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Intro

A few months ago, the other (former) Alvea executives and I made the difficult decision to wind Alvea down and return our remaining funding to investors. In this post, I’ll share an overview of Alvea’s story and highlight a few of our wins and challenges from my perspective as an Alvea Co-Founder and former CTO, in hopes that our experiences might be useful to others who are working on (or considering) ambitious projects to solve the biggest problems in the world. I’m sharing everything below in a personal capacity and as a window into my current thinking—this is not the definitive or official word on Alvea and it doesn’t necessarily represent the views of any other Alvea team members*. I expect my reflections to continue evolving as I further process the journey and outcomes of this project, and hope to share more along the way. 

*Note (added 11/1): Cate Hall, another Alvea Co-Founder and executive, also endorses these reflections.

Alvea’s Story

First vaccine sprint and decision to continue Alvea (December 2021 through April 2022)

We launched Alvea in response to the Omicron wave of COVID-19 (the most transmissible and immune-evasive variant then to have arisen) as a short-term, high-risk project with the goal of developing an easily-deployable, room temperature-stable DNA vaccine against Omicron as quickly as humanly possible, without compromising on safety and quality. We ultimately carried this vaccine candidate into Phase I clinical trials in less than 6 months, becoming the fastest startup ever to take a new drug candidate from company launch to a human clinical trial. Our success in this initial sprint caused us to expand our ambitions for Alvea and explore ways of building on the track record and momentum we’d built up. 

One of our initial strategies was to deploy our first vaccine (which was optimized for the Omicron BA.2 variant), and then leverage our development platform to roll out updated versions in response to the emergence of new variants. However, a few key updates convinced us that this was not a promising path. First, the time between waves of new variants continued to drop, making it more difficult to keep up with viral evolution. Second, the FDA and other regulators began an expedited approval process for updated versions of the mRNA vaccines that had already been authorized, making it more difficult for new vaccines to break into the commercial market (a great pandemic regulatory move, though!). Additionally, early efficacy results for our vaccine were underwhelming and suggested that it was unlikely to provide sufficient protection to justify continued investment, particularly against the newest variants in low- and middle-income countries. In light of these updates we decided to stop development of our candidate and consider other paths forward.

Product pursuits (May 2022 through July 2022)

Despite discontinuing our first vaccine program, we believed we’d landed on a compelling model for general-purpose acceleration of promising drugs and vaccines into the clinic, so we set out to find other high-impact products we could accelerate with this approach. We specifically targeted products and technologies with early published preclinical data that were nearing readiness for clinical testing, with the idea that we could pick them up and dramatically speed up their development and deployment. We ran multiple “product pursuits” in parallel to explore possible technologies, with particular focus on nucleic acid vaccines that could be formulated as dry powders for inhaled administration and on therapeutic interfering particles, a class of RNA therapeutics/prophylactics that are expected to be highly resistant to viral evolution. Neither of these efforts uncovered product opportunities that were clearly good bets under this model—all those identified were either insufficiently promising from an efficacy standpoint, or too far from the clinic for us to make a high-confidence bet. However, the process did yield a set of more speculative technology ideas that involved greater technical risk, but had a strong enough case for impact to potentially be of high expected value.

Second vaccine sprint (August 2022-December 2023)

We ultimately took the highest-upside technologies identified in the product pursuits and combined them to create a new COVID vaccine candidate designed to be broad-spectrum/variant-resistant, shelf-stable at room temperature, and self-administrable by inhalation. This involved betting on much more speculative technologies than we used for our first candidate, but we thought this bet was justified given the potential upside, which included not only the next generation COVID-vaccine itself, but also the validation of platform technologies that could help enable rapid design and efficient distribution of effective countermeasures against future worst-case pathogens.

We set ourselves an ambitious goal of submitting a clinical trial application for the new product in ~4 months from the start of development (compared to multiple years for typical new product development of this kind). While the experiments we ran in this sprint showed initial promise for two of the three core technologies we used in the design, the results were not sufficiently compelling to warrant a rapid push into clinical trials, as it was clear that the underlying technologies required further development prior to being deployed. So, we decided to hold off on the application submission, despite having laid the groundwork for another rapid Phase I trial. 

