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[on-hold music] Imagine waking up to discover that the United States has just pulled thirty-five billion dollars out of foreign aid overnight and that hundreds of
HIV clinics and child malnutrition programs and poverty graduation trials will shut their doors within days and weeks.
Now imagine there's a rapid response team quietly sifting through every single grant, ranking them by lives saved per dollar and building lifeboat bridge grants before the lights go out. That team exists.
It's called Project Resource Optimization, or PRO, and it's turning a disaster into a crash course in faster, smarter, truly life-saving philanthropy. So what can I do?
What can you do to keep the most effective aid on the planet from flatlining? Every week, thousands of people ask us that most important question in the world, "What can I do?"
So every week, I turn around and ask someone who actually knows what the hell they're doing about the very same question, someone who's already answered it for themselves, who is working right now on the front lines of the future, from medicine to food and water to AI and Alzheimer's research.
I find out why they're doing the work they're doing and what we, you and I, can do to support it, to join their work, to fund it, to find our own way to the front lines of the future.
I'm your host, Quinn Emmett, and my guest today is Rob Rosenbaum, one of the co-leads of PRO.
Stick with us to learn how emergency triage, ruthless transparency on both sides of the market, and a few well-placed dollars can keep millions of people from falling off a fiscal cliff, and how you can help build the lifeboats.
As always, for questions or feedback, you can email us at questions@importantnotimportant.com. [on-hold music] Rob, welcome to the show. Everything's great.
Thank you for coming. Yeah. Glad to be here on this perfect Tuesday morning where there's nothing crashing outside of us at all. It's something else.
We're gonna get to all of it, but I do have a two-part question for you, and it sounds like it's one question. It's two.
They're related, and it's because so many of our listeners are either doing the work, like yourself in your previous capacity or this one, or they're trying to find their way in as someone who's a big philanthropist, or they got two bucks, or they work in marketing or art or journalism, or they're a student, whatever.
They're trying to figure out how to apply themselves most effectively, which is obviously something you're doing. So here we go. First question, and listen to them both before you answer.
First one, why do you have to do this job? So of everyone in the world that could be doing this specific work, why you? And the second part is, why do you have to do this work?
So of all the ways that you, Rob, could answer the call in the world, and there's myriad things to do, why do you have to do this work in particular?
I'm gonna answer the latter part of that question first because it's much easier. So why do we have to do this work?
The short answer is that it has to happen, or else literally there are lives that are at stake and that are on the line. When USAID was...
Well, first, when the stop work order and the executive order came through that effectively halted all foreign aid, including USAID's programming, and subsequently as the waivers started coming through in a haphazard kind of way, leaving a lot of life-saving and really vital work still unfunded and effectively terminated for all intents and purposes, it, it became very clear to me and a few colleagues that I've worked with in the past that if there isn't an effort to try to crowd in as much philanthropic funding in very, very targeted ways to save the most important and life-saving programs that are currently at risk or currently halted, two huge calamitous things are gonna happen, and frankly, they are happening right now as we speak.
One is that people are dying.
Regardless of what you might hear from Marco Rubio or others, these terminations and halts in USAID funding have led to real mortality, particularly for children, particularly children under five, and particularly in places where USAID was previously delivering life-saving aid, things like treating severe acute malnutrition, delivering oral rehydration salts for kids who are recovering from diarrhea, delivering routine immunizations, all sorts of different types of interventions and services that we know save lives.
In fact, we know save lives on a very specific cost-effective basis, and I'll get back to that in a second. And they were-- they're not happening.
And so there are real lives on the line, and it is time-bound for a duration through which these programs can continue to, to operate and/or at risk of completely shutting down.
The other kind of piece of the urgency is that second piece that I was talking to, is that the startup costs of trying to restart something after the doors are shut, the lights are off, are extremely high. Mm-hmm.
Right now, we have the ability to basically leverage the fixed cost that were incorporated to stand these projects up.
But once they close the door and they walk away, it's not just financially expensive, but it's politically expensive.
Many of these organizations have spent years, decades, building the relationships within local communities to be able to operate, to be able to deliver services, sometimes where there are very few governing structures and sometimes where you're working directly with the Ministry of Health or with local health officials.When they shut the door and they walk away, to rebuild those relationships is, is gonna be expensive, difficult, timely, in some cases impossible.
And so the opportunity to be able to preserve these programs, in particular the most important of these programs just felt like it, it was a no-brainer. Like, we had to step in and do something.
Your question about why me? Yeah, why did you have to step in? Yeah. Yeah, it's a fair question. I think that the team that I work with, and myself included, have a very
u- a, a unique vantage point to be able to try to support this work. One is our training. We come from a combination of two offices within the former USAID.
One is the Office of the Chief Economist and one is Development Innovation Ventures, which is where I sat before, which was effectively the R&D shop for the agency where we were trying to test new interventions, new innovations, find new different ways of delivering foreign aid, but to do it in a way that we could measurably assess the impact and how much impact was being delivered per dollar or the cost-effectiveness of that intervention.
Mm-hmm. And so when all of this started happening, initially my colleague Caitlin and I, and then a, a team that kind of got built up from there recognized that we weren't gonna be able to save everything.
I mean, at least at the beginning, $35 to $40 billion of aid that was gone, but also that not all of that aid was delivering the same impact per dollar, and that we have now actually the tools, and through our training as economists and through our work at USAID in these particular offices, have the ability to appraise the programs and the interventions that were being delivered and to be able to say, "These ones meet an extremely high threshold where we know that for this number of dollars we can save this many lives," or the inverse of that is, "If we don't raise that money, this many lives are at stake of being lost."
And we can present that in a very sort of direct way to funders to say, "This is what your money is gonna buy." We're not saying step in and fill the ocean. The ocean cannot be filled by private philanthropy.
But what we're saying is that in these very targeted ways, people who are sitting there saying, "I wanna help, but I don't know how," we can tell you, "This is how you can do it in a targeted way to actually save the most lives possible."
That is about as comprehensive as we get for those two questions. Thank you for, for sharing your bona fides. Yeah, no, that goes a long way. So now that we've got that context...
And some of these conversations I always aim for sort of maybe not of the moment, but of, of the era, something that is timely, but both evergreen and examples of how to jump when necessary.
