Colin Aitken: Today’s Greatest Humanitarian Crisis (PEPFAR) #14
Development economist Colin Aitken unpacks the freezing of PEPFAR, whether aid programmes are effective, coping with the tragedy of the USAID/PEPFAR freeze, balancing radical Christian altruism with mental health, and how to think about money.
Articles, organisations, and other media discussed in this episode
GiveWell: Charity evaluator focused on assessing the effectiveness of global charities help with making informed decisions.
PEPFAR Report: Colin’s recent investigation into the cost-effectiveness of the President’s Emergency Plan for AIDS Relief (PEPFAR), which funds efforts to prevent and treat HIV/AIDS in low- and middle-income countries.
Freezing of USAID Article: The impact of freezing USAID funding
Effective Altruism For Christians (EACH): Combining Christian faith with effective altruism
CFI Podcast: Katie Fantaguzzi: Treating children of parasitic stomach worms at Unlimit Health.
NY Times Article: "As Fellow Pro-lifers We Are Begging Marco Rubio to Save Foreign Aid."
Arriving at Amen: by Leah Libresco
Colin’s Blog: Reflections on faith, justice, effective altruism and mental health.
‘Strangers Drowning’ by Larissa MacFarquhar: Exploring the moral dilemmas of radical altruism and the challenges of doing good in the world.
Episode Highlights:
Investigating the effectiveness of aid programmes (PEPFAR):
“So I'd say the parts of the report I was most involved with, our goal was, can we get this kind of estimate outside of PEPFAR so people can have a more trustworthy, not that it's not trustworthy, but an independent source they can trust for PEPFAR's effectiveness? And also, can we do this in multiple ways? So we did this from the mortality data... So I think we're pretty confident that between 7.5 and 30 million lives were saved by PEPFAR…”
Impact of the loss of aid
“My rough back of the envelope guess is, I don't know, maybe one or two million deaths per year forever until we reinstate PEPFAR and sort of similarly effective foreign aid programs, which I don't know, I find it very hard to picture a million people. And that's only the people who die. Like the scale of suffering is probably like 10 or 100 times that.”
Role of Money in Christian Morality
“I think in most cases, people are erring on the wrong side of not caring enough about money versus caring too much about. Well, I mean, people care a lot about money, but caring enough about donating. I think in economics, we talk a lot about comparative advantage, which is, you know, if I can do stuff and you can do stuff, I should do what plays to my strengths the best. And you should do what plays to your strengths the best and we can trade and everything can end up better.
Money Is The Comparative Advantage for US Christians
“And I think for most Americans on a global scale, our comparative advantage is very strongly money. I think the amount of good you can do with your money far outweighs the amount of good you can do with everything else combined.”
Finding Hope in Christ in Moments of Despair
“The lives lost from HIV are not ultimately lost in the sense, but that these people are known by God, they're loved by God. When they die, they return to God. Their sufferings in this life are extremely important, but we're part of a greater picture, a greater plan of God to renew all things, to make good on all things, to do good things for those that he loves. I… I have to remind myself of that when I get especially discouraged because it does feel sometimes like I'm just witnessing this horror tragedy, like a plane crashing every hour… I do have confidence that God will make good and he'll use Christians like you to make a difference for many people out there.”
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JD (01:13)
Colin, thanks so much for coming on.
Colin Aitken (01:15)
Thanks so much for having me. I'm excited.
JD (01:18)
Yes, I'm excited too. You're a friend. I know you well, and you're doing important work that I'd love to share with our listeners. but for those who don't know you share maybe in two minutes, a bit about yourself, your, your background faith and, and how you impact the world. So a lot to pack in, but share a bit about yourself.
Colin Aitken (01:36)
Easy questions. Yeah. So I'm, my name is Colin. I currently work in development economics, but my background is in math. So I came to grad school, did a PhD in algebraic topology, which is like bendy geometry and lots of dimensions. It's super cool stuff and super pointless. maybe I shouldn't, I can say that. I think I have a PhD in it. true.
JD (02:02)
Well, it's bendy, so it's very pointless, but.
Colin Aitken (02:06)
So I started getting into development economics
And now it's my full time work. work on general development economics research, particular areas being like water treatment and child mortality.
We have some vaccine funding projects, all sorts of stuff. So it's something I'm really excited about. And I think it's a cool way where the things I'm passionate about, technically and the things I'm passionate about, like spiritually and ethically have aligned into work I'm very excited to be doing.
JD (02:44)
So your team does work for lots of development programs. You work with an incredibly gifted economist who's won the world's most prestigious prizes for what he does. And you recently released a report on PEPFAR. I'd like to start there because the world is full of global health and poverty problems. We've talked about it in other episodes. I don't think listeners listening to this are like,
totally unaware of the problem of global poverty, 700 million people living on two dollars a day, and the kind of desperation and lack of dignity that comes from that situation, or the problems of preventable diseases, right? There's something like five million children every year who die from some disease under the age of five, and like most of these diseases, we know how to prevent or to treat, and...
All of us could be doing more to help address these problems. recently, PEPFAR has been in the news as something that the US, well, let me get into that and why this matters, because you recently wrote a report about this. So tell me the story about PEPFAR and why we're talking about it today.
Colin Aitken (03:55)
Yeah, so maybe before that, just to clarify a little bit, the PEPFAR report is something I did on my own time outside of work. So it's not like an official thing that our lab did or something that Michael is associated with. I would say it's something Kelsey Piper led the charge on and I was volunteering with it on the weekends. But so PEPFAR is a program, it was started by George Bush.
around 2004, and it is trying to address this global HIV crisis. So in the US, HIV hit hardest, I think, in around the 80s or the 90s, especially in gay communities. And we were able to bring it down using a lot of things, especially some education about safe sex, but especially antiretroviral medication. So this is a medication.