Funding environment change and pivot (Dec 2022 - May 2023) 

As we neared the end of our second sprint, the funding environment for projects like Alvea changed dramatically—the philanthropic funding available for cash-intensive, impact-motivated projects plummeted around the same time that the venture capital market for early stage biotech companies plunged to historic lows. Together, these changes seriously limited Alvea’s funding options.

In response, we cut our burn rate, and proceeded with two parallel efforts:

  1. We ran a series of smaller-scale, lower-cost follow-up experiments to further develop the technologies that underpinned our second vaccine design, and began pursuing government grants and other non-dilutive funding sources to allow us to continue pushing these technologies toward the clinic. Although we collected some promising data from early experiments, we did not secure sufficient funding to make a major commitment to this program in the time we allotted, and were further dissuaded from pursuing it further at Alvea as it did not offer a clear path to financial self-sustainability for the company.
  2. We mapped alternative commercial strategies for Alvea that would incur less technical risk and be a better fit for the new funding environment. After many rounds of iteration we crafted a partnerships-focused business model, where we’d offer our rapid translation and early clinical development capabilities as a service to other biotech companies. The central idea was that we would use the internal systems and infrastructure we’d built to accelerate drug and vaccine candidates from other companies into the clinic, and capture a portion of the commercial value created as a result. This strategy offered a commercial path for Alvea that was more robust to the funding environment (as other companies would be footing most of the bill for development), and was also a means of efficiently expanding our general-purpose rapid response capabilities by working on a diverse set of 3rd party molecules. We built a sales pipeline, pitched versions of this offering to 50+ biotech companies, completed two pilot projects, and lined up an initial customer for an end-to-end development program, at which point we decided to pivot the company completely to this new business model.

Wind down and PanLabs spin out (June-Present)

As we gained traction with the new partnership strategy following our pivot, we continued digging deeper into commercial forecasting for this new strategy, evaluation of the potential paths to impact on worst-case biorisks and global health, and reflection on the global context in which we were operating. This analysis ultimately led us to conclude that despite the promise of the strategy, the path to impact was too long and uncertain, and the commercial potential insufficiently large, for us to feel confident in committing the necessary time and financial resources to its pursuit. 

There was no definitive set of outputs from this analysis that sealed the wind down decision, which unfortunately limits the level of detail I can provide here. There were considerable differences of perspective amongst the departing executives about the conclusions on different points of analysis and the weights they should be assigned—for example, I was optimistic about our commercial prospects but concerned about lock-in effects of the new strategy and counterfactual uses of my and the rest of the team’s time, while others were more skeptical of the viability of the path to realizing Alvea’s upside potential. However, despite these differences, we were ultimately unanimous in concluding that the balance of factors pointed toward winding down and returning our remaining runway to investors. 

As part of the wind down, we helped launch a new non-profit, PanLabs, an impact-focused research and development organization. PanLabs is led by Brian Wang, formerly Alvea’s head of R&D, and he’s joined by a large part of Alvea’s Science team.

Wins

Record time to safe clinical development

Our most concrete win was the development of our original vaccine candidate into the clinic in record time without compromising on safety. To our knowledge, we became the fastest biotech company ever to go from company founding and design of a novel drug candidate to the start of a clinical trial. This achievement required solving a huge number of technical, operational, regulatory, and logistical challenges, which our team consistently knocked out of the park. When we consulted with expert advisors and industry veterans on our overall project and many of the individual problems therein, they often told us that what we were trying to do was likely impossible. We proved them wrong at nearly every turn. While the efficacy of this vaccine was not what we hoped, we believe this success is a testament to what’s achievable when a talented, altruistic group of people come together to tackle a seemingly impossible task. We hope to see many more such projects in the future. 

