunities include sending Christmas cards to deployed troops,  becoming pen pals with someone who is incarcerated, or operating a mental health hotline.

The key when you’re new to volunteering is starting small. “I think a lot of people feel that they have to commit a ton of hours to an organization when they choose to volunteer,” said Fields. “What I have learned is that every person has different tools, strengths, and skills to share. Organizations often welcome volunteers in many different capacities, and will usually work with your schedules.”  

Look at your calendar and figure out what day or days you have small chunks of time to spare. Maybe you’ll find a 30-minute window to make fundraising calls as you wait in the pickup line at your children’s school, or maybe you’ll discover that the library needs volunteers to read to the children who gather there. “Only commit to what you can safely fulfill,” Allison said. “Think about how you can best use and reorganize your time to give yourself more opportunities to serve.” 

And if you can’t commit to any one organization or charity, maybe try helping someone more directly. These types of informal opportunities to help members of your community can easily be found in neighborhood social media pages, or through mutual aid hubs. Mutual aid involves community members coming together to address an issue as a collective, rather than individually. It can be as simple as sharing meals, teaching each other new skills, or pooling your resources to help members of the community purchase necessary medical treatments. 

“An elderly woman in the neighborhood no longer drives, and I take her to get groceries, and not only does it help her get the groceries, but I spend time with her and she’s not lonely and she gets out,” said Huelat. “I think that’s probably the biggest need when we just see people that need assistance. It doesn’t have to be a formal organization.”

“The smoke is very thick, like a dark mushroom in the sky,” said reporter Gus Abelgas in a 1991 television broadcast on the ongoing volcanic eruption of Mount Pinatubo in the Philippines. “It’s just like what we saw in Hiroshima.” 

After 500 years of dormancy, Mount Pinatubo’s June explosion represented one of the largest volcanic events of the 20th century. The eruption forced approximately 30,000 indigenous Aeta people to evacuate the nearby area and killed over 200 people. (An additional 426 people died in the three months following the explosion due to poor conditions in the evacuation zones.) 

The eruption also sent a sulfuric gas cloud into the atmosphere 28 miles high — or five Mount Everests stacked on top of each other. While almost a foot of muddy ash covered the surrounding area, the sulfuric gas mixed with water vapor in the air, creating a layer of a reflective acidic compound that cooled the Earth for two years.

Yes, that’s right: A hot volcanic eruption made the planet cooler.

Sulfur dioxide is one of many aerosol particles that reflects the sun’s light and can act to make temperatures globally cooler than they would be otherwise. Mount Pinatubo’s eruption temporarily dropped global temps by about 0.9 degrees Fahrenheit. That doesn’t sound like a huge jump, but if you were to warm the planet by an additional 0.9 degrees Fahrenheit today, that could trigger increased flooding and fire events, sweeping heat waves, super storms, and even famines.

Collectively, volcanoes around the globe emit 20 to 25 million tons of the cooling aerosol sulfur dioxide annually, but in 1991, Mount Pinatubo alone released 15 million tons of the compound. And while extreme, Mount Pinatubo’s cooling effect is not an anomaly — nor are volcanoes the only sources. 

Air-polluting sources — such as volcanic eruptions, wildfires, and industrial factories — all emit particles that reflect light and cool the planet. To be absolutely clear: This is not at all to say that air pollution is a good thing. Air pollution, after all, contributes to 7 million premature deaths per year globally. Improving air quality should be a top goal across the planet. 

“Many of those same human activities [that contribute to climate change] can increase air pollution in the form of particles, and those particles are both detrimental to health and counteract, to some extent, the warming that comes from greenhouse gasses,” said Jason West, a professor in environmental sciences and engineering at the University of North Carolina at Chapel Hill. 

But in the absence of cooling aerosols, we might have nearly 1 degree Fahrenheit more warming, experts say. Given the world is on track to record its hottest summer on record, this is bad news. While the positive effects of temperature-cooling pollution do not outweigh air pollution sources’ greenhouse gas emissions or the overall cost of these pollutants to human health, they have acted to somewhat slow the rate of warming. As we reduce air pollution — which we must do — we need to be prepared for the short-term consequences of even faster global warming.

The relationship between climate change and air pollution  

Greenhouse gas emissions — such as carbon dioxide, methane, and nitrous oxide — warm the planet by absorbing light and therefore trapping heat. Electricity production (which has soared over the last few decades) and vehicles are some of the largest producers of these gasses.

