My Feelings on the Seriousness of Pandemic Risk

Note: When I try to imagine the rest of my lifetime, I feel pretty optimistic. It’s not that I believe that poverty will magically go away or that people aren’t already feeling and won’t continue to feel some of the impacts of climate change. But I do generally speculate that we won’t see a huge pandemic, nuclear war or similar humanity-devastating outcome.

Even though such risks seem unlikely, I have generally felt that they are still worth mitigating given their seriousness if they do happen. I think this explains my interest in the area, which has driven me to work on a couple projects in biosecurity and pandemic preparedness in my PhD. This post lays out lines of reasoning that have influenced my changing feelings about the seriousness of pandemics.


I first learned about pandemic risk from the Open Philanthropy Project (OPP). According to OPP, “[t]he worst flu pandemic in the past century was the ‘Spanish’ flu epidemic of 1918, which is believed to have been responsible for about 50 million deaths,” or 3-5 percent of the world population at the time [0]. The academic biosecurity community [1] in general fears that modern pandemics have the potential to kill even larger percentages: increased travel and other factors potentially augment the risk, while modern medicine and public health knowledge potentially decrease the risk.

How serious is pandemic risk, versus the 30-40 million people who die each year of non-communicable diseases [2], or climate change, or poverty and improved economic well-being (e.g. housing prices)?

tl;dr: At least 2 historical pandemics killed > 3% of the global population within a few years; extrapolating this gives a death toll of > 210 million people today, which in rate terms is an order of magnitude less than that of non-communicable diseases. When considering modern factors that increase pandemic risk (see Red Note), along with the suddenness of pandemics and several scenarios that are worse than historical ones, pandemic risk seems as or more serious to me than suffering from non-communicable diseases.

(Note 1: Comparing pandemic risk and non-communicable diseases does not make me feel, “Oh, non-communicable diseases aren’t that bad.” Like many, I have had family members die and/or suffer from such diseases. This comparison makes me feel, “Wow, surprisingly this problem feels as or more serious than one I already feel is incredibly serious; I should seriously consider working on it.”)

(Note 2: I recommend the 106-minute movie _Contagion_ and, if you have more time, Laurie Garrett’s book _The Coming Plague_ for vivid (and realistic) depictions of pandemics that go beyond the mainly quantitative arguments below. For more background on the specific pandemic threats that could lead to different numbers of deaths including the ones below, as well as actions that can be taken to mitigate such threats, I recommend the 80000 Hours’ podcasts and OPP cause report [3].)

My feelings about seriousness of pandemic risk

1. I first imagined a scenario in which Spanish flu today kills the same percentage of the world population as it did in 1918. That’s 210-350 million deaths (3-5% of the world population) [4]. The Institute of Disease Modeling performed simulations of a modern Spanish flu (presumably accounting for modern factors like increased air travel and more advanced medicine); this 15-second simulation predicted 33 million deaths in the first 6 months:

This IDM number seems significantly lower than the 3-5% extrapolation. Using the 3-5% extrapolation or the IDM results, one modern Spanish flu would kill as many people as non-communicable diseases do in about 5-8 years or 1 year, respectively. If such a Spanish flu happens once or even twice in my lifetime, then in relative terms, the impact is an order of magnitude smaller than that of non-communicable diseases. I dislike engaging in such speculative estimates, but I see no other way to get an intuitive grasp of how serious the problem is. These estimates made me feel the problem is still extremely serious, but less relatively serious than I had initially thought.

2. At this point, I was surprised and asked why I had previously felt so sure that pandemic risk was as or more serious than non-communicable diseases. I then realized that my comparison of total numbers between the two problems missed part of the picture:

  • Many factors increase pandemic risk and magnitudes in the future [5].
  • The worst past pandemic is not a worst case bound on future pandemics, even if such factors don’t end up increasing pandemic risk. I can’t just hope that the worst or average case death toll for a future pandemic is the Spanish flu number (3-5% of world population) or even the Black Death number (until I know more about how these numbers were estimated, I’m not going to put much faith in them, but Wikipedia [6] estimates 16-23% of the world population). Pandemics seem like forest fires in their potential to scale unpredictably and uncontrollably beyond what one might expect [7]: infectious agents self-replicate just like fires, with billions of proximate humans constituting the firewood.
  • Pandemics unpredictably kill a bunch of people at once; this seems worse than something that kills the same number at a slow, steady rate. I mean “worse” in the sense of denting humanity’s trajectory, by unpredictably killing many people of child-bearing age in a short timeframe [8]. In the case of Black Death, “[i]t took 200 years for the world population to recover to its previous level.” [9] In contrast, many of the non-communicable diseases are diseases of old age; they seem to kill no more than a fixed percentage of the world population in predictable ways. This is not captured in comparison of raw numbers.