One of those, "I've been training my whole life for this" sort of moments are really instructive, I think. So I wanna go to that moment if we could. So where were you, what were you working on when you learned,
like we said, most folks know, though there's a lot going on, it's easy to forget or not have seen it, that foreign aid had effectively been zeroed out.
And then for you and, you know, members of your team, getting the team back together, everybody always loves that part of the movie, what flipped the switch from holy fuck to action?
I was kind of living my best professional life when this happened, which is like a personal tragedy that doesn't extend to anybody else other than I guess my team, 'cause we worked on such a kickass team. Mm-hmm.
As I mentioned, I was at a place called Development Innovation Ventures, or DIV, which is a sort of semi-autonomous o- office within USAID, or was I guess.
And we were the staging ground for trying to find new and innovative technologies and interventions and solutions in foreign aid to try to be able to reach more people, have more impact for less money.
And my job was amazing.
My main role was running diligence on these incredible opportunities and to be able to work them through to a decision panel and ultimately get funding and then manage those awards on the other side to see them deliver.
I mean, one example that is probably the one that's among the n- nearest and dearest to my hearts was from this social enterprise called Vayu.
They were started from a group of pediatricians based in Boston, and they noticed in some work they had been doing in, in low-income countries that there was a lot of respiratory death, unnecessary respiratory death among neonates, premature babies, in part because the respirators that have been developed for these contexts have been developed for wealthy nation contexts in highly functional NICUs, right?
So these things are called CPAP devices. You've probably heard of them in sort of other contexts. I know COVID sort of opened everyone's mind to some of these technologies.
But they're also used i- in pediatrics and particularly for children who are born with immediate respiratory distress. And most of the devices require electricity. They cost thousands of dollars.
They have a lot of really high-tech maintenance that's required.
But all that they're really doing at a functional level is pushing a blended mix of oxygen and ambient air into a kid's lungs to enable them to breathe long enough so they can be resuscitated...
Not just resuscitated, but persist and grow and get kind of over that.
So these guys developed a version of this that costs about less than a 10th the price of what's on the market and is powered solely by the oxygen that's powering through.
It doesn't require electricity and can be deployed to thousands of settings in which this type of intervention had previously been eliminated, or ha- hadn't been a- accessible.
The problem was that they were wonderful, well-meaning, super smart doctors who [laughs] did not have the commercial chops to figure out exactly how to bring this to market and in what markets and the regs and everything around that.
And so we worked with them to fund some implementation science to understand different contexts in which this could work, and then to really kind of supercharge their commercialization efforts so it could go to market and then reach, you know, millions o- of children over the years.
These are the kinds of things that, that we were working on, and these are the kinds of things that were just cut overnight immediately. No, no warning and no plan to try to take them up after.
And frankly, the kinds of things that could make foreign aid a lot more effective and a lot lower cost in the future. Hello, hello. Malcolm Gladwell here.
On this season of Revisionist History, we're going where no podcast has ever gone before. In combination with my three-year-old, we defend the show that everyone else hates. I'm talking, of course, about Paw Patrol.
There's some things that really piss me off when it comes to Paw Patrol. It's pretty simple. It sucks. My son watches Paw Patrol. I hate it.
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These sort of projects couldn't make me more excited, and taking an ax to them overnight, I'm getting borderline Batman at this point with the anger I feel all the time.
And I'm sure for you it's, it's many more than that. I've said before on the show that I, you know, I was an asthma kid, like all the ambulance rides. My parents had health insurance until I ran it out.
I n- have a pretty acute understanding of what it means to not be able to breathe. I had babies in the NICU, and like you said, it's like a technological marvel in there for some of us. This kind of stuff is incredible.
So that's it. So it gives me so much hope and so much anger. I mean, couldn't express those dueling emotions any, any more and better than you just did. And I think that sort of feeds into your second question, right?
What sort of inspired us to try to, like, figure...
To-- Once the sort of ax came down, and I was out of the job real quick, 'cause I was actually a contractor with USAID, so there was no, like, admin leave or furlough or anything.
It was like January twenty-seventh, I was out of the job.
In some ways, though, that gave me a little bit of freedom of not having to sit through endless horrible bureaucracy as things were being turned off and turned back on, and nobody knew what was going on, and nobody was willing to make a call, and all this kind of stuff.
But instead jumped out pretty quickly.
A-a-and, you know, and the, the Genesis story is, I'll tell it real quick, is just that there was a foundation who had decided that they wanted to set aside some funding to try to fill some of these gaps as everything was happening, but were kind of in the similar sense of analysis paralysis that I think a lot of folks were feeling, and asked me and Caitlin to sort of stand up a team initially just to help advise their giving.
But I think very quickly, within the first week, we realized that there was a real kind of public good version of what we're doing here, rather than just advising this one donor.
If we took a sort of high-level, top-down methodological approach, really tried to go out and find what are the highest driving interventions and programs to, to save lives that have been cut, that we could appeal to a much bigger donor base and to try to move, frankly, more philanthropic capital into this urgent and emergency setting i-i-in sort of rapid order.
So that was it. I will say, though, like, something you said really, really stuck with me, which is that pivot, at least for me personally, of going from
just sheer anger and dismay at everything falling apart to being able to go headfirst into this and figure out how to do it.
I think it's the reason our team, you know, has been working around the clock, why our signal channel is, like, blowing up literally every hour of the day as people in different time zones are plugging in and working on things.
It's motivating personally to do that, and it's infuriating to see all of this waste that's been happening out there as a result of these pretty crazy decisions.
It's interesting because so much of the criticism was USAID, USAID, however you want to phrase it, waste, and no one knows what they're going, and the enormity, the pure volume of contractors and middlemen and this and this and this.
And look, man, government is imperfect. I believe in better government. I love government. I love paying my taxes.
It's nice to have roads, and it's nice to have fire people, and it's nice to be able to support folks around the world who, by nature of nothing other than where they were born,
desperately lack for things we take advantage of every day or take for granted every day. But of course, it's easy to aim the same criticism at any public company or private company, for that matter.
You know, for all the criticisms of US spending on this or that, it's, you know, look at the VC model, which is inherently designed to fail. But it, it's interesting.