If you have a lot of HIV virus in your body, you take this medication and it decreases the loads. And it decreases them to the point where you essentially don't have HIV anymore, as long as you continue taking the medication. It's very rare that you can spread the disease to someone else, for example. But a lot of that was focused in the US. And a lot of that is because these drugs were really expensive. So when PEPFAR started,
the cost to deliver a full course, it depends a little what source you check, but you should think roughly like $1,000 a month or so to get someone a course of this drug. So George Bush wanted to address this. Like this was a huge crisis. In some countries, most of the deaths were people dying of AIDS.
more people died of AIDS than died of every single other cause combined. This is an enormous crisis. And he said, basically, we are going to heal everybody by doing this massive drug campaign. So now has other arms, the biggest.
JD (06:03)
because we knew what worked,
right? Like the retrovirals worked, they worked in the US, they could work globally as well.
Colin Aitken (06:10)
Exactly. The concern at the time a lot of economists had was it doesn't look, it might not be cost effective. These drugs, thousands of dollars to deliver them. People were saying, well, why don't we just deliver like condoms or something and stop the spread? But something I think is kind of surprising is PEPFAR invested so much in antiretrovirals over the course of its lifetime. I mean, other groups did too, but PEPFAR is one of the biggest ones.
that it actually pushed the innovation on antiretrovirals forward. So now the cost is like $60 for an entire year of treatment compared to $1,000 for a month. So this is.
JD (06:48)
Hmm, you're the US even. Yeah.
Colin Aitken (06:54)
I'm not going to do the math quickly enough. Something like a hundred times cheaper than it used to be. And as a result, HIV very much is in decline around the world. If you look at like rates of people getting it, rates of deaths, like it peaked around 2004 and it's now at something like half the level it started out as. So it's a tremendously effective program. It's prevented millions of deaths. It's done so.
It started out seemingly very expensive, but it was such a big push and so well coordinated that it actually ended up being one of the most cost effective programs of all time. So if you want to save lives around the world, like this is one of the best programs doing it.
JD (07:34)
of all time. Wow. Yeah.
Yeah, yeah. And just
for clarification,
I think for a lot of people the moral relevance of this issue is like also wrapped up in like who gets this and how they get it and whether they brought it upon themselves. But I think with the case of global HIV prevalence, it is the case that it's hereditary, right? Like most people who have it received it through their parents. Is that right?
Colin Aitken (08:06)
big chunk is hereditary. I guess I personally am a little uncomfortable with the idea of like, oh, this happened through sex, therefore we're okay with you dying from it. I think that's a mentality that I don't know, I find very dangerous and concerning. What is true about HIV, especially in like Africa, is the majority of people who get it are women or children. So children usually get it through their mothers.
There's medication the mothers can take when they're giving birth to prevent transmission, but if they don't have that medication, then the child will be born with it. Women can get it for all sorts of reasons, but a very common reason is like, you know, someone is in a committed marriage, they are doing everything right, but their husband cheats on them and goes and gets HIV and brings it back to them.
I don't have the exact numbers off the top of my head, but this is, think, a main driver of HIV rates and deaths. So even if you are of the opinion that, people who bring them upon themselves, quote unquote, shouldn't be helped, like, a lot of people literally could not have done anything to avoid this.
JD (09:28)
Yeah. And it's not just lives that we're saving, right? But it's also livelihoods and like a life with HIV is a diminished life, right? Like diminished lifespan, the missed quality of life. is there, is there more to be said on that?
Colin Aitken (09:41)
It's hard to put numbers to it. think if you are familiar with like disability adjusted life years, it's a way of trying to kind of quantify how much of it affects your life. Untreated HIV reduces this by about half in a year of your life. So this means if you trust the ways economists try to measure like how well off you are, like half of the benefit you would get in a year of life.
vanishes if you can't treat your HIV.
JD (10:13)
Is it because you get
sick so often? it because, like, is there one particular reason or is it many reasons why people report that?
Colin Aitken (10:22)
It's many reasons. think you get sick more often. The sickness progresses. like as you get more and more, or as your T cell count goes down, you're less and less able to defend against infection. And so you're getting more and more sick. You're stuck basically in bed more often, which means you can't go out and work. So you are losing out on income.
If you're a parent, your family is losing out on income. If you have children and you die early, your children are growing up without parents. It's this far reaching impacts across a lot of areas of life.
JD (11:02)
Yeah, that's helpful. And so we know how to address this issue. We were addressing it through PEPFAR. What happened recently, right? So I guess listeners will be vaguely familiar with the USAID freeze with the current administration. And that affected everything, almost everything, I think, that USAID was working on, including PEPFAR, which I think was before this, like a $6 billion a year program. Like it wasn't...
massive compared to the federal budget, It's like, what, 0.08 % or like, know, fractions of a fraction of a percent.
Colin Aitken (11:36)
Yeah,
it's a tiny fraction. Like I think if you got the part of your taxes that paid for PEPFAR refunded to you, would be, I don't know, a couple of dollars at most. Very tiny fraction of what the US government is spending.
JD (11:52)
Right, six billion, that's, know,
it's 200 million taxpaying Americans, it's like third, or, I can't, what, 15 bucks a person or something, or 30 bucks a person, or?
Colin Aitken (12:02)
1530, something,
a small amount for something that's been saving millions of lives. So what happened? So PEPFAR is actually a program of the State Department, I think. So it's separate from USAID, but all these things are kind of linked. Like if you want to get drugs from companies to people all over the world, you have to work with a bunch of partners.
in between the companies and the people actually getting the drugs. And a lot of that was sort of USAID and State Department linked together doing similar things.