Some aerosol particles — such as sulfate aerosols, particulate matter, and sea salt — prevent warming. Heat dances off bright-colored particles and is absorbed by darker particles (like soot and black carbon). Bright, reflective aerosol particles affect Earth’s temperature by scattering sunlight in the upper part of the atmosphere, the stratosphere. They also create and brighten clouds (which then also reflect light away from the Earth’s surface) by attracting water vapor that attaches and sometimes freezes on the particles. The conglomeration of water vapor prompts the formation and thickening of clouds. 

Natural sources, such as volcanoes, sea spray, and desert storms, can shoot these particles into the atmosphere. Human-made sources, like the burning of coal, also emit aerosols. Vehicles and power plants emit sulfate and nitrate particles.  

While greenhouse gas emissions can persist in the atmosphere for decades or even centuries, cooling aerosol particles live in the atmosphere for only days or weeks due to their composition and climate conditions. Particle size and temperature influence these emissions’ atmospheric lifespan. As Mount Pinatubo demonstrated, the effect of cooling aerosol particles is temporary (in the case of this massive volcanic eruption, the aerosol effect was felt for approximately two years) but they can be very strong. After the far larger eruption of Mount Tambora, 1816 became known as “the year without a summer,” as temperatures dropped by as much as 7 degrees Fahrenheit around the world, crops failed, and tens of thousands of people died from hunger.

In 2018, researchers from the Center for International Climate and Environmental Research, NASA, the University of Leeds, the University of Oxford, and Climate Analytics found that ending the emission of greenhouse gasses will also end human-caused aerosol emissions. The absence of these aerosols will result in global heating and increased rain, especially in locations where aerosol emissions were once regularly emitted. The world must prepare for a temporary spike in warmth in order to address the even more dangerous long-term effects of climate change and air pollution.

If human-caused air pollution disappeared this instant, the world would experience the negative warming consequences of past greenhouse emissions for decades to come, with virtually no lingering cooling effect from the previously emitted particles, said West. 

“Let’s say we emitted greenhouse gases, CO2, and [aerosol cooling] particles at the same rate forever. Eventually, the greenhouse gases are going to win because they’re going to continue to accumulate,” he said. “Whereas the particle concentration would stay the same because it’s short-lived.” Ultimately, aerosol particles have masked some of greenhouse gasses’ effects, but they won’t do so forever. 

Why we need cleaner air 

Despite evidence that keeping cooling aerosol particles from polluting sources would prevent some level of global warming, doing so is not an option. One, because they share a source with greenhouse gasses, and two, because they are unequivocally detrimental to human health. 

Air Quality Index (AQI) levels are used to measure the level of air pollution and range between 0 to 500. Even at relatively moderate levels (101-150 AQI), air pollution causes eye and throat irritation. But, as the intensity and length of exposure increase, so do the consequences. 

PM2.5, a type of fine-particle pollutant, is one of the most harmful air pollutants to human health currently regulated by the Environmental Protection Agency, and exposure to high levels can cause heart attacks, strokes, and severe respiratory problems, and even initiate the onset of chronic conditions such as bronchitis and asthma. The effects are particularly dangerous for those suffering from preexisting lung and heart conditions like obstructive pulmonary disease. 

“All the things we know that cigarette smoking can cause, like cardiovascular disease and lung cancer, likewise, fine particles do that,” said Patrick Kinney, a professor of urban health for Boston University’s School of Public Health. “Of course, we don’t breathe as much [fine particles] as a cigarette smoker does … but it’s the same kind of effect.” 

Infants and children are particularly susceptible to developing cancers and cognitive impairments due to air pollution. Low- and middle-income countries, primarily in Asia and Africa, account for more than 90 percent of these deaths. 

“When we look over the planet, aerosols can have a different influence,” said West. “We expect aerosols to have a bigger effect in the Northern Hemisphere — where most of the pollution sources are — compared to the Southern Hemisphere, which is relatively more pristine. It’s covered by ocean and there’s much less population.” Two-thirds of the African continent and most of Asia lie in the Northern Hemisphere. 

Vehicle exhaust and coal combustion contribute to particularly severe air pollution in densely populated areas within Asia. China and India, the two most populous countries in the world, emit over half of the world’s PM2.5 emissions, and in both countries, air pollution contributes to the deaths of more than 2 million people a year.