It seems like you guys have taken sort of this combination of the effective altruism movement, which is robust and rightly criticized in a lot of ways, and, you know, one of the gold standards which EA supports in a lot of ways through GiveWell and such of Against Malaria, where they say, "This is exactly how much a treated bed net costs.
If you want to know where your money is going, like, that is it," right? And that is a standard for a lot of these things. And it seems like you guys are trying to really
scale that, both that process and the ability for philanthropic folks, at least right now on the private side, to, to feel more confident about where their money is going in this less EA sort of long-term type thing and more in a people are dying today model.
I think that's right. I'm gonna try to respond to a couple things, ideas that came up while you were talking.
So I mean, your first point about criticism of USAID, I mean, part of the thing that's so frustrating about this is I, myself, and the folks that I'm working closely with and, and sort of my people within the agency, we're all such reform-minded folks.
We saw a lot of the challenges. Like, none of us would say that what was happening before was perfect. I think that there was a lot of potentially unnecessary middlemen and things stuck into the system.
I think necessary to what purpose?
I think, you know, incentives are what drive a lot of this stuff and the rules that are put in place, and I actually think that i-in some, like, horrible irony of all this is that part of the reason that there are so many middlemen and so much kind of, like, overhead in foreign aid is because people are so risk-averse and horrified there being- Of course...
waste, loss, or abuse, because foreign aid always has much more scrutiny than, say, defense funding.
And so they have to building these systems that are like, you know, ten dollars to avoid fifty cents falling off the truck or whatever.
And so to then hear that a sense of reason that they're tearing this down is because they're upset about there being too much waste, it's like, that is a...
Actually, the problem is that the pendulum swung too far in the other direction from my own personal perspective. Sure. I think we should be paying for results, and we should be paying for, for measurable impacts.
And frankly, beyond that, I don't particularly care how you're spending the money.
I care about what the results are that are coming out of it.Side conversation, but just the amount of bad faith in which this was undertaken is, is, is so refreshing.
Even if you're gonna take the position, which I don't, that the only thing that foreign aid should be doing is life-saving work, which is what they're saying.
Even if you're gonna do that, the way that they did this is totally asinine and backward. And- Totally...
frankly, like our group is an example that you put four nerds in a basement, and we can like figure out a much more coherent way to actually look through this data.
This idea that it's too complicated and not possible, I think is complete bullshit. Like, I think we have shown at least...
What we've done is not perfect, but I think we have shown that like it is possible to do what they claim they were gonna try to do if they had actually done it in good faith, which they didn't.
So that's one sort of train of thought. I think what you were talking about on the effective altruist thing, I think it is not surprising that you heard some like EA whistles in some of our work that we were doing.
Those are some of our like closest funders and kinda core group that we originally kind of built out from.
I think one thing we've had to do is to start to talk like normal people as we've moved away from those initial funders to try to appeal to other groups of folks. Sure. But really that was one, uh- The same
drivers of effective altruists in terms of wanting to be able to say, "I'm giving this much money to save this many lives", is what we decided that we were gonna try to build our platform around because we thought that would be motivating, honestly.
Well, it's an incredibly respectable baseline. Everybody gets it, right? And you just go from there. Exactly. And what we have in our like toolkit and in our capacity is we can...
I'm not gonna say that we have the super set of the most important projects from USAID. There are things that have fall- Like, we've just had to move so fast. Like, uh- Of course...
I'm not gonna say that we haven't missed some things.
But I feel very confident that everything that we have vetted, deeply vetted, put through our list, run our backend analysis on, are among the best possible like bangs per buck that you could get if this is something that you care about.
And so, you know, we've got like $80 million worth of projects that are still unfunded on our list.
And so our goal is to try to get every single one of those funded because we know that they're delivering really, really important services on the other side.
You've hinted a little bit at this, but I guess I'm always trying to be cognizant that there are listeners coming from such a huge variety of backgrounds who are either gonna go- Yep...
I'm gonna contribute a dollar to this or a million dollars to this, or how do they see it as sort of a transferable lateral move to whatever they're gonna work on.
How do you feel, briefly, I guess, your time inside this innovation center,
how do you feel that that prepared you or didn't prepare you, maybe if it gave you any baggage at all or any prior experiences for triaging billions of dollars overnight?
Think analogous, you know, journalists coming from a big place and they've cut the disinformation beat. Like, what baggage does that person bring from a big newsroom to striking out on their own?
I mean, what was kinda cool about what we were doing is we were fairly... In funding entrepreneurs, like we were also fairly entrepreneurial as an institution within the agency.
And so I think we very much saw ourselves as change agents within the larger bureaucracy.
We actually had a separate pot of separate funding from Open Philanthropy that was given to development innovation ventures specifically to try to figure out how to crack the nut of changing behavior within the agency, how to get- Mm-hmm...
these interventions that we had tested through our pipeline that we knew had rigorous evidence behind them, we knew could deliver better outcomes per dollar.
How do we get those taken up where the big dollars lie within the agency- Mm-hmm... and within foreign aid?
And so, you know, through that work, I don't think we were too sucked into the bureaucracy of it all, although we were creatures of it because that was the world that we had to operate in.
I think many of the people on my team were, were really there because of the work, and it just happened to be within the bureaucracy rather than being kind of like lifelong bureaucrats. Mm-hmm.
Which isn't necessarily bad. I mean, those guys are amazing, and they enabled it all to happen.
Like, my colleagues who like knew the inner workings of all the different policies and stuff, which sounded like, even after a few years there, still sounded like complete like foreign language, like they got things done.
They knew how to move things, and that was super important.
But I think that what prepared us for this was the way in which we, and also similarly from the chief economist office colleagues, had spent our careers up to that time, both in the agency and, and beyond, looking really, really rigorously at research, leading research in many cases.
I think all of us have some sort of a research background in various contexts.
And to be able to look at the literature and say with a reasonable amount of precision, not which organization is good, Catholic Relief Services versus the, versus IRC or whatever you like, but to say this specific program.
We can look at this program, we can look at the interventions that they're delivering, we can map it onto a number of people, we can understand where those people are living and kind of what the type of, frankly, suffering that we might be able to relieve from this.
And then that's the information you need to be able to really kind of like map out and quantify what that impact could be. And I think all of us had training to be able to do that.
And what's addition to just sort of the academic training to be able to do that, that I think gave us a real capability, is that we re- we knew USAID. [upbeat music] Hey, I have three kids. They eat so much.