3. These arguments make me feel again that pandemic risk is extremely serious, at least on par with the suffering caused by non-communicable diseases.

My attitude towards personally working to mitigate pandemic risk

Guided by my interest, I try to pick what to work on based on the seriousness of the problem, how many people are already working on the problem, whether I can actually contribute to the problem and other hard-to-name factors called “personal fit.” The above post only addresses the first factor. At this point, I remain reasonably interested in working to mitigate pandemic risk, as well as other biosecurity risks.

Footnotes

0. Bill Gates paints the picture of a pandemic here:

1. From my current understanding, the academic biosecurity community includes people at the Johns Hopkins Center for Health Security, the Nuclear Threat Initiative, the Open Philanthropy Project and quite a few other institutions. See https://80000hours.org/podcast/episodes/beth-cameron-pandemic-preparedness/ for a full list.

2. This was generated from http://ghdx.healthdata.org/gbd-results-tool:

 

 

 

 

 

3. See https://80000hours.org/podcast/episodes/we-are-not-worried-enough-about-the-next-pandemic/ (“When we talk about biosecurity and pandemic preparedness… something even scarier”), https://80000hours.org/podcast/episodes/beth-cameron-pandemic-preparedness/, https://80000hours.org/podcast/episodes/tom-inglesby-health-security/ and https://www.openphilanthropy.org/research/cause-reports/biosecurity.

4. I don’t know about how the Spanish flu or Black Death death toll estimates are made, so I take them with a grain of salt. However, to take pandemic risk seriously, I don’t require the numbers to be that exact, given that such large numbers are plausible to me based on the exponential nature of pandemics and the huge variance in modern pandemic death tolls, and especially given multiple instances of global pandemics in history.

5. I think there are many factors; ask me if you’re interested. As mentioned before, there are also factors that potentially decrease modern pandemic risk, such as advanced medicine and public health knowledge. I won’t delve into it here, but my feeling is that factors increasing risk outweigh those decreasing it.

6. “In total, the plague may have reduced the world population from an estimated 450 million to 350–375 million in the 14th century.” 75-100 million / 450 million = 16.67-22.22%. https://en.wikipedia.org/wiki/Black_Death.

7. I first heard the pandemic-forest fire analogy from Marc Lipsitch.

8. It’s true that flu usually kills the extremely young or old, not those of child-bearing age. I would guess this is due the stronger immunity of young adults and middle-aged people. However, Spanish flu is a notable exception.

9. https://en.wikipedia.org/wiki/Black_Death

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Can I reduce my energy usage to the global average?

I’m trying to reduce my energy usage to the level of the average global citizen’s. [**EDIT**: I am now tracking how well I’m doing that here.]

I was inspired to do so by renewable energy inventor Saul Griffith. In 2009, he gave a talk about climate change (http://longnow.org/seminars/02009/jan/16/climate-change-recalculated/):

“[Saul Griffith]’s been analyzing his own life in extreme detail to figure out exactly how much energy he uses and what changes might reduce the load. In 2007, when he started, he was consuming about 18,000 watts, like most Americans. The energy budget of the average person in the world is about 2,200 watts… [T]o stay at the world’s energy budget at 16 terawatts, while many of the poorest in the world might raise their standard of living to 2,200 watts, everyone now above that level would have to drop down to it.”

Well, how much can I reduce my energy usage?

I estimate that I could easily be am at **3,000 1,689 (3,385) watts** (the latter number tries to also very roughly account for my portion of energy used by my country’s government and energy used by the education, finance and healthcare services I use). , plus my portion of heating for the dorm I live in and the places I work [no longer in a dorm and don’t use house heat]. (I will update this with numbers when I hear back from my dorm building manager.)