So what happened a little bit after President Trump was inaugurated, all US foreign aid was frozen across the board, irrespective of whether it was any good, what it was doing, how aligned it was with a viewpoint, everything stopped. including that, PEPFAR was part of that. like a week or so later, they had...
tried to bring in a humanitarian waiver. So they tried to say, okay, but life-saving programs like this, we're going to allow to continue. The problem is the waiver didn't really work. So there are a lot of reasons for this, partly miscommunications within the government. If your boss says, hey, there's a waiver, but then the treasury says, but we're still not giving you any money to do your work. You don't really have a way to get the
done. I think Leah Sargent, who's also part of the EA for Christians community, has described this as, they pushed the emergency stop button, but there wasn't an emergency start button. If you suddenly freeze everything, it's really hard to pick a specific program and get it back off the ground. Because, you know,
It's not like you have a subset of people that are just the PEPFAR people. You have the USAID people all over the world. If some of them have been furloughed or on leave or have been taken out of the field and they were the ones getting drugs to people from PEPFAR, you can't just immediately send them back and have them restart. So, I mean, it depends when this airs and what happens in the meantime.
But least as we're recording, my understanding is the vast majority of pet power activities are still stopped.
JD (14:36)
And what's, yeah, the reason for it stopping, did you go into that in the PEPFAR report or did you stick with just the facts on the ground of what's happening to PEPFAR administration and the estimated cost to human life and livelihood? Do you have a good sense of why this is happening and the motives behind it?
Colin Aitken (15:02)
not a super clear sense. I think a lot of government programs are being shut down for reasons that are very opaque, I would say.
I don't think anyone is on the record saying we have intentionally shut down PEMFAR for this reason. I have my guesses as to possible reasons, but probably not guesses I want to share publicly.
JD (15:25)
Yeah, and I think what's especially sad about PEPFAR, one reason why I invited you to talk about it today is because this isn't just any, this isn't just any aid program, and I think we can talk about briefly, maybe, I'd like to actually talk a little bit for a couple minutes about criticisms of aid programs and whether or not they do hold true for PEPFAR. But it's worth mentioning before that that this isn't just any aid program. It's like you said,
on the face of it, the most life-saving, impactful government health program in US history. And if that's the case, this is something of pretty high stakes we're talking about here. So one criticism that I hear most is this sort of dependency criticism.
that you often hear that if the US is paying for other people's lunch, then they have little incentive to go work to provide for their own lunch. And that goes for their healthcare as well. So are we creating dependency by providing aid? And that's a big question, right? I guess you might wanna distinguish between different kinds of aid, but when someone raises that objection, how do you usually think of it as an economist and expert in?
in delivery of these services.
Colin Aitken (16:41)
Yeah, I have several independent thoughts on it. So one thought is the US is a much, much richer country than many of the countries we're working in. like the US GDP per capita is roughly $80,000 a year. The Malawi's GDP per capita is I think roughly $700 per year.
So that's more than a hundred times difference. It's like in the Bible, you have a very clear idea that people who have a lot of wealth are called to use at least some of it for people who have less wealth. And I think that's definitely true on a national scale too. Like in theory, it's great if every government takes care of their own people. But if one government has hundreds of times as much money as a nearby government,
You get this, I think there's a strong calling that some of that wealth should be shared.
I'm not phrasing this well. you should, governments have a calling, not just to their own people, even though that may be a stronger calling, but some calling to people around the world. In the case of...
JD (17:53)
Right, so in this view,
the correct amount for a government to spend on aid is not zero, right? The correct amount is not absolutely nothing at all.
Colin Aitken (18:02)
Yeah, I think when you ask people what should the government spend on aid, it's around 10%. And that currently spend around 1%. So I think there's room within.
Between what people think should be happening and what's actually happening, there is room for an expansion of aid. The problem is that people currently think the government spends about 25 % on aid. that's, I think, a big driver of people wanting decreases. In the case of PEPFAR, I think one risk of dependence is exactly what we're seeing right now.
JD (18:25)
Wow.
Colin Aitken (18:39)
If the US promises, we are going to give you medication, and then suddenly changes its minds and stops, you have these drastic effects. think people are working on forecasting this more specifically, but I'm guessing we're going to see hundreds of thousands of deaths, possibly millions of deaths, depending how long this aid pause lasts.
So one thing PEPFAR was working on before it shut down was trying to pass more of the responsibility to the countries they're working with. So I think it's pretty rare for PEPFAR to be 100 % of the HIV spending in a country, although in most cases, I think it is a majority. But there have been examples. think Botswana and South Africa are good examples. Where to start?
We did this giant HIV push. The US was funding most of it. And over time, we've been handing off more and more of the responsibility and even more and more of the costs to the local government. And when that's possible, it's generally a good thing, I think. You expect a local government to have a better sense of needs. And it makes it more sustainable in the case of
events like this, where the US just suddenly pulls out.
JD (20:00)
Yeah, we had.
We had Katie Fantaguzzi on a different episode and she's at Unlimited Health, formerly SCIF Foundation, she's my assistant, they do deworming. And we've talked about this issue and she talked about how in many cases that charities are working really effectively. It's because of partnerships with local governments, right? Or aid as well, right? It's not that all this aid is massively effective with absolutely no participation of the people receiving it. It's actually precisely because of the participation.
and the cooperation that a lot of this is quite effective.
Colin Aitken (20:36)
Absolutely.
So even in these cases when the US is providing most of the funding, most of the funding they're providing to local groups who are doing the actual work.
JD (20:48)
how do we really know these things work in the case of PEPFAR? These are big numbers, right? Like 20 million lives saved, right? Like you mentioned just now, we'll see hundreds of thousands of lives lost this year, a million or maybe even millions, right? Like where did these numbers come from and how can we be sure that that is the case?
Colin Aitken (21:07)
This was a big thing that spurred us writing the report. So I think.