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And we knew how to read stuff that was written for USAID and translate it to a lay audience. We knew who to call when we had questions about how something was designed or why it was designed.
And I think one of the big things that the donors that we were engaging with, especially early on, but even to this day, have really leaned on us for, is an understanding of the broader ecosystem.
Right now, you can look at a specific project, but really understanding it within the context of the changing tectonic plates that are emerging b- beneath it.
Questions like, "Okay, so we're looking at a project that's gonna be delivering antiretrovirals to orphans and vulnerable children who either are HIV positive or highly susceptible, but is the supply chain still even functioning that will enable those commodities to get to people who are there?
Or who are the producers of this ready to use therapeutic food, RUTF, and is there a way that we can sort of engage on the supply side and the implementation side to sort of smooth that transition and get things there more quickly?"
These types of sort of long built relationships and sort of the ear to the ground about how the changing dynamics I think have been really, really helpful for us to move things along.
I mean, you were as close to outsiders coming in as it could be, but at the same time, you know, could speak enough of the language, knew enough of the skeletons in the closet and, you know, all the acronyms to be able to actually effectively move with the urgency required.
So you open this obligations file. What filters, I guess, are you reaching for first and why?
What's your most proven metrics off the bat to, again, not just, "Hey, these are new ideas," this CPAP machine that costs one-tenth what a typical one was. Established programs.
With all your training, what are you going for and why? Absolutely. And right, just to not conflate, the sort of innovation side of things is a little bit different from what we've been doing for PRO, although- Sure...
I will say that one thing we've been really keen to include and that we thought is really important all along is to not just include the service delivery, but also- Mm-hmm...
some of the research that's trying to- Yeah... understand kind of how to do this work better. And so our list is sort of bifurcated between service delivery and research.
A- and the way I think about that is just not wanting to kind of completely mortgage the future for the present. Like, with fewer resources in this space, we have to keep the research going.
We have to keep learning- Mm-hmm... how to do this better, faster, cheaper. And so we do have some research there. In terms of the filtering, right.
So at first we were saying, hey, we could advise this group, and we could go out and just find a few projects that would be good fits for them and kind of call it a day. Mm-hmm. That probably wouldn't be that hard.
But once we decided to sort of open this up, it became a very different exercise, 'cause now we realize what we really need to do is be comprehensive. We need to start- Mm-hmm...
from the top, from the entirety of all of USAID's twenty twenty-four obligations, thirty-five point five billion dollars and 20 some odd thousand projects worth, and figure out how to make sense of it and how to sort of identify within this...
I don't wanna use, like, diamond in the rough type metaphor because I think there's a lot of good stuff that we're not funding, right? Like, we're not promoting- Of course...
education projects, even though, like, I s- firmly believe in the importance of basic education. Of course. We just decided to sort of choose other things. So part of it was choosing...
It was really a process initially of not so much of inclusion, but of exclusion. What are the things we know aren't gonna be good fits? Mm.
And so taking away things that are, like, giant procurement or just administrative type of actions, things that are really focused just on kind of the strengthening of, of systems or sectors that are not related to health and humanitarian space that we are working in.
So eliminating those. We also decided that we were going to limit the scope, at least initially, to projects working in especially poor countries, recognizing that was likely to have the greatest impact.
Obviously, that biases us away from countries that have high inequality, like South Africa, where there's, like, huge suffering and poverty in some pockets and huge wealth in others. But it gave us a starting point.
And what we were really trying to do, again, is not to find everything that could fit on the list, but to find enough things on the list that we could move them in front of donors and get them saved. Sure.
And so, so we focused on countries specifically, if we want to really nerd out on countries with a lower than eight thousand dollars per capita PPP ratio, which is basically just like...
There's a World Bank listing that enables us to draw lines on this. But basically to try to target the greatest need and the highest impact type of a project. Sure.
That still le- left us with over 600 awards to look into and something like two or three billion dollars worth of awards, which we still knew was gonna be, like, way more than what would be tractable for us to really evaluate.
Yep. But it gave us a sense.
It gave us a starting point that we could start reaching out to organizations and getting a lot more information so that we could really appraise those projects and put forth what we thought were the best ones.
The last thing I'll say is that the database that we started with is comprehensive, but only really an inch deep. So, like, we couldn't- Yeah... do our actual assessment from the information that was on there. Yeah.
And so we needed to go back out.
So we have something called a first cut list that's just sort of to show how we got to that first place to look.But to go from there to what's called our urgent and vetted list or the sort of final list that we're putting forward to recommend for funding took a lot of back and forth, a lot of analysis on our side, but also a lot of co-creation with the organizations to say, "This is like a ten or twelve million dollar project.
Our niche of funders are most likely not gonna be able to move that kind of money.
And so we need to whittle this down to something that is a lot smaller and also a lot more targeted at, like, kind of the core nucleus of the services that we know are driving impact."
And, and I've been so impressed at how collaborative all of the partners, and by partners I mean the large NGOs that deliver a lot of this work, have been in sort of meeting the moment and recognizing there's some triaging that everybody has to do here, but we're all kind of aligned in the goal of trying to save the most life-saving work out there.
Thank you for sharing all this, and it goes into both trade-offs immediately, even on your whatever you call the list. Like, these are the ones, right?
This is urgent, overnight, most effective, et cetera, et cetera, on our first calculation. Like you said, less than eight thousand and, you know, six hundred awards, two, three billion dollars.
Again, you're already like, "That's a fuckton of money," right? And that's a percentage of the overall.
You've also been very transparent, both seemingly with these partners, but also publicly like, "Hey, here's the processes we're running. Here's the intake forms," like all that kind of stuff.
Makes it easier and harder, I imagine. It does. And we made a strategic decision early, and I'm actually really thrilled that you kind of picked up on the transparency. You're welcome.
'Cause that was a strategic decision that we made early because we realized that we were gonna be working with incomplete information.
And so we wanted to be really clear about what we know, what we don't, how far we can take this, and what uncertainties that people are gonna have to live with in making decisions in an emergency.
I was talking to somebody the other day and they're like, "So basically a metaphor you could think about is like you guys were, like, running a museum and there was a giant fire and you had to figure out very quickly which, you know, pieces of art to save."