General-purpose rapid drug development capacity

In the process of developing our lead vaccine candidates and exploring many others, we built general-purpose systems and infrastructure that could be used to accelerate development of diverse drugs and vaccines, for biosecurity and beyond. We honed approaches for quickly in-housing new tools and technologies, squeezing extraordinary work out of external vendors, and leveraging strategic parallelization and vertical integration to radically collapse conventional drug development timelines (e.g. under our oversight, multiple external industry partners reported hitting their own clinical and manufacturing milestones more quickly than they’d previously thought possible). We hope that our success in this area can serve as general inspiration and proof of concept for more efficient drug development, and that others may be in a position to apply the specific strategies we developed. We’re exploring the best ways to share these, but for now please get in touch if you or anyone you know would be interested in learning more!

Team Development

One of Alvea’s biggest indirect achievements, and the piece of our story which I expect may have the greatest long-term impact, is the growth and development that our projects catalyzed for the people who worked there. Many of our team members played central roles in the end-to-end design and development of a vaccine into the clinic. Nearly every person who worked at Alvea took on and solved problems that were thought by many others (both within and outside the company) to be completely intractable, and developed a general attitude of embracing such challenges. In just a little over a year, multiple team members went from being early-career individual contributors, to exceptional managers and directors, helping position them to launch and lead ambitious high-impact projects in the future, in biosecurity and beyond. I believe the central factor in enabling this extraordinary growth and development was the simple fact of continuously putting people in situations where it was required of them.

Medical countermeasure knowledge

Due to the experiences of Alvea’s alumni, there is now far more expertise and experience with pandemic-relevant medical countermeasure development represented in the effective altruism and biosecurity communities. This positions us much better to collectively evaluate whether new medical countermeasure projects are promising and likely to be cost-effective, either as general preparedness measures or in response to specific threats, and to pursue such projects if warranted. We are also excited about opportunities for this knowledge and experience to be applied to biosecurity interventions beyond medical countermeasures, and to other cause areas entirely—Alvea alumni are already working at PanLabs on ambitious countermeasures for worst-case scenario pandemics, on technology roadmapping for Far-UVC, on applying lessons from pharmaceutical regulation to AI governance, and more.

Challenges

Note: The challenges below are selected for high confidence and I’m sharing them here in hopes that they provide useful data points on the kinds of issues that other organizations like Alvea might encounter. Importantly, they are not intended as an explanation or justification for the decision to wind Alvea down.  

Challenges of rapid growth

In early 2022, we rapidly expanded the Alvea team as well as our spending, growing to about 35 people within the first few months of our existence and making big investments in projects, equipment, and people. This growth and early spending was essential for us to hit our initial goals, but once the first sprint was over we failed to quickly recognize where our organizational capacity, head count, and financial and operational overhead required adjustment in service of sustainability. We didn’t confront this issue head-on until the start of 2023, when funding constraints forced us to look more clearly at our overall traction and burn rate and decisively address the discrepancy between the two. We conducted two rounds of layoffs, implemented more rigorous financial tracking and budget controls, and did substantial operational streamlining in the following months which helped address this issue, but our delay had already consumed substantial time and money. 

Costs of complex non-standard corporate set up

A series of our early choices about Alvea’s corporate structure caused lasting issues that negatively affected our prospects. In the process of spinning Alvea up under intense time constraints, we made quick and unusual decisions about corporate governance and the distribution of Alvea’s equity. These decisions created thorny issues and hindered Alvea’s progress by consuming substantial ongoing time and energy from the executive team, and by making fundraising more difficult. Defaulting to standard startup legal structures and norms wherever possible would likely have avoided most of these challenges. 