JD (21:12)
And share more about
the report. you, think I'll mention it in the intro, but this is a roughly 50 page report detailing the most relevant aspects of PEPFAR, what stands to be lost and how to repair it.
Colin Aitken (21:24)
Yeah. And I would say at least the biggest part I was involved in, so it's the part that's most salient to me maybe, is Kelsey Piper was the one who originally asked this and sort of gathered us up and organized writing the report. But the number that's been flying around the news is 25 million lives have been saved by PEPFAR. But the source of this number is PEPFAR. And you know.
you might rightly be skeptical that people reporting their own effectiveness, often they tend to inflate it or they tend to use sketchy methods that make themselves look better. So what we wanted to know is using information that isn't from PEPFAR, could we replicate these numbers or not even replicate them? Could we find numbers we trusted? How many lives did we think were saved by PEPFAR? And you can do this looking primarily at
country level mortality data outside the US. So this is data that other countries are gathering for their own purposes to say how many people died each year. And PEPFAR's impact is big enough that in this data collected by other people for other reasons, you can see the effects of PEPFAR. You can see that in PEPFAR countries, you have this giant drop in mortality starting when PEPFAR started.
So I'd say the parts of the report I was most involved with, our goal was, can we get this kind of estimate outside of PEPFAR so people can have a more trustworthy, not that it's not trustworthy, but an independent source they can trust for PEPFAR's effectiveness? And also, can we do this in multiple ways? So we did this from the mortality data. We also did this from
of a more ground up looking at the effectiveness of antiretrovirals and the amount we've spread. Does that seem similarly cost effective? And the different evidence we looked at all aligned on pretty similar numbers. So I think we're pretty confident that between 7.5 and 30 million lives were saved by PEPFAR. Within that range, we have no reason to doubt PEPFAR's numbers, but we can't say we are 100 % confident.
JD (23:39)
Wow, that's incredible.
Right,
and the cost per life saved is like orders of magnitude lower than it would normally cost for a government health program, right? Like in the US, I think we're willing to spend something like $5 million to save US lives from some, is that roughly? And then, but this is about 100 times less on average that you found in your report, is that right? sorry, a thousand times less, okay, yeah.
Colin Aitken (24:01)
Yeah.
about a thousand times less.
Yeah,
so it depends on the US government agency, but somewhere around $5 million per life saved is what they're willing to spend. Our best guess is that PEPFAR saved lives for about $3,600 per life saved. So that's roughly on par with GiveWell charities.
JD (24:33)
So one thing I've wondered is like, if people are giving to charity and want to fill in the gap from PEPFAR, like would it be possible if some private foundation just like came in and provided the funds that PEPFAR was providing? My sense is that wouldn't really work because a lot of PEPFAR is built on an institution of trust and network and provision between different.
agencies that were distributing, administering these retrovirals. It's not just a funding thing. It's an entire organizational delivery mechanism.
Colin Aitken (25:10)
Yeah.
So I think part of it is you'd need an organization with $6 billion a year to spend, which is not an amount of money I've ever been able to control. But I think in theory, if Petfarr had been stopped with some warning, like if
or even if they restarted it now and said, are going to fund two more years of this program, and then it's going to shut down. The people in PEPFAR could have worked with an external organization to do the handoff properly and said, look, we're providing the funding. Here are our local partners. Now this person's going to provide the funding. You have a year or two to get to know each other, to build trust, to make sure you can get any
weird logistical issues out of the way. But because it was shut down so suddenly, and because my understanding is you can't just go look up anymore, like what are all the partners and how do I reach them and how, where were we buying stuff and where were we getting it? My understanding is it would be very hard at the moment, which isn't to say it's not worth doing. If I
not that the EU is listening to me, but if the EU were to step in and do its own PEPFAR, I think...
It wouldn't be as good as no interruption. There'd still be a massive human cost, but a much less massive human cost than if PEPFAR just ceases to exist.
JD (26:48)
Do
you have a median case estimate of like what is the human cost given everything that's happened and everything that's likely to come next? What's like the most likely average outcome here?
Colin Aitken (26:58)
I think.
There are people working on getting forecast, more trustworthy forecasts of what the actual numbers are. My rough back of the envelope guess is, I don't know, maybe one or two million deaths per year forever until we reinstate PEPFAR and sort of similarly effective foreign aid programs.
which I don't know, I find it very hard to picture a million people.
And that's only the people who die. Like the scale of suffering is probably like 10 or 100 times that.
JD (27:35)
That's like the state of, I mean, it's probably about like the state of Rhode Island, right? Like every single, or several, like Wyoming and Alaska put together every single year dying from this program we pulled out of. Yeah.
Colin Aitken (27:48)
Yeah.
JD (27:53)
It's crushing. mean, it's awful. It's a terrible thing to happen. It's something where Christians can step in and be a light with our donations, with our careers. It's something that a lot of Christians just have absolutely no clue is happening.
which is why I'm really glad you're on here talking about it with us. And it is sobering. mean, even just sitting from our chairs talking about what will happen to millions of people somewhere out there
Just talking about it from our vantage point is just like an absurd thing to do, but it's kind of what we have to do if we can get people mobilized to actually do something. And I do wonder like
What can individuals do from your vantage point on this issue, especially Christians who care about impact? Is this just a call to up our donations for global health and poverty charities in general? Is there something specific we can do for PEPFAR, some specific change we can call our representatives to advocate for? I know Leila Bresco has this pro-lifers for PEPFAR piece that came out in New York Times. What are your thoughts?
Colin Aitken (29:06)
I would definitely trust anything she recommends over my personal thoughts. I definitely think.
Upping global health donations is going to be important.
I think we can expect sort of the scale of global disease and the amount of suffering it's causing to get a lot worse over the next couple of years. And I think as Christians, we have some calling to try and temper that by giving more, doing what we can to stop that. For the case of PEPFAR, I think
depends where you live, but especially if you're living in a red state, calling your representative or your senator and saying, hey, this program is really important to me as a Christian. And can we find a way to bring it back?