And w- what's funny is that when we first started, we called ourselves the Lifeboat Crew. Mm-hmm. Because that was the metaphor that kinda made the most sense to us. The ship is sinking.
We are literally trying to save as many children as we can on, on the limited raft boats that we have. And so part of me was sort of i- with any question about, like, why didn't this make it on is sort of like,
I don't know, man. We're trying to do what we can.
We're trying to save the things that we can, and I feel very confident that what's on there is doing what we're saying, and we're open to continuing to source new projects, of course, onto the list.
But I think that being, like you said, being transparent about what we had a- available was key because in terms of those trade-offs, and I think one of the biggest tensions is always gonna be between sort of rigor and expediency here, and we err it on the side of expediency every time.
Because at the end of the day, like, y- you can have the most beautiful model on the planet that you build out, and by the time you present it, everything's gone and what the hell's the point?
Well, it really is one of those things where the transparency in the processes themselves, but also it lends itself to
and establishes and helps both sides of this two-sided marketplace, potential philanthropic donors and the organizations on the ground, understand that they are, because of what has happened, immediately gonna have to make trade-offs, right?
But at the same time, like you said, every minute, every hour, every day that you spend refining this model to prove that your model works and to make it shinier, more kids are dying. It is a struggle.
And the other piece is that every minute of the day that we ask these organizations to spend engaging with us and answering all of our questions and getting more information is also opportunity cost on their time, which are already working on skeleton crews to try to f- pivot and figure out how they're gonna keep this going.
I mean, we are not, certainly would hope not to be, the only kind of fundraising effort that they have ongoing. And so that we're really cognizant of that.
And then I think in terms of this transparency piece, I think our goal from the beginning, um, and I'm gonna be clear, at the beginning we had no traction, so we were like, we felt guilty asking these organizations for almost anything beyond what they already had off the shelf, but also realized there had to be a little bit of a leap of faith to say, "We're gonna need to at least be able to prove this much to be able to have a chance at moving money."
And groups came on board. Some were early movers, some waited a little bit and then they said, "Oh, r- let's respond to that email that came through a month ago 'cause it seems like it's worth doing." And I don't judge.
I totally respect those decisions. Everyone's got to figure out what they're gonna do here. But I set the
ultimate goal of being able to be that matchmaking service and to be able to come in and say, "Here's what we have," and if a donor says, "I'm really interested in this, but, you know, the people I report to, for whatever reason, I need to see, see X," okay.
We've got a warm lead. We can go back to them and really engage there. Mm-hmm. Mm-hmm.
And so a lot of this has been about what's sort of the minimum viable product we can do to feel confident moving things on and then, you know, dive deeper when there's a warm lead and then it's actually, has a higher ROI for their time anyway.
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on the one hand, it feels so monstrous, right, to be able to say X is how much this child's life is worth or this, you know, mother who in whatever area is suffering from or may suffer maternal health or education, whatever it might be, right?
To harden this science as much as possible, as much as-Our whole job is basically matchmaking as well, right? It's helping people answer this question of what can I do, and you have to be kind of ruthless.
Like, we tell people all the time every election season, right?
We're not gonna recommend that you spend money on this progressive campaign at whatever level that's definitely gonna win, and we're not gonna recommend that you spend it on this, you know, amazing candidate who's gonna get slaughtered in a red state.
We need to be as effective as we can. I know that might not make you feel as good, but we're trying to be effective. We're trying to move the needle on these things.
And it's interesting 'cause I also believe so much in hard science, soft science. The, the whole thing drives me crazy. Like, a program
to which I have very, very good friends who have done this, a program that funds books for people to show up on Sundays and read to kids with cancer is, like, not gonna fit very well into your spreadsheet, but is just so meaningful, right?
But of course, it has to come after when you're down to nuts and bolts, it has to come down to this. Yeah. I mean, I wanna be, like, super, super clear.
Like, our starting point from what we believe and what we want to see happen in this world is so much more generous than what we're doing and is so much less ruthless, right?
But where we unfortunately have been forced to move is to that first marginal dollar, right?
Where are you gonna put that first marginal dollar when everything else goes to hell to be able to sort of start to move the needle at the steepest slope?
If you're stopping where the slope is still nearly vertical, then you're stopping way too soon. There's so much more we can be doing and should be doing, not just in health, in other sectors.
Uh, yeah, so I think you're totally right. I also... I am not an effective altruist. I mean, first off, I don't have enough money to be, but I also don't believe in that strict ruthlessness.
I think that cost effectiveness is a tool that is really important. I think that being able to measure these things is really important.
I think it has a bias towards things that you can measure, which is not necessarily what you care about, right?
If you care about that kid's health progression from strictly from cancer, then no, you're probably not gonna read books, although there is a real link between, like, mental and physical health that maybe- Of course...
you could find a way to, to parse out in some sort of... If you could get a big enough data set and power it for that, which you never could, that'd be freaking impossible. But maybe you could actually do it.
But because you can't measure that and because if what you're actually also solving for is that kid's wellbeing beyond just their, like, physical recovery, well, then you start thinking about other things.
So a lot of it is not just what tools are you using in terms of cost effectiveness, but what are the outcomes that you care about? Mm-hmm. In our case, the outcomes that we decided to care about were at the sort of
foundational level of what you can do in this field, which is save lives of people who are in real, real desperate need.
I think, again, we should be anchoring ourselves in a way different place than at that starting point. But you can't 'cause you didn't make this decision and that's where we are. You know? I think of- Right...
again, we always try to tell people, and part of what our app does is it tells people, like, "Look, there are kids in the US," again, richest country in history, "who need diapers tonight and who need to eat tonight.
And so I need you to throw money at Feeding America," which is this wonderfully effective, you know, conglomerate of, of food kitchens.
But at the same time, we should probably work on really progressive legislation to make this not a problem anymore, right? Right.
And it's the same thing as one of my favorite organizations is, is GiveDirectly, and that is because not just it's so well run and that they operate in these significantly provable places, it is this idea that it is very costly to be poor because, and in the US we make it so costly to be poor that, like you said, you have to prioritize these needs when you have $1, which is if you need shelter and water and food and healthcare,
and you have none of those, but you have $1, and they all cost $1, what do you do there?
And what's so great about GiveDirectly is they say, "Look, some people some days need water, and some days they need shelter or education or transportation." Like, they should have the agency to do that.
