Hiya folks! I'm Patrick McKenzie, better known on the Internets as patio11. (Proof.) Long-time-listener, first-time-caller; I don't think I would consider myself an EA but I've been reading y'all, and adjacent intellectual spaces, for some time now.
Epistemic status: Arbitrarily high confidence with regards to facts of the VaccinateCA experience (though speaking only for myself), moderately high confidence with respect to inferences made about vaccine policy and mechanisms for impact last year, one geek's opinion with respect to implicit advice to you all going forward.
A Thing That Happened Last Year
As some of the California-based EAs may remember, the rollout of the covid-19 vaccines in California and across the U.S. was... not optimal. I accidentally ended up founding a charity, VaccinateCA, which ran the national shadow vaccine location information infrastructure for 6 months.
The core product at the start of the sprint, which some of you may be familiar with, was a site which listed places to get the vaccine in California, sourced by a volunteer-driven operation to conduct an ongoing census of medical providers by calling them. Importantly, that was not our primary vector for impact, though it was very important to our trajectory.
I recently wrote an oral history of VaccinateCA. It may be worth your time. Obligatory disclaimer: I'm speaking, there and here, in entirely my personal capacity, not on behalf of the organization (now wound-down) or others.
A brief summary of impact: I think this effort likely saved many thousands of lives at the margin, at a cost of approximately $1.2 million. This feels remarkable relative to my priors for cost of charitably saving lives at scale in the US, and hence this post.
Some themes of the experience I think you may find useful:
Enabling trade as a mechanism for impact
To a first approximation, Google, the White House, the California governor's office, the Alameda County health department, the pharmacist at CVS, and several hundred thousand other actors have unified values and expectations with regards to the desirability of vaccinating residents of America against covid-19.
They are also bad at trading with each other. Pathologically so, in many cases.
One of the reasons we had such leveraged impact is that we didn't have to build Google, or recruit a few hundred million Americans to use it every day. We just had to find a very small number of people within Google and convince them that Google users would benefit from seeing our data on their surfaces as quickly as possible.
Google and large national pharmacy chains cannot quickly negotiate an API, even given substantial mutual desire to do so. As it turns out, pharmacists already have a data store—pharmacists—and a transport layer—the English language spoken over a telephone call—and if you add a for loop, a cron job, and an SFTP upload to that then Google basically doesn't care about pharmacy chain IT anymore.
Repeat this by many other pairwise interactions between actors within an ecosystem, and we got leveraged impact through their ongoing operations, with a surprising amount of insight into (and perhaps some level of influence upon) policy decisions which your prior (and my prior) would have probably suggested "arbitrarily high confidence that that is substantially above your pay grade."
We didn't have to be chosen by e.g. the White House as the officially blessed initiative. We just had to find that initiative and be useful to it. (Though, if—God forbid—I ever have to do this again, I would give serious consideration to becoming the national initiative prior to asking for permission to do so and then asking the White House whether the White House wanted credit or not.)
Engaging with The System
A recurring theme of our experience was taking a group of professionals who were mostly from tech and making ourselves palatable to public and private partners, many of which were... let's go with "tech-skeptical", for reasons described in the above piece.
The most boring takeaway is having a recognized 501c3 charity is extremely useful and this is far easier to get accomplished than one likely models it as. It isn't as click-button-pay-money as e.g. getting an LLC is, but if you can hire any staff, you can fairly deterministically achieve 501c3 status.
As all of our application docs are public by law feel free to take a gander if you need calibration on how many words are required or what level of sophistication they need to be at. The first cut of half of our words were written by a well-regarded law firm on a pro-bono basis. This would have cost less than $10k at rack rates. Having done it once I am fairly confident I could do it again with less than 2 days effort and no formal legal training.
501c3 status directly unblocked several funders (principally, Donor Advised Funds that were effectively restricted from donating to charitable initiatives without legible status) and, probably even more importantly, successfully promoted us to Probably Know What They Are Doing in the eyes of many governmental partners. (Having dealt with many charities over the years, I question the epistemic logic of that, but it seems like a useful preference to take notice of.)
The other thing which I think this community may perhaps underrate is the usefulness of a carefully planned comms strategy. Partly due to the professional backgrounds of several members of our core team, and partly due to other considerations, we ran a very tight PR ship and intentionally caused a coordinated outburst of positive press early in the life of the project. This was partly designed to help recruit users for our site.
It turned out that the characteristic "has good press" caused several parties whose collaboration we desired to be sharply more willing to do business with us. It was cited by Google as one reason they were willing to engage in conversations with us to use our results as authoritative-enough-for-inclusion-in-Google-products. It helped get government partners in California and elsewhere over the engagement line; we then were able to demonstrate sufficient expertise and utility to get to partnerships, on a spectrum of informal to quite formal.
Brief commentary on career planning for long-termists
I have minimal background in policy and public health. (The closest professionally relevant experience, and it is a stretch, is that I was the HIPAA Compliance Officer at a two person software company, so that we could sell our things to doctors/dentists as well as other businesses.) We ended up with a team of perhaps two dozen core members, and of that I would say one person had material policy experience and perhaps 2-3 had substantial professional experience adjacent to healthcare. I am unaware of anyone who worked on pandemics or public health prior to working with us.