I think representatives are at least somewhat, like they listen to public opinion to know what to focus on. And I think there's so much stuff going on right now that, you know, it's hard to know what the most important things are. But we're in a situation where this program that has saved, you know, 19 million lives.
before 2018 was our best estimate, but huge amounts, huge numbers of lives very cheaply and it's being canceled. I think there's a very strong case to say, hey, if you're gonna focus on one thing, if you are able to push one thing into the budget somehow, if you are able to somehow make one aid program come back, this is the one you should focus on.
JD (30:49)
So if you had to put all of your political capital in one bucket, it'd be this bucket right here to get PEPFAR saved.
Colin Aitken (30:55)
Definitely for foreign aid, I think.
You know, things happening domestically.
JD (31:00)
And to
put it in context, this is under 10 % of the entire foreign aid budget. So foreign aid is like 1 % of the budget, and this is less than a tenth of that. Yeah.
Colin Aitken (31:10)
Yeah.
So not to say what we should do on a domestic scale, but if you are going to do one thing for foreign aid, saving PEPFAR, I think, should be that thing.
JD (31:24)
Well, it's something that is emotionally really taxing. I don't know how you've fared with it, but for me, there's been, and I was talking to a friend who works at USAID. It's been exhausting thinking about the people who'll be affected. It's been terrifying thinking about how something like this could happen. It's been...
a bit of a call to action, right? Like what we do really matters. Like what we do with our time, our money really matters for the world's poorest, for people in desperate need, people who are loved by God, people who aren't deserving, but God loves them anyways. None of us deserve in an ultimate sense.
God's graces and mercy and that's exactly why they're grace and mercy. And we show grace and mercy to others because God is gracious and because that's just what Christians do. And like these people matter to God, their pain matters, their struggles matter, their lives matter. And so it's like exhausting and terrifying and like also really motivating to see an opportunity like this. Cause that's a challenge for the church. That's a challenge for all of us who say that we love Jesus to show our love.
for him by our service to the poor. As he said, those who love me will follow my commandments. And there those who will say, Lord, Lord, didn't we serve you? Didn't we follow you? Didn't we preach about you? And he'll say, depart from me. I never knew you. When I was hungry, where did you come with food? When I was sick with HIV, right? Like where did you provide retrovirals, right?
bit of a modern translation, but I think it's a call. But how have you been coping with it?
Colin Aitken (33:02)
It's definitely been very hard, I think.
It changes from moment to moment. There are moments when I'm deeply depressed, when I'm deeply angry.
A lot of moments where I don't know what to feel because the scale is just so much. The scale is so big. It's like, you know, you imagine one person dying and you're sad and then you imagine 10 people dying. You're like, that's really sad. You imagine a hundred people dying and you're like, that's devastating. And then you imagine, imagine a million people dying and like,
I just freeze up and go numb. Like the scale.
the scale of tragedy we're seeing, I don't think humans are able to comprehend or deal with.
JD (34:02)
I mean,
the plane that crashed in my neighborhood over here in DC a couple weeks ago made national headlines. The 67 lives I think that were lost. If I do the numbers in my head right, the numbers of lives lost from pulling back PEPFAR will be something like a plane like that crashing every single hour, every single day forever until it's reinstated, right? I mean, it's jarring, yeah.
Colin Aitken (34:24)
Yeah.
Yeah. And...
I don't know, I feel like sometimes in Christian circles, you're supposed to present feelings like this as like, I...
thought about this horrible thing and it made me sad. And then I went to God and this is why I'm now feeling better.
But it's something I've brought to God repeatedly with prayers that are everywhere from desperate to angry to
Almost like vengeful. Like how dare this happen.
And I don't know, I think I'm just still doing that.
That wasn't a very clear answer.
JD (35:22)
But it's very honest one. Thank you for your vulnerability. It's been hard on me too. And it is one of those things where I guess was always, this kind of suffering and loss was always existent in the world. something like this just makes it, forces us to recognize that kind of loss and that kind of suffering and evil, right?
yeah, I think the development space is often a very hopeful space, but it just feels like a very dark time. I wanna push back though on what you're saying that like,
Christians find a reason to be hopeful and then kind of move on or they, that's not exactly your words, but I do think there is a proper Christian response here that involves appropriate grief and inappropriate timelines, but then also hope and trust that like the lives lost from.
HIV are not ultimately lost in the sense, but that these people are known by God, they're loved by God. When they die, they return to God. Their sufferings in this life are extremely important, but we're part of a greater picture, a greater plan of God to renew all things, to make good on all things, to do good things for those that he loves. I...
I have to remind myself of that when I get especially discouraged because it does feel sometimes like I'm just witnessing this horror tragedy, like a plane crashing every hour. But then I remember, hey, that was always the case and God was always faithful. And I do have faith, even though sometimes it's hard to see, I do have confidence that God will make good and he'll use Christians like you to make a difference for many people out there. And I think that's part of the hope of this podcast, right? It's like we get here every...
every time we talk about another issue, we talk about climate change or global poverty or the spiritual darkness that's out there and the people who don't know the love of God in Christ for them. And we talk about these things and there's this temptation to cave in, these things are going to crush us, the world and evil and death is so powerful and fatal. And as Christians, we have that ultimate hope that these things aren't fatal in the ultimate sense, that death doesn't have the final say.
And even Christians in this life, are fighting a winning battle. And so that brings me a lot of hope. I also totally understand that there's a time to grieve and this is definitely an incredibly exhausting, incredibly exhausting, awful time.