What you have the agency to do right now is go, "These are the people we have to feed tonight, and this is how much does it cost," right?
I love GiveDirectly, and actually Caitlin, who is my, like, co-lead on this, is now just an advisor because she just took a role heading up the research department at GiveDirectly, and that was great for them, a huge win 'cause she's fantastic.
And no, I think that's right.
And what I really like about sort of the unconditional cash grant model in particularly in really impoverished settings is it both philosophically makes sense to empower people like this to trust that they're gonna make the best decisions for what they need and that that's not gonna look the same to each person, but it also empirically is, has been validated over and over again by really rigorous studies.
So, yeah. Yeah. I assume you have started to run into... Again, it's nice to be able to say we can make this CPAP machine for this much. We can make, you know, a LifeStraw now costs this, or again, a treated bed net.
I imagine you've run into some pretty vital but expensive interventions like the DHS surveys. How do you start to convince philanthropy to do that when the scale is probably gonna be necessarily- Yeah... less?
Oh, that's a really tough question. The cop-out answer is that we're not. [chuckles] Sure. We decided at the beginning that, like- You're four nerds in a basement, man. Like... Yeah.
Our niche, frankly, was going to be people like high net worth individuals or family foundations who could move six or low seven figure types of money, that the people who could, even if they possibly wanted to take up DHS or there's a FEWS NET, if you're familiar with that, or some of these other kind of big data or overall infrastructure type programs, they didn't...
Like, Gates didn't call us, right? And I don't blame them because they have entire teams put in place that long, long has been there.
My personal opinion about that is I don't know even in the world of Gates type funding that these type of public goods are solvable through private philanthropy. Yeah.
You know, I think these are market failures that governments and sort of bilateral and multilateral governance is required to stand up.
There's a reason they didn't exist.For much of humanity, it's a really hard collective action problem. It is such an amazing accomplishment that we've been able to stand up.
DHS is such a good example, a survey that covers the entirety of most low-income countries, at least across Africa, to be able to, say, have some baseline data to be able to design programming around where otherwise that data doesn't exist.
I don't know. I think in terms of your calls to action, and not to jump the gun on there, like- No... we're moving individual philanthropic money, and that's what I'm doing. Yeah.
I think though, that is an advocacy problem, in my opinion- Yeah, sure... more than it is philanthropic problem. It definitely is.
And on the one hand, to direct people while there are 500 Marines on the streets of Los Angeles to advocacy for DHS feels a little bit like punching the ocean.
I don't believe we should ever let go on those things, but I only ask simply because they exist and they have become provable, and also because it is really important, I think, for people to understand that there are certain...
I was a big Civ V, Civ VI player back in the day. Still am. Mm-hmm. Haven't touched VII yet. There are programs that only governments can take on,
even with existence of things like Gates, like you said, and it's a pity to see those go.
But when you're really deciding what are we fighting for tonight, that's not something you can really- And the truth is that, like, people don't vote on foreign aid. I mean, shit, I don't vote on foreign aid.
I mean, it's one of the things that we care about and I'd like to see, you know, politics that takes into consideration not just sort of individual cases, but a sort of philosophy of, of how we govern and how we care about the world that incorporates these kinds of things.
But I'm not sort of naive enough to think that... And someone might listen to this and be like, "All right, I'm gonna go find whoever the DHS candidate is."
They don't exist, and they shouldn't because their constituents don't care enough about it, and that's fine.
But I think that, like, the understanding the importance of the role of governments taking on these types of huge multilateral projects and the value that they create, that for so long these have just been operating with, with incredible importance to a really small number of people who work in this field and basically blind to everybody else, and which is fine, it doesn't affect your world normally.
But it's important to understand what we're losing because the outcomes are gonna be real and they're gonna persist for a long time. You know, I don't think that it's impossible that there is a future version of aid.
In fact, you know, some of what w- we've now sort of folded into the Center for Global Development, or not folded into, they've taken us on as sort of an institutional home.
And part of the thing that's exciting about that is, like, there are a lot of brilliant thinkers there who are trying to think about what does the future of aid could look like in a new administration that actually cared and had kind of a blank slate to do it better, to take sort of advantage of this calamity in a way that can be productive.
And I think we have some lessons from what we've been doing and, and some lessons from what we've all sort of experienced over the last many years in this field to try to inform that and do better next time.
Hopefully, there will be a next time. It's never advantageous on the surface to have something reduced to ashes, obviously, but you often can't control that.
And if there's anything we've learned over the past five years, it's control what you can control.
But we can, again, hopefully, while someone like you is focusing on getting shots that are in cold storage that might not be a supply chain tomorrow to where they need to go, cold storage chains that were impossible to stand up in the first place, to start to think about, "Okay, how do we do this more and better should the opportunity present itself?"
Which I do wanna come back to, like you said, nobody votes for foreign aid, and that's usually not a single-issue voter's thing.
But, you know, one of my favorite people on the planet, one of my favorite organizations, is Amanda Litman.
She runs Run for Something, which specifically recruits and trains progressive candidates under 40 at the state and local level. And I really do believe we're big fans of if this, then what else?
If you give a shit about this, then usually it's transferable to other things.
And I think if you recruit and train someone who is or was on SNAP to be a school board candidate and possibly a school board member, and then more of those at scale, those are probably gonna be more people, should they advance in their careers, who are gonna vote for foreign aid because they have a very inherent degree of understanding and, and empathy
for that. And for people in general, right? That's sort of my point, is that foreign aid doesn't need to be a single-issue topic to move the needle if it's built into a broader vision for what- Sure... what we stand for.
And that's where, you know, we're really trying to build on what, you know, some amazing people have done. I feel like I could talk to you about co-benefits for a very long time.
We're trying to really build that in and popularize it even more. And again, you can kind of extend that, too, to your candidates. Again, these are people who are gonna give a shit about people.
We always talk about, like, trying to find, for example, we got this whole new podcast that's just, like, commiserating about parenting right now, basically. And it seems a little bit out of our usual scope, but it...
What it does is it really broadens the funnel up top to people who... Basically, the baseline is if you're an anti-vaxxer, it's not for you. Otherwise, it's people who are like, "Shit's hard. Parenting is hard.