Concretely, 3,000+ 1,689 (3,385) watts is:

1. *Flights*: Jet fuel for 1 2 roundtrips from SF to Boston each year (385 771 watts)
2. *Land transport*: Gas for 1 8 mi roundtrip on a bus from Boston to Cambridge each week (225 watts)
3. *Stuff*: Energy for production and transportation\* of my laptop and phone, toiletries, clothes, miscellaneous items and the trash these produce (270 watts)
4. *Food*: Energy for production and transportation\* of 1 serving of milk per day, 1 serving of fish per month and 10 servings of vegetables per day (425 watts)
5. *Heat and electric*: Electricity and gas for heating of my dorm and workplace, refrigerator, cooking, laptop and phone (34 watts plus my portion of heating)
6. *Services*: Energy for production, transportation and retail of the healthcare, education and finance services I use (1080 watts)
7. *Society*: My portion of the energy spent by the US government, notably the construction of roads and the purchases and operations of the US military (464 watts)
8. *Buffer*: Things I forgot to count, plus miscellaneous things here and there that aren’t recurring or significant uses of energy (e.g. a random drink of wine over the holidays) (151 watts)

What would I have to change in my life to get to 3,000+ 1,689 (3,385) watts? **I’d start by cutting flights, cars/buses and bought stuff, the highest bang-per-buck areas** for me and Saul (and, I suspect, many of my friends). I actually don’t have that much to cut to get to the lifestyle described above, minus a few things:

1. For 2019, I’m planning on traveling once to Peru for vacation and once to home over the holidays. Re Peru: In general, I’d need to do such vacation travel very infrequently, or replace the holiday trip home with one to a vacation destination.
2. I’d have to cut three trips per week to Cambridge (which I did in Fall 2018) down to one. I could accomplish this by coordinating all my meetings and activities to happen on one day per week, participating in others remotely instead of in person, prioritizing which activities in Cambridge are truly important to me and potentially staying over in Cambridge.
3. I’d have to reduce buying from Amazon (I count 19 orders over 17 weeks in September to December 2018) with the wish list method\*\* or by buying used things, which seems like a great and fair-accounting way to reduce energy usage.
4. Less important things: I could take cold showers exclusively, which I occasionally do for the thrill and am curious to turn into a habit.
5. Relatively easy things: I’d have to continue my habits of not buying recurring new things except food and toiletries (e.g. no recurring clothes!), not buying non-essential things (e.g. no physical books), not buying new big things (e.g. furniture), not using the heat in my room (wear warm clothes or insulate the room instead), etc.

I’ve posted the details of my accounting here, including the numbers I used for energy usage of each lifestyle item or action: https://docs.google.com/spreadsheets/d/1c5741VO0wBtWL5ph4E6APThuwR7lF-LH6arTxPXlv3g/edit?usp=sharing.

How accurate are the numbers I’m using for energy usage per lifestyle action or item? I haven’t checked them myself, but I somewhat don’t care about the exact numbers, because the direction is correct (i.e. using/doing less means reducing your energy usage), and the general action item remains the same: **travel less and buy fewer things and services.** I *do* care about not forgetting my sources of energy usage (e.g. I forgot about electricity for lighting the first time around), and I especially care about not forgetting the biggest contributors. I also care that the numbers’ orders of magnitude are correct. I am inclined to trust Saul’s numbers because he seems to be very rigorous and detailed. You can judge for yourself by watching Saul’s talk (http://longnow.org/seminars/02009/jan/16/climate-change-recalculated/, especially 47:46-51:00) or his other talk (https://www.youtube.com/watch?v=1ewEaTlGz4s, especially 31:00-35:00), which he apparently prepared by combing through 60,000 pages of footnotes of energy data.