Colin Aitken (37:49)
Yeah, that's a good
So I think when you are looking at things at scale, like across millions of people, as opposed to like across the people you know in your life. And I think a big part of the Effective Altruists project is this is important to do because there are so many people who, for relatively small amounts of money, you can have huge impacts in their lives. So I think when you're doing something at scale, out of necessity, you end up kind of oversimplifying their lives.
But you can't go to every single person around the world and understand at a deep level what makes them tick and what's important to them and what's driving them to get up every morning.
But you can go to millions of people and say, hey, you have HIV. It is causing you a lot of suffering in your life. And I can help you. Or even I can help you not give it to your baby so your baby can live to be an adult and live a healthy life.
JD (38:48)
Yeah. Are you mentioning this because
often I hear this criticism like, saving lives isn't all that matters, right? Like obviously it's important to save lives, right? But other...
People say other things are important, right? Like I wanna have a good life. I wanna have like beautiful relationships. I want to have all these other things and the effective altruists are so obsessed with saving lives, right? Like often I think of it as what you're saying is like what pops into my head when I hear that, which is like, no, it's not all that matters, but it is something we can count and it's definitely meaningful, right? Like it's definitely an important metric. And when we're talking about millions, like that matters, so.
Colin Aitken (39:22)
Yeah.
Yeah, I think the temptation to avoid as an effective altruist
you you start to think that's the only thing in people's lives. So you, instead of saying, well, this is a thing I can make an impact on, and then they can go live the rest of their life doing what's best for them. You say, the only thing that matters about this person is that they have HIV and I have fixed that and I am like the main character in their life story. But I think...
I really think there's a humility to it that it's important because if you start thinking, I need to have an impact on every aspect of someone's life or I need to think about everything that's important to them before I do anything, you end up just not doing much because of course there's no way you can affect that. But if you can take someone who has HIV and make them essentially not, if you can take someone who was going to die,
and let them live a full life.
You can recognize there is going to be stuff that's important to them, that isn't that, and you can celebrate that, and you can love the person that they're going to become as a result of that, while recognizing that your lane is kind of, this is the thing I am able to affect as an individual, and everything else is up to them and God and their community and the people they love.
JD (40:52)
Do you find yourself falling into a trap of trying to fix people or trying to simplify people? do you see it? It sounds like you see it in the Effective Autism community and you're hoping, yeah.
Colin Aitken (41:05)
Yeah,
I think the trap is it affects on maybe like a second order level how you're thinking about questions. Because I've definitely noticed among economists, people will say, well, a lot of poverty is in rural areas. I think we should just take people and move them to the rich area. Which, you know, great, if someone wants to do that, I think
lowering barriers, giving them enough money, getting ways to get people to do that if they want to is helpful. I think if you are only looking at an economic lens and can't understand why someone wouldn't want to leave the hometown that they grew up in, it can start to like subtly warp how you're thinking about things. And it can lead you to solutions that do really well on the metrics, but don't do really well in terms of
actually improving people's
JD (42:05)
So.
Let's wrap up this discussion on PEPFAR. So, Leigh Labresco, good person to follow up with if you're interested in more.
bipartisan political engagement on this issue, it seems like.
Colin Aitken (42:21)
Yeah, well, I don't want to sign her up to have a bunch of conversations that she didn't agree to, but you can read her stuff.
JD (42:26)
I mean, I would love
if like, because of this podcast, hundreds of people hit up, or anyone to do something about PEPFAR. would be an amazing reach and impact, if misdirected. anything else that comes out of this as an upshot from PEPFAR that you think listeners should know about?
Colin Aitken (42:45)
I would love it if when things like this happened, when funding for HIV got cut off, when foreign aid was in decline, people knew that church was going to be a force of opposition to that. Not in like a liberal or conservative sense, but in a we are Christians and we care about our neighbors and we are going to do what it takes to make sure our neighbors are cared
I don't think we're there yet. You can tell I'm talking about this on the Christians for Impact podcast and not the Christianity as a whole podcast. It's not something you hear preached about. I mean, maybe you do in some churches, but it's not something you're hearing from the pulpits like, hey, this is one of the humanitarian crises of our time and the church is going to do something about it. And I don't think
JD (43:28)
I know I haven't heard it.
Colin Aitken (43:39)
You can't change the entire church all at once. But I think one thing Christians can do in the meantime is talk to other Christians in their life, in their community, in their church and be like, hey, this is happening. This is a really big deal. And I care about it because Jesus called me to love my neighbor. Invite them into a space where they can do that too.
I that's all my thoughts on that. Maybe a side thought that's interesting. But one thing that was fascinating to me working on this project is in college, I think my sophomore year, I read Leia's book, Arriving at Amen, and it was really formative for me spiritually. It's a book about like Catholic prayer.
And I'm not Catholic, but I learned a lot from it that applied well to my faith and my Christianity and relationship with God. And now cut like 10 years later, and we wrote a report together about PEPFAR. What? God just works in crazy ways, you know?
JD (44:42)
That's very cool. Yeah.
Yeah. Yeah.
So Colin, I love your blog transitioning to talk about that. I'll put it in the show description for people interested in what Colin has been sharing so far. And you have this blog post. I don't remember if it's the title of the blog post or if it's just the content, but you talk about the dilemma you go through where...
you are used to buying like a loaf of bread that costs maybe one or two dollars and that's the budget option. But you really love this like whole grain wheat loaf of bread that costs like $8 probably from Whole Foods, right? And you don't need it. Like it's not nutritionally more healthy and you love to flesh out on that. But every single time,
And correct me if I mis-paraphrase, but every single time that you buy the more expensive loaf of bread, you feel the weight of the suffering of people who you could have helped had you bought the cheaper bread and donated the extra money. And so my question is, when is it okay to buy the $8 loaf of bread? And where have you fallen on that now?