Parenting right now is really hard." Totally. And if we can radicalize, like, a smaller percentage of that big funnel, great.
But the point is, if you give a shit about your kids, we can probably convince you to give a shit about other people's kids, and then extend that Peter Singer circle a little farther and farther each time.
And again, that's why I really do believe in sort of these, like, local and state candidates and building them up, because those are the people who, in five and 10 years, could be up for an office where they have a much, much broader
impact, and hopefully we can start to take back on these, again, humanity-level projects like DHS that are so impactful. So you're talking about looking forward.
We're gonna get to what people can do right now, throwing money at you.
But if you had the time to write the roadmap for more resilient, in every way, I guess, locally led aid tomorrow, are there any specific reforms you're really excited about from your previous work or, or now putting out fires?
One of the things, and I alluded to this before, one of the things in the ways in which my old shop was not just funding innovators, but trying to innovate ourselves, was in how we designforeign aid awards.
And, and I know this is gonna sound real in the weeds, but basically it's about paying for performance and designing contracts such that you're getting...
You're purchasing the outcomes that you care about or trying to, at least the outputs that you know lead to outcomes, rather than focusing just on how each dollar was spent along the way. Mm-hmm.
I think that it's a little bit of a weedsy answer, but I think that could have a tremendous difference just because of the amount of money and emphasis and focus that goes into reporting, or has at least in the past into reporting, that could otherwise be spent on so many kind of better, better goods.
The other place that I would point in terms of kind of how this could be done better is Rachel Glennerster and some others within Center for Global Development have started talking about this a lot, which is kind of what they're calling a radical simplification of foreign aid, which I also really buy into.
And I think one of the things that we found as we started looking through these projects that have a lot of the really kind of key drivers of impact is that in certain contexts, they have also become kitchen sink or Christmas tree or whatever metaphor you wanna use, projects where people keep adding their own kind of things onto it.
So all of a sudden- Mm-hmm... an award that was really focused on delivering, say, clean water in a community, you look at it and you're like, "Why does this have a, like, gender empowerment component of it?"
Not that there's anything wrong with that, but, like, also, why does this now have a microfinance arm to it?
And why does it have all these other things which, like, yes, those things are all important and potentially really impactful on their own, but it makes it really hard to scale that water, safe water program.
And if the purpose you were coming in was because you know that chlorinating people's water has one of the, like, most cost-effective wa-ways of reducing under five mortality, well, you should stick with that and bring that to as many people as possible.
And so I think there are ways that we can get really sharp about, about how we design programs so that they're really laser focused on what they're trying to achieve. I mean, we see so much of that here.
And a-again, it seems almost hypocritical for me to say this when so, again, so much of our push is often on co-benefits and helping people take the best bang for their buck, whether it's their actual buck or their time or, or putting their body on the line, whatever it might be.
Again, like housing here, we make it so difficult. It has to qualify in 700 different ways. That's beyond the regulations for these things. And then you just don't build affordable housing.
It's not arguable at this point. It's, it's very clear that we hold ourselves up in so many different ways because it's gotta satisfy this and this and this.
What would be helpful is to be able to show, look, just by building affordable housing, you get those co-benefits.
We don't have to design that it also has to apply to every one of them because we know in a lot of ways, again, and, and we have to do the research and work to understand that, that those things will typically follow.
And of course, you can build a long tail out of that as much as you want, which makes it very easy to poke holes in it. But if you, not settle, but if you stick with sort of the core pieces there, that's gonna come.
The same thing can apply for, again, treated bed nets or PEPFAR or girls' education or diapers or fucking tampons, you know?
There are things that are gonna follow from that when a real clarity on what you're trying to do and to actually get it done. I, I come back to... You heard about the mission-based economy, Mariana Mazzucato, I think.
She's a really great economist, and she would probably hate me for dumbing this down this much, but it's essentially like you said, outcomes, right?
If your outcome is put a man on the moon and bring him home safely, everything you design, every person you hire, every process, the paint you choose for the rocket should answer to that specific question.
And it's the same thing for put a woman on the moon and bring them back.
And you have to then acknowledge, like, all of the testing of women we haven't done in space because of X and Y and Z, but you do have to get specific about that, and you have to have a clarity to it.
Because like you said, once you put a micro-lending arm to a rocket to the moon and back, you're going, "Well, hold on. What are we doing? What-" Yeah. "What's happening here?"
I have been very em-empowered by that at least. And again, does it mean you're leaving some things out? For sure, but those can be other projects. Totally. That's exactly right.
And other projects that are much better designed to solve that specific program because you're not asking your space team to solve- Yeah... to design a microfinance project. Yeah. No, I, I totally agree with that.
And again, that's... Yeah, I think that's right. I also don't think that at least in the foreign aid sector, that means, like I-I... That you have to, like, just deliver the bed net and then get the hell out.
If what you're solving for is reducing malaria incidents, you can have a program that does a bunch of different components of that, but they need to be, like you said, all serving that one specific outcome, not, not sort of some nebulous sense of doing good-ish kind of things.
But you can also expand while still retaining clarity. So if you're like, "I want to reduce..."
On the one hand, hyper-specific, "I want to reduce the number of kids that get bit by mosquitoes that might be carrying malaria," sure.
But if you go and expand that to, "I want to continue to improve on these huge gains we've made of kids living past five years old," right?
Now you've actually got a, whichever metaphor [chuckles] you want to use, umbrella or basket or tree of other specific projects like that that can support that- Totally... overall goal. And guess what? We've done that.
I mean, it doesn't...
You don't have to dick around on Our World in Data for too long to see, again, how far we've come on that, but how it's mostly Western, Northern countries and in other places, like we know these provable things that can get us there.
So without... Again, I feel like you and I could do this four hours, and you have literally lives to save. So I wanna be as efficient as we can.
So getting to sort of the what can I do part, we usually operate, you know, on these very standard set of operational verbs.
You know, you wanna be heard on a policy level, learning, volunteering, organizing, using your voice, this and that, investing. But let's start with the ethos of why we're here today.
For someone with 10,000.Hundred thousand or a million dollars to give from some institution or family office, whatever. If and how can they meaningfully plug into PROS list this month? Yeah.
I mean, those are the people that we've designed ourselves to try to inform, and we do... I'm excited that we now have a platform, at least by the time this one goes live, to be able to handle donations of any kind.