Alvea started as a time-limited project pursuing a specific near-term objective (taking our DNA vaccine candidate into clinical trials as quickly as possible) to have a large impact in a public health emergency. We maintained a laser-like focus on that objective for the entirety of our first sprint. After our initial success, we decided to continue building Alvea and only then began spending significant time thinking about longer-term strategy. This resulted in a form of strategic “debt” which, despite our strategy work from then on, was challenging to overcome. On reflection, I see missed opportunities for more thorough ideation, analysis, and red-teaming of early strategic roadmaps, and for more explicit recognition of our changed needs following the end of the first sprint. Taking advantage of these opportunities would have come with painful near-term costs, but the setbacks would have been a worthwhile price to pay. The additional investment could have put us on a stronger trajectory by more quickly revealing high-leverage issues and productive strategy alternatives (e.g. experimenting with a partnerships-focused business model months sooner than we did). 

Conclusion

Alvea’s journey and ultimate dissolution have taught me an enormous amount about the challenges of building companies/organizations, of solving big problems, and of aiming for a massive positive impact in the world. The experience has not, however, changed my perspective on the importance or the potential of such pursuits, which I continue to believe in deeply. I hope Alvea’s story may prove useful to those considering other projects in a similar vein. I also recognize that what I’ve written here is incomplete, and that specific people would probably benefit from more detailed explanations or discussion of some of the things I’ve shared (or not shared) above. If that’s you, please don’t hesitate to reach out to me directly.

To conclude, I want to echo the gratitudes shared in the official Alvea announcement—I am enormously thankful to the entire Alvea team, our investors, and our other supporters and collaborators for making it possible for us to take this shot. The people I worked with at Alvea, both within and outside the company, stand out as the most talented, most caring, most fun, and most ambitious team I’ve ever been a part of.

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While I was sad to hear about Alvea's winddown, you do have a lot to be proud of. As you and others have highlighted, the extreme speed to the clinic for your initial vaccine candidate was unprecedented. 

That said, I did want to provide a couple critiques, with the intention of helping guide future EA endeavors in the biotech space. For some context to folks, I'm a mid-career professional working in biologics manufacturing, with experience with both plasmids and vaccines. I also had a number of conversations with Alvea folks at various stages of their clinical development. I'm going to focus here just on the initial push for the 1st candidate, which is the stage I'm most familiar with.

  1. There weren't enough experienced Alvea team members with significant domain expertise in biotech and vaccines. Your speed to the clinic demonstrated that a team of smart and motivated generalists can achieve operational excellence. You were right to mistrust the industry veterans that said those timelines were impossible*. However, I would argue that there are other areas where industry "common wisdom" was correct, and listening to industry common wisdom would have been beneficial:
    1. Competition from mRNA vaccines. Pfizer had already announced development of an Omicron-specific vaccine in Dec 2021 with a trial starting in January 2022. The original COVID vaccine was approved under an EUA 8-months after initiation of clinical trials. I therefore don't think it should have been surprising to see an updated anti-Omicron vaccine approved in Sept 2022, 8-months after initiation of that trial. 
    2. Low efficacy of plasmid vaccines. I won't get into the biology here, but plasmids vaccines have generally been shown to have poor efficacy compared to other modalities.
  2. Related, I think the "sprint" mindset made it difficult to recruit experienced professionals. Speaking just for myself, as someone with a mortgage and a child, it's very difficult for me to justify dropping everything to work on a short term, high-risk project. 
  3. Over indexing on the belief that "FDA and big pharma is too slow and EAs could do better". Generally, FDA and big pharma are (usually) too slow! However, I think as EAs, we need to be realistic about what our marginal contribution can actually be. This is the purpose of assessing for neglectedness in the "impact, neglectedness, tractability" framework. Making COVID vaccines is one of the least neglected cause areas out there, given the billions invested in this space by both industry and the public sector. If I had a main critique of the initial vaccine push, it was along the lines of "how do you think you are going to out-compete Pfizer/Moderna?" (Full-disclosure, I'm an ex-Pfizer employee myself). This also plays into why domain expertise is useful. In a highly crowded space, it's particularly important to understand the competition.

Anyway, these critiques still don't take away from what you accomplished. I would particularly love to hear more at some point about how you managed to get your external partners to meet your timelines, for very self-interested reasons!