Colin Aitken (45:56)
That's a really good question. So I wrote that post, I think when I was 25 or 26, and now I'm 29. So, you know, I haven't had a lot of life experiences then, but I've had some. I have had a lot of And I think
JD (46:12)
You've had a lot of bread.
Colin Aitken (46:18)
have a lot of mixed feelings about that post. I feel very called out by it when I read it now, because I think a lot of the stuff I predicted was going to happen in my life did happen in my life. So I think what I was really worried, I think this is called the hedonic treadmill. I'm not a philosopher, so I don't know what anything is called. But when you indulge yourself a little bit and are like,
oh, I'm going to get this slightly nicer thing. Then you get used to it, and it becomes your baseline. And then the next time you want to get something nice, you have to get something even nicer. And you can apply this to all sorts of luxury things, but it also applies to just basic food. If you go from the $2 bread to the $3 bread, next time you want to upgrade, you're going to have to go to the $4 bread. And I've really...
noticed that happening to me in the last couple of years. And I have mixed feelings about it.
To some extent, I think it's definitely a bad thing. I wish my spending was still what it was when I was 25.
In another sense, I think there is a clear failure mode of this idea where all you can think about any time you spend money is what else the money could have gone to. And because the need in the world is so great and because the amount of money you have as an American, or at least a middle-class American, is so much higher than the typical amount of money someone has in the world.
You can't escape this dilemma, right? Like if you're buying the $1 bread, then you reach a point where you're like, well, I could have slightly less of the $1 bread, or I could skip meals occasionally and donate that money and...
You can never escape this feeling that you're not doing enough. And I think where I'm landing right now is that.
The best way to deal with this is to make all of your decisions about how much to spend at moment, how much to spend and donate all at the same time. So why I do it now is I would set up a budget and say, I know I can live for the next few months on this much per day or this for daily expenses or this much per month for monthly expenses. and I'm psychologically just going to give myself permission.
to spend as much of that budget as I want, knowing that I've already set aside the money that I'm doing.
JD (48:48)
Yeah.
Yeah,
yeah. I think Julia Wise does it this way as well. And she has the famous example in the book Strangers Drowning about the candy apple that cost $4 that she really wanted but always knew wasn't best for the poor if she bought the apple instead of saving it and donating it. And she does the same as you're describing. Yeah. And how has that gone for you? Does it get around the treadmill or?
Colin Aitken (49:14)
thing.
JD (49:18)
It sounds like a a acquiescing somewhat like keeping mental health more intact, but also acknowledging that. Well, maybe the optimal thing is just to set a really low budget and like make little opportunities for yourself to spend beyond the optimal means.
Colin Aitken (49:38)
Yeah, I think personally I should be donating more than I am. I think I would definitely say I've gotten on the hedonic treadmill too much and I could be happy on less. I want to push back a little bit on the idea that this is always acquiescing. I think coming out of college.
I mean, I just, for independent reasons, had really bad mental health my first few years of grad school. And I think I had this idea that benefiting my mental health wasn't okay because what was going on in the world is so much more important. And I think in some sense, it's like just fine to care about yourself being happy and having a baseline mental health. But I think even if what you care about is just what is best for the world,
I think you are much more able to do things that benefit other people if you are relatively stable and happy. Like, I think, I don't know, I've had periods of depression where it was really hard to get out of bed. And if you have driven yourself to that because you care so much about other people, I think it's worth healing that specifically because, I mean, A, because you're valuable and God loves you.
But B, because if you want to help other people, you have to actually be able to help other people. And I think there's some baseline level of mental health that lets you do that a lot better.
JD (51:09)
Are any particular trappings of thoughts that you think impact-minded Christians get into? Like, you know, tormenting oneself for buying the wrong loaf of bread. Are there, yeah, are other examples that might?
Colin Aitken (51:20)
Yeah.
I think it's specifically...
when sort of optimizing turns into guilt, maybe. Like I think it's really helpful to think through, are there downsides of me buying this nice thing? If you're doing that to make like, so you can improve your decision making.
But if you start doing it in a way where you're dwelling on the negatives or every time you do something that's not optimal, you feel deeply guilty, I think it's really easy to accidentally spiral.
JD (51:56)
One struggle I've had with the every dollar matters so much for people who are suffering component of this world that we live in is
one inevitable result of it is that for wealthy Americans, morality just becomes about money. And morality is about more than money, right? It's certainly about money, and money is a huge part of morality. It's a huge part of Jesus's teachings. I've heard it quoted in sermons, I actually don't know if this is true, but I hear it quoted in sermons all the time that Jesus spoke more about money than anything else. And...
So money matters, but it's not the only thing that matters. It seems also really important that we were kind and loving to the people who lived in the flat next door.
and we bake them brownies when their mother fell sick with cancer. Or it seems really important that all the other aspects of Christian life and worship are there.
In one sense, want to say Christian morality is more demanding than secular morality because yes, caring for the widows and orphans and donating matters, but also all these other things matter too, the intentions of your heart. If you hate your brother, you've committed a kind of murder,
That's just something I see, or I see in myself like a tendency towards that spiritual state of mind. Where like, I might even neglect like friendships that I have, or like duties I might have to be a good neighbor to people who literally next door.
Because I think like the 10 minutes it takes to go say hi to that person is like 10 more minutes I could have worked at Christians for Impact. Like had some downstream effects on people living in extreme suffering. And I'm not sure I make the right calculation there. I mean, maybe I'm wrong. Maybe the calculation is always like, you know, hold up in your silo and like avoid all immediate.
decency and focus just on the world's most suffering people. And I think if you could only choose one, that's probably the better thing to choose. But I feel like there's gotta be way to choose both. So I don't know if that resonates with you at all or if you've had any similar experiences.
Colin Aitken (53:54)
I agree there's a way to choose both.