And yet we were, by a fairly considerable margin, much more effective than many similarly situated charitable and public initiatives which appear to have people who put their skill points into getting good at public health and/or policy engagement.
I think that counsels some perhaps counterintuitive things for people who are wondering how to maximize impact on a 10+ year time horizon vis, I don't know, direct intervention against pandemics.
So what was abnormally useful from our professional backgrounds? Speaking for myself:
- sufficient financial wherewithal to commit early and boldly to the project even if it exposed me to temporary career risk
- sufficient social capital to call in favors with various actors within the tech community and get commitments to resources or other things we needed
- good understanding of the "general factor of infrastructure"; in particular, I think if you did a Venn diagram between "understands operations of call centers" and "understands information flow between IT systems in multi-actor ecosystems" I think I'd likely be more skilled than 99.999% of all government employees. (I was not unique on the team in having this curious confluence of interests, which appears much more common in healthcare tech than in public health administration.)
- capability to write good software quickly continues to be a superpower and more people should opt-in to having it available to them
- as discussed previously, PR seemed to be anomalously important for us
Another useful thing, and a difficult one to measure, is placement in a social graph with a sufficiently high density of high agency people. VaccinateCA would likely not have happened but for Karl Yang specifically taking a tweeted suggestion from me and spinning up a Discord server then inviting ten close friends. He has very interesting friends, who have interesting friends, and a sufficient number of them have access to the social script "Hey it is 9 PM and we're going to OSS Californian vaccine availability by tomorrow morning; are you in?"
A thing I really wish we had had available: skilled, experienced people managers. I am not one; many members of the team would likely have benefitted from having one, having come up in professional environments where expectations would be clearly communicated to them and tasks assigned by one. (We got through this by main force and heavily relying on experience various team members had in OSS environments and volunteering environments, which were not always perfect matches for what we needed but beat having no experience at leading large-scale collaborative projects. I joke that my only leadership experience was running a WoW guild, but that is in no way a joke, and in important ways we resembled a WoW guild more than most participants probably realized.)
Also, in clarity of hindsight, I should definitely have fired myself from admin almost immediately in favor of someone shaped something like an office manager or bookkeeper. It was low leverage and an extraordinary tax on cycles that could have been more productively spent on fundraising, strategy, or partner negotiations.
Expression of thanks for extended EA community
VaccinateCA was not explicitly an EA project. I believe a few volunteers consider themselves members of your movement/community; I do not consider myself a member and do not know that to be true of any of our organizers. None of our funders, to my knowledge, would be broadly acknowledged as an "EA funder."
But recent events have not been particularly kind to the brand perception of EA, and as someone who cares no small amount about brand perception but a much larger amount for the truth, I think that VaccinateCA would have been unlikely to happen but for the work of this community and some of your one-hop-out intellectual peers.
(If I had to point at any one artifact in particular, Inadequate Equilibria is a good articulation of a larger memeplex that made me comfortable with "If the evidence of a system's operation contradicts what the Efficient Market Hypothesis counsels is the probable functioning of the system, trust the evidence. Thousands of lives savable by one dedicated team of non-specialists is actually not all that low probability.")
This is not an impression colored by recent events or desire to say something nice to y'all. If I can quote from a memo I wrote on Day 6, asking for the other organizers to agree to the urgent necessity to intensify our operations (from "OSS weekend hack" to "we should become a non-profit, raise millions, then become the national infrastructure provider here") and appoint me CEO to start doing it:
As a gross approximation, bringing 1 dose to 1 person 1 day earlier saves 10^-4 lives. (Or, to put it another way: 10k dose-days = 1 life saved)
I have a complicated values system, but in this it is really simple: I am a consequentialist with regards to saving lives, and at the margin I will favor that almost over every goal. I think we have a small chance today, but a real chance, of saving tens or hundreds of thousands of lives.
1% * 10k lives = expected value of 100 lives saved. That seems a very reasonable first approximation as of Day 6. That’s everyone who was at my wedding. They’re not my family, coworkers, or friends, but they are somebody’s family, coworkers, or friends, and every one of theirs is a life equal in value to ours.
What would I do to save everyone at my wedding? Absolutely anything.
(Formatting is true to original.)
I consider myself fairly well-educated and well-raised in a moral tradition that has spent a lot of brainsweat on questions like "What is one's duty to society and to one's fellow man?" In that moral tradition, presented with the narrow question of "Given that one is in a position of authority and has a course of action available to save hundreds of lives, what is one's duty?", the answer is so straightforward as to be uninteresting.
But nobody, not once in my life, drew out the implication regarding expected value math until you all did.
For this you have my eternal gratitude.
And, should circumstances ever find you or yours looking at an expected value calculation that rhymes with the above, know that you'd have my instant attention and (pending thinking through it, in the words of a well-known articulator of my moral tradition) you have my sword.