* I do want to say that this was not a universal sentiment among industry veterans. Checking back to our initial emails, at least from a manufacturing perspective I never argued that your goals were unachievable. This plays a bit into my third critique as well.

Hey Matt,

thanks for your thoughts! 

1. I generally agree with your point on experience (wrote this in my reflection as well). Your specific examples do not track for me though. We knew that an mRNA omicron vaccine was coming. The point was, that no booster for LMICs was in the pipeline and mRNA vaccines were basically inaccessible in most parts of the world. We also were very aware of the low efficacy of plasmid vaccines but boosting with plasmid vaccines in the context of a new variant was something not tested before and the hypothesis was that it might be sufficient for significant additional protection against Omicron. The latter was certainly the riskiest bet but a valid scientific hypothesis worth testing.

2. It seems a general problem of start-ups that they are not as attractive to settled individuals. I can see how the sprint mentality might have contributed here. Luckily we eventually were able to attract a lot of mid-career professionals. And some people really appreciated the initial 3-month sprint plan, i.e. not having to commit to something in the long term.

3. Again, as far as I could tell no one was working on a COVID-19 booster optimized for LMICs. At the time there were valid concerns that Omicron might cause a lot of trouble for the world. How did we planned to outcompete Pfizer/Moderna? We didn't plan to compete with them on their target audience, but have a vaccine that is shelf stable for 6-months at room temperature (which we achieved), that could be potentially be manufactured nationally, and hopefully sufficiently effective. I think it is worth pointing out that despite not being as amazing as mRNA vaccines, AZ for instance seemed to have saved the most lives during the pandemic because it was more accessible to the global south: https://www.economist.com/graphic-detail/2022/07/13/which-covid-19-vaccine-saved-the-most-lives-in-2021

Thanks for the thoughtful response Max, and I appreciated your separate write-up on this subject.

I do want to highlight though that in his write-up, Kyle listed the improved regulatory environment for updated mRNA vaccines as a reason why Alvea decides not to proceed with your first vaccine candidate. That's really what I was addressing with my comment.

As to the second point about lack of efficacy for plasmid vaccines, I think there were different opinions on this within Alvea. One high ranking person I spoke to gave me the opinion that poor performance of a competitor COVID plasmid vaccine was due to competitor incompetence rather than an issue with plasmid vaccines themselves. That sort of comment is why I mentioned my concern that there may of been a degree of contempt among some in Alvea for big pharma.

Totally agree as to the "practical" efficacy of the adenovirus vaccines though!

Having followed Alvea's journey for a good chunk of this time, I was really impressed by how you all handled the project and your humility in dealing with trial disappointments and winddown.

Record time to safe clinical development

we believe this success is a testament to what’s achievable when a talented, altruistic group of people come together to tackle a seemingly impossible task


Amazing that you got to a clinical trial so quickly! I find myself confused as to how this could happen though: it would be quite surprising to me if other companies and people are just insufficiently clever or hard-working enough or something. Surely there is huge optimisaiton pressure that is already being brought to bear on making R&D and clinical trials go quickly and efficiently as this is a big chunk of how pharma companies make money, and so it seems strange if there were just lots of big wins waiting to be taken in improving the process. What do you think?

One thing to clarify here, Alvea has the record for time from company founding to clinical trial. Established companies have had shorter timelines for going from program conception to a clinical trial. For instance, Pfizer/Moderna went from initial receipt of the COVID sequence to a clinical trial in ~two months or so for their COVID vaccines.

Still an impressive achievement for Alvea though; they were nearly as fast as the pharma giants despite starting from nothing.

As an ex-Alvean and also 15-year industry veteran I can maybe weigh in, particularly because I think this ties in to what was Alvea's main value proposition: speed for pandemic response. There were some aspects that enabled Alvea to go faster than a "from-scratch", hypothetical vaccine program: Alvea based its DNA-Omicron vaccine on an existing, approved vaccine platform (ZyCoV-D), and applied to SAPHRA instead of FDA/EMA. 