I think in most cases, people are erring on the wrong side of not caring enough about money versus caring too much about, well, I mean, people care a lot about money, but caring enough about donating. think in economics, we talk a lot about comparative advantage, which is, know, if I can do stuff and you can do stuff, I should do what plays to my strengths the best. And you should do what plays.
to your strengths the best and we can trade and everything can end up better. And I think for most Americans on a global scale, our comparative advantage is very strongly money. I think the amount of good you can do with your money far outweighs the amount of good you can do with everything else combined. I do think in the effective altruist community, you can start to see kind of the opposite tendency.
So I guess I want to push back on that opposite tendency, but not too strongly. Because I think something I've noticed in this
I I don't want to stereotype, but like suburban type churches is we'll read a passage about the Bible and money and what we owe to other people. And then we'll start talking about what should we do with our money? And then someone will say, well, it's not all about money. And then we won't talk about money at all. And we won't. And I think that temptation is has much bigger effects than the too much.
JD (55:21)
Yes, right.
Yeah.
My pastor and I joked because I like my church's teaching on money. I think they preach it how it is and it's a hard biblical truth that what we have belongs to God and God calls us to serve the poor radically and giving lots and my pastor affirms this. My first Sunday at the church was actually a sermon about this and I came up to him after the service and I said, hey, it's my first week and he said, boy, you had to come this week and I said, no, I'm going to stay here because this was my first week and like statistically,
if you like were talking about this topic on my first day you probably talk about this a lot and this is such an important topic for Christian discipleship so and for the for the poor so thank you so much and he always brings it up every
JD (56:11)
Oh yeah, there we go, there's my camera again. I think once this finishes, I don't think anyone will care. If you're watching, my video just switched to this other camera.
Colin Aitken (56:20)
I think there are really two aspects to when you donate money, right? Like part of it is how much are you giving and part of it is where you're giving. And I think one of the very surprising things effective altruists have learned about the world is that if you give to like the best charities, you can do a hundred times as much good roughly as if you give to, you know.
an average charity. And I think something this means is focusing too hard on the demandingness aspect rather than the finding the best charity aspect, I think is really counterproductive. Like, there is no way, even if I bought the world's cheapest bread and nothing else in my life, I could give a hundred times as much money as I currently give.
Whereas if you have a habit of donating even a small amount, that's a really easy switch you can make with no effort and no guilt and very little time spent. So I worry that the more time we spend talking about what if I increased my donations by 2 % and had to give up.
everything I like in life to get that extra 2 percent, we're missing the bigger picture of actually if we just got everyone on board with giving to more effective places, no one would have to be that demanding. No one would have to feel guilt all the time because the amount we would have to give would be a lot smaller.
JD (57:59)
Yeah, better to give more effectively than like try to give marginally more. Yes. Effective giving an amazing topic that we are super sold on here at Christians for Impact. If you're interested in effective giving, you can listen to our episode with Paul Niehaus or with Jason Dykstra. Having Colin talk about it would be like.
not preaching to the choir, but letting the choir sing, and we've heard them many times. Colin really is a world expert at measuring effectiveness. So if you're interested in getting more effectively, I'm sure Colin would be happy to talk to you about it. We would be happy to talk to you about it. Christians for Impact at Impact Mentorship. Just want to wrap up here, because Colin has to run real soon. If somebody's interested in a career in development economics, Colin, do you volunteer to?
to send advice. I know your time is limited, in principle, if you have the time, are you open to potentially meeting with mentees about development economics careers in an academic, mathy econometrics way?
Colin Aitken (59:03)
look to.
I think. Yeah.
JD (59:05)
Absolutely, Colin has done it in
the past, I will speak for him. I just put him on the spot here. So if you're interested in a career that serves the poor and really answers Matthew 25 through your intellects by working in monitoring evaluation or by researching effective global development, love to connect you to Colin or some of the others we've had on the podcast or haven't, other people like Colin who would love to meet with you and advise you.
Colin also is able to help with Christian monitoring and evaluation professionals. Do want to share a little bit about that and then anything else you'd like to plug?
Colin Aitken (59:45)
If you work for a Christian nonprofit and either your job is monitoring or an evaluation, or you want the nonprofit to build a monitoring and evaluation program and don't know how, you can sign up for our mentoring. What I found from an experience,
The easiest way to do this is if you come in with a plan and then you send us the plan or you send us an analysis you've did that you want feedback on. So you can send that to us. We'll schedule a meeting. On our end, we'll review it before the meeting. And the more concrete ideas you have, the more feedback we can give. So I think something the nonprofit world is often missing. In the academic world, before you publish anything, like
50 people have looked at it and given it like comments ranging from nice and constructive to awful and critical. We will be the nice constructive kind, but I think ideas get a lot better the more people can look at them and the more. You know, we might see something you hadn't thought of and you will have lots of things that we hadn't thought of. And the more the feedback can go back and forth, the better monitoring and evaluation can get. And the more we can have.
trustworthy numbers for how much good Christian organizations are doing and how we can help them to do better.
JD (1:01:00)
Awesome. Anything else you'd like to plug here now, Colin?
We'll have to have you back on to talk about.
Colin Aitken (1:01:06)
If you have several billion dollars that you want to do good in the world and don't
know how to do it, I have a particular opportunity in mind I'd love to talk to you about. don't think
JD (1:01:17)
All at once
or?
Colin Aitken (1:01:19)
This particular opportunity would have to be all at once. It's not that far. But in general, if you want, have money that you want to donate, you can talk to me. I'm not going to tell you to give it to me. So you can trust me.
JD (1:01:34)
Yeah.
We'll have to have you back on to talk about the many, many wisdoms that you have, especially about Christian development charities and how to make them more effective. And just thank you for everything you do to improve the world.
Colin Aitken (1:01:49)
Thank you so much for having me. This was fun.