“We need to switch away from fossil fuels toward renewables,” said West, “which has benefits for both air pollution and for the climate.” 

What will happen to global temperatures? 

If humans keep burning fossil fuels, air pollution will worsen, and so will climate change. Consequently, a warmer planet will make our air quality worse. Hot weather creates the perfect conditions for the reactions that produce ozone (a greenhouse gas). And heat waves can cause droughts. During a drought, forest fires, which produce particle pollution, are more common. “Air pollution affects climate change and climate change affects air pollution,” said Kinney. 

But air pollution is not the only — or most important — byproduct of climate change, he added. Global warming will bring a host of other problems, including extreme heat waves, hurricanes, wildfires, and the proliferation of infectious diseases. 

“This is not new. We’ve had storms always and we’ve had heat waves always,” said Kinney. “But what climate change is doing is making those extremes more extreme, and pushing the sort of upper tail of the extreme distribution for temperature and also for storm intensity.” 

Across the world, natural disasters, including extreme winter storms, wildfires, and flooding, are wreaking havoc on communities that previously never faced such events. “It’s worse than a new normal. I call it a new abnormal,” Michael Mann, a climate scientist at the University of Pennsylvania, previously told Vox.   

Preventing further climate change is, therefore, the greatest concern, and given greenhouse gases and aerosol cooling particles often stem from the same sources, it’s very difficult to isolate the emissions. 

“There are some particles that are warming, such as black carbon particles. They have a warming influence, as well as being bad for health,” said West. “So if we can target black carbon-related emissions, then we could have a benefit for both problems — for both air pollution and health, and for climate. But … many sources are sources of both black carbon and cooling aerosols.” 

Even if the warming and cooling pollutants had different sources, the health outcomes from aerosol particles — heart attacks, strokes, chronic diseases — mean keeping them around isn’t a viable option. 

Thus, scientists and researchers are now looking for ways to mimic the cooling aerosol effect without the same negative impact through a practice known as geoengineering. This field encompasses methods meant to offset the impacts of climate change by influencing the environment. 

One geoengineering method involves injecting salt particles into the air to brighten and increase cloud coverage over the ocean. Despite research dating back to 2012 showing that salt particles cannot slow climate change at a meaningful rate, researchers continue to explore the idea. 

A number of other ideas have been proposed and tested, including producing artificial clouds and placing mirrors in space. Producing clouds would entail shooting sulfur dioxide (the same stuff Mount Pinatubo spat out) into the atmosphere, but initial studies of the practice showed that starting and then stopping the method could lead to dire unknown effects. The consequences of space mirrors seem less deadly but are also less understood, and embarking on such a program would cost trillions of dollars. All of these approaches are also politically contentious. 

While none of these methods is ready for wide-scale use, interest in geoengineering is rising. In late June, the Biden administration released a report indicating the White House is open to geoengineering research aimed at cooling the planet, specifically the “scientific and societal implications of solar radiation modification.” No concrete plans or policies in this field have yet been made, indicating a level of necessary caution given concerns about geoengineering’s little-understood ramifications.

Altering the delicate balance of the Earth’s climate system through intentional intervention carries inherent risks, including crop and wildlife die-offs and unintended shifts in weather patterns. Some methods could create massive droughts in some parts of the world, or even deplete the ozone layer further. 

Another concern is “termination shock.” If geoengineering technology went into effect and was then abruptly ended (by choice or by unpredictable events like terrorist attacks or natural disasters) then the resulting warming would be even more significant and catastrophic than current projections. 

Additionally, given that one country’s decision to engage in a geoengineering method could have global repercussions, scientists and policymakers continue to debate the political repercussions and oversight of this technology.   

And before any of these ideas can come to fruition, scientists and researchers must develop a better understanding of the true impact of the aerosol cooling effect. 

“We know that aerosol particles that come from human emissions have the potential to have a cooling effect on climate,” said Casey Wall, a postdoctoral researcher studying climate science at the University of Oslo. “And we know it can offset some of the warming effects from human greenhouse gas emissions. But the really big debate right now in the climate research community is just how much that aerosol cooling effect offsets the warming from greenhouse gases.” 

Air pollution’s relationship with and on climate change is complex, but at the end of the day, cleaner air will lead to a healthier planet. “Air pollution as we commonly talk about it is a bad thing overall, even though it has this effect of cooling the climate,” said Wall. “The effects on human health overall outweigh that.”