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PaperclipPerfector  2mo ago (text post)   33981 thread views

Culture War Roundup for the week of February 10, 2025

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Scott-featured global health philanthropist and activist John Green made a video about TB treatment and USAID. tl;dw, TB is the brick-shithouse of bacteria, so treatment takes 4-6 months, but the good news is that people mostly aren't contagious during treatment. Stopping treatment increases the risk of treatment-resistance, including the spread of newly-treatment-resistant strains, so interruptions in the supply chain are a major global health problem. Yes, it's bad that global health was overly reliant on the USA, but it requires government-level funding and logistics. (Unsaid, his family pledged $1m/year 2024-2027 for a USAID TB program in the Philippines, in addition to $6.5m for Partners in Health, so he's literally put his money where his mouth is.) His contacts in confirm that drug supplies are being interrupted.

Even if one wants to cut USAID, a stop-work order, rather than a phase-out, was likely a net-negative by most measures of utility.

People dying of TB is bad. But it's net negative only for the countries with the TB problem. Why should US subsidize this?

Because doing good things is good!

You know how every time there's a new potential pandemic you hear about how new diseases are deadlier because the pathogen is not adapted to human hosts? And how a well adapted pathogen doesn't want to kill the host, it wants to live in the host long enough to propagate to other hosts?

TB is arguably the most human adapted pathogen out there. It has our immune system beat six ways from Sunday, kills slowly over an extended period of time, and can lie dormant for years before becoming active again (which means healthy people you let through customs may have a passive infection, and will only turn active and contagious later when they're already in the country). It is also arguably the most difficult bacterial infection to cure. You need to be on multiple powerful medications with significant side effects (including potential blindness) for 6-9 months in order to cure it.

If a TB strain managed to become resistant to one of those medications then it may not be possible to cure it, not without new drug development. In the US we've managed to mostly extirpate the disease at great cost over many years of effort. If an antibiotic resistant strain showed up it could undo decades of progress in US health.

I think a good way to avoid that trojan horse scenario would be to only permit entry to high achieving people from that region of the world as I would assume they are more likely to follow medical advice.

Maybe you shouldn't let people through immigration at all. Maybe the people you do let in should stake a good X amt of currency denominated in USD for the privilege of entering. They can have their money back when they leave if they don't suffer from TB on their way out.

Most people with dormant TB don't know that they have TB: getting to keep their money isn't worth them spreading antibiotic resistant TB.

It'd be interesting to compare the cost-effectiveness of USAID's reduction in pathogens brought to the US and quarantining all international travelers and cargo ships, including economic impact, but the counterfactual in the comment you replied to was "phase-out," not indefinite continuation.

Ah, thank you for pointing this out. It's already paid for and thus unnecessarily cruel - this is the main point. IMO good faith interpretation, from the US government perspective the management of the drug supply chain isn't free, so they are just saving on that.

Because while the NGO's left hand is open demanding money, the NGO's right hand has boatload after boatload of diseased "asylum seekers" poised on your border. One way or another, they will make it your problem.

The selfish motivation is that pathogens don't respect borders. Travel between the US and the Philippines is relatively common, almost a million Americans visited the country in 2024. Any one of them can pick up a new antibiotic resistant strain of TB and bring it home, at which point it's our problem. Solve the problems where they are so we don't have to solve them here in the future.

Wouldn't it be cheaper to:

  • Ban immigration from and travelling to the countries with this problem
  • Treat your own citizens if this issue arises

After a while these poor countries find new sponsors who will solve their problems. Or solve it by themselves.

Will we have to have another World War (or perhaps two as last time) to prevent the American relapse into the fiction that they shouldn't care about anything or anybody abroad?

Cheaper maybe, but more authoritarian than I'd think most would be comfortable with especially considering that immigration isn't necessary here, just travel. TB is incredibly infectious. Even if you ban travel to affected countries, it still leaves you open to second order infections (American travels to e.g. Japan, Japan isn't restricting travel to the Philippines, American contracts antibiotic resistant TB from a Japanese traveler who visited the Philippines). As others have said, there's no guarantee that this antibiotic resistant strain of TB will be treatable without novel antibiotic research (which is expensive as well, and results are not guaranteed).

  1. Poor countries find new sponsors, like China or Russia

  2. Poor countries start advocating for China and Russia and against the US on the world stage

  3. Europeans, who think of poor countries as intrinsically virtuous, pick up the tune

  4. Europeans become more anti-American and wrestle their governments into reducing support for US plans and military logistics

  5. Core US interests abroad, such as supporting Israel, suffer or become significantly more expensive

  6. More money winds up being spent on workarounds than it would have cost to continue bribing the poor countries

An appealing offer, but I'm still waiting to hear the downside.

Europeans become more anti-American and wrestle their governments into reducing support for US plans and military logistics

Trump's stated policy of ”we take what we want from you, no matter if you’re allies or not” is already speedrunning this with little need for anything related to the third world.

If anything, those of my British friends and relations who are not card-carrying anti-Trumpists actually seem to be sneakily impressed.

Part of it is that it seems nice to have a forceful leader who actually tries to do things rather than put all his time and energy into long, boring attempts to explain why he can't do anything. Part of it that in many ways soft power is more insulting than hard power.

"Do what I say because I'm bigger and richer and stronger than you."

has a certain honesty about it.

"We're all friends, right? Obviously we're much bigger than you, but you know what, that doesn't matter. We'd never dream of using our overwhelming military and economic advantage to compel our friends. Oh, btw, can you close this guy's bank account for us? No, we're not going to tell you why. Just trust us. We're all friends, right? Allies, even. You like having our soldiers in your country to protect you from all the other powers who totally aren't selfless like us, don't you? It's such a shame, really - we did everything we could to support countries like China, and they paid us back by trying to be independent. That's not a worry with you, of course. Isn't it nice that we all get along?"

seems nicer on the surface but really isn't.

If anything, those of my British friends and relations who are not card-carrying anti-Trumpists actually seem to be sneakily impressed.

Having as contrast Keir Starmer, who is desperately trying to give away pay Mauritius to take away the British Indian Ocean Territory for no reason other than that a court controlled by enemies of the U.K. said they should is probably helpful here.

Well, yeah. The bar is low.

Has there been a CW post about this that I've missed? Feels like the sort of thing that would get discussed here but I haven't seen any mention of it.

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Banning all travel to and from places millions of Americans visit each year would be costly to the economy so while it might be cheaper for the government it would surely be more expensive for the country. Also, I want freedom to travel where I please. We shouldn't impose travel bans that aren't actually necessary.

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