Quick takes

FYI, next week we will be highlighting the first batch of articles from In Development, @Lauren Gilbert's new global development magazine.  Lauren and most of the authors will be on the Forum to answer your questions throughout the week. More info to come on Monday, but I figured I'd mention in case anyone wanted to read the articles in advance (they are here, and all authors apart from Paul Niehaus will be around to answer questions).  I'm looking forward to the discussion. 

Some women on the Facebook support group "Cluster Headache Patients" comparing labor pain to cluster headache pain: * "Honestly, I had a natural childbirth and a cesarean and cluster headaches are 10 times worse than both." * "2 unmedicated births for me. Would rather do that every day than have another cluster" * "every day though, really?" * "yes. I'd rather go through childbirth without pain relief than CH." * "tenfold worse than popping a baby out" * "Nah, labour/giving birth is a walk in the park compared to ch […] I was in labour with my son for nearly 3 days, then the midwife had to break my cervix with her hands, but I'd still rather do that again than have another CH" * "Labor pain doesn’t even come close to CH! I’d choose labor pain ANY day over suffering from another CH" * "CH is a million times worse" * "I had 4 children, 3 were natural. CH is worse." * "I'd rather have a baby. And my placenta tore during all natural childbirth." * "I gave birth to 4 different babies. The smallest being 8lbs 14oz. The biggest being 10lbs 15oz. I would much rather give natural birth all over again than a CH." * "I've had three babies—one was overdue and born with his arm over his head. Having a baby is still cake compared to clusters."   These are just a few. They go on and on. (So far only one woman claiming childbirth was worse, who "nearly bled out in childbirth, got an episiotomy with zero freezing/drugs.")

The UK is set to pass a law that bans the sale of tobacco to anyone born after 2008. Once the king signs it into law, the UK will become the second country in the world to introduce a generational smoking ban, after the Maldives did so last November. (New Zealand also considered such a ban a few years ago, but did not go through with it.) 

So... what's the general take on the hantavirus outbreak?

An excerpt about the creation of PEPFAR, from "Days of Fire" by Peter Baker. I found this moving.

Gavi's investment opportunity for 2026-2030 says they expect to save 8 to 9 million lives, for which they would require a budget of at least $11.9 billion[1]. Unfortunately, Gavi only raised $9 billion, so they have to make some cuts to their plans[2]. And you really can't reduce spending by $3 billion without making some life-or-death decisions. Gavi's CEO has said that "for every $1.5 billion less, your ability to save 1.1 million lives is compromised"[3]. This would equal a marginal cost of $1,607 $1,363 per life saved, which seems a bit low to me. But I think there is a good chance Gavi's marginal cost per life saved is still cheap enough to clear GiveWell's cost-effectiveness bar. GiveWell hasn't made grants to Gavi, though. Why? ---------------------------------------- 1. https://www.gavi.org/sites/default/files/investing/funding/resource-mobilisation/Gavi-Investment-Opportunity-2026-2030.pdf, pp. 20 & 43 ↩︎ 2. https://www.devex.com/news/gavi-s-board-tasked-with-strategy-shift-in-light-of-3b-funding-gap-110595 ↩︎ 3. https://www.nature.com/articles/d41586-025-02270-x ↩︎

Update (January 28): Marco Rubio has now issued a temporary waiver for "humanitarian programs that provide life-saving medicine, medical services, food, shelter and subsistence assistance."[1] PEPFAR's funding was recently paused as a result of the recent executive order on foreign aid.[2] (It was previously reauthorized until March 25, 2025.[3]) If not exempted, this would pause PEPFAR's work for three months, effective immediately. Marco Rubio has issued waivers for some forms of aid, including emergency food aid, and has the authority to issue a similar waiver for PEPFAR, allowing it to resume work immediately.[4] Rubio has previously expressed (relatively generic) positive sentiments about PEPFAR on Twitter,[5] and I don't have specific reason to think he's opposed to PEPFAR, as opposed to simply not caring strongly enough to give it a waiver without anyone encouraging him to. I think it is worth considering calling your representatives to suggest that they encourage Rubio to give PEPFAR a waiver, similarly to the waiver he provided to programs giving emergency food aid. I have a lot of uncertainty here — in particular, I'm not sure whether this is likely to persuade Rubio — but I think it is fairly unlikely to make things actively worse. I think the argument in favor of calling is likely stronger for people who are represented by Republicans in Congress; I expect Rubio would care much more about pressure from his own party than about pressure from the Democrats.   1. ^ https://apnews.com/article/trump-foreign-assistance-freeze-684ff394662986eb38e0c84d3e73350b 2. ^ My primary source for this quick take is Kelsey Piper's Twitter thread, as well as the Tweets it quotes and the articles it and the quoted Tweet link to. For a brief discussion of what PEPFAR is, see my previous Quick Take. 3. ^ https://www.kff.org/policy-watch/pepfars-short-term-reauthorization-sets-an-uncertain-course-for-its-long-term-future/ 4. ^ htt

I admire influential orgs that publicly change their mind due to external feedback, and GiveWell is as usual exemplary of this (see also their grant "lookbacks"). From their recently published Progress on Issues We Identified During Top Charities Red Teaming, here's how external feedback changed their bottomline grantmaking: Some self-assessed progress that caught my eye — incomplete list, full one here; these "led to important errors or... worsened the credibility of our research" (0 = no progress made, 10 = completely resolved): (As an aside, I've noticed plenty of claims of GW top charity-beating cost-effectiveness figures both on the forum and elsewhere, and I basically never give them the credence I'd give to GW's own estimates, due to the kind of (usually downward) adjustments mentioned above like receiving interventions from other sources or between-program interventions, and GW's sheer reasoning thoroughness behind those adjustments, seriously, click on any of those "(more)"s) Some other issues they'd "been aware of at the time of red teaming and had deprioritized but that we thought were worth looking into following red teaming" — again incomplete list, full one here: I always had the impression GW engaged outside experts a fair bit, so I was pleasantly surprised to learn they thought they weren't doing enough of it and then actually followed through so seriously, this is an A+ example of organisational commitment to and follow-through on self-improvement so I'd like to quote this section in full: Some quick reactions: * I like that GW thinks they should allocate more time to expert conversations vs desk research in most cases * I like that GW are improving their own red-teaming process by having experts review their work in parallel * I too am keen to see what CGD find out re: why GW top-recommended programs aren't funded by other groups you'd expect to do so * the Zipline exploratory grant is very cool, I raved about it previously * I wouldn't