If you’re interested in making these calculations for your life, I’d recommend watching 47:46-51:00 in Saul’s talk to get an overview of the process: http://longnow.org/seminars/02009/jan/16/climate-change-recalculated/ \*\*\*. Then you could use a spreadsheet similar to mine. My spreadsheet has some common line items (e.g. watts for air or car travel) but excludes others that aren’t part of my life (e.g. my room came furnished, so I haven’t bought furniture). Your lifestyle likely has different stuff and actions than mine; to find the numbers of watts for these things or actions, I’d recommend referring to Saul’s slides, which are in high definition here: https://www.dropbox.com/s/86tfvc6mm5gbbv9/longnow16jan09-090905230147-phpapp01.pdf?dl=0. Specifically, pages 75, 79 and 81 are useful for watts on overall goods and services, food and physical goods, respectively. I tried searching for an online energy usage calculator but couldn’t find one\*\*\*\*. If there’s a number you’re looking for that isn’t in Saul’s slides, you might find it in this MIT climate course lecture, although I haven’t looked at the lecture myself and didn’t use it for my calculations: https://ocw.mit.edu/courses/chemistry/5-92-energy-environment-and-society-spring-2007/lecture-notes/energy_calc_guid.pdf.

Am I uncomfortable making these cuts in my life? For me, I’ve always been a pretty cheap homebody. I spend a lot of time using the computer (for work, reading or chatting with friends) or taking walks with nearby friends. I hate owning too many things because I dislike spending mental effort tracking them. So the ideas of living minimally have been easy for me to adopt, and the environmental argument for living this way is a cherry on top. For me, the most difficult sacrifice of these cuts is not flying home more often to see my family and close friends, but I see this as solvable by making my trips home longer and getting better at having a deep relationship remotely, with gifts, cards and quality time online. According to Long Now, after Saul’s cuts, “[h]e’s healthier, eats better, has more time with his family, and the stuff he has he cherishes.” I think that many people would similarly find that living in a lower-footprint way would change their lives in other ways that matter to them, sometimes positive and sometimes negative. If those changes are positive, then these “cuts” will look more like improvements and tend to stick.

I don’t want to say that there’s no environmental motivation for what I’m doing. While I’m not under the illusion that the cuts in my life will, by themselves, put a dent into climate change, I hold out some hope that I will figure out a way to have a larger impact on climate change. Living this way is potentially educational in that endeavor and could make me more credible to have that kind of impact. Moreover, it could be that developed-world citizens *must* make this magnitude of cuts (and/or make up their carbon footprint in some other way\*\*\*\*\*) for it to even be feasible for renewable energy to scale to cover the world’s energy usage. Something just resonates emotionally with me when I hear Saul make this argument, even though he says it in such a nonchalant way (to see him say it with graphics, start at 46:46 in http://longnow.org/seminars/02009/jan/16/climate-change-recalculated/):

“So you now realize that the 18,000 watts or 17,000 watts in Saul Griffith’s life looks a little like extravagant, because if everyone in the world went from 2,500 watts to 18,000 watts suddenly, we are not going to need to have just Renewistan [Saul’s imaginary planet that produces the world’s 2009 energy consumption, 16 TW, from renewable sources]; we are going to need 6 or 7 Renewistans. That’s not going to scale. So it’s inevitable that China and India bring their power consumption per capita up, and probably we shouldn’t begrudge anyone in the less developed nations to do so. And that sort of means that we [developed-world citizens] have to go down.”

If everyone has to make these cuts, then in particular, I have to make these cuts.

Footnotes

\* This figure possibly includes energy for retail as well, i.e. the energy to keep open the store in which I buy food and stuff. I’m not sure.
\*\* The wish list method: whenever I have the desire to buy something, I put it on a wish list and only buy it if, 30 days later, I still feel I need it.
\*\*\* If you have time, I found the whole talk to be very informative, entertaining and inspiring!
\*\*\*\* Saul created such a calculator called WattzOn at some point before 2009, but I wasn’t able to find the calculator today (in 2019). It used to exist, because I found it on Wayback Machine: https://web.archive.org/web/20120212172149/http://wattzon.com/track-and-monitor; however, the calculator doesn’t seem to be functional on Wayback Machine.
\*\*\*\*\* For example, by planting trees.

Max Tegmark Talk Notes

As a Philanthropy Fellow for Harvard Effective Altruism, I had the opportunity to get dinner with MIT physicist Max Tegmark and the other Fellows on Tuesday evening. We had a fascinating discussion about existential risks and the reasons that much of the public today does not even think about the destructive potential of such risks as unfriendly artificial intelligence (AI), while just 50 years ago during the Cold War people all over the world actually felt and believed in the real possibility of human extinction. Max noted that the Cuban Missile Crisis and realistic movies about nuclear war (such as TV shows like Threads) played a large role in making the public aware of these threats, which suggests that films about unfriendly AI, the first of which seems to be the upcoming film Transcendence, could spread public awareness about current existential risks.