Our theory of change at the beginning was that to be able to sort of have the best success at moving money and saving lives was gonna require six to seven-figure donations, that we were just too small a team to handle anything smaller than that.
Mm. I think that we have figured out the technological backend s- side so that we can accommodate smaller donations as well.
And just to be very clear, funding that comes to, quote-unquote, us is actually just going into a pooled fund that's bank- then being redistributed out to, to the organizations.
Our team is, is underwritten by a foundation at least for the next month or so, and we'll see kind of what goes after that. But there's... Wonderfully, we don't have to, like, raise money to keep our stuff going.
We're really just matchmaking. I would say if you are able to talk six or seven figures, give us a call.
One thing that we realized in terms of that sort of translation of USAID ease or whatever into normal nomenclature is we've sort of just
gone from being a strictly analytical shop into most of the work that we're doing now is in the matchmaking and support advisory basically for donors. And so we're very happy to connect with you.
We also have some Kickstarter campaign that's been started by Founders Pledge and, and The Life You Can Save for the sort of higher end donor to, to sort of pool funds to finish off some of the projects that they're most excited about.
They're kicking in the last 30%, which is really cool to sort of close the deal. So there are lots of opportunities to, to be able to do that.
I think the starting point would just be on our website, which is Pro Impact Tools. And then from there, there's a funding opportunities page that has what we've called our urgent and vetted list.
So you'll see kind of every project, A, that's already been picked up, which is super exciting. That green category is what kind of gets us really jazzed every day.
And then everything above that are, are projects that we have run through the gauntlet. We've vetted them. We've talked to them.
We really believe that these, these are the things that are gonna, uh, in this really urgent time, save the most lives.
And most of these have a fiscal cliff that they're facing in the next month or two, where if we don't move, then we've missed the opportunity. So everything that we're doing right now is in the service of matching funds.
I also think on the advocacy side, yes, call your people and tell, like, your reps and everything, and tell them to be much sort of fiercer in their pushback against the dismantling of, of foreign aid.
So far, I can't say that Co- I mean, Congress just doesn't have a big leg to stand on at the moment.
Hopefully, the midterms will change that a bit, and maybe we can have another conversation at some point on the advocacy side. But- Sure....
we're pretty laser-focused right now just on the saving the projects and the people on the other side of it. Sure, 100%. Is there a single data point... This is very aspirational. Again, controlling what you can control.
Is there any single data point in dollars, matches made, lives saved, programs rescued, that would help argue that this has succeeded? And again, keeping that in context. For you, however you wanna judge it. Yeah.
It's a really good question. I'm a firm believer in the need to define success kind of ex ante going into something. I don't know the answer to that.
I would say that part of the reason I think that we're talking today and that we've gotten a little bit of attention here is, is that I think everyone is looking for some version of, of a good news story in this calamity.
And I think there is a glass half full story here that I, I love to tell. You know, we're up to just about $20 million that we've been able to move.
There are hundreds of thousands of lives on the other side of this that, that have been touched and many thousands that will, will be saved unquestionably from the programs that have been able to continue.
This is the ha- glass half full, uh, glass half em- empty version of this is that this is still just a drop in the bucket.
And I think even if we close out our whole list as it stands right now, cross the, what it would be, like, $100 million threshold, I will be able to confidently feel successful about what we've done.
I think even to this point, the ROI on our team of four and a half people and our, you know, month-to-month contracted work, I think is already pretty, pretty astronomical.
But, you know, I'm not willing to call it a success yet when I can still see what, what still needs to, to get done.
I have these three very privileged, wonderful, incredibly weird children who are 10, 11, and 12 today, and I wrote a post a couple years ago.
We had a lot of trouble making our kids, and they're all very close in age and, and they're mostly great, hence the podcast.
But I really don't like missing dinner and bedtime, even though half the time I get to dinner and bedtime and I'm like, "Boy, it'd be great for everybody if I wasn't here right now," making it worse left and right.
But sometimes I have to 'cause of, 'cause of this work, even though I try not to. And I wrote a post about my feelings about that a couple years ago called Did You Hear The One About The Starfish?
And it's sort of rooted in that story of little girl on the beach picking up starfish and throwing them back into the ocean, and some asshole guy walks up and says, "Doing, you can't save all the starfish." And she's...
Hannah looks at the starfish in her hand and she's, "Yeah, but I can save this one." And that's how I try to justify to myself programs like these where you can't fill the bucket. It is a drop in the bucket.
But just showing up is just incredibly meaningful. I mean, that's the Paul Farmer thing.
Yeah, there's 400 Marines on the streets of LA, my old town, but one life is not worth more than the other, and you guys are having s- just, you know, maybe not true to the word exponential, but it is a hell of a thing, so it feels like a success to me, so.
Well, I appreciate that. I appreciate that. And it's not to say that we don't celebrate every win as, as a team. We're just still plowing ahead, you know? How are you taking care of yourself right now?
You can also say I'm not, because that's half of my answer. I don't know. I mean, what you said rings true to me, too.
I have, like, real hard blocks on my calendar during dinner and bedtime, and then before plugging back in. I would say the rest of it's, we're bursting at the seams a little bit over here.
My wife is also working really hard right now on, on some of her work, and so it's been, it's been a tricky time. I think part of it is, is that there is some time-bound nature to this, and- Mm-hmm....
you can't sprint through everything, but you can sprint for a while. And so we're sprinting for now, and I imagine on the other side of this all, take a little bit of time.
I saw a post once that said, "Life is just saying everything will get a little bit easier after this week over and over again, and then you die." And I was like, "Yeah, that feels, that feels about right." Right.
I had a running joke that, like... And anything we need to plan has to be...
This was in a previous job, but had to be two weeks out because it was just far enough that you felt like your calendar might be able to handle it- Mm, mm-hmm....
but close enough that you feel okay 'cause, you know, it's gonna happen. Um. Yep. Yep. Yeah. Yep. Yeah. It's great. It's all impossible, but I
couldn't do a worse job of and believe more in, well, both time off, but also celebrating wins however you wanna contextualize them.
And this is a world where someone had to do this work, and thank God you guys fucking nerds were ready and happy to show up to do it. It's pretty awesome, man. [outro jingle] That's it for this week's conversation.
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