But even trying to account for that, Alvea went faster than any company I'd seen that wasn't in early COVID pandemic-speed (with the full weight of mid/large pharma, funders, governments, regulators, plus also having based their vaccines on their own existing coronavirus platforms as opposed to someone else's). I'm sure there are instances of groups going faster (colleagues did an exhaustive ct.gov search and found them) but I still think its notable that a mostly inexperienced team was in the ~0.1% of fastest programs developed in the last 35 years. I attribute this to:

  1. More sophisticated/aggressive risk appetite - Most biotechs are extremely risk averse, often to the point of irrationality. Execs might add months/years to their timeline (and spend $$$) to reduce risk by a tiny percentage since that is what they are optimizing. E.g. more US biotechs should be executing Phase 1s in the Australia (fastest option, cheaper, very safe bet) vs US (safest bet).  
  2. First principles thinking - As Kyle referenced, not listening to "conventional wisdom", always expanding the space of possibilities and stress-testing assumptions (probably assisted by seeing ourselves as "outsiders") was critical. E.g. nobody thought Alvea could source a comparator vaccine for its trial, the team was able to be one of the few orgs to achieve this. 
  3. Operational excellence - At least biotechs (I'm not as familiar with big pharma, but they are a different reference class) have a pretty sufficing perspective on timelines, Alvea had a maximizing approach: existing timelines were almost never satisfactory. Most companies would have stopped calling manufacturers after the first 3-5 vendors had similar timeline estimates, but at Alvea they would be exhaustive in their search to find a timeline that matched the targets. See Max's post for more details on all all these points btw. 
  4. Value alignment - Most biotechs/pharma are not staffed by many people who believe in the mission to the degree that Alveans believed in their mission. This improved coordination, reduced politics and increased personal risk-taking, e.g. picking a smaller, nimbler CRO versus a "nobody gets fired for picking IBM"-type CRO. This belief in the mission also contributed to the operational excellence - you will move faster if you think you are practicing for responding to the GCBR than if you are advancing a dermatology asset for stockholders. 

For further evidence on the speed improvement: As part of the pivot towards a partnership/service-based business model that Kyle alluded to, we also conducted pilots that allowed us to analyze other biotech's development paths and were consistently able to save (on paper at least) 12-15 months off their timelines by applying lessons learned. 

It is also important to note that from my perspective this product development speed focus did not contribute to the failure of Alvea, but I wasn't involved in the preclinical decision-making and the case could be made that jumping from one program to the next too quickly and without proper strategic consideration might have contributed (as Kyle also referenced above). Given all this, I would end by suggesting people run, not walk, to work with ex-Alveans (myself excluded). 

Thanks, that was useful and interesting to read, and makes more sense now!

Thanks for that additional context Mats. I did want to follow up on US vs ex-US P1 trials.

  1. At this point, Pfizer and Moderna have consistently gotten mRNA vaccines into US trials in ~2 months after receiving a new sequence. Are the timelines to starting a trial in Australia/South Africa/elsewhere considerably shorter?

  2. As a comment, big pharma does perform vaccine trials in the global South, although this is more about seasonality than speed. Pfizer performed a major P1/P2 trial for their RSV vaccine in Australia, because the timing of RSV season in Australia matched well with the development timelines for the drug.

  3. One of the main arguments I see in favor of US or EU P1 trials is that the FDA/EMA are the most sophisticated regulatory agencies, and will provide more useful feedback on your development plan than other agencies. This is particularly relevant if you intend to eventually market a drug in the US, since the FDA only accepts foreign trial data if the study was conducted according to FDA requirements. Since Alvea wasn't really targeting the US market, this is less of a consideration. Still, what do you make of this argument?

  4. I'd also mention that once you get to the P3/BLA stage, filling in a country with a less sophisticated regulatory agency can be a burden. My own experience is that FDA/EMA/Japan are more willing to let sponsors deviate from official guidelines if there is a good scientific justification. Meanwhile, other agencies lack the expertise to assess drugs on the merits and will fall back to saying that you must follow the guidelines. For instance, I've been in the maddening position before of having agencies in small countries repeatedly cite FDA guidance to argue that we need to make some change to our plans, despite the fact that our drug was already approved by the FDA without said change!