I also learned a lot about cosmology from Max’s fascinating talk related to his book Our Mathematical Universe; I’ve posted notes for the talk here. If you find the notes interesting, definitely check out his book, which Ben recommends as an excellent read.

More Tidbits about Tanzanian Culture

Earlier this month, I posted on the Tech in the World blog about what the team and I learned about Tanzanian culture in our first week here in the country. Our team is learning more about Tanzanian culture everyday! Here are more tidbits, many taken from a conversation with our Dar es Salaam Institute of Technology (DIT) contact Ashery:

  • The average marriage age 25 for men and 22 for women.
  • Younger Tanzanians really like to listen to hip-hop and their own, smoother version of R&B called bongo-flava (see this song by Diamond, one of the most popular bongo-flava artists here). In fact, artists like Jay-Z, 50 Cent and Busta Rhymes have performed here. Apparently many students at DIT like Rick Ross.
  • I asked Ashery about Tanzanians who are admired by the general Tanzanian public. Ashery said that Julius Nyerere, the country’s founder, ranks pretty highly on that list because he managed to instill in the citizens a pride about their identities as Tanzanians, rather than as members of different tribes (there are more than 260 tribes) and different religions (40 percent Muslim, 35 percent Christian, and 20 percent Animism). One way he accomplished this was by including each group in his government (it just happens that presidents have alternated between Muslim and Christian for the last few terms) and his socialist message for equality. According to Ashery, this has been important to avoid the tribal infighting—political and violent—that has occurred in neighboring countries like Kenya (during election time) and Rwanda. Ashery (who is Christian) got really excited when he was saying this, pointing to his friend Abdul (who is Muslim) and saying that in Tanzania, different people coexist peacefully. Maybe Julius Nyerere has a biography worth reading.
  • Presidents Clinton, Bush (Jr.), and Obama have all visited Tanzania, and the citizens of Dar es Salaam got so excited that many of them left work to see the presidents.
  • David Cameron, the UK prime minister, has threatened to withhold aid from countries that criminalize same-sex marriage and other activities, which include Tanzania. Tanzania reacted strongly and is in fact relatively intolerant of homosexuality, as evidenced by Pew Global Attitudes survey that found that 95 percent of Tanzanian residents believe homosexuality is a way of life that society should not accept (the seventh-highest rate of non-acceptance in 45 countries surveyed). Ashery said that there has been much debate about this.

That’s all for now!

Shocker

I lie on my bed with my Macbook in front of me, writing a reflection on my first week in Tanzania. Feeling uncomfortable, I toss off my bednet, get off the bed and sit in a nearby chair, bringing my laptop over. I touch one of the ridges of my laptop. Ouch. Did that hurt? I can’t really tell, and touch it again. Is that how the ridge normally feels? It’s a bit sharp. Confused, I ask my roommate Erik to join me in touching the laptop. He (being the electrical engineering major) immediately pulls my Macbook charger out of the laptop and recoils upon touching the tip. “Static shock!” he says. “Really?” I say.

We begin to diagnose the problem. My charger is connected to a 6-outlet power strip and international adapter that we bought yesterday in a Tanzanian supermarket, which is connected to the wall. One of these is broken. Suspecting the Tanzanian-made power strip, we start testing all the outlets on the power strip and even substituting in one of our own power strips. But with each touch of the charger’s tip, we get shocked in greater disbelief. I begin to suspect my charger itself. Indeed, after plugging Ruth’s Macbook charger into the power strip, the shock is gone. So much for my Mag “Safe” Power Adapter; it probably suffered under the strain of Tanzanian humidity and the 240V outlets.

The shocking is entertaining though, so we bring another Tech in the World Fellow—Ramya—over to join in our discovery. Plugging my charger back in, I offer her the charger tip. She takes it in her hand, but… nothing. In confusion, I touch it but feel nothing! Erik finally touches it and recoils. Ramya and I look quizzically at Erik (who seems to be doubting his own senses), but he continues touching, and recoiling from, the charger tip. Ramya and I try again and again but just can’t figure out how to shock ourselves. Erik suddenly says, “Take off your shoes.” I kick off my flip flops and feel the cool tile floor, touching the tip again. Ouch!