Hi Matthew, thanks for engaging and for your thoughtful comments/questions. 

  1. In non-pandemic times, yes. Australia has less requirements for a IND-type submission (GMP certificate only needed prior to enrollment, not at submission); you only need the HREC approval (IRB equivalent) and no national regulatory approval (just a rubber stamp); and depending on the indication and competitive pressures you usually get faster enrollment. 
  2. Agreed. I was talking more about regulatory speed to get into FIH.
  3. You can still get a pre-IND meeting with US regulators and get their feedback before or in parallel to conducting a AU P1 (I recommend before, but if there are few/no uncertainties you might consider in parallel). So you don't have to choose. Agreed that FDA has requirements for foreign data, but it is a low bar (GCP, IRBs, ICs), and you could still get a majority of your data from outside the US. Rule of thumb is you need 20% of your data for an NDA/BLA to be from US populations, but even that rule has been broken successfully. 
  4. These are great points, I don't have a lot of experience with NDA/BLA submissions to foreign countries so your insights are valuable. I'll just note I was specifying people use Australia for P1. Agree that P2s and P3s are another ballgame. 

As the former COO and briefly co-CEO of Alvea, I also endorse Kyle's reflections!

Lots of props to the team - I admire the work that went in here.

Added my notes about Alvea in a separate post. 

Thanks for sharing! I think retrospectives of successful projects are very valuable and always interesting to read.

Thanks for writing this post, and the others, on your experience with Alvea - really interesting reading.

I think the thing that is most impressive to me is that you stopped before you ran out of money and returned money to investors. 

That, in my experience, is extremely unusual in the charitable/not for profit sector... where people often keep going with projects that in their heart of hearts they know are not having much or any impact.

I'm curating this post. I really like the honesty in this post. Evidence I have that makes me think it's doing unusually well here:

  • There's not a lot of fluff, or wishy-washy statements
  • It acknowledges places where you disagreed with other cofounders.

One of Alvea’s biggest indirect achievements [...] is the growth and development that our projects catalyzed for the people who worked there.

I agree with this, from my outside vantage point. It seems pretty wild how some environments tend to level people up while others do so much less.

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I donated my left kidney to a stranger on April 9, 2024, inspired by my dear friend @Quinn Dougherty (who was inspired by @Scott Alexander, who was inspired by @Dylan Matthews). By the time I woke up after surgery, it was on its way to San Francisco. When my recipient woke up later that same day, they felt better than when they went under. I'm going to talk about one complication and one consequence of my donation, but I want to be clear from the get: I would do it again in a heartbeat. Correction: Quinn actually donated in April 2023, before Scott’s donation. He wasn’t aware that Scott was planning to donate at the time. The original seed came from Dylan's Vox article, then conversations in the EA Corner Discord, and it's Josh Morrison who gets credit for ultimately helping him decide to donate. Thanks Quinn! I met Quinn at an EA picnic in Brooklyn and he was wearing a shirt that I remembered as saying "I donated my kidney to a stranger and I didn't even get this t-shirt." It actually said "and all I got was this t-shirt," which isn't as funny. I went home and immediately submitted a form on the National Kidney Registry website. The worst that could happen is I'd get some blood tests and find out I have elevated risk of kidney disease, for free.[1] I got through the blood tests and started actually thinking about whether to do this. I read a lot of arguments, against as well as for. The biggest risk factor for me seemed like the heightened risk of pre-eclampsia[2], but since I live in a developed country, this is not a huge deal. I am planning to have children. We'll just keep an eye on my blood pressure and medicate if necessary. The arguments against kidney donation seemed to center around this idea of preserving the sanctity or integrity of the human body: If you're going to pierce the sacred periderm of the skin, you should only do it to fix something in you. (That's a pretty good heuristic most of the time, but we make exceptions to give blood and get pier