Bajajis and Personal Ownership

This is the first in a series of short stories I am posting about my time in Tanzania as a Tech in the World Fellow. Stay tuned!

Bajajis (also known as tuk-tuks or rickshaws in India) are phenomenally nimble three-wheeled taxis. Ramya tells me that the tuk-tuk drivers in India are daring and skilled at navigating very chaotic traffic at high speeds. In Tanzania, these bajajis are our cheapest way to get around, so naturally they are the first type of transportation we try.

We’re going out to dinner at a beach restaurant; Google Maps says it’s 2 kilometers away. We wave over a bajaji and, in our broken Swahili, ask the driver to take the six of us to the restaurant:

Me: Mbalamwezi? Elfu tatu? [Name of the restaurant. Three thousand schillings.]

Driver: Four thousand [Tanzanian schillings]. Six of you.

Me: [Thumbs up.] [To other TITW students:] Let’s go.

We cram into the bajaji, three of us in the back seat and three of us sitting on the others’ laps. Already we get the premonition of this safety hazard leading to a road accident; our combined weight seems to precariously tip the bajaji from left to right as the driver begins to move. But the driver assuages our fears as he drives swiftly ahead—our forward velocity seems to straighten out our wobbliness (I know I’m in a safe spot in the bajaji anyway, since I am squished underneath Ruth and won’t go flying out the window).

We continue swiftly until we hit traffic, and the two-lane roads give us no option but to sit and wait. At least that’s my thought as I peek out from behind Ruth at the crowded street. But the innovative bajaji driver sees an “opening” on the pedestrian sidewalk to our left (the “sidewalk” is a 10-foot wide dirt strip on either side of the road). Seven men and women walk towards us on the sidewalk 200 meters away, but the daring bajaji driver decides to plow ahead on the sidewalk, passing the sitting cars to our right. He accelerates swiftly left and immediately we drop onto the sidewalk (which is not quite level with the road). The ride on the rocky, unpaved sidewalk is precarious—our heavy bajaji, stuffed with six people, tips ominously from left to right between a sewage ditch and other vehicles, including these big dala dalas. Each of us holds in the simultaneous excitement and terror we feel (with the exception of a few shrieks) as we swing from side to side, narrowly miss the oncoming pedestrians, and turn back into an opening in our original lane.

As exhilarating as driving on the sidewalk is, it feels safe to be back in the correct driving lane. But we hit slow traffic again. This time, our driver sees a new opening right about 10 feet wide, right in between the two directions of traffic. We swerve into this “lane” as cars brush by us on both sides as quickly as 40 mph. Our lane is so narrow that I can touch the dala dalas on our left as we pass them.

Our roller coaster ride ends as we see the beach restaurant on our right. As we continue to use bajajis as our main mode of transportation, I wonder how much more dangerous it really is to ride a bajaji here than it is to take a taxi in the United States. The notion of personal space is relaxed here (in fact, it is considered rude here to stand too far away from someone you’re greeting), and personal space on the road has been no exception. I have a hunch that the probability of getting into an accident in a bajaji here is not significantly different from the probability for taxis in the US, but that many of my US friends would perceive the difference to be pretty high upon reading this story or watching a video of a bajaji ride because of the close quarters in which Tanzanians drive and live.

Just as my US friends would perceive a bajaji to be much less safe than it actually is because of their discomfort with lack of personal space, I think that I and many of my friends overestimate our personal need for our own space, possessions, and privacy in the US relative to how much we actually need to be satisfied. An American culture that supports having your own car, house, and computer doesn’t help; examples of my desire for privacy this past year included the need for a single in my dorm, the need to have my own laptop (which I realized I didn’t actually need for most of my life while using a school computer), and the need to do yoga in my private space of my room (instead of at the gym). Yet living in Tanzania has showed me that I can live without “personal” everything and not lose much in the way of my values of personal growth and achievement. I’ve acclimatized to intimate working conditions, public transportation (including the people packed onto dala dalas—imagine 30 people fitting into this Toyota passenger bus), and dependence on the environment outside my possession and my fellow students for everything from food to sunscreen, power adapters, and money. I’m curious to exchange personal space and possessions for other things that may achieve my values better when I return to life in the US.

Parallel between NGO-Donor and Startup-Investor Relationships

From what I hear, one reason that startups fail is that their visions don’t line up with their investors’. A vision disconnect between the people who are the startup and the people feeding money to the startup leads to an end to funding, replacing some founders, or some other kind of nasty outcome.

The disconnect’s origins make perfect sense. A team of founders and a team of investors both spend lots of time developing their own hypotheses (about business opportunities or the direction of technology or a specific industry), and by the time startup meets investor to raise funding, there is often little overlap. Founders spend their time executing the details of specific visions, while investors meet with many companies and hypothesize broad visions; it’s easy to see why the two sides’ hypotheses don’t often overlap. Unfortunately for the startup, whether the investor funds the startup is exactly the same question as whether the two sides’ visions overlap!

Let me give an example. One of my friends (let’s call him Adam) is building a company that makes data visualization software for wealth managers. Adam told me about his first interaction with one of his prospective investors:

He got really excited when I first explained my company to him, especially when I told him about the partnerships we’ve landed. Then he started asking me these weird questions that had nothing to do with the company. “Are you guys incorporating social?” he asked. “Not in the near future… that doesn’t really fit in our product,” I said. “OK… how about mobile?” “No… not yet.” “Local?” “I don’t think our product has synergies with location either…” After each “no,” he looked more and more disappointed, and I was confused about his questions and dwindling enthusiasm, until I realized it was because he really wanted to invest but my company didn’t fit into any of the theses of his firm – social, mobile, and local!

So Adam didn’t get money because his vision for data visualization for finance didn’t overlap with an investor’s vision for social, mobile, and local.

Interestingly, there is a very parallel relationship in the global health world between non-governmental organizations (NGOs) and donors. Just like startups, non-profit global health NGOs need to raise money to fund their worldwide personnel, materials (any medicines or malaria bed nets, for example), administrative costs, transportation, and any physical capital. So they turn to (often international) private donors to raise money. But just like investors, these donors have their own personal visions for what kind of health solutions they want to see.

One example I picked up in my global health class is the influence of neoliberal philosophy on donors in the 1970s. (Take this interpretation of global health solutions with a grain of salt, but consider it.) According to Professor Salmaan Keshavjee at Harvard Medical School, the economic crisis in the 1970s led to blaming government regulation as the crisis’s cause, and a “justification” to revive a decades-old philosophy of neoliberalism – which argued for the free market’s ability to distribute resources and questioned efficiency of most government intervention. This neoliberal spirit manifested itself not only in the election of conservative leaders like Ronald Reagan and Margaret Thatcher, but also in the shifting policies of global health leaders like the World Bank president Robert McNamara. For health policy, the neoliberal current was the call for free market instead of public sector solutions to distribute health care. The example of people like McNamara set the tone for pro-neoliberal donors.

One instance of this is the influence of international donors in swaying the Ugandan health care system to implement user fees. User fee programs required citizens to pay for medicine, a reversal of medicine previously freely offered by the government. As you can imagine, in a poor country like Uganda, user fees had the effect of substantially reducing access to healthcare, and many families ended up unable to pay to maintain even their basic health. User fee programs were part of this broader neoliberal philosophy that called for free market rather than public sector health care solutions. Even though Uganda’s national health care system worried about the risk of such programs on citizens, it had to implement them because the alternative was to have no money at all, and some Ugandans were worse off because of it.

What are the lessons between the NGO-donor relationship and startup-investor relationship? One key takeaway is that so long as both sides’ priorities are matched, such situations don’t have to occur. The next question, then, is whether or not there exist enough donors with priorities closely aligned with those of NGOs and developing nations (I’m going to focus on the problem for these actors because they seem to be the worst off). And based on the dreadful state of health in many developing nations despite billions of dollars of funding, my guess is that not enough of these vision-aligned donors exist. If that’s true, how can we create more of these? Building potential donors’ awareness and empathy to win them over to the priorities of health organizations on the ground (rather than the donors’ intellectual priorities) might be the answer.